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{"messages": [{"role": "user", "content": "What is (are) Glaucoma ?"}, {"role": "assistant", "content": "Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. While glaucoma can strike anyone, the risk is much greater for people over 60. How Glaucoma Develops  There are several different types of glaucoma. Most of these involve the drainage system within the eye. At the front of the eye there is a small space called the anterior chamber. A clear fluid flows through this chamber and bathes and nourishes the nearby tissues. (Watch the video to learn more about glaucoma. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) In glaucoma, for still unknown reasons, the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and result in loss of vision. Open-angle Glaucoma The most common type of glaucoma is called open-angle glaucoma. In the normal eye, the clear fluid leaves the anterior chamber at the open angle where the cornea and iris meet. When fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye. Sometimes, when the fluid reaches the angle, it passes too slowly through the meshwork drain, causing the pressure inside the eye to build. If the pressure damages the optic nerve, open-angle glaucoma -- and vision loss -- may result. There is no cure for glaucoma. Vision lost from the disease cannot be restored. However, there are treatments that may save remaining vision. That is why early diagnosis is important.  See this graphic for a quick overview of glaucoma,  including how many people it affects, whos at risk, what to do if you have it, and how to learn more.  See a glossary of glaucoma terms."}]}
{"messages": [{"role": "user", "content": "What causes Glaucoma ?"}, {"role": "assistant", "content": "Nearly 2.7 million people have glaucoma, a leading cause of blindness in the United States. Although anyone can get glaucoma, some people are at higher risk. They include - African-Americans over age 40  - everyone over age 60, especially Hispanics/Latinos  - people with a family history of glaucoma. African-Americans over age 40 everyone over age 60, especially Hispanics/Latinos people with a family history of glaucoma.  In addition to age, eye pressure is a risk factor. Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. Thats why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you. Another risk factor for optic nerve damage relates to blood pressure. Thus, it is important to also make sure that your blood pressure is at a proper level for your body by working with your medical doctor. (Watch the animated video to learn more about the causes of glaucoma. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Glaucoma ?"}, {"role": "assistant", "content": "Symptoms of Glaucoma  Glaucoma can develop in one or both eyes. The most common type of glaucoma, open-angle glaucoma, has no symptoms at first. It causes no pain, and vision seems normal. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains. Tests for Glaucoma Glaucoma is detected through a comprehensive eye exam that includes a visual acuity test, visual field test, dilated eye exam, tonometry, and pachymetry. (Watch the animated video to learn more about testing for glaucoma. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)  A visual acuity test uses an eye chart test to measure how well you see at various distances. A visual field test measures your side or peripheral vision. It helps your eye care professional tell if you have lost side vision, a sign of glaucoma. In a dilated eye exam, drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours. In tonometry, an instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. With pachymetry,  a numbing drop is applied to your eye. Your eye care professional uses an ultrasonic wave instrument to measure the thickness of your cornea."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Glaucoma ?"}, {"role": "assistant", "content": "Although open-angle glaucoma cannot be cured, it can usually be controlled. While treatments may save remaining vision, they do not improve sight already lost from glaucoma. The most common treatments for glaucoma are medication and surgery. Medications  Medications for glaucoma may be either in the form of eye drops or pills. Some drugs reduce pressure by slowing the flow of fluid into the eye. Others help to improve fluid drainage. (Watch the video to learn more about coping with glaucoma. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) For most people with glaucoma, regular use of medications will control the increased fluid pressure. But, these drugs may stop working over time. Or, they may cause side effects. If a problem occurs, the eye care professional may select other drugs, change the dose, or suggest other ways to deal with the problem.  Read or listen to ways some patients are coping with glaucoma. Surgery Laser surgery is another treatment for glaucoma. During laser surgery, a strong beam of light is focused on the part of the anterior chamber where the fluid leaves the eye. This results in a series of small changes that makes it easier for fluid to exit the eye. Over time, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking glaucoma drugs. Researching Causes and Treatments Through studies in the laboratory and with patients, NEI is seeking better ways to detect, treat, and prevent vision loss in people with glaucoma. For example, researchers have discovered genes that could help explain how glaucoma damages the eye. NEI also is supporting studies to learn more about who is likely to get glaucoma, when to treat people who have increased eye pressure, and which treatment to use first."}]}
{"messages": [{"role": "user", "content": "What is (are) Glaucoma ?"}, {"role": "assistant", "content": "Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. The most common form of the disease is open-angle glaucoma. With early treatment, you can often protect your eyes against serious vision loss. (Watch the video to learn more about glaucoma. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)  See this graphic for a quick overview of glaucoma, including how many people it affects, whos at risk, what to do if you have it, and how to learn more.  See a glossary of glaucoma terms."}]}
{"messages": [{"role": "user", "content": "What is (are) Glaucoma ?"}, {"role": "assistant", "content": "The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain."}]}
{"messages": [{"role": "user", "content": "What is (are) Glaucoma ?"}, {"role": "assistant", "content": "Open-angle glaucoma is the most common form of glaucoma. In the normal eye, the clear fluid leaves the anterior chamber at the open angle where the cornea and iris meet. When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye. Sometimes, when the fluid reaches the angle, it passes too slowly through the meshwork drain, causing the pressure inside the eye to build. If the pressure damages the optic nerve, open-angle glaucoma -- and vision loss -- may result."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Glaucoma? ?"}, {"role": "assistant", "content": "Anyone can develop glaucoma. Some people are at higher risk than others. They include - African-Americans over age 40  - everyone over age 60, especially Hispanics/Latinos  - people with a family history of glaucoma. African-Americans over age 40 everyone over age 60, especially Hispanics/Latinos people with a family history of glaucoma.  See this graphic for a quick overview of glaucoma, including how many people it affects, whos at risk, what to do if you have it, and how to learn more."}]}
{"messages": [{"role": "user", "content": "How to prevent Glaucoma ?"}, {"role": "assistant", "content": "At this time, we do not know how to prevent glaucoma. However, studies have shown that the early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. So, if you fall into one of the higher risk groups for the disease, make sure to have a comprehensive dilated eye exam at least once every one to two years.  Get tips on finding an eye care professional. Learn what a comprehensive dilated eye exam involves."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Glaucoma ?"}, {"role": "assistant", "content": "At first, open-angle glaucoma has no symptoms. It causes no pain. Vision seems normal. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Glaucoma ?"}, {"role": "assistant", "content": "Yes. Immediate treatment for early stage, open-angle glaucoma can delay progression of the disease. That's why early diagnosis is very important. Glaucoma treatments include medicines, laser surgery, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Glaucoma ?"}, {"role": "assistant", "content": "Through studies in the laboratory and with patients, the National Eye Institute is seeking better ways to detect, treat, and prevent vision loss in people with glaucoma. For example, researchers have discovered genes that could help explain how glaucoma damages the eye. NEI also is supporting studies to learn more about who is likely to get glaucoma, when to treat people who have increased eye pressure, and which treatment to use first."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Glaucoma? ?"}, {"role": "assistant", "content": "Encourage them to have a comprehensive dilated eye exam at least once every two years. Remember -- lowering eye pressure in glaucoma's early stages slows progression of the disease and helps save vision.  Get tips on finding an eye care professional."}]}
{"messages": [{"role": "user", "content": "What is (are) Glaucoma ?"}, {"role": "assistant", "content": "National Eye Institute  National Institutes of Health  2020 Vision Place  Bethesda, MD 20892-3655  301-496-5248  E-mail: 2020@nei.nih.gov  www.nei.nih.gov The Glaucoma Foundation  80 Maiden Lane, Suite 700  New York, NY 10038  212-285-0080 Glaucoma Research Foundation  251 Post Street, Suite 600  San Francisco, CA 94108  1-800-826-6693"}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "High blood pressure is a common disease in which blood flows through blood vessels (arteries) at higher than normal pressures. What Is Blood Pressure? Blood pressure is the force of blood pushing against the walls of the blood vessels as the heart pumps blood. If your blood pressure rises and stays high over time, its called high blood pressure. High blood pressure is dangerous because it makes the heart work too hard, and the high force of the blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes. Types of High Blood Pressure There are two main types of high blood pressure: primary and secondary high blood pressure. - Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages.   - Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed. Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages. Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed. Measuring Blood Pressure Blood pressure is always given as two numbers, the systolic and diastolic pressures. Both are important. - Systolic Pressure  is the pressure of blood against the artery walls when the heart beats.  -  Diastolic Pressure is the pressure of blood against the artery walls when the heart is at rest between beats. Systolic Pressure  is the pressure of blood against the artery walls when the heart beats.  Diastolic Pressure is the pressure of blood against the artery walls when the heart is at rest between beats. Usually these numbers are written one above or before the other -- for example, 120/80 mmHg. The top, or first, number is the systolic and the bottom, or second number, is the diastolic. If your blood pressure is 120/80, you say that it is \"120 over 80.\" Normal Blood Pressure Normal blood pressure for adults is defined as a systolic pressure below 120 mmHg and a diastolic pressure below 80 mmHg. It is normal for blood pressures to change when you sleep, wake up, or are excited or nervous. When you are active, it is normal for your blood pressure to increase. However, once the activity stops, your blood pressure returns to your normal baseline range. Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers that are considered normal for babies, while older teens have numbers similar to adults. Abnormal Blood Pressure Abnormal blood pressure is higher than 120/80 mmHg. If either your systolic or diastolic blood pressure is higher than normal (120/80) but not high enough to be considered high blood pressure (140/90), you have pre-hypertension. Pre-hypertension is a top number between 120 and 139 or a bottom number between 80 and 89 mmHg. For example, blood pressure readings of 138/82, 128/70, or 115/86 are all in the \"pre-hypertension\" range. (Click the table on the right to see the stages of high blood pressure in adults.) A systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher, is considered high blood pressure, or hypertension. Hypertension is the medical term for high blood pressure. If you have diabetes or chronic kidney disease, your recommended blood pressure levels are a systolic blood pressure of 130 mmHg or lower, and a diastolic blood pressure of 80 mmHg or lower. Usually Has No Symptoms High blood pressure is often called \"the silent killer\" because it usually has no symptoms. Occasionally, headaches may occur. Some people may not find out they have high blood pressure until they have trouble with their heart, kidneys, or eyes. When high blood pressure is not diagnosed and treated, it can lead to other life-threatening conditions, including heart attack, heart failure, stroke, and kidney failure. It can also lead to vision changes or blindness. Possible Complications Over Time Over time, high blood pressure can cause - your heart to work too hard and become larger or weaker, which can lead to heart failure.   - small bulges (aneurysms) to worsen in your blood vessels. Common locations for aneurysms are the aorta, which is the main artery from the heart; the arteries in your brain, legs, and intestines; and the artery leading to your spleen.  - blood vessels in your kidneys to narrow, which can cause kidney failure.  - blood vessels in your eyes to burst or bleed, which can cause vision changes and can result in blindness.   - arteries throughout your body to \"harden\" faster, especially those in your heart, brain, kidneys, and legs. This can cause a heart attack, stroke, or kidney failure. your heart to work too hard and become larger or weaker, which can lead to heart failure. small bulges (aneurysms) to worsen in your blood vessels. Common locations for aneurysms are the aorta, which is the main artery from the heart; the arteries in your brain, legs, and intestines; and the artery leading to your spleen. blood vessels in your kidneys to narrow, which can cause kidney failure. blood vessels in your eyes to burst or bleed, which can cause vision changes and can result in blindness. arteries throughout your body to \"harden\" faster, especially those in your heart, brain, kidneys, and legs. This can cause a heart attack, stroke, or kidney failure."}]}
{"messages": [{"role": "user", "content": "What causes High Blood Pressure ?"}, {"role": "assistant", "content": "Changes in Body Functions Researchers continue to study how various changes in normal body functions cause high blood pressure. The key functions affected in high blood pressure include -  kidney fluid and salt balances  -  the renin-angiotensin-aldosterone system   - the sympathetic nervous system activity   - blood vessel structure and function. kidney fluid and salt balances the renin-angiotensin-aldosterone system the sympathetic nervous system activity blood vessel structure and function. Kidney Fluid and Salt Balances The kidneys normally regulate the bodys salt balance by retaining sodium and water and eliminating potassium. Imbalances in this kidney function can expand blood volumes, which can cause high blood pressure. Renin-Angiotensin-Aldosterone System The renin-angiotensin-aldosterone system makes angiotensin and aldosterone hormones. Angiotensin narrows or constricts blood vessels, which can lead to an increase in blood pressure. Aldosterone controls how the kidneys balance fluid and salt levels. Increased aldosterone levels or activity may change this kidney function, leading to increased blood volumes and high blood pressure. Sympathetic Nervous System Activity The sympathetic nervous system has important functions in blood pressure regulation, including heart rate, blood pressure, and breathing rate. Researchers are investigating whether imbalances in this system cause high blood pressure. Blood Vessel Structure and Function Changes in the structure and function of small and large arteries may contribute to high blood pressure. The angiotensin pathway and the immune system may stiffen small and large arteries, which can affect blood pressure. Genetic Causes High blood pressure often runs in families. Years of research have identified many genes and other mutations associated with high blood pressure. However, known genetic factors only account for 2 to 3 percent of all cases. Emerging research suggests that certain DNA changes before birth also may cause the development of high blood pressure later in life. Unhealthy Lifestyle Habits Unhealthy lifestyle habits can cause high blood pressure, including - high sodium intake and sodium sensitivity  - drinking too much alcohol  - lack of physical activity. high sodium intake and sodium sensitivity drinking too much alcohol lack of physical activity. Overweight and Obesity Research studies show that being overweight or obese can increase the resistance in the blood vessels, causing the heart to work harder and leading to high blood pressure. Medicines Prescription medicines such as asthma or hormone therapies (including birth control pills and estrogen) and over-the-counter medicines such as cold relief medicines may cause high blood pressure. This happens because medicines can - change the way your body controls fluid and salt balances  - cause your blood vessels to constrict  -  impact the renin-angiotensin-aldosterone system, leading to high blood pressure.  change the way your body controls fluid and salt balances cause your blood vessels to constrict impact the renin-angiotensin-aldosterone system, leading to high blood pressure. Other Causes Other causes of high blood pressure include medical conditions such as chronic kidney disease, sleep apnea, thyroid problems, or certain tumors. These conditions can change the way your body controls fluids, sodium, and hormones in your blood, which leads to secondary high blood pressure."}]}
{"messages": [{"role": "user", "content": "Who is at risk for High Blood Pressure? ?"}, {"role": "assistant", "content": "Not a Normal Part of Aging Nearly 1 in 3 American adults have high blood pressure. Many people get high blood pressure as they get older. However, getting high blood pressure is not a normal part of aging. There are things you can do to help keep your blood pressure normal, such as eating a healthy diet and getting more exercise. Risk Factors Anyone can develop high blood pressure. However, these factors can increase your risk for developing high blood pressure. -  age  - race or ethnicity  - being overweight  - gender  - lifestyle habits  - a family history of high blood pressure.  age race or ethnicity being overweight gender lifestyle habits a family history of high blood pressure. Age Blood pressure tends to rise with age. In fact, about 65 percent of Americans age 60 or older have high blood pressure. Race/Ethnicity High blood pressure is more common in African American adults than in Caucasian or Hispanic American adults. Compared with these ethnic groups, African Americans -  tend to get high blood pressure earlier in life  - often have higher blood pressure numbers  - are less likely to achieve target blood pressure goals with treatment. tend to get high blood pressure earlier in life often have higher blood pressure numbers are less likely to achieve target blood pressure goals with treatment. Overweight You are more likely to develop prehypertension or high blood pressure if youre overweight or obese. The terms overweight and obese refer to body weight thats greater than what is considered healthy for a certain height. Gender Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop high blood pressure. Lifestyle Habits Unhealthy lifestyle habits can raise your risk for high blood pressure, and they include -  eating too much sodium or too little potassium   - lack of physical activity  - drinking too much alcohol  - smoking  - stress. eating too much sodium or too little potassium lack of physical activity drinking too much alcohol smoking stress. Family History A family history of high blood pressure raises the risk of developing prehypertension or high blood pressure. Some people have a high sensitivity to sodium and salt, which may increase their risk for high blood pressure and may run in families. Genetic causes of this condition are why family history is a risk factor for this condition."}]}
{"messages": [{"role": "user", "content": "How to prevent High Blood Pressure ?"}, {"role": "assistant", "content": "Steps You Can Take You can take steps to prevent high blood pressure by adopting these healthy lifestyle habits. - Follow a healthy eating plan.   - Be physically active.   - Maintain a healthy weight.  - If you drink alcoholic beverages, do so in moderation.   - Quit smoking.  - Learn to cope with and manage stress. Follow a healthy eating plan. Be physically active. Maintain a healthy weight. If you drink alcoholic beverages, do so in moderation. Quit smoking. Learn to cope with and manage stress. Follow a Healthy Eating Plan Follow a healthy eating plan that emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, and whole grains, and that is low in saturated fat, cholesterol, and total fat. Eating this way is even more effective when you also reduce your sodium (salt) intake and calories. One such eating plan is called DASH. DASH stands for Dietary Approaches to Stop Hypertension. This is the name of a study sponsored by the National Institutes of Health that showed that this kind of eating plan can help you prevent and control high blood pressure. The study also showed that combining this kind of eating plan with cutting back on salt in your diet is even more effective at lowering your blood pressure. To learn more about DASH, see  Lowering Your Blood Pressure with DASH. Lower Your Salt Intake In general, the lower your salt intake, the lower your blood pressure. Older adults should limit their sodium intake to 2,300 milligrams (mg) daily. The key to reducing the amount of salt we eat is making wise food choices. Only a small amount of the salt that we eat comes from the salt shaker, and only small amounts occur naturally in food. Most of the salt that we eat comes from processed foods -- for example, canned or processed meat, baked goods, certain cereals, soy sauce, and foods that contain seasoned salts, monosodium glutamate (MSG), and baking soda. Food from fast food restaurants, frozen foods, and canned foods also tend to be higher in sodium. See tips to reduce salt in your diet. Read Food Labels Be sure to read food labels to choose products lower in salt. Look for foods and seasonings that are labeled as low-salt or \"no added salt.\" Look for the sodium content in milligrams and the Percent Daily Value. Aim for foods that are less than 5 percent of the Daily Value of sodium. Foods with 20 percent or more Daily Value of sodium are considered high. To learn more about reading nutrition labels, see  Reading the Label. Be Physically Active  Regular physical activity can lower high blood pressure and reduce your risk for other health problems. Everyone should try to participate in moderate-intensity aerobic exercise at least 2 hours and 30 minutes per week, or vigorous-intensity aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats harder and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time, spread throughout the week. (Watch the video to learn how exercise maintains healthy aging. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Most people dont need to see a doctor before they start a moderate-level physical activity. You should check first with your doctor if you - have heart trouble or have had a heart attack   - are over age 50 and are not used to moderate-level physical activity  - have a family history of heart disease at an early age, or if you have any other serious health problem. have heart trouble or have had a heart attack are over age 50 and are not used to moderate-level physical activity have a family history of heart disease at an early age, or if you have any other serious health problem. See examples of exercises for older adults at Exercises to Try. For more on exercise and physical activity for older adults, visit Go4Life, the exercise and physical activity campaign from the National Institute on Aging. Maintain a Healthy Weight Maintaining a healthy weight can help you control high blood pressure and reduce your risk for other health problems. Blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension. A useful measure of overweight and obesity is body mass index (BMI). BMI measures your weight in relation to your height.  See the BMI calculator to determine your body mass index  or talk to your health care provider. A BMI -  below 18.5 is a sign that you are underweight.   - between 18.5 and 24.9 is in the healthy range.  - between 25 and 29.9 is considered overweight.  - of 30 or more is considered obese. below 18.5 is a sign that you are underweight. between 18.5 and 24.9 is in the healthy range. between 25 and 29.9 is considered overweight. of 30 or more is considered obese. A general goal to aim for is a BMI below 25. Your health care provider can help you set an appropriate BMI goal. Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit  Assessing Your Weight and Health Risk. For more information about losing weight or maintaining your weight, see Aim for a Healthy Weight.  If You Drink  Drinking too much alcohol can raise your blood pressure. Alcohol also adds extra calories, which may cause weight gain. Men should have no more than two drinks a day, and women should have no more than one drink a day. If you drink and would like tips on how to cut back, watch the video \"How To Cut Back on Your Drinking.\" (To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) See how drinking alcohol can affect you as you age. Don't Smoke Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. It increases your chances of stroke, heart disease, peripheral arterial disease, and several forms of cancer. If you smoke, quit. If you don't smoke, don't start. Once you quit, your risk of having a heart attack is reduced after the first year. So you have a lot to gain by quitting. See how to start a smoking quit plan geared to older adults."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of High Blood Pressure ?"}, {"role": "assistant", "content": "High blood pressure is often called the \"silent killer\" because you can have it for years without knowing it. The only way to find out if you have high blood pressure is to have your blood pressure measured. Complications When blood pressure stays high over time, it can damage the body and cause complications. Here are some of the common complications, along with their signs and symptoms. - Aneurysms.  These occur when an abnormal bulge forms in the wall of an artery. Aneurysms develop and grow for years without causing signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow. The signs and symptoms that develop depend on the location of the aneurysm.  - Chronic Kidney Disease. This disease occurs when blood vessels narrow in the kidneys, possibly causing kidney failure.  - Cognitive Changes  Research shows that over time, higher blood pressure numbers can lead to cognitive changes. Signs and symptoms include memory loss, difficulty finding words, and losing focus during conversations.  - Eye Damage. This condition occurs when blood vessels in the eyes burst or bleed. Signs and symptoms include vision changes or blindness.  - Heart Attack. This occurs when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart doesnt get oxygen. The most common warning symptoms of a heart attack are chest pain or discomfort, upper body discomfort, and shortness of breath.  - Heart Failure. This condition occurs when the heart cant pump enough blood to meet the bodys needs. Common signs and symptoms of heart failure include shortness of breath or trouble breathing; feeling tired; and swelling in the ankles, feet, legs, abdomen, and veins in the neck.  - Peripheral Arterial Disease. This is a disease in which plaque builds up in leg arteries and affects blood flow in the legs. When people have symptoms, the most common are pain, cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or climbing stairs.  - Stroke. A stroke occurs when the flow of oxygen-rich blood to a portion of the brain is blocked. The symptoms of a stroke include sudden onset of weakness; paralysis or numbness of the face, arms, or legs; trouble speaking or understanding speech; and trouble seeing.  Aneurysms.  These occur when an abnormal bulge forms in the wall of an artery. Aneurysms develop and grow for years without causing signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow. The signs and symptoms that develop depend on the location of the aneurysm. Chronic Kidney Disease. This disease occurs when blood vessels narrow in the kidneys, possibly causing kidney failure. Cognitive Changes  Research shows that over time, higher blood pressure numbers can lead to cognitive changes. Signs and symptoms include memory loss, difficulty finding words, and losing focus during conversations. Eye Damage. This condition occurs when blood vessels in the eyes burst or bleed. Signs and symptoms include vision changes or blindness. Heart Attack. This occurs when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart doesnt get oxygen. The most common warning symptoms of a heart attack are chest pain or discomfort, upper body discomfort, and shortness of breath. Heart Failure. This condition occurs when the heart cant pump enough blood to meet the bodys needs. Common signs and symptoms of heart failure include shortness of breath or trouble breathing; feeling tired; and swelling in the ankles, feet, legs, abdomen, and veins in the neck. Peripheral Arterial Disease. This is a disease in which plaque builds up in leg arteries and affects blood flow in the legs. When people have symptoms, the most common are pain, cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or climbing stairs. Stroke. A stroke occurs when the flow of oxygen-rich blood to a portion of the brain is blocked. The symptoms of a stroke include sudden onset of weakness; paralysis or numbness of the face, arms, or legs; trouble speaking or understanding speech; and trouble seeing. How Blood Pressure Is Checked Your health care provider usually takes 23 readings at several medical appointments to diagnose high blood pressure. Based on the results of your blood pressure test, your health care provider will diagnose prehypertension or high blood pressure if your systolic or diastolic readings are consistently higher than 120/80 mmHg. Once your health care provider determines the severity of your blood pressure, he or she can order additional tests to determine if your blood pressure is due to other conditions or medicines or if you have primary high blood pressure. Health care providers can use this information to develop your treatment plan. Some people have white coat hypertension. This happens when blood pressure readings are only high when taken in a health care providers office compared with readings taken in any other location. Researchers believe stress, which can occur during the medical appointment, causes white coat hypertension. Preparing for the Test A blood pressure test is easy and painless and can be done in a health care providers office or clinic. To prepare for the test - dont drink coffee or smoke cigarettes for 30 minutes prior to the test   - go to the bathroom before the test. A full bladder can change the reading   - sit for 5 minutes before the test. dont drink coffee or smoke cigarettes for 30 minutes prior to the test go to the bathroom before the test. A full bladder can change the reading sit for 5 minutes before the test. To track blood pressure readings over a period of time, the health care provider may ask you to come into the office on different days and at different times to take your blood pressure. The health care provider also may ask you to check readings at home or at other locations that have blood pressure equipment and to keep a written log of all your results. Whenever you have an appointment with the health care provider, be sure to bring your log of blood pressure readings. Ask the doctor or nurse to tell you your blood pressure reading in numbers and to explain what the numbers mean. Write down your numbers or ask the doctor or nurse to write them down for you. Write Down Your Readings Ask the doctor or nurse to tell you your blood pressure reading in numbers and to explain what the numbers mean. Write down your numbers or ask the doctor or nurse to write them down for you. (The wallet card on the right can be printed out and used to record your blood pressure numbers.) Checking Your Own Blood Pressure You can also check your blood pressure at home with a home blood pressure measurement device or monitor. It is important that the blood pressure cuff fits you properly and that you understand how to use the monitor. A cuff that is too small, for example, can give you a reading that is higher than your actual blood pressure. Your doctor, nurse, or pharmacist can help you check the cuff size and teach you how to use it correctly. You may also ask for their help in choosing the right blood pressure monitor for you. Blood pressure monitors can be bought at discount chain stores and drug stores. When you are taking your blood pressure at home, sit with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart. After a Diagnosis If you're diagnosed with high blood pressure, your doctor will prescribe treatment. Your blood pressure will be tested again to see how the treatment affects it. Once your blood pressure is under control, you'll still need treatment. \"Under control\" means that your blood pressure numbers are in the normal range. Your doctor will likely recommend routine blood pressure tests. He or she can tell you how often you should be tested. The sooner you find out about high blood pressure and treat it, the better. Early treatment may help you avoid problems such as heart attack, stroke and kidney failure. See tips for talking with your doctor after you receive a medical diagnosis."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "Blood pressure is the force of blood pushing against the walls of the blood vessels as the heart pumps blood. If your blood pressure rises and stays high over time, its called high blood pressure. High blood pressure is dangerous because it makes the heart work too hard, and the high force of the blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "Normal blood pressure for adults is defined as a systolic pressure below 120 mmHg and a diastolic pressure below 80 mmHg. It is normal for blood pressures to change when you sleep, wake up, or are excited or nervous. When you are active, it is normal for your blood pressure to increase. However, once the activity stops, your blood pressure returns to your normal baseline range. Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers that are considered normal for babies, while older teens have numbers similar to adults."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "High blood pressure is a common disease in which blood flows through blood vessels (arteries) at higher than normal pressures. There are two main types of high blood pressure: primary and secondary high blood pressure. Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages. Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "Abnormal blood pressure is higher than 120/80 mmHg. If either your systolic or diastolic blood pressure is higher than normal (120/80) but not high enough to be considered high blood pressure (140/90), you have pre-hypertension. Pre-hypertension is a top number between 120 and 139 or a bottom number between 80 and 89 mmHg. For example, blood pressure readings of 138/82, 128/70, or 115/86 are all in the \"pre-hypertension\" range. (Click the table on the right to see the stages of high blood pressure in adults.) The ranges in the table are blood pressure guides for adults who do not have any short-term serious illnesses. People with diabetes or chronic kidney disease should keep their blood pressure below 130/80 mmHg."}]}
{"messages": [{"role": "user", "content": "How to prevent High Blood Pressure ?"}, {"role": "assistant", "content": "You can take steps to help prevent high blood pressure by adopting these healthy lifestyle habits. - Follow a healthy eating plan like DASH (Dietary Approaches to Stop Hypertension), which emphasizes fruits, vegetables, fat-free and low-fat milk and milk products, and whole grains, fish, poultry, beans, seeds, and nuts, and choose and prepare foods with less sodium (salt). See how the  DASH diet (Dietary Approaches to Stop Hypertension) can help with blood pressure control. Follow a healthy eating plan like DASH (Dietary Approaches to Stop Hypertension), which emphasizes fruits, vegetables, fat-free and low-fat milk and milk products, and whole grains, fish, poultry, beans, seeds, and nuts, and choose and prepare foods with less sodium (salt). See how the  DASH diet (Dietary Approaches to Stop Hypertension) can help with blood pressure control.  - Be physically active for at least 2 and one-half hours a week. Check out  Exercises to Try for older adults, or visit  Go4Life, the exercise and physical activity campaign from the National Institute on Aging. (Watch the video to learn how exercise helps maintain healthy aging. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)  Be physically active for at least 2 and one-half hours a week. Check out  Exercises to Try for older adults, or visit  Go4Life, the exercise and physical activity campaign from the National Institute on Aging. (Watch the video to learn how exercise helps maintain healthy aging. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) - Maintain a healthy weight and lose weight if you are overweight or obese. Body mass index (BMI) and waist circumference are measures used to determine if someone is overweight or obese.  See the BMI calculator to determine your body mass index.  Maintain a healthy weight and lose weight if you are overweight or obese. Body mass index (BMI) and waist circumference are measures used to determine if someone is overweight or obese.  See the BMI calculator to determine your body mass index. - If you drink alcoholic beverages, do so in moderation: no more than one drink a day for women, no more than two drinks a day for men.  If you drink alcoholic beverages, do so in moderation: no more than one drink a day for women, no more than two drinks a day for men. - Quit smoking, or don't start smoking. To get help quitting, call 1 (800) QUIT-NOW or check out  Quitting Smoking for Older Adults. Quit smoking, or don't start smoking. To get help quitting, call 1 (800) QUIT-NOW or check out  Quitting Smoking for Older Adults. - Learn to manage stress. Learn about relaxation techniques that may relieve tension.   Learn to manage stress. Learn about relaxation techniques that may relieve tension."}]}
{"messages": [{"role": "user", "content": "How to diagnose High Blood Pressure ?"}, {"role": "assistant", "content": "If you are diagnosed with high blood pressure, here are questions to ask your doctor. -   Your Blood Pressure Numbers       - What is my blood pressure reading in numbers?    - What is my goal blood pressure?    - Is my blood pressure under adequate control?    - Is my systolic pressure too high (over 140)?      Your Blood Pressure Numbers     - What is my blood pressure reading in numbers?   - What is my goal blood pressure?   - Is my blood pressure under adequate control?   - Is my systolic pressure too high (over 140)?   - What is my blood pressure reading in numbers?  - What is my goal blood pressure?  - Is my blood pressure under adequate control?  - Is my systolic pressure too high (over 140)? What is my blood pressure reading in numbers? What is my goal blood pressure? Is my blood pressure under adequate control? Is my systolic pressure too high (over 140)? -   Healthy Lifestyle Habits       - What would be a healthy weight for me?    - Is there a diet to help me lose weight (if I need to) and lower my blood pressure?    - Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)?    - Is it safe for me to start doing regular physical activity?      Healthy Lifestyle Habits     - What would be a healthy weight for me?   - Is there a diet to help me lose weight (if I need to) and lower my blood pressure?   - Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)?   - Is it safe for me to start doing regular physical activity?   - What would be a healthy weight for me?  - Is there a diet to help me lose weight (if I need to) and lower my blood pressure?  - Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)?  - Is it safe for me to start doing regular physical activity? What would be a healthy weight for me? Is there a diet to help me lose weight (if I need to) and lower my blood pressure? Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)? Is it safe for me to start doing regular physical activity? -   Medications       - What is the name of my blood pressure medication?     - Is that the brand name or the generic name?    - What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.)    - What time of day should I take my blood pressure medicine?    - Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine?    - What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due?      Medications     - What is the name of my blood pressure medication?    - Is that the brand name or the generic name?   - What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.)   - What time of day should I take my blood pressure medicine?   - Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine?   - What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due?   - What is the name of my blood pressure medication?   - Is that the brand name or the generic name?  - What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.)  - What time of day should I take my blood pressure medicine?  - Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine?  - What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due? What is the name of my blood pressure medication? Is that the brand name or the generic name? What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.) What time of day should I take my blood pressure medicine? Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine? What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due?"}]}
{"messages": [{"role": "user", "content": "What are the treatments for High Blood Pressure ?"}, {"role": "assistant", "content": "High blood pressure is treated with lifestyle changes and medicines. Treatment can help control blood pressure, but it will not cure high blood pressure, even if your blood pressure readings appear normal. If you stop treatment, your blood pressure and risk for related health problems will rise. For a healthy future, follow your treatment plan closely. Work with your health care team for lifelong blood pressure control."}]}
{"messages": [{"role": "user", "content": "What are the treatments for High Blood Pressure ?"}, {"role": "assistant", "content": "In most cases, the goal is probably to keep your blood pressure below 140/90 mmHg (130/80 if you have diabetes or chronic kidney disease). Normal blood pressure is less than 120/80. Ask your doctor what your blood pressure goal should be. If you have high blood pressure, you will need to treat it and control it for life. This means making lifestyle changes, and, in some cases, taking prescribed medicines, and getting ongoing medical care."}]}
{"messages": [{"role": "user", "content": "What are the treatments for High Blood Pressure ?"}, {"role": "assistant", "content": "Today, many different types of medicines are available to control high blood pressure. These medicines work in different ways. Some lower blood pressure by removing extra fluid and salt from your body. Others affect blood pressure by slowing down the heartbeat, or by relaxing and widening blood vessels. Often, two or more drugs work better than one. Here are the types of medicines used to treat high blood pressure. -   Diuretics (water or fluid Pills)  flush excess sodium from your body, which reduces the amount of fluid in your blood and helps to lower your blood pressure. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.   -  Beta Blockers help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels, which can help to lower your blood pressure.  -  Angiotensin-Converting Enzyme (ACE) Inhibitors. Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure.  -  Angiotensin II Receptor Blockers (ARBs) block angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure.  -  Calcium Channel Blockers keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, which can lower your blood pressure.   -  Alpha Blockers reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down.  -  Alpha-Beta Blockers reduce nerve impulses the same way alpha blockers do. However, like beta blockers, they also slow the heartbeat. As a result, blood pressure goes down.  -  Central Acting Agents act in the brain to decrease nerve signals that narrow blood vessels, which can lower blood pressure.  -  Vasodilators relax the muscles in blood vessel walls, which can lower blood pressure.   Diuretics (water or fluid Pills)  flush excess sodium from your body, which reduces the amount of fluid in your blood and helps to lower your blood pressure. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill. Beta Blockers help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels, which can help to lower your blood pressure. Angiotensin-Converting Enzyme (ACE) Inhibitors. Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure. Angiotensin II Receptor Blockers (ARBs) block angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure. Calcium Channel Blockers keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, which can lower your blood pressure. Alpha Blockers reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down. Alpha-Beta Blockers reduce nerve impulses the same way alpha blockers do. However, like beta blockers, they also slow the heartbeat. As a result, blood pressure goes down. Central Acting Agents act in the brain to decrease nerve signals that narrow blood vessels, which can lower blood pressure. Vasodilators relax the muscles in blood vessel walls, which can lower blood pressure."}]}
{"messages": [{"role": "user", "content": "How to prevent High Blood Pressure ?"}, {"role": "assistant", "content": "Two key measures are used to determine if someone is overweight or obese. These are body mass index, or BMI, and waist circumference. Body mass index (BMI) is a measure of weight in relation to height, and provides an estimate of your total body fat. As your BMI goes up, so do your chances of getting high blood pressure, heart disease, and other health problems. A BMI -  below 18.5 is a sign that you are underweight.  - between 18.5 and 24.9 is in the healthy range.  - between 25 and 29.9 is considered overweight.  - of 30 or more is considered obese.  below 18.5 is a sign that you are underweight. between 18.5 and 24.9 is in the healthy range. between 25 and 29.9 is considered overweight. of 30 or more is considered obese. See the Body Mass Index Table, available from the National Heart, Lung, and Blood Institute (NHLBI). Body mass index (BMI) applies to both men and women, but it does have some limits. - It may overestimate body fat in in someone who is very muscular or who has swelling from fluid retention (called edema)  - It may underestimate body fat in older persons and others who have lost muscle mass. It may overestimate body fat in in someone who is very muscular or who has swelling from fluid retention (called edema) It may underestimate body fat in older persons and others who have lost muscle mass. Thats why waist measurement is often checked as well. Another reason is that too much body fat in the stomach area also increases disease risk. A waist measurement of more than 35 inches in women and more than 40 inches in men is considered high."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "Blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension. If you are overweight or obese, work with your health care provider to develop a plan to help you lower your weight and maintain a healthy weight. Aim to reduce your weight by 7 to 10 percent over six months, which can lower your risk for health problems. For example, if you are overweight at 200 pounds, try to lose 14 to 20 pounds over six months. After that, you may have to continue to lose weight to get to a healthy weight."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "\"DASH\" stands for \"Dietary Approaches to Stop Hypertension.\" This is the name of a clinical study that tested the effects of nutrients in food on blood pressure. Study results indicated that you can reduce high blood pressure by following an eating plan that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products, and that is low in saturated fat, cholesterol, total fat, and added sugars. The DASH eating plan also includes whole grains, poultry, fish, and nuts, and has reduced amounts of red meats, sweets, added sugars, and beverages containing sugars. A second study, called \"DASH-Sodium,\" showed that eating less salt also lowered blood pressure in people following either the DASH eating plan or the typical American diet. But those following DASH, especially those with high blood pressure, benefited the most. For more information on using the DASH eating plan, see  Your Guide to Lowering Your Blood Pressure with DASH."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "Only a small amount of the salt that we eat comes from the salt shaker, and only small amounts occur naturally in food. Most of the salt that we eat comes from processed foods -- for example, canned or processed meat, baked goods, and certain cereals, and foods with soy sauce, seasoned salts, monosodium glutamate (MSG), and baking soda. Food from fast food restaurants, frozen foods, and canned foods also tend to be higher in sodium."}]}
{"messages": [{"role": "user", "content": "What is (are) High Blood Pressure ?"}, {"role": "assistant", "content": "Older adults should limit their sodium (salt) intake to 1,500 mg a day. That's about 2/3 of a teaspoon of salt. Here are tips to reduce salt in your diet. - Buy fresh, plain frozen, or canned with no salt added vegetables. Choose foods packed in water instead of broth or salt.   -  Use fresh poultry, fish, and lean meat, rather than canned or processed types.  - Use herbs, spices, and salt-free seasoning blends in cooking and at the table.  - Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.  - Choose convenience foods that are low in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressingsthese often have a lot of sodium.  - Rinse canned foods, such as tuna, to remove some sodium.  - When available, buy low- or reduced-sodium or no-salt-added versions of foods.   - Choose ready-to-eat breakfast cereals that are low in sodium.  Buy fresh, plain frozen, or canned with no salt added vegetables. Choose foods packed in water instead of broth or salt. Use fresh poultry, fish, and lean meat, rather than canned or processed types. Use herbs, spices, and salt-free seasoning blends in cooking and at the table. Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt. Choose convenience foods that are low in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressingsthese often have a lot of sodium. Rinse canned foods, such as tuna, to remove some sodium. When available, buy low- or reduced-sodium or no-salt-added versions of foods. Choose ready-to-eat breakfast cereals that are low in sodium."}]}
{"messages": [{"role": "user", "content": "What is (are) Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Enlarged and Misshapen Bones Paget's disease of bone causes affected bones to become enlarged and misshapen. Our bones are living tissue, and our bodies are constantly breaking down old bone and replacing it with new bone. In Paget's disease, however, old bone is broken down and replaced at a faster rate than normal. The new bone is larger and weaker than normal bone. Paget's disease can occur in any bone in the body, but it is most common in the pelvis, spine, skull, and leg bones. It may occur in just one bone or in several bones, but it does not affect the entire skeleton or spread from affected bones to normal bones. Common symptoms include pain, misshapen bones, and a greater chance of broken bones. Complications Paget's disease can also lead to complications, such as arthritis, headaches, hearing loss, or nervous system problems, depending on which bones are affected. If not treated, Paget's disease can reduce a person's ability to perform activities of daily living, thereby reducing quality of life. Although it is the second most common bone disease after osteoporosis, Paget's disease is still uncommon. According to Bone Health and Osteoporosis: A Report of the Surgeon General, an estimated 1 million people in the U.S. have Paget's disease, or about 1.3 people per 100 men and women age 45-74. The disease is more common in older people and those of Northern European heritage. Men are more likely than women to have the disease. Cause is Unknown Paget's disease is named after the British surgeon, Sir James Paget, who first identified the disease in 1877. Researchers are not sure what causes it. Heredity may be a factor in some cases. Research suggests that a close relative of someone with Paget's disease is seven times more likely to develop the disease than someone without an affected relative. However, most people with Paget's disease do not have any relatives with the disease. Researchers think the disease also may be caused by other factors, such as a slow-acting virus. A Treatable Disease The good news is that Paget's disease of bone is treatable, especially if it is diagnosed early. In recent years, the Food and Drug Administration has approved several medications that can stop or slow the disease's progression. In some cases, surgery can help patients manage the symptoms and complications of the disease."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Symptoms Many people don't know they have Paget's disease because they have a mild case of the disease and do not have any symptoms. However, people with more advanced cases of the disease will likely have symptoms. Symptoms vary depending on which bone or bones are affected. People with Paget's disease may experience - bone pain  - misshapen bones  - fractures  - osteoarthritis of the joints adjacent to bone affected by the disease.  bone pain misshapen bones fractures osteoarthritis of the joints adjacent to bone affected by the disease. Paget's disease can also cause a variety of neurological complications as a result of compression of nerve tissue by bone affected by the disease. Misshapen bone is most obvious when the leg bones, skull, or bones of the spine are affected. Leg bones may become bowed, the skull may become enlarged, and malformed spinal bones may cause curvature of the spine. Complications People with Paget's disease also are more likely to break bones because bones affected by the disease are more fragile. Enlarged and malformed bones can distort the position of bones and joints. This causes wear and tear on the joints next to bones affected by Paget's disease, resulting in arthritis. On very rare occasions, Paget's disease is linked to the development of osteosarcoma, a type of bone cancer. Less than one percent of patients have this complication."}]}
{"messages": [{"role": "user", "content": "How to diagnose Paget's Disease of Bone ?"}, {"role": "assistant", "content": "An Underdiagnosed Disease Experts believe that Paget's disease is underdiagnosed; people with a mild case and no symptoms may never know they have the disease. Or, they may receive a diagnosis by accident when x-rays or other laboratory tests done for another reason reveal Paget's disease. When symptoms do occur, they usually appear gradually and, in the early stages, may be confused with those of arthritis or other medical problems. Sometimes a person may not receive a clear diagnosis until the disease progresses and complications develop. Diagnostic Tests X-rays are almost always used to diagnose Paget's disease, but the disease may be discovered using one of three tests: - x-rays  -  an alkaline phosphatase blood test  -  or a bone scan. x-rays an alkaline phosphatase blood test or a bone scan. Bones affected by Paget's disease have a distinctive appearance on x-rays, which may show increased bone density, an abnormal bone structure, bowing, and enlargement. X-rays of leg bones may show very tiny fractures called microfractures. The enzyme alkaline phosphatase is involved in the normal growth of new bone. Having higher-than-normal levels of this chemical in the blood, however, may be a sign of Paget's disease. The alkaline phosphatase blood test measures the level of this substance. A bone scan provides a picture of the affected bones that doctors can use to see how far the disease has progressed. If a bone scan done for another reason suggests Paget's disease, the doctor can order x-rays to confirm the diagnosis. If the Disease Runs in the Family Early diagnosis and treatment of Paget's disease is important. Because Paget's disease can be hereditary, some experts recommend that the brothers, sisters, and children of anyone with the disease talk to their doctor about having an alkaline phosphatase blood test every 2 to 3 years after about age 40."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Early Diagnosis is Important Although there is no cure for Paget's disease of bone, it is treatable. Treatment is most effective when the disease is diagnosed early, before it causes major changes in the affected bones. The goal of treatment is to relieve bone pain and prevent the disease from progressing. Medications Are Available The Food and Drug Administration has approved several medications that can stop or slow down the progression of the disease and reduce pain and other symptoms. These medications fall into two categories: bisphosphonates and calcitonin. Both medications work by stopping or reducing the excessive breakdown of old bone that leads to excessive formation of new, but weaker, bone. People with Paget's disease should talk to their doctors about which medication is right for them. Bisphosphonates Six bisphosphonates are currently available for patients with Paget's disease. Doctors most commonly recommend the strongest ones, which include - risedronate  - alendronate   - pamidronate   - zoledronic acid   - tiludronate and etidronate are not as strong but may be appropriate for some patients.  risedronate alendronate pamidronate zoledronic acid tiludronate and etidronate are not as strong but may be appropriate for some patients. Some of the bisphosphonates approved for the treatment of Paget's disease, including risedronate and alendronate, are also approved for the treatment of osteoporosis. However, people with Paget's disease must take higher dosages of these medicines for shorter periods of time than people with osteoporosis. Calcitonin Doctors also may prescribe calcitonin to treat Paget's disease in some people, although it has been found to be less effective than bisphosphonates. Calcitonin is a naturally occurring hormone made by the thyroid gland. Your doctor may recommend that you repeat calcitonin treatments with brief rest periods in between treatments. The nasal spray form of calcitonin is not recommended or approved to treat Paget's disease. Surgery Surgery may be a treatment option for some people. Hip or knee replacement surgery may help people with severe arthritis. Surgery can also realign affected leg bones to reduce pain or help broken bones heal in a better position. Nutrition and Exercise Good nutrition and exercise are important for bone health, and that is true for people with Paget's disease as well. Women over age 50 should consume 1,200 milligrams (mg) of calcium daily. Men between the ages of 51 and 70 should consume 1,000 mg of calcium a day, and men over 70 should consume 1,200 mg per day. People ages 51 to 70 should consume at least 600 international units (IU) of vitamin D daily. People over age 70 should consume at least 800 IUs daily. Calcium keeps bones strong, and vitamin D helps the body absorb calcium. Exercise is very important in maintaining bone health, avoiding weight gain, and keeping joints mobile. However, people with Paget's disease need to avoid putting too much stress on affected bones. They should discuss their exercise program with their doctor to make sure it is a good one for them. Finding New Treatments Recently, there have been major advances in the treatment of Paget's disease of bone. Research into new treatments continues. Some researchers are trying to identify the genetic and viral causes of the disease. Other researchers are learning more about bone biology to better understand how the body breaks down old bone and replaces it with new bone."}]}
{"messages": [{"role": "user", "content": "What is (are) Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Paget's disease of bone is a disease that causes affected bones to become enlarged and misshapen. Our bones are living tissue, and our bodies are constantly breaking down old bone and replacing it with new bone. In Paget's disease, however, old bone is broken down and replaced at a faster rate than normal. The new bone is larger and weaker than normal bone."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Pain may be a symptom, especially among people with more advanced Paget's disease. Affected bones also can become enlarged, misshapen, and more fragile and likely to break. Misshapen bones tend to be most noticeable in the legs, skull, and spine."}]}
{"messages": [{"role": "user", "content": "What are the complications of Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Over time, Paget's disease may lead to other medical conditions, including arthritis, headaches, hearing loss, and nervous system problems, depending on which bones are affected. On very rare occasions, Paget's disease is associated with the development of osteosarcoma, a type of bone cancer. Less than one percent of patients have this complication."}]}
{"messages": [{"role": "user", "content": "How to diagnose Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Paget's disease is almost always diagnosed by x-ray, although it may be discovered using one of two other tests: an alkaline phosphatase blood test or a bone scan. Paget's disease is often found by accident when a person undergoes one of these tests for another reason. In other cases, a person experiences problems that lead his or her physician to order these tests. If Paget's disease is first suggested by an alkaline phosphatase blood test or bone scan, the physician usually orders an x-ray to verify the diagnosis. A bone scan is typically used to identify all the bones in the skeleton that are affected by the disease."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Paget's Disease of Bone ?"}, {"role": "assistant", "content": "The Food and Drug Administration has approved several medications that can stop or slow down the progression of the disease and reduce pain and other symptoms. These medications fall into two categories: bisphosphonates and calcitonin. Doctors most often prescribe one of the four strongest bisphosphonates, which are risedronate, alendronate, pamidronate, and zoledronic acid."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Paget's Disease of Bone ?"}, {"role": "assistant", "content": "Yes. Some complications from Paget's disease respond well to surgery. Joint replacement may be helpful in people with severe arthritis of the hip or knee. Surgery can also realign affected leg bones to reduce pain or help broken bones heal in a better position."}]}
{"messages": [{"role": "user", "content": "What is (are) Urinary Tract Infections ?"}, {"role": "assistant", "content": "A Common Problem With Aging Urinary tract infections (UTIs) are a common bladder problem, especially as people age. UTIs are the second most common type of infection in the body. Each year, UTIs cause more than 8 million visits to health care providers. UTIs can happen anywhere in the urinary system (which includes the kidneys, bladder, and urethra). But UTIs are most common in the bladder. A UTI in the bladder is called cystitis. Infections in the bladder can spread to the kidneys. A UTI in the kidneys is called pyelonephritis. Sometimes, a UTI can also develop in the urethra, but this is less common. A UTI in the urethra is called urethritis. Some UTIs Lead to Severe Problems Most UTIs are not serious. But some UTIs, such as kidney infections, can lead to severe problems. Bacteria from a kidney infection may spread to the bloodstream, causing a life-threatening condition called septicemia. When kidney infections occur frequently or last a long time, they may cause permanent damage to the kidneys, including kidney scars, poor kidney function, and high blood pressure."}]}
{"messages": [{"role": "user", "content": "What causes Urinary Tract Infections ?"}, {"role": "assistant", "content": "Most urinary tract infections, or UTIs, are caused by bacteria that enter the urethra and then the bladder. A type of bacteria that normally lives in the bowel (called E. coli) causes most UTIs. UTIs can also be caused by fungus (another type of germ). Who Gets UTIs? Although everyone has some risk for UTIs, some people are more likely to get UTIs than others. These include people who have - spinal cord injuries or other nerve damage around the bladder.  - a blockage in the urinary tract that can trap urine in the bladder. The blockage can be caused by kidney stones, an enlarged prostate, or a birth defect.  - diabetes  - problems with the bodys natural defense (or immune) system  - pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal position into the vagina. When pelvic organs are out of place, they can push on the bladder and urethra and make it hard to fully empty the bladder. This causes urine to stay in the bladder. When urine stays in the bladder too long, it makes an infection more likely spinal cord injuries or other nerve damage around the bladder. a blockage in the urinary tract that can trap urine in the bladder. The blockage can be caused by kidney stones, an enlarged prostate, or a birth defect. diabetes problems with the bodys natural defense (or immune) system pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal position into the vagina. When pelvic organs are out of place, they can push on the bladder and urethra and make it hard to fully empty the bladder. This causes urine to stay in the bladder. When urine stays in the bladder too long, it makes an infection more likely UTIs in Women More than half of women will have at least one UTI in their lifetime. Women are more likely than men to get UTIs because they have a shorter urethra, making it easier for bacteria to reach the bladder. Also, the bowel and urethral openings are closer together in women than in men, making it easier for E. coli (a bacteria that lives in the bowel) to travel from the bowel to the urethra. Many women suffer from frequent UTIs. Some women have 3 or more UTIs a year. However, very few women will have frequent UTIs throughout their lives. More typically, a woman will have a period of 1 or 2 years with frequent UTIs. After this period, the UTIs may stop or happen less often. Older women are more likely to get UTIs because the bladder muscles weaken and make it hard to fully empty the bladder. This causes urine to stay in the bladder. When urine stays in the bladder too long, it makes an infection more likely. UTIs in Men Men are less likely than women to have a first UTI. But once a man has a UTI, he is likely to have another. Bacteria from a UTI can spread to the prostate. Once there, the bacteria can hide deep inside prostate tissue. Prostate infections are hard to cure because antibiotics may not be able to reach the infected prostate tissue. Activities That Can Increase Risk - Having sex. Sexual activity can move bacteria from the bowel or vaginal cavity to the urethral opening. Urinating after sex lowers the risk of infection.  - Using a catheter to urinate. A catheter is a tube placed in the urethra and bladder to help people empty the bladder. The catheter can make a direct path for bacteria to reach the bladder.  - Using certain birth controls. Diaphragms can bring bacteria with them when they are placed. Spermicides (a birth control that kills sperm) may also make UTIs more likely. Having sex. Sexual activity can move bacteria from the bowel or vaginal cavity to the urethral opening. Urinating after sex lowers the risk of infection. Using a catheter to urinate. A catheter is a tube placed in the urethra and bladder to help people empty the bladder. The catheter can make a direct path for bacteria to reach the bladder. Using certain birth controls. Diaphragms can bring bacteria with them when they are placed. Spermicides (a birth control that kills sperm) may also make UTIs more likely."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Urinary Tract Infections ?"}, {"role": "assistant", "content": "Symptoms of a urinary tract infection (UTI) in the bladder may include - cloudy, bloody, or foul-smelling urine  - pain or burning during urination  - strong and frequent need to urinate, even right after emptying the bladder  - a mild fever below 101 degrees Fahrenheit in some people. cloudy, bloody, or foul-smelling urine pain or burning during urination strong and frequent need to urinate, even right after emptying the bladder a mild fever below 101 degrees Fahrenheit in some people. If the UTI spreads to the kidneys, symptoms may include - chills and shaking   - night sweats  - feeling tired or generally ill   - fever above 101 degrees Fahrenheit  - pain in the side, back, or groin  - flushed, warm, or reddened skin  - mental changes or confusion   - nausea and vomiting  - very bad abdominal pain in some people. chills and shaking night sweats feeling tired or generally ill fever above 101 degrees Fahrenheit pain in the side, back, or groin flushed, warm, or reddened skin mental changes or confusion nausea and vomiting very bad abdominal pain in some people. Symptoms May Vary Symptoms may differ depending on age, gender, and catheter use. In some elderly people, mental changes and confusion may be the only signs of a UTI. Older women and men with a UTI are more likely to be tired, shaky, and weak. They are also more likely to have muscle aches and abdominal pain. In a person with a catheter, the only symptom may be fever that does not have another likely cause. Germs without Symptoms Some people may have germs in the bladder or urinary tract, but not feel any symptoms. If a urine test shows that you have germs in your urine, but you do not feel any symptoms, you may not need any treatment. If you have germs in your urine but you feel okay, talk to your health care provider about whether antibiotics -- the medications that treat UTIs -- are needed. Diagnosis  To find out if a person has a UTI, the health care provider will ask about symptoms. He or she will then test a sample of urine. The urine test looks for bacteria that may cause the infection. The urine test also looks for white blood cells, which the body makes to fight infection. Because healthy people sometimes have bacteria in their urine, both bacteria and white blood cells must be in the urine to diagnose a UTI. If a person has UTIs often, the health care provider may order some extra tests to see if the persons urinary tract is normal. (Watch the video to learn more about what to expect when seeking help for a bladder problem. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "How to prevent Urinary Tract Infections ?"}, {"role": "assistant", "content": "Changing some of these daily habits may help prevent urinary tract infections (UTIs). - Wipe from front to back after using the toilet. Women should wipe from front to back to keep bacteria from getting into the urethra. This step is most important after a bowel movement. Wipe from front to back after using the toilet. Women should wipe from front to back to keep bacteria from getting into the urethra. This step is most important after a bowel movement. - Drink lots of fluids, especially water. Fluids can help flush bacteria from the urinary system. Water is best. Most healthy people should try to drink six to eight, 8-ounce glasses of fluid each day. (Some people need to drink less water because of certain conditions. For example, if you have kidney failure or heart disease, you should not drink this much fluid. Ask your health care provider how much fluid is healthy for you.) Drink lots of fluids, especially water. Fluids can help flush bacteria from the urinary system. Water is best. Most healthy people should try to drink six to eight, 8-ounce glasses of fluid each day. (Some people need to drink less water because of certain conditions. For example, if you have kidney failure or heart disease, you should not drink this much fluid. Ask your health care provider how much fluid is healthy for you.) - Urinate often and when the urge arises. Try to urinate at least every 3 to 4 hours. Bacteria are more likely to grow in the bladder when urine stays in the bladder too long.  Urinate often and when the urge arises. Try to urinate at least every 3 to 4 hours. Bacteria are more likely to grow in the bladder when urine stays in the bladder too long. - Urinate after sex. Both women and men should urinate shortly after sex to flush away bacteria that may have entered the urethra during sex.  Urinate after sex. Both women and men should urinate shortly after sex to flush away bacteria that may have entered the urethra during sex. - Wear cotton underwear and loose-fitting clothes. Wearing looser, cotton clothing will allow air to keep the area around the urethra dry. Tight-fitting jeans and nylon underwear should be avoided because they can trap moisture and help bacteria grow. Wear cotton underwear and loose-fitting clothes. Wearing looser, cotton clothing will allow air to keep the area around the urethra dry. Tight-fitting jeans and nylon underwear should be avoided because they can trap moisture and help bacteria grow. Cranberry Juice Drinking cranberry juice or taking cranberry supplements may also help prevent UTIs. Some studies have shown that cranberry products make UTIs less likely, especially in people who get UTIs often. But in other studies, cranberry products did not help."}]}
{"messages": [{"role": "user", "content": "What is (are) Urinary Tract Infections ?"}, {"role": "assistant", "content": "Urinary tract infections (UTI) are a common bladder problem, especially as people age. UTIs are the second most common type of infection in the body. Each year, UTIs cause more than 8 million visits to health care providers. UTIs can happen anywhere in the urinary system (which includes the kidneys, bladder, and urethra). But UTIs are most common in the bladder. A UTI in the bladder is called cystitis. Infections in the bladder can spread to the kidneys. A UTI in the kidneys is called pyelonephritis. Sometimes, a UTI can also develop in the urethra, but this is less common. A UTI in the urethra is called urethritis. Learn more about urinary tract infections in adults."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Urinary Tract Infections ?"}, {"role": "assistant", "content": "Symptoms of a UTI in the bladder may include - cloudy, bloody, or foul-smelling urine  - pain or burning during urination  - strong and frequent need to urinate, even right after emptying the bladder  - a mild fever below 101 degrees Fahrenheit in some people. cloudy, bloody, or foul-smelling urine pain or burning during urination strong and frequent need to urinate, even right after emptying the bladder a mild fever below 101 degrees Fahrenheit in some people. If the UTI spreads to the kidneys, symptoms may include - chills and shaking   - night sweats  - feeling tired or generally ill   - fever above 101 degrees Fahrenheit  - pain in the side, back, or groin  - flushed, warm, or reddened skin  - mental changes or confusion   - nausea and vomiting  - very bad abdominal pain in some people. chills and shaking night sweats feeling tired or generally ill fever above 101 degrees Fahrenheit pain in the side, back, or groin flushed, warm, or reddened skin mental changes or confusion nausea and vomiting very bad abdominal pain in some people. Symptoms may differ depending on age, gender, and catheter use. In some elderly people, mental changes and confusion may be the only signs of a UTI. Older women and men with a UTI are more likely to be tired, shaky, and weak. They are also more likely to have muscle aches and abdominal pain. In a person with a catheter, the only symptom may be fever that does not have another likely cause. Learn more about the signs and symptoms of urinary tract infections in adults."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Urinary Tract Infections? ?"}, {"role": "assistant", "content": "Although everyone has some risk for UTIs, some people are more likely to get UTIs than others. These include people who have -  spinal cord injuries or other nerve damage around the bladder   -  a blockage in the urinary tract that can trap urine in the bladder. A blockage in the urinary tract can be caused by kidney stones, an enlarged prostate, or a birth defect.   -  diabetes   -  problems with the bodys natural defense (or immune) system   -  pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal position into the vagina. When pelvic organs are out of place, they can push on the bladder and urethra and make it hard to fully empty the bladder. This causes urine to stay in the bladder. When urine stays in the bladder too long, it makes an infection more likely.  spinal cord injuries or other nerve damage around the bladder a blockage in the urinary tract that can trap urine in the bladder. A blockage in the urinary tract can be caused by kidney stones, an enlarged prostate, or a birth defect. diabetes problems with the bodys natural defense (or immune) system pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal position into the vagina. When pelvic organs are out of place, they can push on the bladder and urethra and make it hard to fully empty the bladder. This causes urine to stay in the bladder. When urine stays in the bladder too long, it makes an infection more likely. Learn more about risk factors for urinary tract infections."}]}
{"messages": [{"role": "user", "content": "How to prevent Urinary Tract Infections ?"}, {"role": "assistant", "content": "Changing some of these daily habits may help prevent UTIs. - Wipe from front to back after using the toilet. Women should wipe from front to back to keep bacteria from getting into the urethra. This step is most important after a bowel movement.  Wipe from front to back after using the toilet. Women should wipe from front to back to keep bacteria from getting into the urethra. This step is most important after a bowel movement.  - Drink lots of fluid, especially water. Fluids can help flush bacteria from the urinary system. Water is best. Most healthy people should try to drink six to eight, 8-ounce glasses of fluid each day. (Some people need to drink less water because of certain conditions. For example, if you have kidney failure or heart disease, you should not drink this much fluid. Ask your health care provider how much fluid is healthy for you.)  Drink lots of fluid, especially water. Fluids can help flush bacteria from the urinary system. Water is best. Most healthy people should try to drink six to eight, 8-ounce glasses of fluid each day. (Some people need to drink less water because of certain conditions. For example, if you have kidney failure or heart disease, you should not drink this much fluid. Ask your health care provider how much fluid is healthy for you.)  - Urinate often and when the urge arises. Try to urinate at least every 3 to 4 hours. Bacteria are more likely to grow in the bladder when urine stays in the bladder too long.  Urinate often and when the urge arises. Try to urinate at least every 3 to 4 hours. Bacteria are more likely to grow in the bladder when urine stays in the bladder too long. - Urinate after sex. Both women and men should urinate shortly after sex to flush away bacteria that may have entered the urethra during sex.  Urinate after sex. Both women and men should urinate shortly after sex to flush away bacteria that may have entered the urethra during sex. - Wear cotton underwear and loose-fitting clothes. Wearing looser, cotton clothing will allow air to keep the area around the urethra dry. Tight-fitting jeans and nylon underwear should be avoided because they can trap moisture and help bacteria grow. Wear cotton underwear and loose-fitting clothes. Wearing looser, cotton clothing will allow air to keep the area around the urethra dry. Tight-fitting jeans and nylon underwear should be avoided because they can trap moisture and help bacteria grow. Drinking cranberry juice or taking cranberry supplements also may help prevent UTIs. Some studies have shown that cranberry products make UTIs less likely, especially in people who get UTIs often. But in other studies, cranberry products did not help."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Urinary Tract Infections ?"}, {"role": "assistant", "content": "Because most UTIs are caused by bacteria, bacteria-fighting medications called antibiotics are the usual treatment. The type of antibiotic and length of treatment depend on the patients history and the type of bacteria causing the infection. Bladder infections may eventually get better on their own. But antibiotics can make the symptoms go away much more quickly. People usually feel better within a day or two of starting antibiotics. Drinking lots of fluids and urinating often may also speed healing. If needed, pain-killers can relieve the pain of a UTI. A heating pad on the back or abdomen may also help. Learn more about treating urinary tract infections."}]}
{"messages": [{"role": "user", "content": "What is (are) Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Alcohol, also known as ethanol, is a chemical found in beverages like beer, wine, and distilled spirits such as whiskey, vodka, and rum. Through a process called fermentation, yeast converts the sugars naturally found in grains and grapes into the alcohol that is in beer and wine. Another process, called distillation, concentrates alcohol in the drink making it stronger, producing what are known as distilled spirits."}]}
{"messages": [{"role": "user", "content": "What is (are) Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Blood alcohol concentration (BAC) measures the percentage of ethanolthe chemical name for alcohol in alcoholic beveragesin a persons blood. As you drink, you increase your blood alcohol concentration (BAC) level. The higher the BAC, the more impaired a person is. In all states, it is against the law for people to drive if their blood alcohol concentration is above .08. The effects of increased blood alcohol levels can include -  reduced inhibitions   -  slurred speech   - motor impairment   - confusion   -  memory problems   - concentration problems   - coma   - breathing problems   - death.  reduced inhibitions slurred speech motor impairment confusion memory problems concentration problems coma breathing problems death. Learn more about the risks of alcohol overdose."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Its not always obvious that someone drinks too much. For older adults, clues to a possible alcohol problem include memory loss, depression, anxiety, poor appetite, unexplained bruises, falls, sleeping problems, and inattention to cleanliness or appearance. Answering \"yes\" to at least one of the following questions is also a sign of a possible drinking problem: - Have you ever felt you should cut down on your drinking?  - Have people annoyed you by criticizing your drinking?  - Have you ever felt bad or guilty about your drinking?  - Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? Have you ever felt you should cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? If you answered yes to any of these questions, talk with your health care provider. Also seek help if you feel you are having drinking-related problems with your health, relationships, or work."}]}
{"messages": [{"role": "user", "content": "What is (are) Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "If a person drinks too much or too often he or she may develop an alcohol use disorder (AUD). An AUD can range in severity from mild to severe. On one end of this spectrum, drinking might cause sickness, depression, or sleeping problems. More severe symptoms include drinking more than intended or craving alcohol once youve stopped drinking. AUD can be a lifelong disease in which people have a strong need to drink, cannot control their drinking once they start, and over time need to drink greater and greater amounts of alcohol to get high. Older adults who develop a severe AUD become physically dependent on alcohol. When they stop drinking, they can get nauseated, sweaty, shaky, and restless. These withdrawal symptoms can cause them to start drinking again to feel better, even though doing so can lead to physical or psychological problems.  Learn more about alcohol use disorder."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "There is not one right treatment for everyone with alcohol problems. In general, many people need more than one kind of treatment. Medicines can help people with alcohol use disorder quit drinking. Meeting with a therapist or substance-abuse counselor or with a support group may also help. Support from family and friends is important, too. A doctor can help a person decide on the best treatment. Making a change sooner rather than later makes treatment more likely to succeed. Learn more about treatment options for alcohol problems.  Learn more about available types of alcohol treatment.  (Watch the video to learn more about getting help for alcohol use disorder (AUD). To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Prescription medicines can help people with alcohol use disorder reduce their drinking, avoid going back to heavy drinking, and get sober. None of them works in every person. There are three medications approved by the U.S. Food and Drug Administration for the treatment of alcohol use disorder. - Naltrexone (Depade, ReVia, Vivitrol) acts in the brain to reduce craving for alcohol  -  Acamprosate (Campral) helps manage withdrawal symptoms such as anxiety, nausea, and sweating that may lead to a drinking relapse   - Disulfiram (Antabuse) makes a person feel sick after drinking alcohol.  Naltrexone (Depade, ReVia, Vivitrol) acts in the brain to reduce craving for alcohol Acamprosate (Campral) helps manage withdrawal symptoms such as anxiety, nausea, and sweating that may lead to a drinking relapse Disulfiram (Antabuse) makes a person feel sick after drinking alcohol."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Talking about alcohol use with a professional is beneficial to many people. Counseling  either one-on-one or in groups  can help develop skills to stop or reduce drinking, develop reachable goals, manage the triggers that lead to alcohol misuse and build a strong social support system that supports healthy habits. There are many kinds of counseling approaches. - cognitive behavior therapy   - motivational enhancement therapy  - marital and family counseling  - brief interventions cognitive behavior therapy motivational enhancement therapy marital and family counseling brief interventions Learn more about each type of behavioral therapy.  Counseling can be provided by - primary care doctors   - psychiatrists  -  psychologists  -  social workers  - certified alcohol counselors.  primary care doctors psychiatrists psychologists social workers certified alcohol counselors."}]}
{"messages": [{"role": "user", "content": "Where to find support for people with Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Many people with alcohol problems find it helpful to talk with others who have faced similar problems. Mutual help groups, such as Alcoholics Anonymous (AA) 12-step programs, help people recover from alcohol use disorder. AA meetings are open to anyone who wants to stop drinking. Attending mutual-help groups is beneficial for many people who want to stop drinking. Many people continue to go to support/mutual help groups even after medical treatment for their alcohol problems ends. There are other mutual help groups available such as Smart Recovery, Life Ring, and Moderation Management.  Learn more about available types of treatment for alcohol problems."}]}
{"messages": [{"role": "user", "content": "What is (are) Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Some people with an alcohol use disorder are treated in a facility, such as a hospital, mental health center, or substance abuse clinic. Treatment may last as long as several weeks. This type of treatment typically involves detoxification (when a person is weaned from alcohol), medicine, and counseling.  Learn more about treatment settings for alcohol problems.   Use the Behavioral Health Treatment Services Locator to find a treatment facility."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Most people with alcohol problems can be treated successfully. People with an alcohol use disorder and those who misuse alcohol and cannot stay within healthy drinking limits should stop drinking altogether. Others can cut back until their drinking is under control. Changing drinking habits isnt easy. Often it takes more than one try to succeed. But people dont have to go it alone. There are plenty of sources of help. (Watch the video to learn more about getting help for alcohol use disorder (AUD). To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) A doctor can help decide the best treatment for people with alcohol problems. Many people need more than one kind of treatment. Medicines can help people with an alcohol use disorder quit drinking. Meeting with a therapist or substance-abuse counselor or with a support group may also help. Support from family and friends is important, too. Making a change sooner rather than later makes treatment more likely to succeed. When treatment is successful, people have longer and longer periods without drinking alcohol. Finally, they are able to stop drinking or stick to healthy drinking limits. But treatment does not always work. Relapse is common among people who overcome alcohol problems. People with drinking problems are most likely to relapse during periods of stress or when exposed to people or places associated with past drinking.  Learn more about the treatment process for alcohol use disorder."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alcohol Use and Older Adults ?"}, {"role": "assistant", "content": "Older people with alcohol problems respond to treatment as well as younger people. Some studies suggest that older adults do better when they are treated with other people the same age instead of mixed in with younger adults. Some communities have treatment programs and support groups specifically for older adults."}]}
{"messages": [{"role": "user", "content": "What is (are) Osteoarthritis ?"}, {"role": "assistant", "content": "Affects Many Older People Osteoarthritis is the most common form of arthritis among older people, and it is one of the most frequent causes of physical disability among older adults. The disease affects both men and women. Before age 45, osteoarthritis is more common in men than in women. After age 45, osteoarthritis is more common in women. It is estimated that 33.6% (12.4 million) of individuals age 65 and older are affected by the disease. Osteoarthritis occurs when cartilage, the tissue that cushions the ends of the bones within the joints, breaks down and wears away. In some cases, all of the cartilage may wear away, leaving bones that rub up against each other. Joint Stiffness and Pain Symptoms range from stiffness and mild pain that comes and goes to severe joint pain. Osteoarthritis affects hands, low back, neck, and weight-bearing joints such as knees, hips, and feet. osteoarthritis affects just joints, not internal organs. Hands Osteoarthritis of the hands seems to run in families. If your mother or grandmother has or had osteoarthritis in their hands, youre at greater-than-average risk of having it too. Women are more likely than men to have osteoarthritis in the hands. For most women, it develops after menopause. When osteoarthritis involves the hands, small, bony knobs may appear on the end joints (those closest to the nails) of the fingers. They are called Heberdens (HEBerr-denz) nodes. Similar knobs, called Bouchards (boo-SHARDZ) nodes, can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled, and they may ache or be stiff and numb. The base of the thumb joint also is commonly affected by osteoarthritis. Knees The knees are among the joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling, and pain, which make it hard to walk, climb, and get in and out of chairs and bathtubs. Osteoarthritis in the knees can lead to disability. Hips The hips are also common sites of osteoarthritis. As with knee osteoarthritis, symptoms of hip osteoarthritis include pain and stiffness of the joint itself. But sometimes pain is felt in the groin, inner thigh, buttocks, or even the knees. Osteoarthritis of the hip may limit moving and bending, making daily activities such as dressing and putting on shoes a challenge. Spine Osteoarthritis of the spine may show up as stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can cause pressure on the nerves where they exit the spinal column, resulting in weakness, tingling, or numbness of the arms and legs. In severe cases, this can even affect bladder and bowel function."}]}
{"messages": [{"role": "user", "content": "What causes Osteoarthritis ?"}, {"role": "assistant", "content": "Risk Increases With Age Researchers suspect that osteoarthritis is caused by a combination of factors in the body and the environment. The chance of developing osteoarthritis increases with age. It is estimated that 33.6% (12.4 million) of individuals age 65 and older are affected by the disease. Wear and Tear on Joints Affects Cartilage Osteoarthritis often results from years of wear and tear on joints. This wear and tear mostly affects the cartilage, the tissue that cushions the ends of bones within the joint. Osteoarthritis occurs when the cartilage begins to fray, wear away, and decay. Putting too much stress on a joint that has been previously injured, improper alignment of joints, and excess weight all may contribute to the development of osteoarthritis."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Osteoarthritis ?"}, {"role": "assistant", "content": "Pain and Stiffness in Joints Different types of arthritis have different symptoms. In general, people with most forms of arthritis have pain and stiffness in their joints. Osteoarthritis usually develops slowly and can occur in any joint, but often occurs in weight-bearing joints. Early in the disease, joints may ache after physical work or exercise. Most often, osteoarthritis occurs in the hands, hips, knees, neck, or low back. Common Signs Common signs of osteoarthritis include - joint pain, swelling, and tenderness  - stiffness after getting out of bed  - a crunching feeling or sound of bone rubbing on bone. joint pain, swelling, and tenderness stiffness after getting out of bed a crunching feeling or sound of bone rubbing on bone. Not everyone with osteoarthritis feels pain, however. In fact, only a third of people with x-ray evidence of osteoarthritis report pain or other symptoms. Diagnosis To make a diagnosis of osteoarthritis, most doctors use a combination of methods and tests including a medical history, a physical examination, x-rays, and laboratory tests. - A medical history is the patient's description of symptoms and when and how they began. The description covers pain, stiffness, and joint function, and how these have changed over time.   - A physical examination includes the doctor's examination of the joints, skin, reflexes, and muscle strength. The doctor observes the patient's ability to walk, bend, and carry out activities of daily living.  - X-rays are limited in their capacity to reveal how much joint damage may have occurred in osteoarthritis. X-rays usually don't show osteoarthritis damage until there has been a significant loss of cartilage.  A medical history is the patient's description of symptoms and when and how they began. The description covers pain, stiffness, and joint function, and how these have changed over time. A physical examination includes the doctor's examination of the joints, skin, reflexes, and muscle strength. The doctor observes the patient's ability to walk, bend, and carry out activities of daily living. X-rays are limited in their capacity to reveal how much joint damage may have occurred in osteoarthritis. X-rays usually don't show osteoarthritis damage until there has been a significant loss of cartilage. Questions Your Doctor May Ask It is important for people with joint pain to give the doctor a complete medical history. Answering these questions will help your doctor make an accurate diagnosis: - Is the pain in one or more joints?  - When does the pain occur and how long does it last?  - When did you first notice the pain?  - Does activity make the pain better or worse?  - Have you had any illnesses or accidents that may account for the pain?  - Is there a family history of any arthritis or rheumatic diseases?  - What medicines are you taking? Is the pain in one or more joints? When does the pain occur and how long does it last? When did you first notice the pain? Does activity make the pain better or worse? Have you had any illnesses or accidents that may account for the pain? Is there a family history of any arthritis or rheumatic diseases? What medicines are you taking? A patient's attitudes, daily activities, and levels of anxiety or depression have a lot to do with how severe the symptoms of osteoarthritis may be. Who Can Provide Care Treating arthritis often requires a multidisciplinary or team approach. Many types of health professionals care for people with arthritis. You may choose a few or more of the following professionals to be part of your health care team. - Primary care physicians -- doctors who treat patients before they are referred to other specialists in the health care system. Often a primary care physician will be the main doctor to treat your arthritis. Primary care physicians also handle other medical problems and coordinate the care you receive from other physicians and health care providers. Primary care physicians -- doctors who treat patients before they are referred to other specialists in the health care system. Often a primary care physician will be the main doctor to treat your arthritis. Primary care physicians also handle other medical problems and coordinate the care you receive from other physicians and health care providers. - Rheumatologists  -- doctors who specialize in treating arthritis and related conditions that affect joints, muscles, and bones. Rheumatologists  -- doctors who specialize in treating arthritis and related conditions that affect joints, muscles, and bones. - Orthopaedists  -- surgeons who specialize in the treatment of, and surgery for, bone and joint diseases. Orthopaedists  -- surgeons who specialize in the treatment of, and surgery for, bone and joint diseases. - Physical therapists  -- health professionals who work with patients to improve joint function. Physical therapists  -- health professionals who work with patients to improve joint function. - Occupational therapists  -- health professionals who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy. Occupational therapists  -- health professionals who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy. - Dietitians -- health professionals who teach ways to use a good diet to improve health and maintain a healthy weight. Dietitians -- health professionals who teach ways to use a good diet to improve health and maintain a healthy weight. - Nurse educators  -- nurses who specialize in helping patients understand their overall condition and implement their treatment plans. Nurse educators  -- nurses who specialize in helping patients understand their overall condition and implement their treatment plans. - Physiatrists (rehabilitation specialists) -- medical doctors who help patients make the most of their physical potential.  Physiatrists (rehabilitation specialists) -- medical doctors who help patients make the most of their physical potential. - Licensed acupuncture therapists  -- health professionals who reduce pain and improve physical functioning by inserting fine needles into the skin at specific points on the body. Licensed acupuncture therapists  -- health professionals who reduce pain and improve physical functioning by inserting fine needles into the skin at specific points on the body. - Psychologists  -- health professionals who seek to help patients cope with difficulties in the home and workplace resulting from their medical conditions. Psychologists  -- health professionals who seek to help patients cope with difficulties in the home and workplace resulting from their medical conditions. - Social workers -- professionals who assist patients with social challenges caused by disability, unemployment, financial hardships, home health care, and other needs resulting from their medical conditions. Social workers -- professionals who assist patients with social challenges caused by disability, unemployment, financial hardships, home health care, and other needs resulting from their medical conditions. - Chiropractors  -- health professionals who focus treatment on the relationship between the body's structure -- mainly the spine -- and its functioning. Chiropractors  -- health professionals who focus treatment on the relationship between the body's structure -- mainly the spine -- and its functioning. - Massage therapists  -- health professionals who press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet. Massage therapists  -- health professionals who press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoarthritis ?"}, {"role": "assistant", "content": "Treatment Goals: Manage Pain, Improve Function Osteoarthritis treatment plans often include ways to manage pain and improve function. Such plans can include exercise, rest and joint care, pain relief, weight control, medicines, surgery, and non-traditional treatment approaches. Current treatments for osteoarthritis can relieve symptoms such as pain and disability, but right now there are no treatments that can cure osteoarthritis. Exercise: One of the Best Treatments Exercise is one of the best treatments for osteoarthritis. It can improve mood and outlook, decrease pain, increase flexibility, and help you maintain a healthy weight. The amount and form of exercise will depend on which joints are involved, how stable the joints are, whether or not the joint is swollen, and whether a joint replacement has already been done. Ask your doctor or physical therapist what exercises are best for you The following types of exercise are part of a well-rounded arthritis treatment plan. -  Strengthening exercises.  These exercises strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands, inexpensive devices that add resistance.  - Aerobic activities.  These are exercises, such as brisk walking or low-impact aerobics, that get your heart pumping and can keep your lungs and circulatory system in shape.   -  Range-of-motion activities.  These keep your joints limber.  - Balance and agility exercises.  These help you maintain your balance and reduce the risk of falling.   Strengthening exercises.  These exercises strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands, inexpensive devices that add resistance. Aerobic activities.  These are exercises, such as brisk walking or low-impact aerobics, that get your heart pumping and can keep your lungs and circulatory system in shape.  Range-of-motion activities.  These keep your joints limber. Balance and agility exercises.  These help you maintain your balance and reduce the risk of falling. To see examples of exercises for older adults, see  Exercises to Try or visit Go4Life,  the National Institute on Agings exercise and physical activity program for older adults. Weight Control If you are overweight or obese, you should try to lose weight. Weight loss can reduce stress on weight-bearing joints, limit further injury, increase mobility, and reduce the risk of associated health problems. A dietitian can help you develop healthy eating habits. A healthy diet and regular exercise help reduce weight. Rest and Relief from Stress on Joints Treatment plans include regularly scheduled rest. You must learn to recognize the bodys signals, and know when to stop or slow down. This will prevent the pain caused by overexertion. Although pain can make it difficult to sleep, getting proper sleep is important for managing arthritis pain. If you have trouble sleeping, you may find that relaxation techniques, stress reduction, and biofeedback can help. Timing medications to provide maximum pain relief through the night can also help. If joint pain interferes with your ability to sleep or rest, consult your doctor. Some people find relief from special footwear and insoles that can reduce pain and improve walking or from using canes to take pressure off painful joints. They may use splints or braces to provide extra support for joints and/ or keep them in proper position during sleep or activity. Splints should be used only for limited periods of time because joints and muscles need to be exercised to prevent stiffness and weakness. If you need a splint, an occupational therapist or a doctor can help you get a properly fitted one. Non-drug Pain Relief and Alternative Therapies People with osteoarthritis may find many nondrug ways to relieve pain. Below are some examples. - Heat and cold. Heat or cold (or a combination of the two) can be useful for joint pain. Heat can be applied in a number of different ways -- with warm towels, hot packs, or a warm bath or shower -- to increase blood flow and ease pain and stiffness. In some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation, can relieve pain or numb the sore area. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.) Heat and cold. Heat or cold (or a combination of the two) can be useful for joint pain. Heat can be applied in a number of different ways -- with warm towels, hot packs, or a warm bath or shower -- to increase blood flow and ease pain and stiffness. In some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation, can relieve pain or numb the sore area. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.) - Transcutaneous electrical nerve stimulation (TENS). TENS is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception. Transcutaneous electrical nerve stimulation (TENS). TENS is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception. - Massage.  In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.  Massage.  In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease. -  Acupuncture.  Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system. A large study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM) revealed that acupuncture relieves pain and improves function in knee osteoarthritis, and it serves as an effective complement to standard care.  Acupuncture.  Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system. A large study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM) revealed that acupuncture relieves pain and improves function in knee osteoarthritis, and it serves as an effective complement to standard care. - Nutritional supplements, such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. Additional studies have been carried out to further evaluate these claims. It is unknown whether they might change the course of disease. Nutritional supplements, such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. Additional studies have been carried out to further evaluate these claims. It is unknown whether they might change the course of disease. - Folk remedies. These include the wearing of copper bracelets, following special diets, and rubbing WD-40 on joints to lubricate them. Although these practices may or may not be harmful, no scientific research to date shows that they are helpful in treating osteoarthritis. They can also be expensive, and using them may cause people to delay or even abandon useful medical treatment. Folk remedies. These include the wearing of copper bracelets, following special diets, and rubbing WD-40 on joints to lubricate them. Although these practices may or may not be harmful, no scientific research to date shows that they are helpful in treating osteoarthritis. They can also be expensive, and using them may cause people to delay or even abandon useful medical treatment. For general information on alternative therapies, see the Complementary Health Approaches topic. Medications Doctors consider a number of factors when choosing medicines for their patients. In particular, they look at the type of pain the patient may be having and any possible side effects from the drugs. For pain relief, doctors usually start with acetaminophen because the side effects are minimal. If acetaminophen does not relieve pain, then non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be used. Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, are available only with a prescription. Other medications, including corticosteroids, hyaluronic acid, and topical creams are also used. Reduce the Risks of NSAID Use Most medicines used to treat osteoarthritis have side effects, so it is important for people to learn about the medicines they take. For example, people over age 65 and those with any history of ulcers or stomach bleeding should use non-steroidal anti-inflammatory drugs, or NSAIDs, with caution. There are measures you can take to help reduce the risk of side effects associated with NSAIDs. These include taking medications with food and avoiding stomach irritants such as alcohol, tobacco, and caffeine. In some cases, it may help to take another medication along with an NSAID to coat the stomach or block stomach acids. Although these measures may help, they are not always completely effective. For more tips on how older adults can avoid side effects, see Side Effects  in the Taking Medicines topic. Surgery For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following goals. - Removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopic debridement).  - Repositioning of bones (osteotomy).  - Resurfacing (smoothing out) bones (joint resurfacing). Removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopic debridement). Repositioning of bones (osteotomy). Resurfacing (smoothing out) bones (joint resurfacing). Joint Replacement Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. Some prostheses are joined to bone surfaces with special cements. Others have porous surfaces and rely on the growth of bone into that surface (a process called biologic fixation) to hold them in place. Artificial joints can last 10 to 15 years or longer. Surgeons choose the design and components of prostheses according to their patients weight, sex, age, activity level, and other medical conditions. Joint replacement advances in recent years have included the ability, in some cases, to replace only the damaged part of the knee joint, leaving undamaged parts of the joint intact, and the ability to perform hip replacement through much smaller incisions than previously possible. For more on joint replacement see the Hip Replacement and Knee Replacement topics. Deciding on Surgery The decision to use surgery depends on several factors, including the patients age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his or her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily."}]}
{"messages": [{"role": "user", "content": "What is (are) Osteoarthritis ?"}, {"role": "assistant", "content": "Osteoarthritis is the most common form of arthritis among older people. It affects hands, low back, neck, and weight-bearing joints such as knees, hips, and feet. Osteoarthritis occurs when cartilage, the tissue that cushions the ends of the bones within the joints, breaks down and wears away. This causes bones to rub together, causing pain, swelling, and loss of motion of the joint."}]}
{"messages": [{"role": "user", "content": "How many people are affected by Osteoarthritis ?"}, {"role": "assistant", "content": "The chance of developing osteoarthritis increases with age. It is estimated that 33.6% (12.4 million) of individuals age 65 and older are affected by the disease."}]}
{"messages": [{"role": "user", "content": "What causes Osteoarthritis ?"}, {"role": "assistant", "content": "Osteoarthritis often results from years of wear and tear on joints. This wear and tear mostly affects the cartilage, the tissue that cushions the ends of bones within the joint. Osteoarthritis occurs when the cartilage begins to fray, wear away, and decay. Putting too much stress on a joint that has been repeatedly injured may lead to the development of osteoarthritis, too. A person who is overweight is more likely to develop osteoarthritis because of too much stress on the joints. Also, improper joint alignment may lead to the development of osteoarthritis."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Osteoarthritis ?"}, {"role": "assistant", "content": "Warning signs of osteoarthritis include -  joint pain  -  swelling or tenderness in one or more joints  -  stiffness after getting out of bed or sitting for a long time  -  a crunching feeling or sound of bone rubbing on bone.  joint pain swelling or tenderness in one or more joints stiffness after getting out of bed or sitting for a long time a crunching feeling or sound of bone rubbing on bone. Not everyone with osteoarthritis develops symptoms. In fact, only a third of people with x-ray evidence of osteoarthritis report pain or other symptoms."}]}
{"messages": [{"role": "user", "content": "How to diagnose Osteoarthritis ?"}, {"role": "assistant", "content": "No single test can diagnose osteoarthritis. When a person feels pain in his or her joints, it may or may not be osteoarthritis. The doctor will use a combination of tests to try to determine if osteoarthritis is causing the symptoms. These may include a medical history, a physical examination, x-rays, and laboratory tests. A patient's attitudes, daily activities, and levels of anxiety or depression have a lot to do with how much the symptoms of osteoarthritis affect day-to-day living."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoarthritis ?"}, {"role": "assistant", "content": "Warm towels, hot packs, or a warm bath or shower can provide temporary pain relief. Medications such as non-steroidal anti-inflammatory drugs, or NSAIDs, help reduce pain and inflammation that result from osteoarthritis. A doctor or physical therapist can recommend if heat or cold is the best treatment. For osteoarthritis in the knee, wearing insoles or cushioned shoes may reduce joint stress."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoarthritis ?"}, {"role": "assistant", "content": "People with osteoarthritis may find many non-drug ways to relieve pain. Below are some examples. Heat and cold.  Heat or cold (or a combination of the two) can be useful for joint pain. Heat can be applied in a number of different ways -- with warm towels, hot packs, or a warm bath or shower -- to increase blood flow and ease pain and stiffness. In some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation, can relieve pain or numb the sore area. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.) Transcutaneous electrical nerve stimulation (TENS). TENS is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception. Massage.  In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease. Acupuncture.  Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system. A large study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM) revealed that acupuncture relieves pain and improves function in knee osteoarthritis, and it serves as an effective complement to standard care. Nutritional supplements, such as glucosamine and chondroitin sulfate, have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. Additional studies have been carried out to further evaluate these claims. It is unknown whether they might change the course of disease. Folk remedies  include the wearing of copper bracelets, following special diets, and rubbing WD-40 on joints to lubricate them. Although these practices may or may not be harmful, no scientific research to date shows that they are helpful in treating osteoarthritis. They can also be expensive, and using them may cause people to delay or even abandon useful medical treatment. For general information about alternative therapies, see the Complementary Health Approaches  topic."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoarthritis ?"}, {"role": "assistant", "content": "Doctors consider a number of factors when choosing medicines for their patients. In particular, they look at the type of pain the patient may be having and any possible side effects from the drugs. For pain relief, doctors usually start with acetaminophen because the side effects are minimal. If acetaminophen does not relieve pain, then non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be used. Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, are available only with a prescription. Corticosteroids, hyaluronic acid, and topical creams are also used. Most medicines used to treat osteoarthritis have side effects, so it is important for people to learn about the medicines they take. For example, people over age 65 and those with any history of ulcers or stomach bleeding should use non-steroidal anti-inflammatory drugs, or NSAIDs, with caution. There are measures you can take to help reduce the risk of side effects associated with NSAIDs. These include taking medications with food and avoiding stomach irritants such as alcohol, tobacco, and caffeine. In some cases, it may help to take another medication along with an NSAID to coat the stomach or block stomach acids. Although these measures may help, they are not always completely effective. For more tips on how older adults can avoid medication side effects, see Side Effects in the Taking Medicines topic."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoarthritis ?"}, {"role": "assistant", "content": "For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following. - Removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopic debridement).  - Repositioning of bones (osteotomy).  - Resurfacing (smoothing out) bones (joint resurfacing). Removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopic debridement). Repositioning of bones (osteotomy). Resurfacing (smoothing out) bones (joint resurfacing). The decision to use surgery depends on several factors, including the patients age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his or her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily."}]}
{"messages": [{"role": "user", "content": "What is (are) Problems with Taste ?"}, {"role": "assistant", "content": "Taste, or gustation, is one of our most robust senses. Although there is a small decline in taste in people over 60, most older people will not notice it because normal aging does not greatly affect our sense of taste. Problems with taste occur less frequently than problems with smell. How Our Sense of Taste Works Our sense of taste, along with our sense of smell, is part of our chemical sensing system. Normal taste occurs when tiny molecules released by chewing or the digestion of food stimulate special sensory cells in the mouth and throat. These taste cells, or gustatory cells, send messages through three specialized taste nerves to the brain, where specific tastes are identified. Damage to these nerves following head injury can lead to taste loss. The taste cells are clustered within the taste buds of the tongue and roof of the mouth, and along the lining of the throat. Many of the small bumps that can be seen on the tip of the tongue contain taste buds. At birth, we have about 10,000 taste buds scattered on the back, sides, and tip of the tongue. After age 50, we may start to lose taste buds. Five Taste Sensations We can experience five basic taste sensations: sweet, sour, bitter, salty, and umami, or savory. Umami is the taste we get from glutamate, a building block of protein found in chicken broth, meat stock, and some cheeses. Umami is also the taste associated wtih MSG (monosodium glutamate) that is often added to foods as a flavor enhancer. The five taste qualities combine with other oral sensations, such as texture, spiciness, temperature, and aroma to produce what is commonly referred to as flavor. It is flavor that lets us know whether we are eating an apple or a pear. Flavors and the Sense of Smell Many people are surprised to learn that we recognize flavors largely through our sense of smell. Try holding your nose while eating chocolate. You will be able to distinguish between its sweetness and bitterness, but you can't identify the chocolate flavor. That's because the distinguishing characteristic of chocolate is largely identified by our sense of smell as aromas are released during chewing. Food flavor is affected by a head cold or nasal congestion because the aroma of food does not reach the sensory cells that detect odors. More information on this topic can be found in the topic Problems With Smell  Smell and Taste Closely Linked Smell and taste are closely linked senses. Many people mistakenly believe they have a problem with taste, when they are really experiencing a problem with smell. It is common for people who lose their sense of smell to say that food has lost its taste. This is incorrect; the food has lost its aroma, but taste remains. In older people, there is a normal decline in the sense of smell and the taste of food shifts toward blandness. This is why people often believe they have a taste problem. When Taste is Impaired Problems with taste can have a big impact on an older person's life. Because taste affects the amount and type of food we eat, when there are problems with taste, a person may change his or her eating habits. Some people may eat too much and gain weight, while others may eat too little and lose weight. A loss of appetite, especially in older adults, can lead to loss of weight, poor nutrition, weakened immunity, and even death. Taste helps us detect spoiled food or liquids and it also helps some people detect ingredients they are allergic to. A problem with taste can weaken or remove an early warning system that most of us take for granted. A distorted sense of taste can be a serious risk factor for illnesses that require sticking to a specific diet. Loss of taste can cause us to eat too much sugar or salt to make our food taste better. This can be a problem for people with such illnesses as diabetes or high blood pressure. In severe cases, loss of taste can lead to depression. Taste Problems Are Often Temporary When an older person has a problem with taste, it is often temporary and minor. True taste disorders are uncommon. When a problem with taste exists, it is usually caused by medications, disease, some cancer treatments, or injury. Many older people believe that there is nothing they can do about their weakened sense of taste. If you think you have a problem with your sense of taste, see your doctor. Depending on the cause of your problem, your doctor may be able to suggest ways to regain your sense of taste or to cope with the loss of taste."}]}
{"messages": [{"role": "user", "content": "What causes Problems with Taste ?"}, {"role": "assistant", "content": "Loss of taste may be permanent or temporary, depending on the cause. As with vision and hearing, people gradually lose their ability to taste as they get older, but it is usually not as noticeable as loss of smell. Medications and illness can make the normal loss of taste worse. Common Causes Problems with taste are caused by anything that interrupts the transfer of taste sensations to the brain, or by conditions that affect the way the brain interprets the sensation of taste. Some people are born with taste disorders, but most develop them after an injury or illness. Among the causes of taste problems are - medications   - upper respiratory and middle ear infections   - radiation for treatment of head and neck cancers  - exposure to certain chemicals   - head injury   - some surgeries  - poor oral hygiene and dental problems  - smoking. medications upper respiratory and middle ear infections radiation for treatment of head and neck cancers exposure to certain chemicals head injury some surgeries poor oral hygiene and dental problems smoking. In many cases, people regain their sense of taste when they stop taking medications or when the illness or injury clears up. Medications.Taking medications can affect our ability to taste. Some antibiotics and antihistamines as well as other medications can cause a bad taste in the mouth or a loss of taste. One type of taste disorder is characterized by a persistent bad taste in the mouth, such as a bitter or salty taste. This is called dysgeusia and it occurs in older people, usually because of medications or oral health problems. Upper Respiratory and Middle Ear Infections. Respiratory infections such as the flu can lead to taste disorders.  Radiation for Head and Neck Cancers.  People with head and neck cancers who receive radiation treatment to the nose and mouth regions commonly experience problems with their sense of smell and taste as an unfortunate side effect. Older people who have lost their larynx or voice box commonly complain of poor ability to smell and taste.  Exposure to Certain Chemicals.  Sometimes exposure to certain chemicals, such as insecticides and solvents, can impair taste. Avoid contact with these substances, and if you do come in contact with them and experience a problem, see your doctor. Head Injury.  Previous surgery or trauma to the head can impair your sense of taste because the taste nerves may be cut, blocked or physically damaged. Some Surgeries.  Some surgeries to the ear nose and throat can impair taste. These include third molarwisdom toothextraction and middle ear surgery. Poor Oral Hygiene and Dental Problems.  Gum disease can cause problems with taste and so can can dentures and inflammation or infections in the mouth. If you take several medications, your mouth may produce less saliva. This causes dry mouth, which can make swallowing and digestion difficult and increase dental problems. Practice good oral hygiene, keep up to date with your dental appointments, and tell your dentist if you notice any problems with your sense of taste. Smoking. Tobacco smoking is the most concentrated form of pollution that most people are exposed to. Smokers often report an improved sense of taste after quitting. When To See the Doctor Be sure to see your doctor if you have had a taste problem for a while or if you notice that your problem with taste is associated with other symptoms. Let your doctor know if you are taking any medications that might affect your sense of taste. You may be able to change or adjust your medicine to one that will not cause a problem with taste. Your doctor will work with you to get the medicine you need while trying to reduce unwanted side effects."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Problems with Taste ?"}, {"role": "assistant", "content": "Symptoms Vary With Disorders There are several types of taste disorders depending on how the sense of taste is affected. People who have taste disorders usually lose their ability to taste or can no longer perceive taste in the same way. True taste disorders are rare. Most changes in the perception of food flavor result from the loss of smell.  Phantom Taste Perception. The most common taste complaint is \"phantom taste perception\" -- tasting something when nothing is in the mouth.  Hypogeusia. Some people have hypogeusia, or the reduced ability to taste sweet, sour, bitter, salty, and savory, or umami. This disorder is usually temporary. Dysgeusia. Dysgeusia is a condition in which a foul, salty, rancid, or metallic taste sensation will persist in the mouth. Dysgeusia is sometimes accompanied by burning mouth syndrome, a condition in which a person experiences a painful burning sensation in the mouth. Although it can affect anyone, burning mouth syndrome is most common in middle-aged and older women.  Ageusia. Other people can't detect taste at all, which is called ageusia. This type of taste disorder can be caused by head trauma; some surgical procedures, such as middle ear surgery or extraction of the third molar; radiation therapy; and viral infections. Why a Diagnosis Is Important If you think you have a taste disorder, see your doctor. Loss of the sense of taste can lead to depression and a reduced desire to eat. Loss of appetite can lead to loss of weight, poor nutrition and weakened immunity. In some cases, loss of taste can accompany or signal conditions such as diabetes. Sometimes, a problem with taste can be a sign of a disease of the nervous system, such multiple sclerosis, Alzheimer's disease, or Parkinsons disease. Do You Have a Taste Disorder? If you think you have a taste disorder, try to identify and record the circumstances surrounding it. Ask yourself the following questions: - When did I first become aware of it?  - What changes in my taste do I notice?  - Do all foods and drinks taste the same?  - Have there been any changes in my sense of smell?  - Does the change in taste affect my ability to eat normally?  -  What medications do I take? What are the names of the medications? How much do I take? What is the health condition for which I take them?   -  Have I recently had a cold or the flu? When did I first become aware of it? What changes in my taste do I notice? Do all foods and drinks taste the same? Have there been any changes in my sense of smell? Does the change in taste affect my ability to eat normally? What medications do I take? What are the names of the medications? How much do I take? What is the health condition for which I take them? Have I recently had a cold or the flu? Talking With Your Doctor Bring this information with you when you visit the doctor. He or she may refer you to an otolaryngologist, a specialist in diseases of the ear, nose, and throat. An accurate assessment of your taste loss will include, among other things - a physical examination of your ears, nose, and throat   - a dental examination and assessment of oral hygiene  - a review of your health history  - a taste test supervised by a health care professional. a physical examination of your ears, nose, and throat a dental examination and assessment of oral hygiene a review of your health history a taste test supervised by a health care professional. Tests for Taste Disorders Some tests are designed to measure the lowest concentration of a substance that a person can detect or recognize. Your doctor may ask you to compare the tastes of different substances or to note how the intensity of a taste grows when a substance's concentration is increased. Scientists have developed taste tests in which the patient responds to different concentrations of a substance. This may involve a simple \"sip, spit, and rinse\" test or the application of a substance directly to your tongue using an eye dropper. By using these tests, your doctor can determine if you have a true taste disorder and what type it is. If your doctor suspects that nerves in your mouth or head may be affected, he or she may order an X-ray, usually a CAT scan, to look further into the head and neck area. Once the cause of a taste disorder is found, your doctor may be able to treat it. Many types of taste disorders are reversible, but if not, counseling and self-help techniques may help you cope."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Problems with Taste ?"}, {"role": "assistant", "content": "Relief Is Possible Although there is no treatment for any gradual loss of taste that occurs with aging, relief from taste disorders is possible for many older people. Depending on the cause of your problem with taste, your doctor may be able to treat it or suggest ways to cope with it. Scientists are studying how loss of taste occurs so that treatments can be developed. Some patients regain their sense of taste when the condition or illness that is causing the loss of taste is over. For example, a middle ear infection often affects taste temporarily. Often, correcting the general medical problem can restore the sense of taste. Check Your Medications Often, a certain medication is the cause of a taste disorder, and stopping or changing the medicine may help eliminate the problem. If you take medications, ask your doctor if they can affect your sense of taste. If so, ask if you can take other medications or safely reduce the dose. Do not stop taking your medications unless directed by your doctor. Your doctor will work with you to get the medicines you need while trying to reduce unwanted side effects. If Your Diet Is Affected Because your sense of taste may gradually decline, you may not even notice the change. But your diet may change, and not for the better. You may lose interest in food and eat less, but you may choose foods that are high in fat and sugars. Or, you may eat more than you should, hoping to get more flavor from every bite. If you lose some or all of your sense of taste, there are things you can do to make your food taste better: - Prepare foods with a variety of colors and textures  - Use aromatic herbs and hot spices to add more flavor; however avoid adding more sugar or salt to food   - If your diet permits, use small amounts of cheese, bacon bits, or butter on vegetables, as well as olive oil or toasted nuts  - Avoid combination dishes, such as casseroles, that can hide individual flavors and dilute taste. Prepare foods with a variety of colors and textures Use aromatic herbs and hot spices to add more flavor; however avoid adding more sugar or salt to food If your diet permits, use small amounts of cheese, bacon bits, or butter on vegetables, as well as olive oil or toasted nuts Avoid combination dishes, such as casseroles, that can hide individual flavors and dilute taste. If Your Sense of Taste Does Not Return If you cannot regain your sense of taste, there are things you can do to ensure your safety. Take extra care to avoid food that may have spoiled. If you live with other people, ask them to smell and taste food to make sure it is fresh. People who live alone should discard food if there is a chance it is spoiled. For those who wish to have additional help, there may be support groups in your area. These are often associated with smell and taste clinics in medical school hospitals. Some online bulletin boards also allow people with smell and taste disorders to share their experiences. Not all people with taste disorders will regain their sense of taste, but most can learn to live with it."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Problems with Taste ?"}, {"role": "assistant", "content": "The National Institute on Deafness and Other Communication Disorders (NIDCD) supports basic and clinical investigations of smell and taste disorders at its laboratories in Bethesda, Md. and at universities and chemosensory research centers across the country. These chemosensory scientists are exploring how to - prevent the effects of aging on taste and smell   -  develop new diagnostic tests  -  understand associations between taste disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses  - improve treatment methods and rehabilitation strategies.  prevent the effects of aging on taste and smell develop new diagnostic tests understand associations between taste disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses improve treatment methods and rehabilitation strategies. Studies on Aging and Taste A recent NIDCD-funded study has shown that small variations in our genetic code can raise or lower our sensitivity to sweet tastes, which might influence a persons desire for sweets. Scientists have also made progress in understanding how our sense of taste changes as we age. Older adults often decide what to eat based on how much they like or dislike certain tastes. Scientists are looking at how and why this happens in order to develop more effective ways to help older people cope better with taste problems. Studies on Taste Receptors Some of the most recent chemosensory research focuses on identifying the key receptors expressed by our taste cells and understanding how those receptors send signals to the brain. Researchers are also working to develop a better understanding of how sweet and bitter substances attach to their targeted receptors. This research holds promise for the development of sugar or salt substitutes that could help combat obesity or hypertension, as well as the development of bitter blockers that could make life-saving medicines more acceptable to children. Taste cellsas well as sensory cells that help us smellare the only sensory cells in the human body that are regularly replaced throughout life. Researchers are exploring how and why this happens so that they might find ways to replace other damaged sensory cells. Gut and Sweet Receptors Scientists are gaining a better understanding of why the same receptor that helps our tongue detect sweet taste can also be found in the human gut. Recent research has shown that the sweet receptor helps the intestine to sense and absorb sugar and turn up the production of blood sugar-regulation hormones, including the hormone that regulates insulin release. Further research may help scientists develop drugs targeting the gut taste receptors to treat obesity and diabetes. Effects of Medications on Taste Scientists are also working to find out why some medications and medical procedures can have a harmful effect on our senses of taste and smell. They hope to develop treatments to help restore the sense of taste to people who have lost it."}]}
{"messages": [{"role": "user", "content": "What is (are) Problems with Taste ?"}, {"role": "assistant", "content": "Taste is the ability to detect different sensations in the mouth, such as sweet or salty. It is part of your body's chemical sensing system. Taste combines with other oral sensations, such as texture, spiciness, temperature, and aroma to produce what is commonly referred to as flavor."}]}
{"messages": [{"role": "user", "content": "How many people are affected by Problems with Taste ?"}, {"role": "assistant", "content": "Roughly 200,000 people each year visit a doctor for a chemosensory problem such as a taste disorder. Many more taste disorders go unreported."}]}
{"messages": [{"role": "user", "content": "What causes Problems with Taste ?"}, {"role": "assistant", "content": "The most common causes of taste disorders are medications, infections, head trauma, and dental problems. Most people who have a problem with taste are taking certain medications or they have had a head or neck injury. Gum disease, dry mouth, and dentures can contribute to taste problems, too. Other causes are radiation therapy for head and neck cancers, smoking, and some surgeries."}]}
{"messages": [{"role": "user", "content": "How to prevent Problems with Taste ?"}, {"role": "assistant", "content": "Problems with taste that occur with aging cannot be prevented. However you may be able to protect yourself against other causes of taste loss with these steps. - Prevent upper respiratory infections such as colds and the flu. Wash your hands frequently, especially during the winter months, and get a flu shot every year.   - Avoid Head Injuries. Always wear seatbelts when riding in a car and a helmet when bicycling.   - Avoid Exposure to Toxic Chemicals. Avoid contact with chemicals that might cause smell problems such as paints, insecticides, and solvents, or wear a respirator if you cannot avoid contact.   - Review Your Medications. If you are taking antibiotics or antihistamines or other medications and notice a change in your sense of taste, talk to your doctor. You may be able to adjust or change your medicine to one that will not cause a problem with taste. Do not stop taking your medications unless directed by your doctor.   - Dont Smoke. It can impair the sense of taste. For free help to quit smoking, visit Smokefree.gov  Prevent upper respiratory infections such as colds and the flu. Wash your hands frequently, especially during the winter months, and get a flu shot every year. Avoid Head Injuries. Always wear seatbelts when riding in a car and a helmet when bicycling. Avoid Exposure to Toxic Chemicals. Avoid contact with chemicals that might cause smell problems such as paints, insecticides, and solvents, or wear a respirator if you cannot avoid contact. Review Your Medications. If you are taking antibiotics or antihistamines or other medications and notice a change in your sense of taste, talk to your doctor. You may be able to adjust or change your medicine to one that will not cause a problem with taste. Do not stop taking your medications unless directed by your doctor. Dont Smoke. It can impair the sense of taste. For free help to quit smoking, visit Smokefree.gov"}]}
{"messages": [{"role": "user", "content": "What causes Problems with Taste ?"}, {"role": "assistant", "content": "Yes. Certain medicines can cause a change in our ability to taste. The medicines that most frequently do this are certain antibiotics and some antihistamines, although other medications can affect our sense of taste as well. If your medicine is causing a problem with your sense of taste, your doctor may be able to adjust or change your medicine. If not, he or she may suggest ways to manage your problem. Do not stop taking your medications unless directed by your doctor. Your doctor will work with you to get the medicine you need while trying to reduce unwanted side effects."}]}
{"messages": [{"role": "user", "content": "How to diagnose Problems with Taste ?"}, {"role": "assistant", "content": "Doctors can diagnose a taste disorder by measuring the lowest concentration of a substance that a person can detect. The doctor may also ask a patient to compare the tastes of different substances or to note how the intensity of a taste grows when a substance's concentration is increased. Scientists have developed taste tests in which a person responds to different concentrations of a substance. This may involve a simple \"sip, spit, and rinse\" test, or the application of a substance directly to the tongue with an eye dropper. By using these tests, your doctor can determine if you have a true taste disorder and what type it is."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Problems with Taste ?"}, {"role": "assistant", "content": "Depending on the cause of your taste disorder, your doctor may be able to treat your problem or suggest ways to cope with it. If a certain medication is the cause of the problem, your doctor may be able to adjust or change your medicine. Your doctor will work with you to get the medicine you need while trying to reduce unwanted side effects. Some patients with respiratory infections regain their sense of taste when the illness is over. Often, correcting a general medical problem can restore the sense of taste. Occasionally, the sense of taste returns to normal on its own without any treatment."}]}
{"messages": [{"role": "user", "content": "What is (are) Problems with Taste ?"}, {"role": "assistant", "content": "You can help your doctor make a diagnosis by writing down important information about your problem beforehand and giving the information to your doctor during your visit. Write down answers to the following questions. - When did I first become aware of my taste problem?   - What changes in my sense of taste did I notice?  -  Do all foods and drinks taste the same?   - Have there been any changes in my sense of smell?   - Does the change in taste affect my ability to eat normally?   - What medicines do I take? What are the names of the medicines? How much do I take? What is the health condition for which I take the medicine?   - Have I recently had a cold or the flu?  When did I first become aware of my taste problem? What changes in my sense of taste did I notice? Do all foods and drinks taste the same? Have there been any changes in my sense of smell? Does the change in taste affect my ability to eat normally? What medicines do I take? What are the names of the medicines? How much do I take? What is the health condition for which I take the medicine? Have I recently had a cold or the flu?"}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Problems with Taste ?"}, {"role": "assistant", "content": "The National Institute on Deafness and Other Communication Disorders (NIDCD) supports basic and clinical investigations of smell and taste disorders at its laboratories in Bethesda, Md. and at universities and chemosensory research centers across the country. These chemosensory scientists are exploring how to - prevent the effects of aging on taste and smell   - develop new diagnostic tests   - understand associations between taste disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses  - improve treatment methods and rehabilitation strategies.  prevent the effects of aging on taste and smell develop new diagnostic tests understand associations between taste disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses improve treatment methods and rehabilitation strategies."}]}
{"messages": [{"role": "user", "content": "What is (are) Anxiety Disorders ?"}, {"role": "assistant", "content": "Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. However, anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. These feelings can interfere with daily activities such as job performance, school work, and relationships. (Watch the video to learn about the types of anxiety disorders. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Anxiety Disorders in Older Adults Studies estimate that anxiety disorders affect up to 15 percent of older adults in a given year. More women than men experience anxiety disorders. They tend to be less common among older adults than younger adults. But developing an anxiety disorder late in life is not a normal part of aging. Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In older adults, anxiety disorders often occur at the same time as depression, heart disease, diabetes, and other medical problems. In some cases, these other problems need to be treated before a person can respond well to treatment for anxiety. There are three types of anxiety disorders discussed here. - generalized anxiety disorder  - social phobia  - panic disorder generalized anxiety disorder social phobia panic disorder Generalized Anxiety Disorder (GAD) All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.  Learn more about generalized anxiety disorder (GAD).  Social Phobia In social phobia, a person fears being judged by others or of being embarrassed. This fear can get in the way of doing everyday things such as going to work, running errands, or meeting with friends. People who have social phobia often know that they shouldn't be so afraid, but they can't control their fear.  Learn more about social phobia.  Panic Disorder In panic disorder, a person has sudden, unexplained attacks of terror, and often feels his or her heart pounding. During a panic attack, a person feels a sense of unreality, a fear of impending doom, or a fear of losing control. Panic attacks can occur at any time. Learn more about panic disorder.  Anxiety Disorders Are Treatable In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the type of disorder, the persons preference, and the expertise of the doctor. If you think you have an anxiety disorder, talk to your doctor."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Anxiety Disorders ?"}, {"role": "assistant", "content": "Excessive, Irrational Fear Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread. Unlike the relatively mild, brief anxiety caused by a specific event (such as speaking in public or a first date), severe anxiety that lasts at least six months is generally considered to be problem that might benefit from evaluation and treatment. Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In older adults, anxiety disorders often occur at the same time as depression, heart disease, diabetes, and other medical problems. In some cases, these other problems need to be treated before a person can respond well to treatment for anxiety. Symptoms of Generalized Anxiety Disorder (GAD) GAD develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress. People with GAD cant seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They cant relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include - fatigue  - headaches  - muscle tension  - muscle aches  - difficulty swallowing  - trembling  - twitching  - irritability  - sweating  -  nausea  - lightheadedness  - having to go to the bathroom frequently  - feeling out of breath  -  hot flashes.  fatigue headaches muscle tension muscle aches difficulty swallowing trembling twitching irritability sweating nausea lightheadedness having to go to the bathroom frequently feeling out of breath hot flashes. When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they dont avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe. Symptoms of Social Phobia In social phobia, a person fears being judged by others or of being embarrassed. This fear can get in the way of doing everyday things such as going to work, running errands or meeting with friends. People who have social phobia often know that they shouldn't be so afraid, but they can't control their fear. People with social phobia tend to -  be very anxious about being with other people and have a hard time talking to them, even though they wish they could  - be very self-conscious in front of other people and feel embarrassed  - be very afraid that other people will judge them  - worry for days or weeks before an event where other people will be  - stay away from places where there are other people  - have a hard time making friends and keeping friends  -  blush, sweat, or tremble around other people  -  feel nauseous or sick to their stomach when with other people. be very anxious about being with other people and have a hard time talking to them, even though they wish they could be very self-conscious in front of other people and feel embarrassed be very afraid that other people will judge them worry for days or weeks before an event where other people will be stay away from places where there are other people have a hard time making friends and keeping friends blush, sweat, or tremble around other people feel nauseous or sick to their stomach when with other people. Symptoms of Panic Disorder In panic disorder, a person has sudden, unexplained attacks of terror, and often feels his or her heart pounding. During a panic attack, a person feels a sense of unreality, a fear of impending doom, or a fear of losing control. Panic attacks can occur at any time. People with panic disorder may have - sudden and repeated attacks of fear  - a feeling of being out of control during a panic attack  - an intense worry about when the next attack will happen  - a fear or avoidance of places where panic attacks have occurred in the past  - physical symptoms during an attack, such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain.  sudden and repeated attacks of fear a feeling of being out of control during a panic attack an intense worry about when the next attack will happen a fear or avoidance of places where panic attacks have occurred in the past physical symptoms during an attack, such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain. Seeking Treatment Anxiety disorders are treatable. If you think you have an anxiety disorder, talk to your doctor. If your doctor thinks you may have an anxiety disorder, the next step is usually seeing a mental health professional. It is advisable to seek help from professionals who have particular expertise in diagnosing and treating anxiety. Certain kinds of cognitive and behavioral therapy and certain medications have been found to be especially helpful for anxiety."}]}
{"messages": [{"role": "user", "content": "How to diagnose Anxiety Disorders ?"}, {"role": "assistant", "content": "Anxiety disorders sometimes run in families, but no one knows for sure why some people have them while others don't. Anxiety disorders are more common among younger adults than older adults, and they typically start in early life. However, anyone can develop an anxiety disorder at any time. Below are risk factors for these anxiety disorders. - Generalized Anxiety Disorder (GAD)  -  Social Anxiety Disorder (Social Phobia)  - Panic Disorder Generalized Anxiety Disorder (GAD) Social Anxiety Disorder (Social Phobia) Panic Disorder Generalized Anxiety Disorder - Risk Factors Generalized anxiety disorder (GAD) affects about 6.8 million American adults, including twice as many women as men. The disorder develops gradually and can begin at any point in the life cycle, although the years of highest risk are between childhood and middle age. The average age of onset is 31 years old. Social Phobia - Risk Factors Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. There is some evidence that genetic factors are involved. Panic Disorder - Risk Factors Panic disorder affects about 6 million American adults and is twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited. Diagnosis Can Be Difficult There are a number of reasons why it can be difficult to accurately diagnose an anxiety disorder in older adults. - Anxiety disorders among older adults frequently occur at the same time as other illnesses such as depression, diabetes, heart disease, or a number of other medical illnesses. Problems with cognition (thinking) and changes in life circumstances can also complicate matters. Sometimes the physical signs of these illnesses can get mixed up with the symptoms of anxiety, making it difficult to determine if a person has a true anxiety disorder. For instance, a person with heart disease sometimes has chest pain, which can also be a symptom of a panic disorder.  Anxiety disorders among older adults frequently occur at the same time as other illnesses such as depression, diabetes, heart disease, or a number of other medical illnesses. Problems with cognition (thinking) and changes in life circumstances can also complicate matters. Sometimes the physical signs of these illnesses can get mixed up with the symptoms of anxiety, making it difficult to determine if a person has a true anxiety disorder. For instance, a person with heart disease sometimes has chest pain, which can also be a symptom of a panic disorder. -  Doctors can have difficulty distinguishing between anxiety caused by adapting to difficult life changes, and a true anxiety disorder. For example, if you fell and broke a hip, you may be justifiably fearful of going out for a while. But that would not mean you have developed an anxiety disorder. Doctors can have difficulty distinguishing between anxiety caused by adapting to difficult life changes, and a true anxiety disorder. For example, if you fell and broke a hip, you may be justifiably fearful of going out for a while. But that would not mean you have developed an anxiety disorder. - Sometimes the worrying symptoms of a medical illness can lead to an anxiety disorder. Or, sometimes the side effects of medication can cause anxiety. Also, a disability or a change in lifestyle caused by a medical illness may lead to an anxiety disorder. Muscle tightness, feeling very tense all the time, and difficulty sleeping can also be symptoms of a physical illness or an anxiety disorder, complicating diagnosis. Sometimes the worrying symptoms of a medical illness can lead to an anxiety disorder. Or, sometimes the side effects of medication can cause anxiety. Also, a disability or a change in lifestyle caused by a medical illness may lead to an anxiety disorder. Muscle tightness, feeling very tense all the time, and difficulty sleeping can also be symptoms of a physical illness or an anxiety disorder, complicating diagnosis. Diagnosis Here is how these anxiety disorders are diagnosed. - Generalized Anxiety Disorder (GAD)  - Panic Disorder  - Social Anxiety Disorder (Social Phobia) Generalized Anxiety Disorder (GAD) Panic Disorder Social Anxiety Disorder (Social Phobia) Generalized Anxiety Disorder (GAD) - Diagnosis GAD can be diagnosed once a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD may visit a doctor many times before they find out they have this disorder. They ask their doctors to help them with headaches or trouble falling asleep, which can be symptoms of GAD, but they don't always get the help they need right away. It may take doctors some time to be sure that a person has GAD instead of something else. Social Phobia - Diagnosis A doctor can tell that a person has social phobia if the person has had symptoms for at least 6 months. Social phobia usually starts during youth. Without treatment, it can last for many years or a lifetime. Panic Disorder - Diagnosis People with panic disorder may sometimes go from doctor to doctor for years and visit the emergency room repeatedly before someone correctly diagnoses their condition. This is unfortunate, because panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to certain kinds of medication or certain kinds of cognitive psychotherapy, which help change thinking patterns that lead to fear and anxiety. If You Have Symptoms Anxiety disorders are treatable. If you think you have an anxiety disorder, talk to your family doctor. Your doctor should do an exam to make sure that another physical problem isn't causing the symptoms. The doctor may refer you to a mental health specialist. You should feel comfortable talking with the mental health specialist you choose. If you do not, seek help elsewhere. Once you find a mental health specialist you are comfortable with, you should work as a team and make a plan to treat your anxiety disorder together. Talk About About Past Treatment People with anxiety disorders who have already received treatment for an anxiety disorder should tell their doctor about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects may have occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Anxiety Disorders ?"}, {"role": "assistant", "content": "Clinical trials are part of clinical research and at the heart of all treatment advances. Clinical trials look at new ways to prevent, detect, or treat disease. The National Institute of Mental Health at NIH supports research studies on mental health and disorders. To learn how clinical trials work, see  Participating in Clinical Trials. To see NIH-funded studies currently recruiting participants in anxiety disorders, visit www.ClinicalTrials.gov  and type in \"anxiety disorders.\" Clinical Trials.gov is the NIH/National Library of Medicine's registry of federally and privately funded clinical trials for all disease. To see personal stories of people who have volunteered for clinical trials, visit  NIH Clinical Trials Research and You."}]}
{"messages": [{"role": "user", "content": "How many people are affected by Anxiety Disorders ?"}, {"role": "assistant", "content": "Studies estimate that anxiety disorders affect around 15 percent of older adults in a given year. More women than men experience anxiety disorders. They tend to be less common among older adults than younger adults. But developing an anxiety disorder late in life is not a normal part of aging."}]}
{"messages": [{"role": "user", "content": "What is (are) Anxiety Disorders ?"}, {"role": "assistant", "content": "Anxiety disorders are a collection of disorders that include generalized anxiety disorder (GAD), social phobia, and panic disorder."}]}
{"messages": [{"role": "user", "content": "What is (are) Anxiety Disorders ?"}, {"role": "assistant", "content": "All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks. People with GAD cant seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They cant relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes. When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they dont avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.  Learn more about generalized anxiety disorder (GAD)."}]}
{"messages": [{"role": "user", "content": "What is (are) Anxiety Disorders ?"}, {"role": "assistant", "content": "In social phobia, a person fears being judged by others or of being embarrassed. This fear can get in the way of doing everyday things such as going to work, running errands or meeting with friends. People who have social phobia often know that they shouldn't be so afraid, but they can't control their fear. People with social phobia tend to -  be very anxious about being with other people and have a hard time talking to them, even though they wish they could  - be very self-conscious in front of other people and feel embarrassed  - be very afraid that other people will judge them  - worry for days or weeks before an event where other people will be  - stay away from places where there are other people  - have a hard time making friends and keeping friends  -  blush, sweat, or tremble around other people  -  feel nauseous or sick to their stomach when with other people. be very anxious about being with other people and have a hard time talking to them, even though they wish they could be very self-conscious in front of other people and feel embarrassed be very afraid that other people will judge them worry for days or weeks before an event where other people will be stay away from places where there are other people have a hard time making friends and keeping friends blush, sweat, or tremble around other people feel nauseous or sick to their stomach when with other people.  Learn more about social phobia."}]}
{"messages": [{"role": "user", "content": "What is (are) Anxiety Disorders ?"}, {"role": "assistant", "content": "In panic disorder, a person has sudden, unexplained attacks of terror, and often feels his or her heart pounding. During a panic attack, a person feels a sense of unreality, a fear of impending doom, or a fear of losing control. Panic attacks can occur at any time. People with panic disorder may have - sudden and repeated attacks of fear  - a feeling of being out of control during a panic attack  - an intense worry about when the next attack will happen  - a fear or avoidance of places where panic attacks have occurred in the past  - physical symptoms during an attack, such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain.  sudden and repeated attacks of fear a feeling of being out of control during a panic attack an intense worry about when the next attack will happen a fear or avoidance of places where panic attacks have occurred in the past physical symptoms during an attack, such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain. Learn more about panic disorder."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Anxiety Disorders? ?"}, {"role": "assistant", "content": "Generalized anxiety disorder (GAD) affects about 6.8 million American adults, including twice as many women as men. The disorder develops gradually and can begin at any point in the life cycle, although the years of highest risk are between childhood and middle age. The average age of onset is 31 years old. Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. There is some evidence that genetic factors are involved.  Panic disorder  affects about 6 million American adults and is twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Anxiety Disorders ?"}, {"role": "assistant", "content": "Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out. If you dont have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan. To learn about more mental health resources, see  Help for Mental Illness,  from the National Institute of Mental Health at NIH."}]}
{"messages": [{"role": "user", "content": "What is (are) Anxiety Disorders ?"}, {"role": "assistant", "content": "Cognitive behavioral therapy (CBT) is a type of psychotherapy that is very useful in treating anxiety disorders. It can help people change the thinking patterns that support their fears and change the way they react to anxiety-provoking situations. For example, cognitive behavioral therapy can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Anxiety Disorders ?"}, {"role": "assistant", "content": "Exposure-based treatment has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Sometimes the therapist will accompany the person to a feared situation to provide support and guidance. Exposure exercises are undertaken once the patient decides he is ready for it and with his cooperation. To be effective, therapy must be directed at the persons specific anxieties and must be tailored to his or her needs. A typical side effect is temporary discomfort involved with thinking about confronting feared situations."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetes ?"}, {"role": "assistant", "content": "Too Much Glucose in the Blood Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health. Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all of the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body does not make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes. Types of Diabetes There are three main kinds of diabetes: type 1, type 2, and gestational diabetes. The result of type 1 and type 2 diabetes is the same: glucose builds up in the blood, while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, oftentimes leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. Type 1 Diabetes Type 1 diabetes, which used to be called called juvenile diabetes or insulin-dependent diabetes, develops most often in young people. However, type 1 diabetes can also develop in adults. With this form of diabetes, your body no longer makes insulin or doesnt make enough insulin because your immune system has attacked and destroyed the insulin-producing cells. About 5 to 10 percent of people with diabetes have type 1 diabetes. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. Learn more about type 1 diabetes here. Type 2 Diabetes Type 2 diabetes, which used to be called adult-onset diabetes or non insulin-dependent diabetes, is the most common form of diabetes. Although people can develop type 2 diabetes at any age -- even during childhood -- type 2 diabetes develops most often in middle-aged and older people. Type 2 diabetes usually begins with insulin resistancea condition that occurs when fat, muscle, and liver cells do not use insulin to carry glucose into the bodys cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the pancreas keeps up with the added demand by making more insulin. Over time, the pancreas doesnt make enough insulin when blood sugar levels increase, such as after meals. If your pancreas can no longer make enough insulin, you will need to treat your type 2 diabetes. Learn more about type 2 diabetes here. Gestational Diabetes Some women develop gestational diabetes during the late stages of pregnancy. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Although this form of diabetes usually goes away after the baby is born, a woman who has had it and her child are more likely to develop diabetes later in life. Prediabetes Prediabetes means your blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with prediabetes are at an increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is that if you have prediabetes, you can reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes.  Learn more about prediabetes here.  Signs of Diabetes Many people with diabetes experience one or more symptoms, including extreme thirst or hunger, a frequent need to urinate and/or fatigue. Some lose weight without trying. Additional signs include sores that heal slowly, dry, itchy skin, loss of feeling or tingling in the feet and blurry eyesight. Some people with diabetes, however, have no symptoms at all. How Many Have Diabetes? Nearly 29 million Americans age 20 or older (12.3 percent of all people in this age group) have diabetes, according to 2014 estimates from the Centers for Disease Control and Prevention (CDC). About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 alone. People can get diabetes at any age, but the risk increases as we get older. In 2014, over 11 million older adults living in the U.S -- nearly 26 percent of people 65 or older -- had diabetes. See more statistics about diabetes from the  National Diabetes Statistics Report 2014. (Centers for Disease Control and Prevention.) If Diabetes is Not Managed Diabetes is a very serious disease. Over time, diabetes that is not well managed causes serious damage to the eyes, kidneys, nerves, heart, gums and teeth. If you have diabetes, you are more likely than people without diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or stroke at an earlier age than others. The best way to protect yourself from the serious complications of diabetes is to manage your blood glucose, blood pressure and cholesterol and to avoid smoking. It is not always easy, but people who make an ongoing effort to manage their diabetes can greatly improve their overall health."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Diabetes? ?"}, {"role": "assistant", "content": "Diabetes is a serious, life-long disease. It can lead to problems such as heart disease, stroke, vision loss, kidney disease, and nerve damage. More than 8 million people in the United States have type 2 diabetes and dont know it. Many people dont find out they have diabetes until they are faced with problems such as blurry vision or heart trouble. Certain factors can increase your risk for diabetes, and its important to know what they are. Type 1 Diabetes Type 1 diabetes is an autoimmune disease. In an autoimmune reaction, antibodies, or immune cells, attach to the bodys own healthy tissues by mistake, signaling the body to attack them. At present, scientists do not know exactly what causes the body's immune system to attack the cells, but many believe that both genetic factors and environmental factors, such as viruses, are involved. Studies are now underway to identify these factors and prevent type 1 diabetes in people at risk.  Learn more about the causes of type 1 diabetes.  Type 2 Diabetes Type 2 diabetes -- the most common form -- is linked closely to overweight and obesity, high blood pressure, and abnormal cholesterol levels. Many people with type 2 diabetes are overweight. Being overweight can keep your body from using insulin properly. Genes also play an important role in a person's risk for type 2 diabetes. Having certain genes or combinations of genes may increase or decrease a persons risk for developing the disease.  Here are the risk factors for type 2 diabetes. -  being over 45 years of age  -  being overweight or obese  - having a first-degree relative -- a parent, brother, or sister -- with diabetes  - being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) being over 45 years of age being overweight or obese having a first-degree relative -- a parent, brother, or sister -- with diabetes being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) - having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds  - having blood pressure of 140/90 or higher, or having been told that you have high blood pressure.  - having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher  - being inactive or exercising fewer than three times a week.  - having polycystic ovary syndrome, also called PCOS (women only)  - on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)  - history of cardiovascular disease (disease affecting the heart and blood vessels). having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds having blood pressure of 140/90 or higher, or having been told that you have high blood pressure. having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher being inactive or exercising fewer than three times a week. having polycystic ovary syndrome, also called PCOS (women only) on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) history of cardiovascular disease (disease affecting the heart and blood vessels).  Learn more about the causes of type 2 diabetes.  Prediabetes and Type 2 Diabetes Before people develop type 2 diabetes, they usually have prediabetes -- a condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. People with prediabetes are more likely to develop diabetes within 10 years and also are more likely to have a heart attack or stroke. Prediabetes is increasingly common in the U.S. adult population. In 2012, about 86 million people in the U.S. had pre-diabetes, and 51% of those 65 or older had prediabetes. Learn more about prediabetes.  Gestational Diabetes Some women develop diabetes during the late stages of pregnancy. This is called gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it has a lifelong risk for developing diabetes, mostly type 2."}]}
{"messages": [{"role": "user", "content": "How to prevent Diabetes ?"}, {"role": "assistant", "content": "The two most common forms of diabetes are type 1 and type 2. Currently, there is no way to delay or prevent type 1 diabetes. However, research has shown that type 2 diabetes can be prevented or delayed in people at risk for the disease. Preventing type 2 diabetes can mean a healthier and longer life without serious complications from the disease such as heart disease, stroke, blindness, kidney failure, and amputations. Preventing Type 2 Diabetes Before people develop type 2 diabetes, they usually have prediabetes -- a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes. The good news is that if you have prediabetes, there are ways to reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes Benefits of Weight Loss and Exercise  The Diabetes Prevention Program (DPP) is a landmark study by the National Institute of Diabetes and Digestive and Kidney Diseases. DPP researchers found that adults at high risk for type 2 diabetes were able to cut their risk in half by losing a modest amount of weight and being active almost every day. This means losing 5 to 7 percent of body weight (that's 10 pounds if you weigh 200 pounds) and getting 150 minutes of physical activity a week. The drug metformin reduced the risk of type 2 diabetes by 34 percent but was more effective in younger and heavier adults. (Watch the video to learn more about preventing type 2 diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) The benefits of weight loss and regular exercise have long-lasting value. In a DPP follow-up trial known as the Diabetes Prevention Program Outcome Study (DPPOS), people at risk of type 2 diabetes who kept off the weight they had lost and who continued to exercise regularly delayed the onset of type 2 diabetes by about 4 years. The DPP study also showed that modest weight loss (achieved by following a low calorie, low-fat diet) and moderate physical activity were especially effective in preventing or delaying the development of diabetes in older people. In fact, people over the age of 60 were able to reduce their risk for developing type 2 diabetes by 71 percent. How to Lower Your Risk Making modest lifestyle changes can help prevent or delay type 2 diabetes in people who are at risk. Here are some tips. Reach and Maintain a Reasonable Body Weight Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. The Body Mass Index chart  (seen here) can be used to find out whether someone is normal weight, overweight, or obese. Body mass index is a measurement of body weight relative to height for adults age 20 or older. To use the chart -  find the person's height in the left-hand column   -  move across the row to find the number closest to the person's weight   -  find the number at the top of that column   - The number at the top of the column is the persons BMI. find the person's height in the left-hand column move across the row to find the number closest to the person's weight find the number at the top of that column The number at the top of the column is the persons BMI. The words above the BMI number indicate whether the person is normal weight, overweight, or obese. People who are overweight or obese should consider talking with a health care provider about ways to lose weight and reduce the risk of diabetes. The BMI has certain limitations. The BMI may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle.  Waist Measurement. In addition to weight, the location of excess fat on the body can be important. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance and increases a persons risk for type 2 diabetes. This is true even if a persons body mass index (BMI) falls within the normal range. To measure the waist, a person should - place a tape measure around the bare abdomen just above the hip bone  - make sure the tape is snug but isnt digging into the skin and is parallel to the floor  - relax, exhale, and measure. place a tape measure around the bare abdomen just above the hip bone make sure the tape is snug but isnt digging into the skin and is parallel to the floor relax, exhale, and measure. Make Healthy Food Choices What you eat has a big impact on your weight and overall health. By developing healthy eating habits, you can help manage your body weight, blood pressure, and cholesterol. Reducing portion size, increasing the amount of fiber you consume (by eating more fruits and vegetables) and limiting fatty and salty foods are key to a healthy diet. Here are more tips for eating well with diabetes. - Make a diabetes meal plan with help from your health care team.   - Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt.   - Eat foods with more fiber, such as whole grain cereals, breads, crackers, rice, or pasta.   - Choose foods such as fruits, vegetables, whole grains, bread and cereals, and low-fat or skim milk and cheese.   - Drink water instead of juice and regular soda.   - When eating a meal, fill half of your plate with fruits and vegetables, one quarter with a lean protein, such as beans, or chicken or turkey without the skin, and one quarter with a whole grain, such as brown rice or whole wheat pasta. Make a diabetes meal plan with help from your health care team. Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt. Eat foods with more fiber, such as whole grain cereals, breads, crackers, rice, or pasta. Choose foods such as fruits, vegetables, whole grains, bread and cereals, and low-fat or skim milk and cheese. Drink water instead of juice and regular soda. When eating a meal, fill half of your plate with fruits and vegetables, one quarter with a lean protein, such as beans, or chicken or turkey without the skin, and one quarter with a whole grain, such as brown rice or whole wheat pasta. For more about healthy eating and older adults see  \"Eating Well as You Get Older.\" Be Physically Active Get at least 30 minutes of exercise at least five days a week. Regular exercise reduces diabetes risk in several ways. It - helps you lose weight  - controls your cholesterol and blood pressure  -  improves your body's use of insulin.  helps you lose weight controls your cholesterol and blood pressure improves your body's use of insulin. Many people make walking part of their daily routine because its easy, fun and convenient. But you can choose any activity that gets you moving. Its fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program. Many people make walking part of their daily routine because its easy, fun and convenient. But you can choose any activity that gets you moving. Its fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program. For more information on exercise and older adults, see  Exercises to Try or visit Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Diabetes ?"}, {"role": "assistant", "content": "Diabetes is often called a \"silent\" disease because it can cause serious complications even before you have symptoms. Symptoms can also be so mild that you dont notice them. An estimated 8 million people in the United States have type 2 diabetes and dont know it, according to 2012 estimates by the Centers for Disease Control and Prevention (CDC). Common Signs Some common symptoms of diabetes are: - being very thirsty  - frequent urination  - feeling very hungry or tired  - losing weight without trying  - having sores that heal slowly  - having dry, itchy skin  - loss of feeling or tingling in the feet  - having blurry eyesight. being very thirsty frequent urination feeling very hungry or tired losing weight without trying having sores that heal slowly having dry, itchy skin loss of feeling or tingling in the feet having blurry eyesight. Signs of type 1 diabetes usually develop over a short period of time. The signs for type 2 diabetes develop more gradually. Tests for Diabetes The following tests are used to diagnose diabetes or prediabetes. - An A1C test measures your average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and prediabetes. It does not require fasting and blood can be drawn for the test any time of the day.  An A1C test measures your average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and prediabetes. It does not require fasting and blood can be drawn for the test any time of the day. - A fasting plasma glucose, or FPG test, measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or prediabetes.  A fasting plasma glucose, or FPG test, measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or prediabetes. - In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes.  In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes. - An oral glucose tolerance test, or OGTT, measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women.  An oral glucose tolerance test, or OGTT, measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women. If any of these tests show that you might have diabetes, your doctor will need to repeat the test with a second measurement unless there are clear symptoms of diabetes. Get more details about tests for diabetes. Who Should Get Tested? Because type 2 diabetes is more common in older people, anyone who is 45 or older should consider getting tested. If you are 45 or older and overweight, getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more risk factors, you also should talk with your doctor about being tested. See risk factors for type 2 diabetes. Why Early Detection is Important Diabetes is a serious disease that can lead to a number of health problems such as heart disease, stroke, vision problems, kidney disease and even death. Sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick. Many people do not find out they have the disease until they have diabetes complications, such as a heart attack or stroke. Finding out early if you have diabetes is important because treatment can prevent or delay the complications of the disease."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetes ?"}, {"role": "assistant", "content": "Diabetes cannot be cured, but it can be managed. Managing blood glucose (blood sugar) as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes. Know What To Do Every Day To manage your diabetes, here are things to do every day.  -  Take your medicines.   -  Keep track of your blood glucose (blood sugar).   -  Check your blood pressure if your doctor advises.   -  Check your feet.   -  Brush your teeth and floss.   -  Stop smoking.   -  Eat well.   -  Be active.  Take your medicines. Keep track of your blood glucose (blood sugar). Check your blood pressure if your doctor advises. Check your feet. Brush your teeth and floss. Stop smoking. Eat well. Be active. (Watch the video to learn more about what one woman does to manage her diabetes every day. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Take Your Diabetes Medicines People with type 1 diabetes control their blood sugar with insulin -- delivered either by injection or with a pump. Many people with type 2 diabetes can control blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some may need both, as well as lifestyle modification. Ask your doctor if you need to take aspirin every day to prevent a heart attack or stroke. Keep Track of Your Blood Glucose One of the best ways to find out how well you are taking care of your diabetes is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medication. Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three a day or even more. You may be told to check before eating, before bed, and sometimes in the middle of the night. Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for some of the supplies and equipment you need to check your glucose levels.  See what diabetes supplies and services Medicare covers.  Check Your Blood Pressure Check your blood pressure if your doctor advises and keep a record of it. You can check your pressure at home with a home blood pressure measurement device or monitor. Blood pressure monitors can be bought at discount chain stores and drug stores. When you are taking your blood pressure at home, sit with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart. Check with your health care provider to make sure you are using the monitor correctly. Check Your Feet Foot care is very important for people with diabetes. High blood glucose levels and a reduced blood supply to the limbs cause nerve damage that reduces feeling in the feet. Someone with nerve damage may not feel a pebble inside his or her sock that is causing a sore. Or a blister caused by poorly fitting shoes may go unnoticed. Foot injuries such as these can cause ulcers, which may, if not cared for, ultimately lead to the need for amputation. If you have diabetes, - check your feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails.   - report sores, blisters, breaks in the skin, infections, or buildup of calluses to a podiatrist or a family doctor.   - never walk barefoot.   - have your feet checked at every doctor visit.   - take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet.  check your feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. report sores, blisters, breaks in the skin, infections, or buildup of calluses to a podiatrist or a family doctor. never walk barefoot. have your feet checked at every doctor visit. take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet. Learn more about taking care of your feet. Brush Your Teeth and Floss People with diabetes can have tooth and gum problems more often if their blood glucose stays high. High blood glucose also can make tooth and gum problems worse. You can even lose your teeth. Here are ways to protect your teeth and gums. -  Keep your blood glucose as close to normal as possible.   - Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times.   - Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth.  - If you wear false teeth, keep them clean.  - Call your dentist right away if you have problems with your teeth and gums. Keep your blood glucose as close to normal as possible. Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times. Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth. If you wear false teeth, keep them clean. Call your dentist right away if you have problems with your teeth and gums.  Learn more about how diabetes can affect your mouth and teeth. Stop Smoking If you smoke, stop. Smoking raises your risk for many diabetes problems, including heart attack and stroke. Ask for help to quit. Call 1-800 QUITNOW (1-800-784-8669). For more information on smoking and older adults, see  Quitting Smoking for Older Adults.  Eat Well People with diabetes don't need to buy or prepare special foods. The foods that are best for someone with diabetes are excellent choices for everyone: foods that are low in fat, salt, and sugar, and high in fiber, such as beans, fruits, vegetables, and whole grains. These foods help you reach and stay at a weight that's good for your body, keep your blood pressure, glucose and cholesterol in a desirable range, and prevent or delay heart and blood vessel disease. For more on healthy eating, see Small Steps for Eating Healthy Foods. Be Active Try to exercise almost every day for a total of about 30 to 60 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. (Tip: you dont need to get your exercise in all at one time.) For more information on exercise and older adults, see Exercise: How to Get Started or visit  Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging. Be sure to check with your doctor before starting an exercise program. Other Areas To Manage Here are other areas to manage if you have diabetes. - Take care of your eyes.   - Protect your kidneys.  -  Protect your skin.  - Learn how to cope with stress.  Take care of your eyes. Protect your kidneys. Protect your skin. Learn how to cope with stress. Take Care of Your Eyes High blood glucose and high blood pressure from diabetes can hurt your eyes. It can even cause blindness, or other painful eye problems. Here are ways to prevent diabetes eye problems. - Keep your blood glucose and blood pressure as close to normal as you can.   - Have an eye care professional examine your eyes once a year. Have this exam even if your vision is okay.  Keep your blood glucose and blood pressure as close to normal as you can. Have an eye care professional examine your eyes once a year. Have this exam even if your vision is okay.  Learn more about eye disease and diabetes. Protect Your Kidneys High blood glucose and high blood pressure may damage the kidneys. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Here are ways to prevent diabetes kidney problems. - Keep your blood glucose and blood pressure as close to your target goal as you can.  - Get tested at least once a year for kidney disease. Ask your doctor if you should be tested.   - Follow the healthy eating plan you work out with your doctor or dietitian. If you already have kidney problems, your dietitian may suggest you cut back on protein.  Keep your blood glucose and blood pressure as close to your target goal as you can. Get tested at least once a year for kidney disease. Ask your doctor if you should be tested. Follow the healthy eating plan you work out with your doctor or dietitian. If you already have kidney problems, your dietitian may suggest you cut back on protein. Learn more about keeping your kidneys healthy. Protect Your Skin Skin care is very important, too. Because people with diabetes may have more injuries and infections, they should protect their skin by keeping it clean and taking care of minor cuts and bruises. Learn How To Cope With Stress Stress can raise your blood glucose (blood sugar). While it is hard to remove stress from your life, you can learn to handle it. Try deep breathing, gardening, taking a walk, meditating, working on your hobby, or listening to your favorite music."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetes ?"}, {"role": "assistant", "content": "Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health. Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all of the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body does not make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetes ?"}, {"role": "assistant", "content": "Type 1 diabetes, which used to be called called juvenile diabetes or insulin-dependent diabetes, develops most often in young people. However, type 1 diabetes can also develop in adults. With this form of diabetes, your body no longer makes insulin or doesnt make enough insulin because your immune system has attacked and destroyed the insulin-producing cells. About 5 to 10 percent of people with diabetes have type 1 diabetes. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. Learn more about type 1 diabetes here.  Learn more about type 1 diabetes here. Type 2 diabetes, which used to be called adult-onset diabetes or non insulin-dependent diabetes, is the most common form of diabetes. Although people can develop type 2 diabetes at any age -- even during childhood -- type 2 diabetes develops most often in middle-aged and older people. Type 2 diabetes usually begins with insulin resistancea condition that occurs when fat, muscle, and liver cells do not use insulin to carry glucose into the bodys cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the pancreas keeps up with the added demand by making more insulin. Over time, the pancreas doesnt make enough insulin when blood sugar levels increase, such as after meals. If your pancreas can no longer make enough insulin, you will need to treat your type 2 diabetes.  Learn more about type 2 diabetes here."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetes ?"}, {"role": "assistant", "content": "Prediabetes means your blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. In 2012, about 86 million people in the U.S. had prediabetes, and 51% of those 65 or older had prediabetes. People with prediabetes are at an increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is that if you have prediabetes, you can reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes.  Learn more about prediabetes here."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetes ?"}, {"role": "assistant", "content": "Studies have shown that most people with prediabetes develop type 2 diabetes within a few years, unless they change their lifestyle. Most people with prediabetes dont have any symptoms. Your doctor can test your blood to find out if your blood glucose levels are higher than normal. Losing weightat least 5 to 10 percent of your starting weightcan prevent or delay diabetes or even reverse prediabetes. Thats 10 to 20 pounds for someone who weighs 200 pounds. You can lose weight by cutting the amount of calories and fat you consume and by being physically active at least 30 to 60 minutes every day. Physical activity also helps your body use the hormone insulin properly. Your body needs insulin to use glucose for energy. Medicine can help control the amount of glucose in your blood. Ask your doctor if medicine to control glucose is right for you. Learn more about prediabetes here."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Diabetes ?"}, {"role": "assistant", "content": "Many people with diabetes experience one or more symptoms, including extreme thirst or hunger, a frequent need to urinate and/or fatigue. Some lose weight without trying. Additional signs include sores that heal slowly, dry, itchy skin, loss of feeling or tingling in the feet and blurry eyesight. Some people with diabetes, however, have no symptoms at all."}]}
{"messages": [{"role": "user", "content": "What causes Diabetes ?"}, {"role": "assistant", "content": "Type 1 diabetes is an autoimmune disease. In an autoimmune reaction, antibodies, or immune cells, attach to the body's own healthy tissues by mistake, signaling the body to attack them. At present, scientists do not know exactly what causes the body's immune system to attack the insulin-producing cells in the pancreas in people with type 1 diabetes. However, many believe that both genetic factors and environmental factors are involved. Studies now are underway to identify these factors and prevent type 1 diabetes in people at risk. Type 2 diabetesthe most common form of diabetesis caused by a combination of factors, including insulin resistance, a condition in which the bodys muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin.  Get more details about who should be tested for diabetes."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetes ?"}, {"role": "assistant", "content": "Diabetes is a very serious disease. Over time, diabetes that is not well managed causes serious damage to the eyes, kidneys, nerves, and heart, gums and teeth. If you have diabetes, you are more likely than someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or stroke at an earlier age than others. The best way to protect yourself from the serious complications of diabetes is to manage your blood glucose, blood pressure, and cholesterol and avoid smoking. It is not always easy, but people who make an ongoing effort to manage their diabetes can greatly improve their overall health."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Diabetes? ?"}, {"role": "assistant", "content": "Here are the risk factors for type 2 diabetes. -  being over 45 years of age  -  being overweight or obese  - having a first-degree relative -- a parent, brother, or sister -- with diabetes  - being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)  - having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds  - having blood pressure of 140/90 or higher, or having been told that you have high blood pressure.  - having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher  - being inactive or exercising fewer than three times a week.  - having polycystic ovary syndrome, also called PCOS (women only)  - on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)  - history of cardiovascular disease (disease affecting the heart and blood vessels). being over 45 years of age being overweight or obese having a first-degree relative -- a parent, brother, or sister -- with diabetes being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds having blood pressure of 140/90 or higher, or having been told that you have high blood pressure. having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher being inactive or exercising fewer than three times a week. having polycystic ovary syndrome, also called PCOS (women only) on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) history of cardiovascular disease (disease affecting the heart and blood vessels)."}]}
{"messages": [{"role": "user", "content": "How to prevent Diabetes ?"}, {"role": "assistant", "content": "The two most common forms of diabetes are type 1 and type 2. Currently, there is no way to delay or prevent type 1 diabetes. However, research has shown that making modest lifestyle changes can prevent or delay type 2 diabetes in people at risk for the disease. In the Diabetes Prevention Program (DPP), a landmark study by the National Institute of Diabetes and Digestive and Kidney Diseases, researchers found that adults at high risk for type 2 diabetes were able to cut their risk in half by losing a modest amount of weight and being active almost every day. This means losing 5 to 7 percent of body weight (that's 10 pounds if you weigh 200 pounds) and getting 150 minutes of physical activity a week. The DPP study also showed that modest weight loss (achieved by following a low calorie, low-fat diet) and moderate physical activity were especially effective in preventing or delaying the development of diabetes in older people. In fact, people over the age of 60 were able to reduce their risk for developing type 2 diabetes by 71 percent. (Watch the video to learn more about preventing type 2 diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetes ?"}, {"role": "assistant", "content": "People with type 1 diabetes control their blood sugar with insulin -- either with shots or an insulin pen. Many people with type 2 diabetes can control blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some people may need to take both, along with lifestyle modification. (Watch the video to learn how one woman manages her type 2 diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) To manage your diabetes, here are things to do every day. -  Take your medicines for diabetes and for any other health problems, even when you feel good.  Take your medicines for diabetes and for any other health problems, even when you feel good. -  Keep track of your blood glucose (blood sugar). You may want to check it one or more times a day. Be sure to talk about it with your health care team.  Keep track of your blood glucose (blood sugar). You may want to check it one or more times a day. Be sure to talk about it with your health care team. -  Check your blood pressure if your doctor advises and keep a record of it. Check your blood pressure if your doctor advises and keep a record of it. -  Check your feet every day for cuts, blisters, red spots and swelling. Call your health care team right away about any sores that do not go away.  Check your feet every day for cuts, blisters, red spots and swelling. Call your health care team right away about any sores that do not go away. -  Brush your teeth and floss every day to keep your mouth, teeth and gums healthy.  Brush your teeth and floss every day to keep your mouth, teeth and gums healthy. -  Stop smoking.  Ask for help to quit. Call 1-800 QUIT NOW ( 1-800-784-8669)  Stop smoking.  Ask for help to quit. Call 1-800 QUIT NOW ( 1-800-784-8669) -  Eat well.  Ask your doctor to give you the name of someone trained to help you create a healthy eating plan, such as a dietitian.  See small steps for eating healthy foods.  Eat well.  Ask your doctor to give you the name of someone trained to help you create a healthy eating plan, such as a dietitian.  See small steps for eating healthy foods.  -  Be active.  Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. To learn more, see  Exercise: How To Get Started, or visit Go4Life,  the exercise and physical activity campaign for older adults from the National Institute on Aging.  Be active.  Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. To learn more, see  Exercise: How To Get Started, or visit Go4Life,  the exercise and physical activity campaign for older adults from the National Institute on Aging."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetes ?"}, {"role": "assistant", "content": "Heart disease and stroke are the leading causes of death for people with diabetes. Controlling the ABCs of diabetes -- your blood glucose, your blood pressure, and your cholesterol, as well as stopping smoking -- can help prevent these and other complications from diabetes. -  A is for the A1C test  -  B is for Blood pressure  -  C is for Cholesterol. A is for the A1C test B is for Blood pressure C is for Cholesterol. - The A1C test (A-one-C) shows you what your blood glucose has been over the last three months. Your health care provider does this test to see what your blood glucose level is most of the time. This test should be done at least twice a year for all people with diabetes and for some people more often as needed. For many people with diabetes, an A1C test result of under 7 percent usually means that their diabetes treatment is working well and their blood glucose is under control.  The A1C test (A-one-C) shows you what your blood glucose has been over the last three months. Your health care provider does this test to see what your blood glucose level is most of the time. This test should be done at least twice a year for all people with diabetes and for some people more often as needed. For many people with diabetes, an A1C test result of under 7 percent usually means that their diabetes treatment is working well and their blood glucose is under control. -  B is for Blood pressure. The goal for most people is 140/90 but may be different for you. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease. Your blood pressure should be checked at every doctor visit. Talk with your health care provider about your blood pressure goal.  B is for Blood pressure. The goal for most people is 140/90 but may be different for you. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease. Your blood pressure should be checked at every doctor visit. Talk with your health care provider about your blood pressure goal. - C is for Cholesterol (ko-LES-ter-ol). The LDL goal for most people is less than 100. Low density lipoprotein, or LDL-cholesterol, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. Talk with your health care provider about your cholesterol goal.  C is for Cholesterol (ko-LES-ter-ol). The LDL goal for most people is less than 100. Low density lipoprotein, or LDL-cholesterol, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. Talk with your health care provider about your cholesterol goal. Ask your health care team - what your A1C, blood pressure, and cholesterol numbers are.  - what your ABCs should be.  - what you can do to reach your target.  what your A1C, blood pressure, and cholesterol numbers are. what your ABCs should be. what you can do to reach your target."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetes ?"}, {"role": "assistant", "content": "See your health care team at least twice a year to find and treat any problems early. Ask what steps you can take to reach your goals. If you have diabetes, take these steps.  At each visit,  be sure you have a - blood pressure check  -  foot check  -  weight check  -  review of your self-care plan. blood pressure check foot check weight check review of your self-care plan.  Two times each year, get - an A1C test. It may be checked more often if it is over 7. an A1C test. It may be checked more often if it is over 7. Once each year,  be sure you have a - cholesterol test  - triglyceride (try-GLISS-er-ide) test - a type of blood fat  - complete foot exam  - dental exam to check teeth and gums. Tell your dentist you have diabetes.  - dilated eye exam to check for eye problems  - flu shot  - urine and a blood test to check for kidney problems. cholesterol test triglyceride (try-GLISS-er-ide) test - a type of blood fat complete foot exam dental exam to check teeth and gums. Tell your dentist you have diabetes. dilated eye exam to check for eye problems flu shot urine and a blood test to check for kidney problems.  At least once, get a - pneumonia (nu-MOH-nya) shot.  pneumonia (nu-MOH-nya) shot.  If you have Medicare,  ask your health care team if Medicare will cover some of the costs for -  learning about healthy eating and diabetes self-care  - special shoes, if you need them  - medical supplies  - diabetes medicines. learning about healthy eating and diabetes self-care special shoes, if you need them medical supplies diabetes medicines. (Watch the video for important things to remember when visiting your health care team. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetes ?"}, {"role": "assistant", "content": "People with diabetes should - do aerobic activities,  such as brisk walking, which use the bodys large muscles to make the heart beat faster. The large muscles are those of the upper and lower arms and legs and those that control head, shoulder, and hip movements.  - do activities to strengthen muscles and bone, such as sit-ups or lifting weights. Aim for two times a week.  - stretch to increase flexibility, lower stress, and help prevent muscle soreness after physical activity.  do aerobic activities,  such as brisk walking, which use the bodys large muscles to make the heart beat faster. The large muscles are those of the upper and lower arms and legs and those that control head, shoulder, and hip movements. do activities to strengthen muscles and bone, such as sit-ups or lifting weights. Aim for two times a week. stretch to increase flexibility, lower stress, and help prevent muscle soreness after physical activity. Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. (Tip: you dont need to get your exercise in all at one time.) For more information on exercise and older adults, see Exercises To Try or visit  Go4Life, the exercise and physical activity campaign from the National Institute on Aging. Always talk with a doctor before starting a new physical activity program."}]}
{"messages": [{"role": "user", "content": "How to prevent Diabetes ?"}, {"role": "assistant", "content": "Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. If you are overweight or obese, choose sensible ways to reach and maintain a reasonable body weight. - Make healthy food choices. What you eat has a big impact on your weight and overall health. By developing healthy eating habits you can help control your body weight, blood pressure, and cholesterol. Reducing portion size, increasing the amount of fiber you consume (by eating more fruits and vegetables) and limiting fatty and salty foods are key to a healthy diet. Make healthy food choices. What you eat has a big impact on your weight and overall health. By developing healthy eating habits you can help control your body weight, blood pressure, and cholesterol. Reducing portion size, increasing the amount of fiber you consume (by eating more fruits and vegetables) and limiting fatty and salty foods are key to a healthy diet. -  Get at least 30 minutes of exercise at least five days a week. Regular exercise reduces diabetes risk in several ways: it helps you lose weight, controls your cholesterol and blood pressure, and improves your body's use of insulin. Many people make walking part of their daily routine because it's easy, fun and convenient. But you can choose any activity that gets you moving. It's fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program.   Get at least 30 minutes of exercise at least five days a week. Regular exercise reduces diabetes risk in several ways: it helps you lose weight, controls your cholesterol and blood pressure, and improves your body's use of insulin. Many people make walking part of their daily routine because it's easy, fun and convenient. But you can choose any activity that gets you moving. It's fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Medicare is a federal health insurance program for people - age 65 and older - under age 65 with certain disabilities who have been receiving Social Security disability benefits for a certain amount of time (24 months in most cases) - of any age who have End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a transplant. age 65 and older under age 65 with certain disabilities who have been receiving Social Security disability benefits for a certain amount of time (24 months in most cases) of any age who have End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a transplant. Medicare helps with the cost of health care, but it does not cover all medical expenses."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Medicare Part A is hospital insurance that helps cover inpatient care in hospitals. Part A also helps cover skilled nursing facility care for a limited period of time, hospice care, and home health care, if you meet certain conditions. Most people don't have to pay a monthly premium for Medicare Part A when they turn age 65 because they or a spouse paid Medicare taxes while they were working. If a person is hospitalized, Medicare helps pay for the following services. - Care - general nursing - Room - semiprivate room  - Hospital services - meals, most services and supplies Care - general nursing Room - semiprivate room Hospital services - meals, most services and supplies If a person is hospitalized, Medicare does NOT pay for the following services. - Care - private-duty nursing  - Room - private room (unless medically necessary) - Hospital services - television and telephone Care - private-duty nursing Room - private room (unless medically necessary) Hospital services - television and telephone For important information about Medicare Part A, visit http://www.medicare.gov to view or print copies of \"Your Medicare Benefits\" or \"Medicare & You.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\")"}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Medicare Part B is medical insurance. It helps cover medical services such as doctor's services, outpatient care and other medical services that Part A doesn't cover. Part B also covers some preventive services, such as flu shots and diabetes screening, to help you maintain your health and to keep certain illnesses from getting worse. Enrollment in Part B is optional, and most people who choose it must pay a monthly fee, or premium. There may be a late enrollment penalty for Part B if the person doesn't join when he or she is first eligible. For important information about Part B, visit http://www.medicare.gov to view or print copies of \"Your Medicare Benefits\" or \"Medicare & You.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") You can also contact your State Health Insurance Assistance Program (SHIP) which gives free health insurance counseling and guidance to people with Medicare -- or to family and friends who have authorization to help someone with Medicare questions. To get the most up-to-date telephone numbers, call 1-800-Medicare (1-800-633-4227) or visit http://www.medicare.gov. (TTY users should call 1-877-486-2048.) Under \"Search Tools,\" select \"Find Helpful Phone Numbers and Websites.\" To sign up for Medicare Part B, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you are getting benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Medicare Advantage Plans, sometimes known as Medicare Part C, are plans people can join to get their Medicare benefits. Medicare Advantage Plans are available in many areas of the country, and a person who joins one of these plans will get all Medicare-covered benefits. These plans cover hospital costs (Part A), medical costs (Part B), and sometimes prescription drug costs (Part D). Medicare Advantage Plans may also offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. To join a Medicare Advantage Plan, a person must have Medicare Part A and Part B and must pay the monthly Medicare Part B premium to Medicare. In addition, it might be necessary to pay a monthly premium to the Medicare Advantage Plan for the extra benefits that they offer. In most of these plans, there are generally extra benefits and lower co-payments than in Original Medicare. (See Question #6 for information about Original Medicare.) However, a person may have to see doctors that belong to the plan or go to certain hospitals to get services. A person can switch plans each year in the fall if desired. To find out what Medicare Advantage Plans are available in your area, visit http://www.medicare.gov and choose the link Compare Health Plans and Medigap Policies in Your Area to use the Medicare Options Compare tool, or call 1-800-MEDICARE (1-800-633-4227)."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Medicare Part D helps pay for medications that a doctor may prescribe. This coverage may help lower prescription drug costs. Medicare drug plans are run by insurance companies and other private companies approved by Medicare. A person who joins Original Medicare and who wants prescription drug coverage will need to choose and sign up for a Medicare Prescription Drug plan (PDP). A person who joins one of the Medicare Advantage Plans will automatically receive prescription drug coverage through that plan if it's offered, usually for an extra cost. For more information about Medicare Part D, visit http://www.medicare.gov to get free copies of \"Your Guide to Medicare Prescription Drug Coverage\" and \"Compare Medicare Prescription Drug Plans.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") You may also call 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Original Medicare is managed by the Federal government and lets people with Medicare go to any doctor, hospital or other health care provider who accepts Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest. People in Original Medicare must choose and join a Medicare Prescription Drug Plan if they want to get Medicare prescription drug coverage. For more information about Original Medicare, visit http://www.medicare.gov for a free copy of \"Your Medicare Benefits.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\")"}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "People who choose Original Medicare may wish to consider Medigap, a type of Medicare supplement insurance. Medigap policies are sold by private insurance companies to fill gaps in Original Medicare Plan coverage, such as out-of-pocket costs for Medicare co-insurance and deductibles, or for services not covered by Medicare. A Medigap policy only works with Original Medicare. A person who joins a Medicare Advantage Plan generally doesn't need (and can't use) a Medigap policy. For more information about Medigap policies, visit  http://www.medicare.gov to view a copy of \"Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") You can also call 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Some people think that Medicare and Medicaid are the same. Actually, they are two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. If you have questions about Medicaid, you can call your State Medical Assistance (Medicaid) office for more information. Visit  http://www.medicare.gov on the web. (Under \"Search Tools,\" select \"Find Helpful Phone Numbers and Websites.\") Or, call 1-800-Medicare (1-800-633-4227) to get the telephone number. TTY users should call 1-877-486-2048."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Home health care is short-term skilled care at home after hospitalization or for the treatment of an illness or injury. Home health agencies provide home care services, including skilled nursing care, physical therapy, occupational therapy, speech therapy, medical social work, and care by home health aides. Home health services may also include durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers, and medical supplies for use at home."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Here are questions to ask when considering a home health agency. - Is the agency Medicare-approved?   - How long has the agency served the community?   - Does this agency provide the services my relative or friend needs?   - How are emergencies handled?   - Is the staff on duty around the clock?   - How much do services and supplies cost?   - Will agency staff be in regular contact with the doctor? Is the agency Medicare-approved? How long has the agency served the community? Does this agency provide the services my relative or friend needs? How are emergencies handled? Is the staff on duty around the clock? How much do services and supplies cost? Will agency staff be in regular contact with the doctor? You can use Medicare's \"Home Health Compare\" tool to compare home health agencies in your area. Visit http://www.medicare.gov. Under \"Search Tools,\" select \"Compare Home Health Agencies in Your Area.\""}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Here are some questions to ask when considering choosing a nursing home. You may want to make surprise visits at different times of the day to verify conditions. - Is the nursing home Medicare- or Medicaid-certified?  - Does the nursing home have the level of care needed (such as skilled or custodial care) and is a bed available?  - Does the nursing home have special services if needed in a separate unit (such as a ventilator or rehabilitation) and is a bed available?   - Are residents clean, well groomed, and appropriately dressed for the season or time of day?  - Is the nursing home free from strong, unpleasant odors?  - Does the nursing home appear to be clean and well kept?  - Does the nursing home conduct staff background checks?  - Does the nursing home staff interact warmly and respectfully with home residents?  - Does the nursing home meet cultural, religious, and language needs?  - Are the nursing home and the current administrator licensed?  Is the nursing home Medicare- or Medicaid-certified? Does the nursing home have the level of care needed (such as skilled or custodial care) and is a bed available? Does the nursing home have special services if needed in a separate unit (such as a ventilator or rehabilitation) and is a bed available? Are residents clean, well groomed, and appropriately dressed for the season or time of day? Is the nursing home free from strong, unpleasant odors? Does the nursing home appear to be clean and well kept? Does the nursing home conduct staff background checks? Does the nursing home staff interact warmly and respectfully with home residents? Does the nursing home meet cultural, religious, and language needs? Are the nursing home and the current administrator licensed?"}]}
{"messages": [{"role": "user", "content": "What to do for Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Nursing home care can be very expensive. Medicare generally doesn't cover nursing home care. There are many ways people can pay for nursing home care. For example, they can use their own money, they may be able to get help from their state, or they may use long-term care insurance. Nursing home care isn't covered by many types of health insurance. Most people who enter nursing homes begin by paying for their care out of their own pocket. As they use up their resources over a period of time, they may eventually become eligible for Medicaid. Medicaid is a state and Federal program that will pay most nursing home costs for people with limited income and resources. Eligibility varies by state. Medicaid pays for care for about 7 out of every 10 nursing home residents. Medicaid will pay for nursing home care only when provided in a Medicaid-certified facility. For information about Medicaid eligibility, call your state Medical Assistance (Medicaid) Office. If you have questions about Medicaid, you can call your State Medical Assistance (Medicaid) office for more information. Visit http://www.medicare.gov on the web. (Under \"Search Tools,\" select \"Find Helpful Phone Numbers and Websites.\") Or, call 1-800-Medicare (1-800-633-4227) to get the telephone number. TTY users should call 1-877-486-2048."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Medicare does cover skilled nursing care after a 3-day qualifying hospital stay. Skilled care is health care given when the person needs skilled nursing or rehabilitation staff to manage, observe, and evaluate his or her care. Care that can be given by non-professional staff isn't considered skilled care. Medicare does not cover custodial care or adult day care. For more information on Medicare coverage of skilled nursing facility care, visit http://www.medicare.gov to look at or print a copy of the booklet \"Medicare Coverage of Skilled Nursing Facility Care.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") You can also call 1-800-Medicare (1-800-633-4227) to find out if a free copy can be mailed to you. TTY users should call 1-877-486-2048."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "Hospice care is a special way of caring for people who are terminally ill (dying) and helping their families cope. Hospice care includes treatment to relieve symptoms and keep the individual comfortable. The goal is to provide end-of-life care, not to cure the illness. Medical care, nursing care, social services, drugs for the terminal and related conditions, durable medical equipment, and other types of items and services can be a part of hospice care."}]}
{"messages": [{"role": "user", "content": "What is (are) Medicare and Continuing Care ?"}, {"role": "assistant", "content": "The general number for Medicare is 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048. You can also visit http://www.medicare.gov. The \"Medicare & You\" handbook is mailed out to all Medicare enrollees in the fall. It includes detailed information about all aspects of Medicare. On the following pages you will find phone numbers, web addresses, and names of publications that provide detailed information about various aspects of Medicare. If a person needs to sign up for Medicare, call Social Security at 1-800-772-1213 or go to http://www.ssa.gov to find out more. Your State Health Insurance Assistance Program, or SHIP, gives free health insurance counseling and guidance to people with Medicare -- or to family and friends who have authorization to help someone with Medicare questions. To get the most up-to-date SHIP telephone numbers, call 1-800-Medicare (1-800-633-4227) or visit http://www.medicare.gov. (TTY users should call 1-877-486-2048.) Under \"Search Tools,\" select \"Find Helpful Phone Numbers and Websites.\" For information about enrolling in Medicare Part A or Part B, visit http://www.medicare.gov and view a copy of \"Medicare & You.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") Or, you can contact your State Health Insurance Assistance Program. For information about Medicare prescription drug coverage, visit http://www.medicare.gov to get a free copy of \"Your Guide to Medicare Prescription Drug Coverage.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") If you have questions about Medicaid, you can call your State Medical Assistance (Medicaid) office for more information. Visit http://www.medicare.gov on the web. (Under \"Search Tools,\" select \"Find Helpful Phone Numbers and Websites.\") Or, call 1-800-Medicare (1-800-633-4227) to get the telephone number. TTY users should call 1-877-486-2048. To find out about Medigap policies, visit http://www.medicare.gov to view a copy of \"Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") You can also call 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048. To find out about PACE (Programs of All-Inclusive Care for the Elderly), which provides coverage for low-income, frail, older adults who get health care in the community, call your State Medical Assistance (Medicaid) office or visit PACE to find out if a person is eligible and if there is a PACE site nearby. Several states have State Pharmacy Assistance Programs (SPAPs) that help people who qualify pay for prescription drugs. To find out about the SPAPs in your state, call 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048. For more information about the Medicare Summary Notice, including a sample MSN and information on how to read it, visit http://www.medicare.gov and select \"Medicare Billing.\" Or call 1-800-Medicare (1-800-633-4227) and say \"Billing.\" TTY users should call 1-877-486-2048. For information about appeals, visit http://www.medicare.gov to get a free copy of \"Your Medicare Rights and Protections.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\") You can also call 1-800-Medicare (1-800-633-4227) to find out if a free copy can be mailed to you. TTY users should call 1-877-486-2048. To find out if a patient is eligible for Medicare's home health care services, call the Regional Home Health Intermediary (RHHI). An RHHI is a private company that contracts with Medicare to pay bills and check on the quality of home health care. To contact an RHHI, or get local telephone numbers for your State Hospice Organization, call 1-800-Medicare (1-800-633-4227) or visit http://www.medicare.gov. TTY users should 1-877-486-2048. To compare home health agencies in your area, you can use Medicare's \"Home Health Compare\" tool. Go to http://www.medicare.gov and under \"Search Tools,\" select \"Compare Home Health Agencies in Your Area.\" For more information on Medicare coverage of skilled nursing facility care, visit http://www.medicare.gov to look at or print a copy of the booklet \"Medicare Coverage of Skilled Nursing Facility Care.\" (Under \"Search Tools,\" select \"Find a Medicare Publication.\")"}]}
{"messages": [{"role": "user", "content": "What is (are) Knee Replacement ?"}, {"role": "assistant", "content": "There are many different types and designs of artificial knees. Most consist of three components: -  the femoral component, which is the part that attaches to the thigh bone  - the tibial component, the part that attaches to the shin bone   - the patellar component, the knee cap. the femoral component, which is the part that attaches to the thigh bone the tibial component, the part that attaches to the shin bone the patellar component, the knee cap. Total and Partial Knee Replacement Knee replacement may be either total or partial/unicompartmental. In total knee replacement, as the name suggests, the entire knee joint is replaced. You will likely need a total knee replacement if you have damage to several parts of your knee. In partial/unicompartmental knee replacement, the surgeon replaces just the damaged part of the knee. You may be able to have a partial knee replacement if only one section of your knee is damaged. However, when one part is replaced, there is a chance that another part will develop arthritis, requiring further surgery. Cemented and Uncemented Joint Components Joint components may also be attached to your own bone in different ways. Most are cemented with a special joint glue into your existing bone; others rely on a process called biologic fixation to hold them in place. This means that the parts are made with a porous surface, and over time your own bone grows into the joint surface to secure them. In some cases, surgeons use a combination of cemented and uncemented parts. This is referred to as a hybrid implant. Minimally Invasive Surgery While some knee replacement surgery requires an 8- to 12-inch incision in the front of the knee, surgeons at many medical centers are now performing what is called minimally invasive surgery using incisions of 3 to 5 inches or even smaller. Because the incision is smaller, there may be less pain and a shorter recovery time. If you think you might be interested in minimally invasive surgery, speak with your surgeon."}]}
{"messages": [{"role": "user", "content": "What are the complications of Knee Replacement ?"}, {"role": "assistant", "content": "While new technology and advances in surgical techniques have greatly reduced the risks involved with knee replacements, there are still some risks you should be aware of. Two of the most common possible problems are blood clots and infection. Preventing Blood Clots Blood clots can occur in the veins of your legs after knee replacement surgery. To reduce the risk of clots, your doctor may have you elevate your leg periodically and prescribe special exercises, support hose, or blood thinners. Preventing Infections Infection can occur when bacteria enter the bloodstream from skin or urinary tract infections. To reduce the risk of infection, your doctors may prescribe antibiotics for you to take prior to your surgery and for a short time afterward. Other Complications Other complications, such as new or ongoing pain, stiffness, fracture, bleeding, or injury to the blood vessels can occur. Serious medical complications, such as heart attack or stroke, are very rare. Warning Signs To Watch For To minimize the risk of complications, it is important to recognize signs of potential problems early and contact your doctor. For example, tenderness, redness, and swelling of your calf or swelling of your thigh, ankle, calf, or foot could be warning signs of a possible blood clot. Warning signs of infection include fever or chills, tenderness and swelling of the wound, and drainage from the wound. You should call your doctor if you experience any of these symptoms. It is important to get instructions from your doctor before leaving the hospital and follow them carefully once you get home. Doing so will give you the greatest chance of a successful surgery."}]}
{"messages": [{"role": "user", "content": "What is the outlook for Knee Replacement ?"}, {"role": "assistant", "content": "Recovery from knee replacement extends long after you leave the hospital. Preparing for recovery requires learning what to expect in the days and weeks following surgery. It requires understanding what you will and wont be able to do  and when. It also means arranging for social support and arranging your house to make everyday tasks easier and to help speed your recovery. Find Someone To Stay with You Because you will not be able to drive for several weeks after surgery, you will need someone to take you home from the hospital and be on hand to run errands or take you to appointments until you can drive yourself. If you live with someone, you should have them plan to stay home with you or at least stay close by, in case you need help. If you dont live with a family member or have one close by, a friend or neighbor may be able to help. Other options include staying in an extended-care facility during your recovery or hiring someone to come to your home and help you. Your hospital social worker should be able to help you make arrangements. Prepare Your Home for Your Recovery To prepare your home for your recovery, stock up on needed items before you leave for the hospital. Make sure you have plenty of non-perishable foods on hand. Prepare meals and freeze them to put in the microwave when you need an easy meal. In the first weeks after surgery, you should avoid going up and down stairs. If your bedroom is on the second floor of your home, consider moving to a downstairs bedroom temporarily or sleeping on the sofa. Set Up a Recovery Station Set up a recovery station at home. Place a sturdy chair where you plan to spend most of your time sitting during the first weeks after surgery. The chair should be 18 to 20 inches high and should have two arms and a firm seat and back. Place a foot stool in front of the chair so you can elevate your legs, and place items you will need such as the television remote control, telephone, medicine, and tissues where you can reach them easily from the chair. Place items you use every day at arms level to avoid reaching up or bending down. Ask your doctor or physical therapist about devices and tips that may make daily activities easier once you get home. Devices you may find helpful include long-handled reachers to retrieve items placed on high shelves or dropped on the floor, aprons with pockets that allow you to carry items while leaving your hands free for crutches, shower benches that let you sit while you shower, and dressing sticks to help you get dressed without bending your new knee excessively. Safeguard Against Falls Because a fall can damage your new knee, making your home a safe place is crucial. Before your surgery, look for and correct hazards, including cluttered floors, loose electrical cords, unsecured rugs, and dark hallways. Bathrooms are likely places to fall, so particular attention is needed there. A raised toilet seat can make it easier to get up and down. Grab bars in the tub can keep you steady. Textured shapes on the shower floor can minimize slipping. Gradually Increase Activity It is also important to exercise to get stronger while avoiding any activities that can damage or dislocate your new joint. Activity should include a graduated walking program (where you slowly increase the time, distance, and pace that you walk) and specific exercises several times a day to prevent scarring, restore movement, and stabilize and strengthen your new knee. Remember Follow-ups Your surgeon will let you know about follow-up visits. Even after you have healed from surgery, you will need to see your surgeon periodically for examinations and x-rays to detect any potential problems with your knee. By preparing for surgery and recovery and following your doctor's advice, you can get the greatest benefits from your new knee with the least risk of complications for many years to come."}]}
{"messages": [{"role": "user", "content": "What is (are) Knee Replacement ?"}, {"role": "assistant", "content": "The main reason to have knee replacement surgery is to ease pain and disability caused by arthritis or other joint problems, while preserving movement. Less commonly, it is used to correct some kinds of knee deformity."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Knee Replacement ?"}, {"role": "assistant", "content": "Treatments your doctor will likely recommend before knee replacement include - exercises to strengthen the muscles around the knee and improve flexibility  - weight loss, if needed, to reduce the load the knee must bear   - walking aids such as canes to reduce stress on the joint   - shoe inserts to improve the knees alignment  - medicines to relieve pain.  exercises to strengthen the muscles around the knee and improve flexibility weight loss, if needed, to reduce the load the knee must bear walking aids such as canes to reduce stress on the joint shoe inserts to improve the knees alignment medicines to relieve pain."}]}
{"messages": [{"role": "user", "content": "What is (are) Knee Replacement ?"}, {"role": "assistant", "content": "Knee replacement may be either total or partial/unicompartmental. In total knee replacement, as the name suggests, the entire knee joint is replaced. You will likely need a total knee replacement if you have damage to several parts of your knee. In partial/unicompartmental knee replacement, the surgeon replaces just the damaged part of the knee. You may be able to have a partial knee replacement if only one section of your knee is damaged. However, when one part is replaced, there is a chance that another part will develop arthritis, requiring further surgery."}]}
{"messages": [{"role": "user", "content": "What is (are) Knee Replacement ?"}, {"role": "assistant", "content": "A physical therapist will teach you exercises to help your recovery. You can expect some pain, discomfort, and stiffness as you begin therapy, but to get the best results from your new knee, it is important to do all of the exercises your physical therapist recommends."}]}
{"messages": [{"role": "user", "content": "What are the complications of Knee Replacement ?"}, {"role": "assistant", "content": "Two of the most common possible problems are blood clots and infection. Other complications, such as new or ongoing pain, stiffness, fracture, bleeding, or injury to the blood vessels can occur. Serious medical complications, such as heart attack or stroke, are very rare."}]}
{"messages": [{"role": "user", "content": "What are the complications of Knee Replacement ?"}, {"role": "assistant", "content": "To reduce the risk of clots, your doctor may have you elevate your leg periodically and prescribe special exercises, support hose, or blood thinners. To reduce the risk of infection, your doctor may prescribe antibiotics for you to take prior to your surgery and for a short time afterward."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Knee Replacement? ?"}, {"role": "assistant", "content": "Because a fall can damage your new knee, making your home a safe place is crucial. Before your surgery, look for and correct hazards, including cluttered floors, loose electrical cords, unsecured rugs, and dark hallways. A raised toilet seat can make it easier to get up and down. Grab bars in the tub can keep you steady."}]}
{"messages": [{"role": "user", "content": "What is (are) Knee Replacement ?"}, {"role": "assistant", "content": "You can learn more about knee replacement from the following resources. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)   Information Clearinghouse  National Institutes of Health  1 AMS Circle  Bethesda, MD 20892-3675  Phone: 301-495-4484  Toll Free: 877-22-NIAMS (226-4267)  TTY: 301-565-2966  Fax: 301-718-6366  Email: NIAMSinfo@mail.nih.gov  Website:  http://www.niams.nih.gov American Physical Therapy Association  Website: http://www.apta.org  Arthritis Foundation  Website:  http://www.arthritis.org The Knee Society  Website:  http://www.kneesociety.org  MedlinePlus  Website: http://www.nlm.nih.gov/medlineplus/kneereplacement.html"}]}
{"messages": [{"role": "user", "content": "What is (are) Balance Problems ?"}, {"role": "assistant", "content": "Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be very troublesome sensations. If the feeling happens often, it could be a sign of a balance problem. Balance problems are among the most common reasons that older adults seek help from a doctor. In 2008, an estimated 14.8 percent of American adults (33.4 million) had a balance or dizziness problem during the past year. Why Good Balance is Important Having good balance means being able to control and maintain your body's position, whether you are moving or remaining still. An intact sense of balance helps you - walk without staggering  - get up from a chair without falling   - climb stairs without tripping  - bend over without falling. walk without staggering get up from a chair without falling climb stairs without tripping bend over without falling. The part of the inner ear responsible for balance is the vestibular system, often referred to as the labyrinth. To maintain your body's position, the labyrinth interacts with other systems in the body, such as the eyes, bones and joints. Good balance is important to help you get around, stay independent, and carry out daily activities. Learn how your body maintains its balance. When People Have Problems with Balance As they get older, many people experience problems with their sense of balance. They feel dizzy or unsteady, or as if they or their surroundings were in motion. Disturbances of the inner ear are a common cause. Vertigo, the feeling that you or the things around you are spinning, is also a common symptom. Balance disorders are one reason older people fall. Falls and fall-related injuries, such as hip fracture, can have a serious impact on an older person's life. If you fall, it could limit your activities or make it impossible to live independently. Many people often become more isolated after a fall. According to the Centers for Disease Control and Prevention, roughly more than one-third of adults ages 65 years and older fall each year. Among older adults, falls are the leading cause of injury-related deaths.  Learn other ways a fall may affect an older adult's life. BPPV (Benign Paroxysmal Positional Vertigo) There are many types of balance disorders. One of the most common is benign paroxysmal positional vertigo, or BPPV. In BPPV, you experience a brief, intense feeling of vertigo when you change the position of your head, such as when rolling over to the left or right, upon getting out of bed, or when looking for an object on a high or low shelf. BPPV is more likely to occur in adults aged 60 and older, but can also occur in younger people. In BPPV, small calcium particles in the inner ear become displaced and disrupt the inner ear balance sensors, causing dizziness. The reason they become displaced is not known; the cause may be an inner ear infection, head injury, or aging. Labyrinthitis This is an infection or inflammation of the inner ear that causes dizziness and loss of balance. It is often associated with an upper respiratory infection such as the flu. Mnire's Disease Mnire's disease is a balance disorder that causes a person to experience - vertigo  - hearing loss that comes and goes  - tinnitus, which is a ringing or roaring in the ears  - a feeling of fullness in the ear.  vertigo hearing loss that comes and goes tinnitus, which is a ringing or roaring in the ears a feeling of fullness in the ear. It affects adults of any age. The cause is unknown. See a fuller list of balance disorders. There are many ways to treat balance disorders. Treatments vary depending on the cause. See your doctor if you are experiencing dizziness, vertigo, or other problems with your balance."}]}
{"messages": [{"role": "user", "content": "How to prevent Balance Problems ?"}, {"role": "assistant", "content": "People are more likely to have problems with balance as they get older. But age is not the only reason these problems occur; there are other causes, too. In some cases, you can help reduce your risk for certain balance problems. Problems in the Inner Ear Some balance disorders are caused by problems in the inner ear. The part of the inner ear that is responsible for balance is the vestibular system, also known as the labyrinth. When the labyrinth becomes infected or swollen, this condition is called labyrinthitis. It is typically accompanied by vertigo and imbalance. Upper respiratory infections and other viral infections, and, less commonly, bacterial infections, can lead to labyrinthitis. Other Causes Other balance diseorers may involve another part of the body, such as the brain or the heart. For example, diseases of the circulatory system, such as stroke, can cause dizziness and other balance problems. Smoking and diabetes can increase the risk of stroke. Low blood pressure can also cause dizziness. Aging, infections, head injury and many medicines may also result in a balance problem. Problems Caused by Medications Balance problems can also result from taking many medications. For example, some medicines, such as those that help lower blood pressure, can make a person feel dizzy. Ototoxic drugs are medicines that damage the inner ear. If your medicine is ototoxic, you may feel off balance. Sometimes the damage lasts only as long as you take the drug; many times it is permanent. Groups of drugs that are more likely to be ototoxic include -  antidepressants  - anti-seizure drugs (anticonvulsants)  -  hypertensive (high blood pressure) drugs  - sedatives  - tranquilizers  -  anxiolytics (anti-anxiety drugs)   - aminoglycosides (a type of antibiotic)   - diuretics  - vasodilators  - certain analgesics (painkillers)  - certain chemotherapeutics (anti-cancer drugs). antidepressants anti-seizure drugs (anticonvulsants) hypertensive (high blood pressure) drugs sedatives tranquilizers anxiolytics (anti-anxiety drugs) aminoglycosides (a type of antibiotic) diuretics vasodilators certain analgesics (painkillers) certain chemotherapeutics (anti-cancer drugs). Check with your doctor if you notice a problem while taking a medication. Ask if other medications can be used instead. If not, ask if the dosage can be safely reduced. Sometimes it cannot. However, your doctor will help you get the medication you need while trying to reduce unwanted side effects. Diet and Lifestyle Can Help Your diet and lifestyle can help you manage certain balance-related problems. For example, Mnire's disease, which causes vertigo and other balance and hearing problems, is linked to a change in the volume of fluid in the inner ear. By eating low-salt (low-sodium) or salt-free foods, and steering clear of caffeine and alcohol, you may make Mnire's disease symptoms less severe. See suggestions for limiting salt (sodium) in your diet. Balance problems due to high blood pressure can be managed by eating less salt (less sodium), maintaining a healthy weight, and exercising. Balance problems due to low blood pressure may be managed by drinking plenty of fluids, such as water, avoiding alcohol, and being cautious regarding your body's posture and movement, such as standing up slowly and avoiding crossing your legs when youre seated. Learn more about managing high blood pressure (hypertension). Learn more about manging low blood pressure (hypotension). Prevent Ear Infections The ear infection called otitis media is common in children, but adults can get it too. Otitis media can sometimes cause dizziness. You can help prevent otitis media by washing your hands frequently. Also, talk to your doctor about getting a yearly flu shot to stave off flu-related ear infections. If you still get an ear infection, see a doctor immediately before it becomes more serious. Learn more about otitis media and other ear infections. (Centers for Disease Control and Prevention)"}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Balance Problems ?"}, {"role": "assistant", "content": "Some people may have a balance problem without realizing it. Others might think they have a problem, but are too embarrassed to tell their doctor, friends, or family. Here are common symtoms experienced by people with a balance disorder. Symptoms If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience other symptoms such as: - dizziness or vertigo (a spinning sensation)   - falling or feeling as if you are going to fall  - lightheadedness, faintness, or a floating sensation  - blurred vision  - confusion or disorientation. dizziness or vertigo (a spinning sensation) falling or feeling as if you are going to fall lightheadedness, faintness, or a floating sensation blurred vision confusion or disorientation. Other symptoms might include nausea and vomiting, diarrhea, changes in heart rate and blood pressure, and fear, anxiety, or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression. Diagnosis Can Be Difficult Balance disorders can be difficult to diagnose. Sometimes they are a sign of other health problems, such as those affecting the brain, the heart, or circulation of the blood. People may also find it hard to describe their symptoms to the doctor. Questions to Ask Yourself You can help identify a balance problem by asking yourself some key questions. If you answer \"yes\" to any of these questions, you should discuss the symptom with your doctor. - Do I feel unsteady?   - Do I feel as if the room is spinning around me, even only for brief periods of time?  - Do I feel as if I'm moving when I know I'm standing or sitting still?   - Do I lose my balance and fall?   - Do I feel as if I'm falling?  - Do I feel lightheaded, or as if I might faint?   - Does my vision become blurred?   - Do I ever feel disoriented, losing my sense of time, place, or identity? Do I feel unsteady? Do I feel as if the room is spinning around me, even only for brief periods of time? Do I feel as if I'm moving when I know I'm standing or sitting still? Do I lose my balance and fall? Do I feel as if I'm falling? Do I feel lightheaded, or as if I might faint? Does my vision become blurred? Do I ever feel disoriented, losing my sense of time, place, or identity? Questions to Ask Your Doctor If you think that you have a balance disorder, you should schedule an appointment with your family doctor. You can help your doctor make a diagnosis by writing down key information about your dizziness or balance problem beforehand and giving the information to your doctor during the visit. Tell your doctor as much as you can. Write down answers to these questions for your doctor: - How would you describe your dizziness or balance problem?  -  If it feels like the room is spinning around you, which ways does it appear to turn?  - How often do you have dizziness or balance problems?  - Have you ever fallen?   - If so, when did you fall, where did you fall, and how often have you fallen?  - What medications do you take? Remember to include all over-the-counter medications, including aspirin, antihistamines, and sleep aids.   - What is the name of the medication?  - How much do you take each day?   - What times of the day do you take the medication?  - What is the health condition for which you take the medication?  How would you describe your dizziness or balance problem? If it feels like the room is spinning around you, which ways does it appear to turn? How often do you have dizziness or balance problems? Have you ever fallen? If so, when did you fall, where did you fall, and how often have you fallen? What medications do you take? Remember to include all over-the-counter medications, including aspirin, antihistamines, and sleep aids. What is the name of the medication? How much do you take each day? What times of the day do you take the medication? What is the health condition for which you take the medication? See a video about describing symptoms and health concerns during a doctor visit. Seeing a Specialist Your doctor may refer you to an otolaryngologist. This is a doctor with special training in problems of the ear, nose, throat, head, and neck. The otolaryngologist may ask you for your medical history and perform a physical examination to help figure out the possible causes of the balance disorder. He or she, as well as an audiologist (a person who specializes in assessing hearing and balance disorders), may also perform tests to determine the cause and extent of the problem.  Learn what's involved in visiting a medical specialist."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Balance Problems ?"}, {"role": "assistant", "content": "Your doctor can recommend strategies to help reduce the effects of a balance disorder. Scientists are studying ways to develop new, more effective methods to treat and prevent balance disorders. Balance disorders can be signs of other health problems, such as an ear infection, stroke, or multiple sclerosis. In some cases, you can help treat a balance disorder by seeking medical treatment for the illness that is causing the disorder. Exercises for Balance Disorders Some exercises help make up for a balance disorder by moving the head and body in certain ways. The exercises are developed especially for a patient by a professional (often a physical therapist) who understands the balance system and its relationship with other systems in the body. In benign paroxysmal positional vertigo, or BPPV, small calcium particles in the inner ear become displaced, causing dizziness. BPPV can often be effectively treated by carefully moving the head and torso to move the displaced calcium particles back to their original position. For some people, one session will be all that is needed. Others might need to repeat the procedure several times at home to relieve their dizziness. Treating Mnire's Disease Mnire's disease is caused by changes in fluid volumes in the inner ear. People with Mnire's disease can help reduce its dizzying effects by lowering the amount of sodium, or salt (sodium) in their diets. Limiting alcohol or caffeine also may be helpful.  See suggestions for limiting salt (sodium) in your diet. Medications such as corticosteroids and the antibiotic gentamicin are used to treat Mnire's disease. Gentamicin can help reduce the dizziness that occurs with Mnire's disease, but in some cases it can also destroy sensory cells in the inner ear, resulting in permanent hearing loss. Corticosteroids don't cause hearing loss, but research is underway to determine if they are as effective as gentamicin. Learn more about ways to treat Mnire's disease. In some cases, surgery may be necessary to relieve a balance disorder. Treating Problems Due to High or Low Blood Pressure Balance problems due to high blood pressure can be managed by eating less salt (sodium), maintaining a healthy weight, and exercising. Balance problems due to low blood pressure may be managed by drinking plenty of fluids, such as water, avoiding alcohol, and being cautious regarding your body's posture and movement, such as standing up slowly and avoiding crossing your legs when youre seated. Learn more about managing high blood pressure (hypertension).   Learn more about managing low blood pressure (hypotension).  Coping with a Balance Disorder Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan. Talk to your doctor about whether its safe to drive, as well as ways to lower your risk of falling and getting hurt during daily activities, such as when you walk up or down stairs, use the bathroom, or exercise. To reduce your risk of injury from dizziness, avoid walking in the dark. You should also wear low-heeled shoes or walking shoes outdoors. If necessary, use a cane or walker and modify conditions at your home and workplace, such as by adding handrails. Current Research Scientists are working to understand the complex interactions between the brain and the part of the inner ear responsible for balance. They are also studying the effectiveness of certain exercises as a treatment option for balance disorders. In a study funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), researchers created a virtual reality grocery store. This virtual store is a computer-simulated environment that seems to be a physical place in the real world, designed so people with balance disorders can safely walk on a treadmill as they practice looking for items on store shelves. The goal is to help reduce a person's dizziness in confusing environments. NIDCD-supported scientists are also studying the use of a vestibular implant to stop a Mnires attack by restoring normal electrical activity in the vestibular nerve. This nerve conveys balance information to the brain. The device uses the same technology found in a cochlear implant, a medical device that currently provides a sense of sound to people who are deaf or hard-of-hearing. An NIDCD-supported clinical trial in benign paroxysmal positioning vertigo (BPPV) showed that repositioning maneuvers work well, and offered clinicians a range of choices in selecting the treatment best suited to each individuals unique needs. See more information about research on balance problems."}]}
{"messages": [{"role": "user", "content": "What is (are) Balance Problems ?"}, {"role": "assistant", "content": "A balance disorder is a disturbance of the body systems controlling balance. This disturbance can make people feel dizzy, unsteady, or as if they were spinning. Balance disorders are a common cause of falls and fall-related injuries, such as hip fractures."}]}
{"messages": [{"role": "user", "content": "How many people are affected by Balance Problems ?"}, {"role": "assistant", "content": "In 2008, an estimated 14.8 percent of American adults (33.4 million) had a balance or dizziness problem during the past year. See statistics about the frequency of balance and other sensory impairments in older adults.  (Centers for Disease Control and Prevention)"}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Balance Problems ?"}, {"role": "assistant", "content": "If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience other symptoms such as -  dizziness or vertigo (a spinning sensation)  -  falling or feeling as if you are going to fall  -  lightheadedness, faintness, or a floating sensation  -  blurred vision  -  confusion or disorientation.  dizziness or vertigo (a spinning sensation) falling or feeling as if you are going to fall lightheadedness, faintness, or a floating sensation blurred vision confusion or disorientation. Other symptoms might include nausea and vomiting, diarrhea, changes in heart rate and blood pressure, and fear, anxiety, or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression."}]}
{"messages": [{"role": "user", "content": "What is (are) Balance Problems ?"}, {"role": "assistant", "content": "There are many types of balance disorders. Three of the most common are BPPV (benign paroxysmal positional vertigo), labyrinthitis, and Menieres disease. BPPV (benign paroxysmal positional vertigo) is one of the most common balance disorders among older adults. With BPPV, you experience a brief, intense feeling of vertigo that occurs when you change the position of your head. You may also experience BPPV when rolling over to the left or right upon getting out of bed, or when looking up for an object on a high shelf. In BPPV, small calcium particles in the inner ear become displaced, causing dizziness. The reason the particles get displaced is not known, although it may result from an inner ear infection, head injury, or aging.  Labyrinthitis is  is another type of balance disorder. The labyrinth is an organ of the inner ear that helps you maintain your balance. When the labyrinth becomes infected or swollen, it is typically accompanied by vertigo and imbalance. Upper respiratory infections and other viral infections, and, less commonly, bacterial infections, can lead to labyrinthitis. Mnire's disease is a balance disorder that causes - vertigo  - hearing loss that comes and goes  - tinnitus, which is a ringing or roaring in the ears   - a feeling of fullness in the ear. vertigo hearing loss that comes and goes tinnitus, which is a ringing or roaring in the ears a feeling of fullness in the ear. Mnire's disease can affect adults of any age. The cause is unknown.  See a fuller list of balance disorders."}]}
{"messages": [{"role": "user", "content": "What causes Balance Problems ?"}, {"role": "assistant", "content": "Some balance disorders are caused by problems in the inner ear. The part of the inner ear that is responsible for balance is the vestibular system, often refered to as the labyrinth. When the labyrinth becomes infected or swollen -- a condition called labyrinthitis -- it is typically accompanied by vertigo and imbalance. Upper respiratory infections, other viral infections, and, less commonly, bacterial infections, can lead to labyrinthitis. Other balance disorders may involve another part of the body, such as the brain or the heart. For example, diseases of the circulatory system, such as stroke, can cause dizziness and other balance problems. Smoking and diabetes can increase the risk of stroke. Low blood pressure also can cause dizziness. Aging, infections, head injury, and many medicines may also result in a balance problem."}]}
{"messages": [{"role": "user", "content": "What causes Balance Problems ?"}, {"role": "assistant", "content": "Yes. Many prescription medications, such as those used to lower blood pressure, can make a person feel dizzy. Other medicines might damage the inner ear. These medicines, called ototoxic medicines, can make you feel off balance. Sometimes the damage lasts only as long as you take the drug. Other times it is permanent. Groups of drugs that are more likely to be ototoxic include - antidepressants  - anti-seizure drugs (anticonvulsants)  - hypertensive (high blood pressure) drugs  - sedatives  - tranquilizers  - anxiolytics (anti-anxiety drugs)   - aminoglycosides (a type of antibiotic)   - diuretics  - vasodilators  - certain analgesics (painkillers)  - certain chemotherapeutics (anti-cancer drugs).  antidepressants anti-seizure drugs (anticonvulsants) hypertensive (high blood pressure) drugs sedatives tranquilizers anxiolytics (anti-anxiety drugs) aminoglycosides (a type of antibiotic) diuretics vasodilators certain analgesics (painkillers) certain chemotherapeutics (anti-cancer drugs)."}]}
{"messages": [{"role": "user", "content": "How to prevent Balance Problems ?"}, {"role": "assistant", "content": "An ear infection called otitis media can cause balance problems. Otitis media is most common in children, but adults can get it, too. You can help prevent otitis media by washing your hands frequently. Also, talk to your doctor about getting a yearly flu shot to stave off flu-related ear infections. If you do get an ear infection, see a doctor immediately before it becomes more serious. Learn more about otitis media and other ear infections.  (Centers for Disease Control and Prevention)"}]}
{"messages": [{"role": "user", "content": "What is (are) Balance Problems ?"}, {"role": "assistant", "content": "You can help your doctor make a diagnosis by writing down key information about your dizziness or balance problem beforehand and giving the information to your doctor during the visit. Write down answers to these questions for your doctor: - How would you describe your dizziness or balance problem?  - If the room is spinning around you, which ways does it appear to turn?   - How often do you have dizziness or balance problems?  - Have you ever fallen?   - If so, when did you fall, where did you fall, and how often have you fallen? Tell your doctor as much as you can.  - What medications do you take? Remember to include all over-the-counter medicines, including aspirin, antihistamines, or sleep aids.   - What is the name of the medication?   - How much medication do you take each day?   - What times of the day do you take the medication?  - What is the health condition for which you take the medication? How would you describe your dizziness or balance problem? If the room is spinning around you, which ways does it appear to turn? How often do you have dizziness or balance problems? Have you ever fallen? If so, when did you fall, where did you fall, and how often have you fallen? Tell your doctor as much as you can. What medications do you take? Remember to include all over-the-counter medicines, including aspirin, antihistamines, or sleep aids. What is the name of the medication? How much medication do you take each day? What times of the day do you take the medication? What is the health condition for which you take the medication? See a video on describing symptoms and health concerns during a doctor visit."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Balance Problems ?"}, {"role": "assistant", "content": "In BPPV (benign paroxysmal positional vertigo), small calcium particles in the inner ear become displaced, causing dizziness. A doctor, otolaryngologist, audiologist, or physical therapist can treat BPPV by carefully moving the head and torso to move the displaced calcium particles back to their original position Learn more about causes and treatments for BPPV. An NIDCD-supported clinical trial in BPPV showed that repositioning maneuvers work well, and offered clinicians a range of choices in selecting the treatment best suited to each individuals unique needs."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Balance Problems ?"}, {"role": "assistant", "content": "Mnire's disease is caused by changes in fluid volumes in the inner ear. People with Mnire's disease can help reduce its dizzying effects by lowering the amount of salt (sodium) in their diets. Limiting alcohol or caffeine also may be helpful. Some medications, such as corticosteroids or the antibiotic gentamicin, also are used to treat Mnire's disease. Although gentamicin can help reduce the dizziness that occurs with Mnire's disease, it occasionally destroys sensory cells in the inner ear, which can result in permanent hearing loss. Corticosteroids don't cause hearing loss; however, research is underway to determine if they are as effective as gentamicin  Learn more about the treatments for Mnire's disease."}]}
{"messages": [{"role": "user", "content": "How to prevent Balance Problems ?"}, {"role": "assistant", "content": "Scientists are working to understand the complex interactions between the brain and the part of the inner ear responsible for balance. They are also studying the effectiveness of certain exercises as a treatment option for balance disorders. An NIDCD-supported clinical trial in benign paroxysmal positioning vertigo (BPPV) showed that repositioning maneuvers work well, and offered clinicians a range of choices in selecting the treatment best suited to each individuals unique needs. NIDCD-funded researchers have created a virtual reality grocery store. This virtual store is a computer-simulated environment that seems to be a physical place in the real world. It is designed so people with balance disorders can safely walk on a treadmill as they practice looking for items on store shelves. The goal is to help reduce a person's dizziness in confusing environments. NIDCD-supported scientists are also studying the use of a vestibular implant to stop a Mnires attack by restoring normal electrical activity in the vestibular nerve. This nerve conveys balance information to the brain. The device uses the same technology found in a cochlear implant, a medical device that currently provides a sense of sound to people who are deaf or hard-of-hearing."}]}
{"messages": [{"role": "user", "content": "What is (are) Quitting Smoking for Older Adults ?"}, {"role": "assistant", "content": "Many former smokers who are 50 and older say that their main reason for quitting was for their health or due to their doctors advice. Another common reason smokers quit is to be in control of their lives and to be free from cigarettes. A lot of former smokers also said that pleasing or helping a loved one was a big part of their decision to quit. These all are good reasons. The most important reasons for quitting are the ones you decide on for yourself."}]}
{"messages": [{"role": "user", "content": "What causes Quitting Smoking for Older Adults ?"}, {"role": "assistant", "content": "Yes. Smoking is the leading cause of cancer in the United States, and it increases the risk of many types of cancer, including -  lung cancer  - throat cancer  -  mouth cancer  -  nasal cavity cancer (cancer in the airways of the nose)  - esophageal cancer (cancer of the esophagus)  - stomach cancer  -  pancreatic cancer (cancer of the pancreas)  -  kidney cancer   - bladder cancer  -  cervical cancer (cancer of the cervix)  -  acute myeloid leukemia (blood cancer).  lung cancer throat cancer  mouth cancer  nasal cavity cancer (cancer in the airways of the nose) esophageal cancer (cancer of the esophagus) stomach cancer  pancreatic cancer (cancer of the pancreas)  kidney cancer  bladder cancer  cervical cancer (cancer of the cervix)  acute myeloid leukemia (blood cancer). If you smoke, you are up to 10 times more likely to get cancer than a person who has never smoked. This depends on how much and how long you smoked."}]}
{"messages": [{"role": "user", "content": "What is (are) Quitting Smoking for Older Adults ?"}, {"role": "assistant", "content": "One of the keys to successfully quitting is preparation. A great way to prepare to quit smoking is to create a quit plan. Quit plans - keep you focused on quit smoking strategies that can help you be confident and motivated to quit   - help you identify challenges you will face as you quit and ways to overcome them   -  can improve your chances of quitting smoking for good.  keep you focused on quit smoking strategies that can help you be confident and motivated to quit help you identify challenges you will face as you quit and ways to overcome them can improve your chances of quitting smoking for good. Use these steps to create your own customized quit plan. Pick a Quit Date. Make a list of reasons to quit. Decide where you will get support. Decide on your Quit methods. Plan how to avoid your triggers. Plan how to overcome cravings and urges. Decide how to reward yourself after certain milestones. Plan what to do the day before your Quit Date. Here are some quit plan resources. -  Check out  Worksheets for Your Quit Plan on this website.   -  See \"Start Your Quit Plan Online Today\" at  SmokeFree 60Plus, a quit-smoking website from the National Cancer Institute.  -  Learn about the  Quit Guide from the Centers from Disease Control and Prevention (CDC).  Check out  Worksheets for Your Quit Plan on this website. See \"Start Your Quit Plan Online Today\" at  SmokeFree 60Plus, a quit-smoking website from the National Cancer Institute. Learn about the  Quit Guide from the Centers from Disease Control and Prevention (CDC)."}]}
{"messages": [{"role": "user", "content": "What is (are) Quitting Smoking for Older Adults ?"}, {"role": "assistant", "content": "Quitlines are free, anonymous telephone counseling services. These programs have helped more than 3 million smokers. When you call a quitline, you talk to a trained counselor who can help you develop a strategy for quitting or help you stay on track. The counselor can provide material that could improve your chances of quitting. - You can call the National Cancer Institutes Smoking Quitline at (877) 44U-QUIT or (877) 448-7848 between 8:00 a.m. and 8:00 p.m. Eastern Time.  You can call the National Cancer Institutes Smoking Quitline at (877) 44U-QUIT or (877) 448-7848 between 8:00 a.m. and 8:00 p.m. Eastern Time. - You can also call your states quitline. Call (800) QUIT-NOW or (800) 784-8669 to be connected with free resources about quitting and counseling information in your state.  You can also call your states quitline. Call (800) QUIT-NOW or (800) 784-8669 to be connected with free resources about quitting and counseling information in your state. - If you are a veteran, you can call (855)-QUIT VET or (855) 784-8838 between 8:00 a.m. and 8:00 p.m. Eastern Time on Mondays through Fridays.  If you are a veteran, you can call (855)-QUIT VET or (855) 784-8838 between 8:00 a.m. and 8:00 p.m. Eastern Time on Mondays through Fridays. You can also check out SmokeFree 60Plus. a quit-smoking website for older adults developed by the National Cancer Institute."}]}
{"messages": [{"role": "user", "content": "What is (are) Quitting Smoking for Older Adults ?"}, {"role": "assistant", "content": "These quit smoking websites offer you free, accurate information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking. The National Cancer Institute sponsors - Smokefree 60+.gov, a quit-smoking website for older adults  - Smokefree.gov   - SmokefreeWomen   - SmokefreeEspanol    -   SmokefreeVET  Smokefree 60+.gov, a quit-smoking website for older adults Smokefree.gov SmokefreeWomen SmokefreeEspanol   SmokefreeVET Other online resources are -   Be Tobacco Free , a website from the U.S. Department of Health and Human Services  -  A  Quit Guide from the Centers from Disease Control and Prevention (CDC).   Be Tobacco Free , a website from the U.S. Department of Health and Human Services A  Quit Guide from the Centers from Disease Control and Prevention (CDC). Most states also have quit-smoking websites that have resources, such as free supplies of nicotine replacement therapy, informational mailings, and more. Mobile tools can also help, especially when you're on the go. These include text messaging services and free apps. -  See SmokefreeTXT, a text messaging service   -  See QuitSTART and QuitGuide, free quit smoking apps  See SmokefreeTXT, a text messaging service  See QuitSTART and QuitGuide, free quit smoking apps"}]}
{"messages": [{"role": "user", "content": "What is (are) Prostate Cancer ?"}, {"role": "assistant", "content": "How Tumors Form The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong -- cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous. How Prostate Cancer Occurs Prostate cancer occurs when a tumor forms in the tissue of the prostate, a gland in the male reproductive system. In its early stage, prostate cancer needs the male hormone testosterone to grow and survive. The prostate is about the size of a large walnut. It is located below the bladder and in front of the rectum. The prostate's main function is to make fluid for semen, a white substance that carries sperm. Prostate cancer is one of the most common types of cancer among American men. It is a slow-growing disease that mostly affects older men. In fact, more than 60 percent of all prostate cancers are found in men over the age of 65. The disease rarely occurs in men younger than 40 years of age. Prostate Cancer Can Spread Sometimes, cancer cells break away from a malignant tumor in the prostate and enter the bloodstream or the lymphatic system and travel to other organs in the body. When cancer spreads from its original location in the prostate to another part of the body such as the bone, it is called metastatic prostate cancer -- not bone cancer. Doctors sometimes call this distant disease. Surviving Prostate Cancer Today, more men are surviving prostate cancer than ever before. Treatment can be effective, especially when the cancer has not spread beyond the region of the prostate."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Prostate Cancer? ?"}, {"role": "assistant", "content": "Scientists don't know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases your chances of getting a disease. Age Age is the most important risk factor for prostate cancer. The disease is extremely rare in men under age 40, but the risk increases greatly with age. More than 60 percent of cases are diagnosed in men over age 65. The average age at the time of diagnosis is 65. Race Race is another major risk factor. In the United States, this disease is much more common in African American men than in any other group of men. It is least common in Asian and American Indian men. Family History A man's risk for developing prostate cancer is higher if his father or brother has had the disease. Other Risk Factors Scientists have wondered whether obesity, lack of exercise, smoking, radiation exposure, might increase risk. But at this time, there is no firm evidence that these factors contribute to an increased risk."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Prostate Cancer ?"}, {"role": "assistant", "content": "Symptoms Most cancers in their early, most treatable stages don't cause any symptoms. Early prostate cancer usually does not cause symptoms. However, if prostate cancer develops and is not treated, it can cause these symptoms: - a need to urinate frequently, especially at night  - difficulty starting urination or holding back urine  - inability to urinate  - weak or interrupted flow of urine  - painful or burning urination  - difficulty in having an erection  - painful ejaculation  - blood in urine or semen  - pain or stiffness in the lower back, hips, or upper thighs. a need to urinate frequently, especially at night difficulty starting urination or holding back urine inability to urinate weak or interrupted flow of urine painful or burning urination difficulty in having an erection painful ejaculation blood in urine or semen pain or stiffness in the lower back, hips, or upper thighs. Any of these symptoms may be caused by cancer, but more often they are due to enlargement of the prostate, which is not cancer. If You Have Symptoms If you have any of these symptoms, see your doctor or a urologist to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system. The doctor will ask questions about your medical history and perform an exam to try to find the cause of the prostate problems. The PSA Test The doctor may also suggest a blood test to check your prostate specific antigen, or PSA, level. PSA levels can be high not only in men who have prostate cancer, but also in men with an enlarged prostate gland and men with infections of the prostate. PSA tests may be very useful for early cancer diagnosis. However, PSA tests alone do not always tell whether or not cancer is present. PSA screening for prostate cancer is not perfect. (Screening tests check for disease in a person who shows no symptoms.) Most men with mildly elevated PSA do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. A recent study revealed that men with low prostate specific antigen levels, or PSA, may still have prostate cancer. Also, the digital rectal exam can miss many prostate cancers. Other Tests The doctor may order other exams, including ultrasound, MRI, or CT scans, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope. If Cancer is Present If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "If tests show that you have cancer, you should talk with your doctor in order to make treatment decisions. Working With a Team of Specialists A team of specialists often treats people with cancer. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. Clinical Trials for Prostate Cancer Some prostate cancer patients take part in studies of new treatments. These studies -- called clinical trials -- are designed to find out whether a new treatment is safe and effective. Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. Men with prostate cancer who are interested in taking part in a clinical trial should talk with their doctor. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Click here to see a list of the current clinical trials on prostate cancer. A separate window will open. Click the \"x\" in the upper right hand corner of the \"Clinical Trials\" window to return here."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "Choosing Treatment There are a number of ways to treat prostate cancer, and the doctor will develop a treatment to fit each man's needs. The choice of treatment mostly depends on the stage of the disease and the grade of the tumor. But doctors also consider a man's age, general health, and his feelings about the treatments and their possible side effects. Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, or hormonal therapy. Some men receive a combination of therapies. A cure is the goal for men whose prostate cancer is diagnosed early. Weighing Treatment Options You and your doctor will want to consider both the benefits and possible side effects of each option, especially the effects on sexual activity and urination, and other concerns about quality of life. Surgery, radiation therapy, and hormonal therapy all have the potential to disrupt sexual desire or performance for a short while or permanently. Discuss your concerns with your health care provider. Several options are available to help you manage sexual problems related to prostate cancer treatment. Watchful Waiting The doctor may suggest watchful waiting for some men who have prostate cancer that is found at an early stage and appears to be growing slowly. Also, watchful waiting may be advised for older men or men with other serious medical problems. For these men, the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits. Doctors monitor these patients with regular check-ups. If symptoms appear or get worse, the doctor may recommend active treatment. Surgery Surgery is used to remove the cancer. It is a common treatment for early stage prostate cancer. The surgeon may remove the entire prostate with a type of surgery called radical prostatectomy or, in some cases, remove only part of it. Sometimes the surgeon will also remove nearby lymph nodes. Side effects of the operation may include lack of sexual function or impotence, or problems holding urine or incontinence. Improvements in surgery now make it possible for some men to keep their sexual function. In some cases, doctors can use a technique known as nerve-sparing surgery. This may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery. Some men with trouble holding urine may regain control within several weeks of surgery. Others continue to have problems that require them to wear a pad. Radiation Therapy Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Doctors may recommend it instead of surgery, or after surgery, to destroy any cancer cells that may remain in the area. In advanced stages, the doctor may recommend radiation to relieve pain or other symptoms. It may also be used in combination with hormonal therapy. Radiation can cause problems with impotence and bowel function. The radiation may come from a machine, which is external radiation, or from tiny radioactive seeds placed inside or near the tumor, which is internal radiation. Men who receive only the radioactive seeds usually have small tumors. Some men receive both kinds of radiation therapy. For external radiation therapy, patients go to the hospital or clinic -- usually for several weeks. Internal radiation may require patients to stay in the hospital for a short time. Hormonal Therapy Hormonal therapy deprives cancer cells of the male hormones they need to grow and survive. This treatment is often used for prostate cancer that has spread to other parts of the body. Sometimes doctors use hormonal therapy to try to keep the cancer from coming back after surgery or radiation treatment. Side effects can include impotence, hot flashes, loss of sexual desire, and thinning of bones. Some hormone therapies increase the risk of blood clots. Monitoring Treatment Regardless of the type of treatment you receive, you will be closely monitored to see how well the treatment is working. Monitoring may include - a PSA blood test -- usually every 3 months to 1 year.  - bone scan and/or CT scan to see if the cancer has spread.  - a complete blood count to monitor for signs and symptoms of anemia.  - looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function. a PSA blood test -- usually every 3 months to 1 year. bone scan and/or CT scan to see if the cancer has spread. a complete blood count to monitor for signs and symptoms of anemia. looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Prostate Cancer ?"}, {"role": "assistant", "content": "Scientists continue to look at new ways to prevent, treat, and diagnose prostate cancer. Research has already led to a number of advances in these areas. Dietary Research Several studies are under way to explore the causes of prostate cancer. Some researchers think that diet may affect a man's chances of developing prostate cancer. For example, some studies show that prostate cancer is more common in populations that consume a high-fat diet, particularly animal fat, and in populations with diets that lack certain nutrients. Research on Testosterone Some research suggests that high levels of testosterone may increase a man's risk of prostate cancer. The difference in prostate cancer risk among racial groups could be related to high testosterone levels, but it also could result from diet or other lifestyle factors. Genetic Research Researchers are studying changes in genes that may increase the risk for developing prostate cancer. Some studies are looking at the genes of men who were diagnosed with prostate cancer at a relatively young age, such as less than 55 years old, and the genes of families who have several members with the disease. Other studies are trying to identify which genes, or arrangements of genes, are most likely to lead to prostate cancer. Much more work is needed, however, before scientists can say exactly how genetic changes relate to prostate cancer. Prevention Research Several studies have explored ways to prevent prostate cancer. In October 2008, initial results of a study on the use of the dietary supplements vitamin E and selenium found that they did not provide any benefit in reducing the number of new cases of the disease. A few studies suggest that a diet that regularly includes tomato-based foods may help protect men from prostate cancer, but there are no studies that conclusively prove this hypothesis. According to results of a study that was re-analyzed in 2013, men who took finasteride, a drug that affects male hormone levels, reduced their chances of getting prostate cancer by nearly 30 percent compared to men who took a placebo. Unlike earlier findings from this study, this new analysis showed no increased risk of late stage disease due to use of finasteride. Stopping Prostate Cancer from Returning Scientists are also looking at ways to stop prostate cancer from returning in men who have already been treated for the disease. These approaches use drugs such as finasteride, flutamide, nilutamide, and LH-RH agonists that manipulate hormone levels. In 2010, the FDA approved a therapeutic cancer vaccine, Provenge, for use in some men with metastatic prostate cancer. Provenge may provide a 4-month improvement in overall survival compared with a placebo vaccine. Other similar vaccine therapies are in development. Research on New Blood Tests Some researchers are working to develop new blood tests to detect the antibodies that the immune system produces to fight prostate cancer. When used along with PSA testing, the antibody tests may provide more accurate results about whether or not a man has prostate cancer. Researching New Approaches to Treatment Through research, doctors are trying to find new, more effective ways to treat prostate cancer. Cryosurgery -- destroying cancer by freezing it -- is under study as an alternative to surgery and radiation therapy. To avoid damaging healthy tissue, the doctor places an instrument known as a cryoprobe in direct contact with the tumor to freeze it. Doctors are studying new ways of using radiation therapy and hormonal therapy, too. Studies have shown that hormonal therapy given after radiation therapy can help certain men whose cancer has spread to nearby tissues. Scientists are also testing the effectiveness of chemotherapy and biological therapy for men whose cancer does not respond, or stops responding, to hormonal therapy. They are also exploring new ways to schedule and combine various treatments. For example, they are studying hormonal therapy to find out if using it to shrink the tumor before a man has surgery or radiation might be a useful approach. For men with early stage prostate cancer, researchers are also comparing treatment with watchful waiting. The results of this work will help doctors know whether to treat early stage prostate cancer immediately or only later on, if symptoms occur or worsen."}]}
{"messages": [{"role": "user", "content": "What is (are) Prostate Cancer ?"}, {"role": "assistant", "content": "The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong -- cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous."}]}
{"messages": [{"role": "user", "content": "What is (are) Prostate Cancer ?"}, {"role": "assistant", "content": "The prostate is a male sex gland, about the size of a large walnut. It is located below the bladder and in front of the rectum. The prostate's main function is to make fluid for semen, a white substance that carries sperm. Prostate cancer occurs when a tumor forms in the tissue of the prostate. In its early stage, prostate cancer needs the male hormone testosterone to grow and survive."}]}
{"messages": [{"role": "user", "content": "How many people are affected by Prostate Cancer ?"}, {"role": "assistant", "content": "Prostate cancer is one of the most common types of cancer among American men. It is a slow-growing disease that mostly affects older men. In fact, more than 60 percent of all prostate cancers are found in men over the age of 65. The disease rarely occurs in men younger than 40 years of age."}]}
{"messages": [{"role": "user", "content": "What is (are) Prostate Cancer ?"}, {"role": "assistant", "content": "Sometimes, cancer cells break away from the malignant tumor in the prostate and enter the bloodstream or the lymphatic system and travel to other organs in the body. When cancer spreads from its original location in the prostate to another part of the body such as the bone, it is called metastatic prostate cancer, not bone cancer. Doctors sometimes call this \"distant\" disease."}]}
{"messages": [{"role": "user", "content": "What causes Prostate Cancer ?"}, {"role": "assistant", "content": "Scientists don't know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases your chances of getting a disease."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Prostate Cancer? ?"}, {"role": "assistant", "content": "Age is the most important risk factor for prostate cancer. The disease is extremely rare in men under age 40, but the risk increases greatly with age. More than 60 percent of cases are diagnosed in men over age 65. The average age at the time of diagnosis is 65."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Prostate Cancer? ?"}, {"role": "assistant", "content": "Yes. Race is another major risk factor. In the United States, this disease is much more common in African American men than in any other group of men. It is least common in Asian and American Indian men. A man's risk for developing prostate cancer is higher if his father or brother has had the disease. Diet also may play a role. There is some evidence that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk. Studies to find out whether men can reduce their risk of prostate cancer by taking certain dietary supplements are ongoing."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Prostate Cancer? ?"}, {"role": "assistant", "content": "Scientists have wondered whether obesity, lack of exercise, smoking, and radiation exposure, might increase risk. But at this time, there is no conclusive evidence that any of these factors contribute to an increased risk."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Prostate Cancer ?"}, {"role": "assistant", "content": "- a need to urinate frequently, especially at night  - difficulty starting urination or holding back urine  - inability to urinate  - weak or interrupted flow of urine a need to urinate frequently, especially at night difficulty starting urination or holding back urine inability to urinate weak or interrupted flow of urine If prostate cancer develops and is not treated, it can cause these symptoms: - painful or burning urination  - difficulty in having an erection  - painful ejaculation  - blood in urine or semen  - pain or stiffness in the lower back, hips, or upper thighs painful or burning urination difficulty in having an erection painful ejaculation blood in urine or semen pain or stiffness in the lower back, hips, or upper thighs"}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Prostate Cancer ?"}, {"role": "assistant", "content": "Yes. Any of the symptoms caused by prostate cancer may also be due to enlargement of the prostate, which is not cancer. If you have any of the symptoms mentioned in question #10, see your doctor or a urologist to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system."}]}
{"messages": [{"role": "user", "content": "How to diagnose Prostate Cancer ?"}, {"role": "assistant", "content": "Doctors use tests to detect prostate abnormalities, but tests cannot show whether abnormalities are cancer or another, less serious condition. The results from these tests will help the doctor decide whether to check the patient further for signs of cancer. The most common test is a blood test for prostate specific antigen or PSA -- a lab measures the levels of PSA in a blood sample. The level of PSA may rise in men who have prostate cancer, an enlarged prostate, or infection in the prostate."}]}
{"messages": [{"role": "user", "content": "How to diagnose Prostate Cancer ?"}, {"role": "assistant", "content": "The doctor may order other exams, including ultrasound, MRI, or CT scans, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope. If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "There are a number of ways to treat prostate cancer, and the doctor will develop a treatment to fit each man's needs. The choice of treatment mostly depends on the stage of the disease and the grade of the tumor. But doctors also consider a man's age, general health, and his feelings about the treatments and their possible side effects. Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, or hormonal therapy. Some men receive a combination of therapies. A cure is probable for men whose prostate cancer is diagnosed early."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "Surgery, radiation therapy, and hormonal therapy all have the potential to disrupt sexual desire or performance for a short while or permanently. Discuss your concerns with your health care provider. Several options are available to help you manage sexual problems related to prostate cancer treatment."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "With watchful waiting, a man's condition is closely monitored, but treatment does not begin until symptoms appear or change. The doctor may suggest watchful waiting for some men who have prostate cancer that is found at an early stage and appears to be growing slowly. Also, watchful waiting may be advised for older men or men with other serious medical problems. For these men, the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits. Doctors monitor these patients with regular check-ups. If symptoms appear or get worse, the doctor may recommend active treatment."}]}
{"messages": [{"role": "user", "content": "What is (are) Prostate Cancer ?"}, {"role": "assistant", "content": "Surgery is a common treatment for early stage prostate cancer. It is used to remove the cancer. The surgeon may remove the entire prostate -- a type of surgery called radical prostatectomy -- or, in some cases, remove only part of it. Sometimes the surgeon will also remove nearby lymph nodes. Side effects may include lack of sexual function (impotence), or problems holding urine (incontinence)."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Doctors may recommend it instead of surgery or after surgery to destroy any cancer cells that may remain in the area. In advanced stages, the doctor may recommend it to relieve pain or other symptoms. Radiation can cause problems with impotence and bowel function. The radiation may come from a machine, which is external radiation, or from tiny radioactive seeds placed inside or near the tumor, which is internal radiation. Men who receive only the radioactive seeds usually have small tumors. Some men receive both kinds of radiation therapy. For external radiation therapy, patients go to the hospital or clinic -- usually 5 days a week for several weeks. Internal radiation may require patients to stay in the hospital for a short time."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "Hormonal therapy deprives cancer cells of the male hormones they need to grow and survive. This treatment is often used for prostate cancer that has spread to other parts of the body. Sometimes doctors use hormonal therapy to try to keep the cancer from coming back after surgery or radiation treatment. Side effects can include impotence, hot flashes, loss of sexual desire, and thinning of bones."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "Regardless of the type of treatment you receive, you will be closely monitored to see how well the treatment is working. Monitoring may include - a PSA blood test, usually every 3 months to 1 year.  - bone scan and/or CT scan to see if the cancer has spread. a PSA blood test, usually every 3 months to 1 year. bone scan and/or CT scan to see if the cancer has spread. - a complete blood count to monitor for signs and symptoms of anemia.  - looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function. a complete blood count to monitor for signs and symptoms of anemia. looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Prostate Cancer ?"}, {"role": "assistant", "content": "Through research, doctors are trying to find new, more effective ways to treat prostate cancer. Cryosurgery -- destroying cancer by freezing it -- is under study as an alternative to surgery and radiation therapy. To avoid damaging healthy tissue, the doctor places an instrument known as a cryoprobe in direct contact with the tumor to freeze it. Doctors are studying new ways of using radiation therapy and hormonal therapy, too. Studies have shown that hormonal therapy given after radiation therapy can help certain men whose cancer has spread to nearby tissues. Scientists are also testing the effectiveness of chemotherapy and biological therapy for men whose cancer does not respond or stops responding to hormonal therapy. They are also exploring new ways to schedule and combine various treatments. For example, they are studying hormonal therapy to find out if using it to shrink the tumor before a man has surgery or radiation might be a useful approach. They are also testing combinations of hormone therapy and vaccines to prevent recurrence of prostate cancer. In 2010, the FDA approved a therapeutic cancer vaccine, Provenge, for use in some men with metastatic prostate cancer. This approval was based on the results of a clinical trial that demonstrated a more than 4-month improvement in overall survival compared with a placebo vaccine. Other similar vaccine therapies are in development."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Prostate Cancer? ?"}, {"role": "assistant", "content": "Researchers are studying changes in genes that may increase the risk for developing prostate cancer. Some studies are looking at the genes of men who were diagnosed with prostate cancer at a relatively young age, less than 55 years old, and the genes of families who have several members with the disease. Other studies are trying to identify which genes, or arrangements of genes, are most likely to lead to prostate cancer. Much more work is needed, however, before scientists can say exactly how genetic changes relate to prostate cancer. At the moment, no genetic risk has been firmly established."}]}
{"messages": [{"role": "user", "content": "What is (are) Dry Mouth ?"}, {"role": "assistant", "content": "Dry mouth is the feeling that there is not enough saliva in the mouth. Everyone has dry mouth once in a while -- if they are nervous, upset, under stress, or taking certain medications. But if you have dry mouth all or most of the time, see a dentist or physician. Many older adults have dry mouth, but it is not a normal part of aging. (Watch the video to learn more about dry mouth. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Why Saliva is Important Saliva does more than keep your mouth wet. It protects teeth from decay, helps heal sores in your mouth, and prevents infection by controlling bacteria, viruses, and fungi in the mouth. Saliva helps digest food and helps us chew and swallow. Saliva is involved in taste perception as well. Each of these functions of saliva is hampered when a person has dry mouth. How Dry Mouth Feels Dry mouth can be uncomfortable. Some people notice a sticky, dry feeling in the mouth. Others notice a burning feeling or difficulty while eating. The throat may feel dry, too, making swallowing difficult and choking common. Also, people with dry mouth may get mouth sores, cracked lips, and a dry, rough tongue."}]}
{"messages": [{"role": "user", "content": "What causes Dry Mouth ?"}, {"role": "assistant", "content": "People get dry mouth when the glands in the mouth that make saliva are not working properly. Because of this, there might not be enough saliva to keep your mouth healthy. There are several reasons why these glands, called salivary glands, might not work right. Medicines and Dry Mouth More than 400 medicines, including some over-the-counter medications, can cause the salivary glands to make less saliva, or to change the composition of the saliva so that it can't perform the functions it should. As an example, medicines for urinary incontinence, allergies, high blood pressure, and depression often cause dry mouth. Diseases That Can Cause Dry Mouth Some diseases can affect the salivary glands. Dry mouth can occur in patients with diabetes. Dry mouth is also the hallmark symptom of the fairly common autoimmune disease Sjgren's syndrome. Sjgren's syndrome can occur either by itself or with another autoimmune disease like rheumatoid arthritis or lupus. Salivary and tear glands are the major targets of the syndrome and the result is a decrease in production of saliva and tears. The disorder can occur at any age, but the average person with the disorder at the Sjgren's Syndrome Clinic of the National Institute of Dental and Craniofacial Research (NIDCR) is in his or her late 50s. Women with the disorder outnumber men 9 to 1. Cancer Treatments and Dry Mouth Certain cancer treatments can affect the salivary glands. Head and neck radiation therapy can cause the glands to produce little or no saliva. Chemotherapy may cause the salivary glands to produce thicker saliva, which makes the mouth feel dry and sticky. Injury to the head or neck can damage the nerves that tell salivary glands to make saliva."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Dry Mouth ?"}, {"role": "assistant", "content": "Treatment for Dry Mouth  Dry mouth treatment will depend on what is causing the problem. If you think you have dry mouth, see your dentist or physician. He or she can help to determine what is causing your dry mouth. If your dry mouth is caused by medicine, your physician might change your medicine or adjust the dosage. If your salivary glands are not working right but can still produce some saliva, your dentist or physician might give you a medicine that helps the glands work better. Your dentist or physician might also suggest that you use artificial saliva to keep your mouth wet. Do's and Don'ts Do's - Do drink water or sugarless drinks often. That will make chewing and swallowing easier when eating.  - Do chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow.  - Do use a humidifier at night to promote moisture in the air while you sleep. Do drink water or sugarless drinks often. That will make chewing and swallowing easier when eating. Do chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow. Do use a humidifier at night to promote moisture in the air while you sleep. Donts - Don't consume drinks with caffeine such as coffee, tea, and some sodas. Caffeine can dry out the mouth.  - Don't use tobacco or alcohol. They dry out the mouth. Don't consume drinks with caffeine such as coffee, tea, and some sodas. Caffeine can dry out the mouth. Don't use tobacco or alcohol. They dry out the mouth. Gene Therapy Research for Salivary Gland Dysfunction Scientists at NIHs National Institute of Dental and Craniofacial Research (NIDCR) are exploring the potential use of gene therapy to treat salivary gland dysfunction. The idea is to transfer additional or replacement genes into the salivary glands of people with Sjgren's syndrome and cancer patients whose salivary glands were damaged during radiation treatment. The hope is that these genes will increase the production of saliva and eliminate the chronic parched sensation that bothers people with dry mouth conditions. NIDCR recently completed a clinical study, a research study in humans, on gene therapy for radiation-damaged salivary glands. The study showed that gene therapy can be safely performed in salivary glands and that it has the potential to help head and neck cancer survivors with dry mouth. Read NIDCRs news release  to learn more about the studys findings. Based on the promising results of this trial, similar clinical trials are planned in the near future. Research on Sjgrens Syndrome and Other Diseases Affecting Salivary Glands NIDCR is also conducting clinical trials to study new approaches for improving salivary flow in patients with Sjogrens syndrome. Such studies include testing the effectiveness of a monoclonal antibody as well as a corticosteroid to see whether either of these treatments helps improve salivary flow. Other studies are focused on learning how diseases such as diabetes, auto inflammatory diseases, and granulomatous diseases cause salivary gland dysfunction. Such studies could one day lead to better ways of preventing and treating salivary gland conditions. To stay abreast of any new studies on gene therapy and salivary gland function, visit ClinicalTrials.gov.  ClinicalTrials.gov lists all federally and many privately funded clinical trials in the U.S. and around the world; the web site is updated frequently."}]}
{"messages": [{"role": "user", "content": "What is (are) Dry Mouth ?"}, {"role": "assistant", "content": "Dry mouth is the condition of not having enough saliva, or spit, to keep your mouth wet. Everyone has dry mouth once in a while -- if they are nervous, upset, or under stress. But if you have dry mouth all or most of the time, it can be uncomfortable and lead to serious health problems. Though many older adults have dry mouth, it is not a normal part of aging. (Watch the video to learn more about dry mouth. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What is (are) Dry Mouth ?"}, {"role": "assistant", "content": "Saliva does more than keep your mouth wet. It helps digest food, protects teeth from decay, helps to heal sores in your mouth, and prevents infection by controlling bacteria, viruses, and fungi in the mouth. Saliva is also what helps us chew and swallow. Each of these functions of saliva is hampered when a person has dry mouth."}]}
{"messages": [{"role": "user", "content": "What causes Dry Mouth ?"}, {"role": "assistant", "content": "Dry mouth can cause several problems, including difficulty tasting, chewing, swallowing, and speaking. Swallowing may be especially difficult for those with too little saliva. For example, people with dry mouth may be unable to swallow dry food at all unless they also drink fluids with food. They also need to take small bites of food and be very aware of chewing and swallowing so they don't choke. Dry mouth may also increase the chance of developing dental decay as well as oral fungal infections such as thrush, which causes painful white patches in the mouth."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Dry Mouth ?"}, {"role": "assistant", "content": "Dry mouth can be uncomfortable. Some people notice a sticky, dry feeling in the mouth. Others notice a burning feeling or difficulty while eating. The throat may feel dry, too, and swallowing without extra fluids can often be difficult. Also, people with dry mouth may develop mouth sores, cracked lips, and a dry, rough tongue."}]}
{"messages": [{"role": "user", "content": "What causes Dry Mouth ?"}, {"role": "assistant", "content": "Yes. More than 400 medicines, including some over-the-counter medications, can cause the salivary glands to make less saliva, or to change the composition of the saliva so that it can't perform the functions it should. As an example, medicines for urinary incontinence, allergies, high blood pressure, and depression often cause dry mouth."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Dry Mouth ?"}, {"role": "assistant", "content": "Certain cancer treatments can affect the salivary glands. Head and neck radiation therapy can cause the glands to produce little or no saliva. Chemotherapy may cause the salivary glands to produce thicker saliva, which makes the mouth feel dry and sticky."}]}
{"messages": [{"role": "user", "content": "What causes Dry Mouth ?"}, {"role": "assistant", "content": "Some diseases affect the salivary glands. Sjgren's syndrome and diabetes can cause dry mouth. Injury to the head or neck can damage the nerves that tell salivary glands to make saliva."}]}
{"messages": [{"role": "user", "content": "What is (are) Dry Mouth ?"}, {"role": "assistant", "content": "Sjgren's Syndrome Clinic  National Institute of Dental and Craniofacial Research  Building 10, Room 1N113  10 Center Drive MSC 1190  Bethesda, MD 20892-1190  301-435-8528   http://www.nidcr.nih.gov/Research/NIDCRLaboratories/ MolecularPhysiology/SjogrensSyndrome/default.htm"}]}
{"messages": [{"role": "user", "content": "What is (are) Dry Mouth ?"}, {"role": "assistant", "content": "For information about the clinical trial on this topic, visit: http://www.clinicaltrials.gov/ct/show/NCT00372320?order=1. If you would like to read an interview with Dr. Bruce Baum, the study's principal investigator, click on: http://www.nidcr.nih.gov/Research/ ResearchResults/InterviewsOHR/TIS032007.htm."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Dry Mouth ?"}, {"role": "assistant", "content": "Dry mouth treatment will depend on what is causing the problem. If you think you have dry mouth, see your dentist or physician. He or she can help to determine what is causing your dry mouth. If your dry mouth is caused by medicine, your physician might change your medicine or adjust the dosage. If your salivary glands are not working right, but can still produce some saliva, your dentist or physician might give you a special medicine that helps the glands work better. He or she might suggest that you use artificial saliva to keep your mouth wet. (Watch the video to learn how dry mouth is treated. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What is (are) Dry Mouth ?"}, {"role": "assistant", "content": "You should avoid sticky and sugary foods. If you do eat them, brush immediately afterwards. Also, be aware that spicy and salty foods can cause pain in a dry mouth. You should also avoid drinks with caffeine and alcohol. They can dry out the mouth."}]}
{"messages": [{"role": "user", "content": "What is (are) Dry Mouth ?"}, {"role": "assistant", "content": "National Institute of Dental and Craniofacial Research  1 NOHIC Way  Bethesda, MD 20892-3500  (301) 402-7364  http://www.nidcr.nih.gov"}]}
{"messages": [{"role": "user", "content": "What is (are) Osteoporosis ?"}, {"role": "assistant", "content": "A Bone Disease Osteoporosis is a disease that thins and weakens the bones to the point that they become fragile and break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but any bone can be affected. You can't \"catch\" osteoporosis or give it to someone else. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass, placing them at risk for more serious bone loss and fractures. Although osteoporosis can strike at any age, it is most common among older people, especially older women. How Bone Loss Occurs Bone is living tissue. Throughout our lives, the body breaks down old bone and replaces it with new bone. But as people age, more bone is broken down than is replaced. The inside of a bone normally looks like a honeycomb, but when a person has osteoporosis, the spaces inside this honeycomb become larger, reflecting the loss of bone density and strength. (The word \"osteoporosis\" means \"porous bone.\") The outside of long bones -- called the cortex -- also thins, further weakening the bone. Sometime around the age of 30, bone mass stops increasing, and the goal for bone health is to keep as much bone as possible for as long as you can. In most women, the rate of bone loss increases for several years after menopause, then slows down again, but continues. In men, the bone loss occurs more slowly. But by age 65 or 70, most men and women are losing bone at the same rate. Weak Bones Can Lead to Fractures Osteoporosis is often called \"silent\" because bone loss occurs without symptoms. People may not know that they have osteoporosis until a sudden strain, bump, or fall causes a bone to break. This can result in a trip to the hospital, surgery, and possibly a long-term disabling condition. Broken bones in your spine are painful and very slow to heal. People with weak bones in their spine gradually lose height and their posture becomes hunched over. Over time a bent spine can make it hard to walk or even sit up. Broken hips are a very serious problem as we age. They greatly increase the risk of death, especially during the year after they break. People who break a hip might not recover for months or even years. Because they often cannot care for themselves, they are more likely to have to live in a nursing home. Prevention and Treatment The good news is that osteoporosis can often be prevented and treated. Healthy lifestyle choices such as proper diet, exercise, and treatment medications can help prevent further bone loss and reduce the risk of fractures."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Osteoporosis? ?"}, {"role": "assistant", "content": "Risk Factors You Can't Change   Some risk factors for osteoporosis cannot be changed. These include - Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis.  - Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis.  - Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. African-American and Hispanic women are also at risk, but less so.  - Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too.  - History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another. Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis. Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis. Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. African-American and Hispanic women are also at risk, but less so. Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another. Risk Factors You Can Change There are other risk factors for osteoporosis that can be changed. -  Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D -- either from your diet, supplements, or sunlight -- can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health.  - Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise.  - Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies.  Learn more about smoking and bone health.   Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D -- either from your diet, supplements, or sunlight -- can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health. Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise. Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies.  Learn more about smoking and bone health.   - Medications. Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones.   - Low body weight. Women who are thin -- and small-boned -- are at greater risk for osteoporosis.  Medications. Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones. Low body weight. Women who are thin -- and small-boned -- are at greater risk for osteoporosis.  Use this checklist to find out if you are at risk for weak bones.  Many of these risk factors, both ones you can change and ones you cannot change, affect peak bone mass, which is when your bones achieve maximum strength and density. Because high peak bone density can reduce osteoporosis risk later in life, it makes sense to pay more attention to those factors that affect peak bone mass. Learn more about peak bone mass."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Osteoporosis ?"}, {"role": "assistant", "content": "Fractures -- A Possible Warning Sign Osteoporosis does not have any symptoms until a fracture occurs. Women and men with osteoporosis most often break bones in the hip, spine, and wrist. But any fracture in an older person could be a warning sign that the bone is weaker than optimal. Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spine fractures due to osteoporosis. Multiple spine fractures can cause a curved spine, stooped posture, back pain, and back fatigue. Women and men who have had a fracture are at high risk of experiencing another one. A fracture over the age of 50 or several fractures before that age may be a warning sign that a person has already developed osteoporosis. People over the age of 50 who have experienced a fracture should talk to their doctor about getting evaluated for osteoporosis. Risk Factors for Fractures The more likely you are to fall, the higher your risk for a fracture. And more severe falls increase your risk for fractures. Factors that increase your risk of falling and of fracturing a bone include - decreased muscle strength   - poor balance  -  impaired eyesight  - impaired mental abilities   - certain medications, such as tranquilizers and muscle relaxants  - hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks.  decreased muscle strength poor balance impaired eyesight impaired mental abilities certain medications, such as tranquilizers and muscle relaxants hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks. The angle at which you fall also affects your risk of fracture. Hip Fractures Although low bone mass (or low bone density) plays an important role in determining a person's risk of osteoporosis, it is only one of many risk factors for fractures. Various aspects of bone geometry, such as tallness, hip structure, and thighbone (femur) length, can also affect your chances of breaking a bone if you fall. Increasing age, too much weight loss, a history of fractures since age 50, having an existing spine fracture, and having a mother who fractured her hip all increase the risk of hip fracture regardless of a person's bone density. People with more risk factors have a higher chance of suffering a hip fracture."}]}
{"messages": [{"role": "user", "content": "How to diagnose Osteoporosis ?"}, {"role": "assistant", "content": "Who Should Be Tested? The United States Preventive Service Task Force recommends that women aged 65 and older be screened (tested) for osteoporosis, as well as women aged 60 and older who are at increased risk for an osteoporosis-related fracture. However, the decision of whether or not to have a bone density test is best made between a patient and his or her physician. Medicare will usually cover the cost of a bone density test, and a follow up test every 2 years, for female beneficiaries. It also will cover screening and follow up of any male Medicare recipients who have significant risk factors for osteoporosis. When To Talk With a Doctor Consider talking to your doctor about being evaluated for osteoporosis if - you are a man or woman over age 50 or a postmenopausal woman and you break a bone  - you are a woman age 65 or older  - you are a woman younger than 65 and at high risk for fractures   - you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause  - you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss   - you have a chronic illness or are taking a medication that is known to cause bone loss   - you have anorexia nervosa or a history of this eating disorder.  - you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty.  you are a man or woman over age 50 or a postmenopausal woman and you break a bone you are a woman age 65 or older you are a woman younger than 65 and at high risk for fractures you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss you have a chronic illness or are taking a medication that is known to cause bone loss you have anorexia nervosa or a history of this eating disorder. you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty. Diagnosing Osteoporosis Diagnosing osteoporosis involves several steps, starting with a physical exam and a careful medical history, blood and urine tests, and possibly a bone mineral density assessment. When recording information about your medical history, your doctor will ask questions to find out whether you have risk factors for osteoporosis and fractures. The doctor may ask about -  any fractures you have had   -  your lifestyle (including diet, exercise habits, and whether you smoke)  - current or past health problems   - medications that could contribute to low bone mass and increased fracture risk  - your family history of osteoporosis and other diseases   - for women, your menstrual history.  any fractures you have had your lifestyle (including diet, exercise habits, and whether you smoke) current or past health problems medications that could contribute to low bone mass and increased fracture risk your family history of osteoporosis and other diseases for women, your menstrual history. The doctor will also do a physical exam that should include checking for loss of height and changes in posture and may include checking your balance and gait (the way you walk). Bone Density Tests The test used to diagnose osteoporosis is called a bone density test. This test is a measure of how strong -- or dense -- your bones are and can help your doctor predict your risk for having a fracture. Bone density tests are painless, safe, and require no preparation on your part. Bone density tests compare your bone density to the bones of an average healthy young adult. The test result, known as a T-score, tells you how strong your bones are, whether you have osteoporosis or osteopenia (low bone mass that is not low enough to be diagnosed as osteoporosis), and your risk for having a fracture. Some bone density tests measure the strength of the hip, spine, and/or wrist, which are the bones that break most often in people with osteoporosis. Other tests measure bone in the heel or hand. Although no bone density test is 100 percent accurate, it is the single most important diagnostic test to predict whether a person will have a fracture in the future. The most widely recognized bone density test is a central DXA (dual-energy x-ray absorptiometry) scan of the hip and spine. This test shows if you have normal bone density, low bone mass, or osteoporosis. It is also used to monitor bone density changes as a person ages or in response to treatment."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoporosis ?"}, {"role": "assistant", "content": "Who Treats Osteoporosis? Although there is no cure for osteoporosis, it can be treated. If your doctor does not specialize in osteoporosis, he or she can refer you to a specialist. There is not one type of doctor who cares for people with osteoporosis. Many family doctors have been learning about osteoporosis and can treat people who have it. Endocrinologists, rheumatologists, geriatricians, and internists are just a few of the specialists who can provide care to people with osteoporosis.  Here is how to find an appropriate health care professional to treat osteoporosis. The Goal of Treatment The goal of treatment is to prevent fractures. A balanced diet rich in calcium, adequate vitamin D, a regular exercise program, and fall prevention are all important for maintaining bone health. Medications Several medications are approved by the Food and Drug Administration for the treatment of osteoporosis. Since all medications have side effects, it is important to talk to your doctor about which medication is right for you. Bisphosphonates. Several bisphosphonates are approved for the prevention or treatment of osteoporosis. These medications reduce the activity of cells that cause bone loss. - Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. - A few people have muscle, bone, or joint pain while using these medicines.  A few people have muscle, bone, or joint pain while using these medicines. -  Side effects of intravenous bisphosphonates may include flu-like symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates.  Side effects of intravenous bisphosphonates may include flu-like symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates. - The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. Parathyroid hormone. A form of human parathyroid hormone (PTH) is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Use of the drug for more than 2 years is not recommended.  RANK ligand (RANKL) inhibitor. A RANK ligand (RANKL) inhibitor is approved for postmenopausal women with osteoporosis who are at high risk for fracture Estrogen agonists/antagonists. An estrogen agonist/ antagonist (also called a selective estrogen receptor modulator or SERM) is approved for the prevention and treatment of osteoporosis in postmenopausal women. SERMs are not estrogens, but they have estrogen-like effects on some tissues and estrogen-blocking effects on other tissues. Calcitonin. Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. Calcitonin is a hormone involved in calcium regulation and bone metabolism. Estrogen and Hormone Therapy. Estrogen is approved for the treatment of menopausal symptoms and osteoporosis in women after menopause. - Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Osteoporosis ?"}, {"role": "assistant", "content": "Scientists are pursuing a wide range of basic and clinical studies on osteoporosis. Significant advances in preventing and treating osteoporosis continue to be made. Such advances are the direct result of research focused on -  determining the causes and consequences of bone loss at the cellular and tissue levels  - assessing risk factors  - developing new strategies to maintain and even enhance bone density and reduce fracture risk  - exploring the roles of such factors as genetics, hormones, calcium, vitamin D, drugs, and exercise on bone mass. determining the causes and consequences of bone loss at the cellular and tissue levels assessing risk factors developing new strategies to maintain and even enhance bone density and reduce fracture risk exploring the roles of such factors as genetics, hormones, calcium, vitamin D, drugs, and exercise on bone mass.  Get more information about ongoing research on osteoporosis from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) at NIH."}]}
{"messages": [{"role": "user", "content": "What is (are) Osteoporosis ?"}, {"role": "assistant", "content": "Osteoporosis is a disease that thins and weakens the bones to the point that they break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but osteoporosis can be the cause of bone fractures anywhere."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Osteoporosis? ?"}, {"role": "assistant", "content": "Some risk factors for osteoporosis cannot be changed. These include - Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis.  - Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis.  - Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. African-American and Hispanic women are also at risk, but less so.  - Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too.  - History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another. Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis. Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis. Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. African-American and Hispanic women are also at risk, but less so. Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Osteoporosis? ?"}, {"role": "assistant", "content": "Here are risk factors for osteoporosis that you can control. -  Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D -- either from your diet, supplements, or sunlight -- can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health.  - Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise.  - Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies.  Learn more about smoking and bone health.    - Medications.  Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones.  - Low body weight. Women who are thin -- and small-boned -- are at greater risk for osteoporosis. Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D -- either from your diet, supplements, or sunlight -- can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health. Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise. Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies.  Learn more about smoking and bone health.  Medications.  Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones. Low body weight. Women who are thin -- and small-boned -- are at greater risk for osteoporosis."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Osteoporosis? ?"}, {"role": "assistant", "content": "If you have any of these red flags, you could be at high risk for weak bones. Talk to your doctor, nurse, pharmacist, or other health care professional. Do any of these apply to you? - ____ Im older than 65.  - ____ Ive broken a bone after age 50.  - ____ My close relative has osteoporosis or has broken a bone.   - ____ My health is fair or poor.   - ____ I smoke.   - ____ I am underweight for my height.  - ____ I started menopause before age 45.  - ____ Ive never gotten enough calcium.  - ____ I have more than two drinks of alcohol several times a week.  - ____ I have poor vision, even with glasses.  - ____ I sometimes fall.  - ____ Im not active.  - ____ I have one of these medical conditions:       - Hyperthyroidism    - Chronic lung disease    - Cancer    - Inflammatory bowel disease    - Chronic hepatic or renal disease    - Hyperparathyroidism    - Vitamin D deficiency    - Cushings disease    - Multiple sclerosis    - Rheumatoid arthritis      ____ Im older than 65. ____ Ive broken a bone after age 50. ____ My close relative has osteoporosis or has broken a bone. ____ My health is fair or poor. ____ I smoke. ____ I am underweight for my height. ____ I started menopause before age 45. ____ Ive never gotten enough calcium. ____ I have more than two drinks of alcohol several times a week. ____ I have poor vision, even with glasses. ____ I sometimes fall. ____ Im not active. ____ I have one of these medical conditions:     - Hyperthyroidism   - Chronic lung disease   - Cancer   - Inflammatory bowel disease   - Chronic hepatic or renal disease   - Hyperparathyroidism   - Vitamin D deficiency   - Cushings disease   - Multiple sclerosis   - Rheumatoid arthritis    - Hyperthyroidism  - Chronic lung disease  - Cancer  - Inflammatory bowel disease  - Chronic hepatic or renal disease  - Hyperparathyroidism  - Vitamin D deficiency  - Cushings disease  - Multiple sclerosis  - Rheumatoid arthritis  Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic hepatic or renal disease Hyperparathyroidism Vitamin D deficiency Cushings disease Multiple sclerosis Rheumatoid arthritis - ____ I take one of these medicines:       - Oral glucocorticoids (steroids)     - Cancer treatments (radiation, chemotherapy)    - Thyroid medicine    - Antiepileptic medications    - Gonadal hormone suppression    - Immunosuppressive agents     ____ I take one of these medicines:     - Oral glucocorticoids (steroids)    - Cancer treatments (radiation, chemotherapy)   - Thyroid medicine   - Antiepileptic medications   - Gonadal hormone suppression   - Immunosuppressive agents   - Oral glucocorticoids (steroids)   - Cancer treatments (radiation, chemotherapy)  - Thyroid medicine  - Antiepileptic medications  - Gonadal hormone suppression  - Immunosuppressive agents Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents"}]}
{"messages": [{"role": "user", "content": "Who is at risk for Osteoporosis? ?"}, {"role": "assistant", "content": "Women have smaller bones, and they lose bone more rapidly than men because of hormone changes that occur after menopause. Therefore, women are at higher risk for osteoporosis."}]}
{"messages": [{"role": "user", "content": "How to prevent Osteoporosis ?"}, {"role": "assistant", "content": "Preventing falls is a special concern for men and women with osteoporosis. Falls can increase the likelihood of fracturing a bone in the hip, wrist, spine, or other part of the skeleton. In addition to the environmental factors listed below, falls can also be caused by impaired vision or balance, chronic diseases that affect mental or physical functioning, and certain medications, such as sedatives and antidepressants. It is also important that individuals with osteoporosis be aware of any physical changes that affect their balance or gait, and that they discuss these changes with their health care provider. Here are some tips to help eliminate the environmental factors that lead to falls.  Outdoors: - Use a cane or walker for added stability.   - Wear rubber-soled shoes for traction.  - Walk on grass when sidewalks are slippery.  - In winter, carry salt or kitty litter to sprinkle on slippery sidewalks.  - Be careful on highly polished floors that become slick and dangerous when wet.  - Use plastic or carpet runners when possible. Use a cane or walker for added stability. Wear rubber-soled shoes for traction. Walk on grass when sidewalks are slippery. In winter, carry salt or kitty litter to sprinkle on slippery sidewalks. Be careful on highly polished floors that become slick and dangerous when wet. Use plastic or carpet runners when possible.  Indoors: -  Keep rooms free of clutter, especially on floors.   - Keep floor surfaces smooth but not slippery.  - Wear supportive, low-heeled shoes even at home.  - Avoid walking in socks, stockings, or slippers.  - Be sure carpets and area rugs have skid-proof backing or are tacked to the floor.  - Be sure stairwells are well lit and that stairs have handrails on both sides.  - Install grab bars on bathroom walls near tub, shower, and toilet.  - Use a rubber bath mat in shower or tub.  - Keep a flashlight with fresh batteries beside your bed.  - If using a step stool for hard-to-reach areas, use a sturdy one with a handrail and wide steps.  - Add ceiling fixtures to rooms lit by lamps.  - Consider purchasing a cordless phone so that you dont have to rush to answer the phone when it rings, or so that you can call for help if you do fall. Keep rooms free of clutter, especially on floors. Keep floor surfaces smooth but not slippery. Wear supportive, low-heeled shoes even at home. Avoid walking in socks, stockings, or slippers. Be sure carpets and area rugs have skid-proof backing or are tacked to the floor. Be sure stairwells are well lit and that stairs have handrails on both sides. Install grab bars on bathroom walls near tub, shower, and toilet. Use a rubber bath mat in shower or tub. Keep a flashlight with fresh batteries beside your bed. If using a step stool for hard-to-reach areas, use a sturdy one with a handrail and wide steps. Add ceiling fixtures to rooms lit by lamps. Consider purchasing a cordless phone so that you dont have to rush to answer the phone when it rings, or so that you can call for help if you do fall. Learn more about devices that can help prevent falls in older adults."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Osteoporosis? ?"}, {"role": "assistant", "content": "The more likely you are to fall, the higher your risk for a fracture. And more severe falls increase your risk for fractures. Factors that increase your risk of falling and of fracturing a bone include - decreased muscle strength   - poor balance  -  impaired eyesight  - impaired mental abilities   - certain medications, such as tranquilizers and muscle relaxants  - hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks.  decreased muscle strength poor balance impaired eyesight impaired mental abilities certain medications, such as tranquilizers and muscle relaxants hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks."}]}
{"messages": [{"role": "user", "content": "What is (are) Osteoporosis ?"}, {"role": "assistant", "content": "If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid high-impact exercise to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis. If you have health problemssuch as heart trouble, high blood pressure, diabetes, or obesityor if you aren't used to energetic activity, check with your doctor before you begin a regular exercise program."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Osteoporosis ?"}, {"role": "assistant", "content": "Osteoporosis does not have any symptoms until a fracture occurs. Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spinal fractures due to osteoporosis. People who have experienced a fracture are at high risk of having another one. A fracture over the age of 50 or several fractures before that age may be a warning sign that a person has already developed osteoporosis. Any fracture in an older person should be followed up for suspicion of osteoporosis."}]}
{"messages": [{"role": "user", "content": "What is (are) Osteoporosis ?"}, {"role": "assistant", "content": "Consider talking to your doctor about being evaluated for osteoporosis if - you are a man or woman over age 50 or a postmenopausal woman and you break a bone  - you are a woman age 65 or older  - you are a woman younger than 65 and at high risk for fractures   - you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause  - you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss   - you have a chronic illness or are taking a medication that is known to cause bone loss   - you have anorexia nervosa or a history of this eating disorder.  - you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty.  you are a man or woman over age 50 or a postmenopausal woman and you break a bone you are a woman age 65 or older you are a woman younger than 65 and at high risk for fractures you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss you have a chronic illness or are taking a medication that is known to cause bone loss you have anorexia nervosa or a history of this eating disorder. you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty.  Here is how to find an appropriate health care professional to treat osteoporosis."}]}
{"messages": [{"role": "user", "content": "How to diagnose Osteoporosis ?"}, {"role": "assistant", "content": "Diagnosing osteoporosis involves several steps, starting with a physical exam and a careful medical history, blood and urine tests, and possibly a bone mineral density assessment. When recording information about your medical history, your doctor will ask questions to find out whether you have risk factors for osteoporosis and fractures. The doctor may ask about -  any fractures you have had   -  your lifestyle (including diet, exercise habits, and whether you smoke)  - current or past health problems   - medications that could contribute to low bone mass and increased fracture risk  - your family history of osteoporosis and other diseases   - for women, your menstrual history.  any fractures you have had your lifestyle (including diet, exercise habits, and whether you smoke) current or past health problems medications that could contribute to low bone mass and increased fracture risk your family history of osteoporosis and other diseases for women, your menstrual history."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoporosis ?"}, {"role": "assistant", "content": "A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk. Nutrition.  The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in balanced proportion. In particular, calcium and vitamin D are needed for strong bones and for your heart, muscles, and nerves to function properly.   Exercise. Exercise is an important component of an osteoporosis prevention and treatment program. Exercise not only improves your bone health, but it increases muscle strength, coordination, and balance, and leads to better overall health. Although exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. As extra insurance against fractures, your doctor can recommend specific exercises to strengthen and support your back. Therapeutic medications.  Several medications are available for the prevention and/or treatment of osteoporosis, including: bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMS); calcitonin; parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor. (Watch the video to learn how exercise helped a 70-year-old woman with osteoporosis. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What are the treatments for Osteoporosis ?"}, {"role": "assistant", "content": "Several medications are approved by the Food and Drug Administration for the treatment of osteoporosis. Since all medications have side effects, it is important to talk to your doctor about which medication is right for you. Bisphosphonates. Several bisphosphonates are approved for the prevention or treatment of osteoporosis. These medications reduce the activity of cells that cause bone loss. - Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. - A few people have muscle, bone, or joint pain while using these medicines.  A few people have muscle, bone, or joint pain while using these medicines. -  Side effects of intravenous bisphosphonates may include flu-like symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates.  Side effects of intravenous bisphosphonates may include flu-like symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates. - The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. Parathyroid hormone. A form of human parathyroid hormone (PTH) is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Use of the drug for more than 2 years is not recommended.  RANK ligand (RANKL) inhibitor. A RANK ligand (RANKL) inhibitor is approved for postmenopausal women with osteoporosis who are at high risk for fracture Estrogen agonists/antagonists. An estrogen agonist/ antagonist (also called a selective estrogen receptor modulator or SERM) is approved for the prevention and treatment of osteoporosis in postmenopausal women. SERMs are not estrogens, but they have estrogen-like effects on some tissues and estrogen-blocking effects on other tissues. Calcitonin. Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. Calcitonin is a hormone involved in calcium regulation and bone metabolism. Estrogen and hormone therapy. Estrogen is approved for the treatment of menopausal symptoms and osteoporosis in women after menopause. - Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first."}]}
{"messages": [{"role": "user", "content": "What is (are) Osteoporosis ?"}, {"role": "assistant", "content": "Millions of Americans are able to lead healthy, productive lives while living with osteoporosis. If you have been feeling symptoms of depressionsuch as loss of appetite, hopelessness, feeling useless and helpless, or having thoughts of suicidefor more than 2 weeks, consult a doctor, social worker, or therapist. Medications and counseling are available to fight depression.  Learn more about the emotional impact of osteoporosis.  Learn more about older adults and depression. (Watch the video to learn more about coping with osteoporosis. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What is (are) Kidney Disease ?"}, {"role": "assistant", "content": "What the Kidneys Do You have two kidneys. They are bean-shaped and about the size of a fist. They are located in the middle of your back, on the left and right of your spine, just below your rib cage. The kidneys filter your blood, removing wastes and extra water to make urine. They also help control blood pressure and make hormones that your body needs to stay healthy. When the kidneys are damaged, wastes can build up in the body. Kidney Function and Aging Kidney function may be reduced with aging. As the kidneys age, the number of filtering units in the kidney may decrease, the overall amount of kidney tissue may decrease, and the blood vessels that supply the kidney may harden, causing the kidneys to filter blood more slowly. If your kidneys begin to filter less well as you age, you may be more likely to have complications from certain medicines. There may be an unsafe buildup of medicines that are removed from your blood by your kidneys. Also, your kidneys may be more sensitive to certain medicines. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) and some antibiotics may harm your kidneys in some situations. The next time you pick up a prescription or buy an over-the-counter medicine or supplement, ask your pharmacist how the product may affect your kidneys and interact with your other medicines. (Watch the video to learn more about what the kidneys do. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Learn more about how the kidneys work.  How Kidney Disease Occurs Kidney disease means the kidneys are damaged and can no longer remove wastes and extra water from the blood as they should. Kidney disease is most often caused by diabetes or high blood pressure. According to the Centers for Disease Control and Prevention, more than 20 million Americans may have kidney disease. Many more are at risk. The main risk factors for developing kidney disease are - diabetes   - high blood pressure   - cardiovascular (heart and blood vessel) disease   - a family history of kidney failure. diabetes high blood pressure cardiovascular (heart and blood vessel) disease a family history of kidney failure. Each kidney contains about one million tiny filtering units made up of blood vessels. These filters are called glomeruli. Diabetes and high blood pressure damage these blood vessels, so the kidneys are not able to filter the blood as well as they used to. Usually this damage happens slowly, over many years. This is called chronic kidney disease. As more and more filtering units are damaged, the kidneys eventually are unable to maintain health. Early kidney disease usually has no symptoms, which means you will not feel different. Blood and urine tests are the only way to check for kidney damage or measure kidney function. If you have diabetes, high blood pressure, heart disease, or a family history of kidney failure, you should be tested for kidney disease. Kidney Failure  Kidney disease can get worse over time, and may lead to kidney failure. Kidney failure means very advanced kidney damage with less than 15% normal function. End-stage renal disease (ESRD) is kidney failure treated by dialysis or kidney transplant. If the kidneys fail, treatment options such as dialysis or a kidney transplant can help replace kidney function. Some patients choose not to treat kidney failure with dialysis or a transplant. If your kidneys fail, talk with your health care provider about choosing a treatment that is right for you. (Watch the video to learn more about how kidney disease progresses. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "How to prevent Kidney Disease ?"}, {"role": "assistant", "content": "Risk Factors Diabetes and high blood pressure are the two leading causes of kidney disease. Both diabetes and high blood pressure damage the small blood vessels in your kidneys and can cause kidney disease -- without you feeling it. Other risk factors for kidney disease include: - cardiovascular (heart) disease  - family history -- if you have a mother, father, sister, or brother who has had kidney failure, then you are at increased risk. cardiovascular (heart) disease family history -- if you have a mother, father, sister, or brother who has had kidney failure, then you are at increased risk. Additionally, African Americans, Hispanics, and Native Americans are at high risk for developing kidney failure. This is in part due to high rates of diabetes and high blood pressure in these communities.  If you have ANY of these risk factors, talk to your health care provider about getting tested for kidney disease. If you have kidney disease, you may not feel any different. It is very important to get tested if you are at risk. (Watch the video to learn more about reducing your risk for kidney disease. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Prevention If you are at risk for kidney disease, the most important steps you can take to keep your kidneys healthy are to - get your blood and urine checked for kidney disease.  - manage your diabetes, high blood pressure, and heart disease. get your blood and urine checked for kidney disease. manage your diabetes, high blood pressure, and heart disease. Manage your diabetes and high blood pressure, and keep your kidneys healthy by -  eating healthy foods: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat dairy foods  - cutting back on salt   - limiting your alcohol intake   - being more physically active   - losing weight if you are overweight   - taking your medicines the way your provider tells you to   - keeping your cholesterol levels in the target range   - taking steps to quit, if you smoke  - seeing your doctor regularly.  eating healthy foods: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat dairy foods cutting back on salt limiting your alcohol intake being more physically active losing weight if you are overweight taking your medicines the way your provider tells you to keeping your cholesterol levels in the target range taking steps to quit, if you smoke seeing your doctor regularly. By following these steps and keeping risk factors under control -- especially your blood pressure -- you may be able to delay or even prevent kidney failure. Talk to your health care provider to find out the steps that are right for you. Learn about preventing high blood pressure.  Learn about preventing type 2 diabetes."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Kidney Disease ?"}, {"role": "assistant", "content": "Kidney Disease Kidney disease is often called a \"silent\" disease, because most people have no symptoms with early kidney disease. In fact, you might feel just fine until your kidneys have almost stopped working. Do NOT wait for symptoms! If you are at risk for kidney disease, talk to your health care provider about getting tested. (Watch the video to learn more about the symptoms of kidney disease. To enlarge the videos on this page, click the brackets in the lower right-hand corner of the video screen. To reduce the videos, press the Escape (Esc) button on your keyboard.) Symptoms of Kidney Failure Kidney failure means that damaged kidneys are filtering less than 15% of the amount of blood filtered by healthy kidneys. If kidney disease progresses to kidney failure, a number of symptoms may occur. Some people experience fatigue, some lose their appetite, and some have leg cramps. These problems are caused by waste products that build up in the blood, a condition known as uremia. Healthy kidneys remove waste products from the blood. When the kidneys stop working, uremia occurs. The kidneys also make hormones and balance the minerals in the blood. When the kidneys stop working, most people develop conditions that affect the blood, bones, nerves, and skin. These problems may include itching, sleep problems, restless legs, weak bones, joint problems, and depression. How Kidney Disease Is Diagnosed  Blood and urine tests are the only way to check for kidney damage or measure kidney function. It is important for you to get checked for kidney disease if you have the key risk factors, which are - diabetes  - high blood pressure   - heart disease  - a family history of kidney failure.  diabetes high blood pressure heart disease a family history of kidney failure. If you are at risk, ask about your kidneys at your next medical appointment. The sooner you know you have kidney disease, the sooner you can get treatment to help delay or prevent kidney failure. If you have diabetes, high blood pressure, heart disease, or a family history of kidney failure, you should get a blood and urine test to check your kidneys. Talk to your provider about how often you should be tested. (Watch the video to learn more about tests for kidney disease.) Blood Test The blood test checks your GFR. GFR stands for glomerular (glow-MAIR-you-lure) filtration rate. GFR is a measure of how much blood your kidneys filter each minute. This shows how well your kidneys are working. GFR is reported as a number. -  A GFR of 60 or higher is in the normal range.   - A GFR below 60 may mean you have kidney disease. However, because GFR decreases as people age, other information may be needed to determine if you actually have kidney disease.  - A GFR of 15 or lower may mean kidney failure.  A GFR of 60 or higher is in the normal range. A GFR below 60 may mean you have kidney disease. However, because GFR decreases as people age, other information may be needed to determine if you actually have kidney disease. A GFR of 15 or lower may mean kidney failure. You can't raise your GFR, but you can try to keep it from going lower. Ask your healthcare provider what you can do to keep your kidneys healthy.  Learn more about the GFR test. Urine Test The urine test looks for albumin (al-BYOO-min), a type of protein, in your urine. A healthy kidney does not let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. This test has several different names. You could be told that you are being screened for \"proteinuria\" or \"albuminuria\" or \"microalbuminuria.\" Or you could be told that your \"urine albumin-to-creatinine ratio\" (UACR) is being measured. If you have albumin or protein in your urine, it could mean you have kidney disease. -  A urine albumin result below 30 is normal.  - A urine albumin result above 30 is not normal and may mean kidney disease. A urine albumin result below 30 is normal. A urine albumin result above 30 is not normal and may mean kidney disease. Learn more about the urine albumin test. Your healthcare provider might do additional tests to be sure."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Kidney Disease ?"}, {"role": "assistant", "content": "Different Treatments for Different Stages There are several types of treatments related to kidney disease. Some are used in earlier stages of kidney disease to protect your kidneys. These medications and lifestyle changes help you maintain kidney function and delay kidney failure. Other treatments, such as dialysis and transplantation, are used to treat kidney failure. These methods help replace kidney function if your own kidneys have stopped working. Treatments for Early Kidney Disease Treatments for early kidney disease include both diet and lifestyle changes and medications. - Making heart-healthy food choices and exercising regularly to maintain a healthy weight can help prevent the diseases that cause further kidney damage.  - If you already have diabetes and/or high blood pressure, keeping these conditions under control can keep them from causing further damage to your kidneys.   - Choose and prepare foods with less salt and sodium. Aim for less than 2,300 milligrams of sodium each day.   - Eat the right amount of protein. Although it is important to eat enough protein to stay healthy, excess protein makes your kidneys work harder. Eating less protein may help delay progression to kidney failure. Talk to your dietitian or other health care provider about what is the right amount of protein for you.  - If you have been diagnosed with kidney disease, ask your doctor about seeing a dietitian. A dietitian can teach you how to choose foods that are easier on your kidneys. You will also learn about the nutrients that matter for kidney disease. You can find a dietitian near you through the Academy of Nutrition and Dietetics directory.  - If you smoke, take steps to quit. Cigarette smoking can make kidney damage worse.  Making heart-healthy food choices and exercising regularly to maintain a healthy weight can help prevent the diseases that cause further kidney damage. If you already have diabetes and/or high blood pressure, keeping these conditions under control can keep them from causing further damage to your kidneys. Choose and prepare foods with less salt and sodium. Aim for less than 2,300 milligrams of sodium each day. Eat the right amount of protein. Although it is important to eat enough protein to stay healthy, excess protein makes your kidneys work harder. Eating less protein may help delay progression to kidney failure. Talk to your dietitian or other health care provider about what is the right amount of protein for you. If you have been diagnosed with kidney disease, ask your doctor about seeing a dietitian. A dietitian can teach you how to choose foods that are easier on your kidneys. You will also learn about the nutrients that matter for kidney disease. You can find a dietitian near you through the Academy of Nutrition and Dietetics directory. If you smoke, take steps to quit. Cigarette smoking can make kidney damage worse. Medicines Medicines can also help protect the kidneys. People with kidney disease often take medicines to lower blood pressure, control blood glucose, and lower blood cholesterol. Two types of blood pressure medicines -- angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) -- may protect the kidneys and delay kidney failure. These medicines may even protect kidney function in people who don't have high blood pressure. The most important step you can take to treat kidney disease is to control your blood pressure. Many people need two or more medicines to keep their blood pressure at a healthy level. For most people, the blood pressure target is less than 140/90 mm Hg. An ACE inhibitor, ARB, or diuretic (water pill) may help control blood pressure. Your healthcare provider will work with you to choose the right medicines for you. (Watch the video to learn more about medications and kidney disease. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Be Safe With Your Medicines Some older adults with kidney disease may take medicines for other diseases as well. If you have kidney disease, you need to be careful about all the medicines you take. Your kidneys do not filter as well as they did in the past. This can cause an unsafe buildup of medicines in your blood. Some medicines can also harm your kidneys. As kidney disease progresses, your doctor may need to change the dose (or amount) of all medicines that affect the kidney or are removed by the kidney. You may need to take some medicines in smaller amounts or less often. You may also need to stop taking a medicine or switch to a different one. Effects of NSAID Drugs Non-steroidal anti-inflammatory drugs (NSAIDs) can harm your kidneys, especially if you have kidney disease, diabetes, and high blood pressure. NSAIDs include common over-the-counter and prescription medicines for headaches, pain, fever, or colds. Ibuprofen and naproxen are NSAIDs, but NSAIDs are sold under many different brand names. If you have kidney disease, do not use NSAIDs. Ask your pharmacist or health care provider if the medicines you take are safe to use. You also can look for NSAIDs on Drug Facts labels."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Kidney Disease ?"}, {"role": "assistant", "content": "Kidney disease can get worse over time, and may lead to kidney failure. Kidney failure means advanced kidney damage with less than 15% normal function. Most people with kidney failure have symptoms from the build up of waste products and extra water in their body. End-stage renal disease (ESRD) is kidney failure treated by dialysis or kidney transplant.  If kidney disease progresses to kidney failure, the goal of treatment changes. Since the kidneys no longer work well enough to maintain health, it is necessary to choose a treatment in order to maintain health. There are two main options for this: dialysis and transplantation. Some patients choose not to treat kidney failure with dialysis or a transplant. Instead, they receive supportive care to treat their symptoms. Before you and your health care team decide on a treatment plan, it is important that you understand how each treatment option is likely to affect how long you will live or how good you will feel. If your kidney disease is progressing, talk with your health care provider about choosing a treatment that is right for you. (Watch the video to learn more about dialysis decisions. To enlarge the videos on this page, click the brackets in the lower right-hand corner of the video screen. To reduce the videos, press the Escape (Esc) button on your keyboard.) Two Kinds of Dialysis Dialysis is a treatment that takes waste products and extra fluid out of your body. In hemodialysis, your blood passes through a filter outside of your body and the clean blood is returned to your body. In hemodialysis, blood is run through a filter outside of your body and the clean blood is returned to the body. Hemodialysis is usually done at a dialysis center three times a week, but it can also be done at home. Each session usually lasts between three and four hours. Peritoneal dialysis is another way to remove wastes from your blood. This kind of dialysis uses the lining of your abdominal cavity (the space in your body that holds organs like the stomach, intestines, and liver) to filter your blood. It works by putting a special fluid into your abdomen that absorbs waste products in your blood as it passes through small blood vessels in this lining. This fluid with the waste products is then drained away. A key benefit of peritoneal dialysis is that it can be done at home, while you sleep. Hemodialysis and peritoneal dialysis do not cure kidney failure. They are treatments that help replace the function of the kidneys and may help you feel better and live longer. But, for some people who have many health problems and are age 75 or older, studies show that treatment with dialysis may not help. If You Are on Dialysis Although patients with kidney failure are now living longer than ever, over the years, kidney disease can cause problems such as -  depression   - heart disease  - bone disease  - arthritis  - nerve damage  - malnutrition. depression heart disease bone disease arthritis nerve damage malnutrition. To stay as healthy as possible for as long as possible while on dialysis, - follow your dietitian's advice,   - take your medicines, and   - follow healthy lifestyle and diet habits to keep a healthy weight and control blood pressure, blood sugar, and cholesterol.  follow your dietitian's advice, take your medicines, and follow healthy lifestyle and diet habits to keep a healthy weight and control blood pressure, blood sugar, and cholesterol. Dialysis can be a special challenge for older adults, especially those who have other diseases or conditions. For example, for hemodialysis, a person must be able to leave home, travel to the dialysis facility, and sit for 4 hours during treatment. Peritoneal dialysis can be done at home, but someone needs to help. Often, older adults need help with some or all of these activities. They and their families need to think about these issues as they choose treatment options and living facilities.  Learn more about dialysis. Eating, Diet, and Nutrition on Dialysis For people who are on dialysis or approaching total kidney failure, adequate nutrition is important for maintaining energy, strength, healthy sleep patterns, bone health, heart health, and good mental health. The diet should be based on the type of treatment the person is getting. -  People on hemodialysis must watch how much fluid they drink and avoid eating foods with too much sodium, potassium, and phosphorus.   - In contrast, people on peritoneal dialysisa type of dialysis that uses the lining of the abdomen, or belly, to filter the blood inside the bodymay be able to eat more potassium-rich foods because peritoneal dialysis removes potassium from the body more efficiently than hemodialysis.   - Both hemodialysis and peritoneal dialysis can remove proteins from the body, so anyone on either form of dialysis should eat protein-rich foods such as meat, fish, and eggs. People on hemodialysis must watch how much fluid they drink and avoid eating foods with too much sodium, potassium, and phosphorus. In contrast, people on peritoneal dialysisa type of dialysis that uses the lining of the abdomen, or belly, to filter the blood inside the bodymay be able to eat more potassium-rich foods because peritoneal dialysis removes potassium from the body more efficiently than hemodialysis. Both hemodialysis and peritoneal dialysis can remove proteins from the body, so anyone on either form of dialysis should eat protein-rich foods such as meat, fish, and eggs. All dialysis centers have a renal dietitian, who helps people with kidney failure make healthy food choices. People who are on dialysis should talk with their clinics renal dietitian. The renal dietitian can help make a meal plan that will help their treatment work well. Kidney Transplantation  Some people with kidney failure -- including older adults -- may be able to receive a kidney transplant. This involves having a healthy kidney from another person surgically placed into your body. The new, donated kidney does the work the failed kidneys used to do. The donated kidney can come from someone you dont know who has recently died, or from a living person -- usually a family member. But you might also be able to receive a kidney from an unrelated donor, including your spouse or a friend. Due to the shortage of kidneys, patients on the waiting list for a deceased donor kidney may wait many years. (Watch the video to learn more about kidney transplantation.) Kidney transplantation is a treatment for kidney failure -- not a cure. You will need to see your healthcare provider regularly. And you will need to take medicines for as long as you have your transplant. These medicines suppress your immune system so it doesn't reject the transplanted kidney. Eating, Diet, and Nutrition After a Transplant After a transplant, it is still important to make healthy food choices. It is still important to eat foods with less salt. This may help you keep a healthy blood pressure. You should also choose foods that are healthy for your heart, like fresh fruits, fresh or frozen vegetables, whole grains, and low-fat dairy foods. If you were on dialysis before the transplant, you may find that your diet after transplant is much easier to follow. You can drink more fluids and eat many of the fruits and vegetables you had to eat less of while on dialysis. You may even need to gain a little weight, but be careful not to gain weight too quickly. All transplant clinics have a renal dietitian, who helps people with kidney failure make healthy food choices. People who have had a transplant should talk with their clinics renal dietitian. The renal dietitian can help make a meal plan that will help keep the new kidney healthy. Learn more about kidney transplantation. Choosing Not to Treat With Dialysis or Transplant You may choose not to treat kidney failure with dialysis or a transplant. Instead, you may choose to focus on treating its complications. If you choose this path, you will still get care from your health care team. Your care may include - medicines to protect remaining kidney function for as long as possible   - medicines to treat symptoms of kidney failure (such as nausea, anemia, and poor appetite)  - advice on diet and lifestyle choices, and   - care to ease symptoms, provide relief from physical and emotional pain, and enhance quality of life.  medicines to protect remaining kidney function for as long as possible medicines to treat symptoms of kidney failure (such as nausea, anemia, and poor appetite) advice on diet and lifestyle choices, and care to ease symptoms, provide relief from physical and emotional pain, and enhance quality of life. You have the right to choose not to start dialysis or undergo transplant surgery. You may choose not to treat with dialysis or transplant if you feel that the burdens would outweigh the benefits. Or, you may make this choice if you feel these treatments would lower your quality of life. Only you know what it is like for you to live with kidney failure. Treatment with no dialysis or transplant may be a choice for you if - you and your doctor feel dialysis or transplant will not improve your health. For some people who have many health problems and are age 75 or older, studies show that treatment with dialysis may not help.   - you feel youve accomplished what you wanted in life.  - family and friends support your decision.  you and your doctor feel dialysis or transplant will not improve your health. For some people who have many health problems and are age 75 or older, studies show that treatment with dialysis may not help. you feel youve accomplished what you wanted in life. family and friends support your decision. Choosing the Right Treatment Not all treatments are right for all people. Talk to your doctor and other health professionals -- including nurses, dietitians, and diabetes educators -- to figure out the best treatment plan for you. The right choice for you depends upon your medical condition, lifestyle, and personal likes and dislikes. Each treatment option may have a different effect on -  how long you live  - your overall health  - what and how much you can do  - how well you can get around  - how you feel emotionally  - how well you can think, learn, and remember   - your sex life.  how long you live your overall health what and how much you can do how well you can get around how you feel emotionally how well you can think, learn, and remember your sex life."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Kidney Disease ?"}, {"role": "assistant", "content": "Many areas of Research Researchers are working at every stage of kidney disease to improve diagnosis and treatment, including -  trying to find a better way to identify who is at greatest risk for rapidly progressing kidney disease  -  trying to find more effective medications to treat kidney disease and its risk factors, and   -  improving dialysis and the results of kidney transplantation. trying to find a better way to identify who is at greatest risk for rapidly progressing kidney disease trying to find more effective medications to treat kidney disease and its risk factors, and improving dialysis and the results of kidney transplantation. Several areas of research supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) hold great potential. Emphasis is being placed on research related to prevention and early intervention in kidney disease. Interaction With Other Diseases Another focus is on the interaction between kidney disease, diabetes, and cardiovascular (heart) disease. Advances in treatments for diabetes and high blood pressure may help reduce the damage these conditions do to the kidneys in the first place. Research into how to predict who will develop kidney disease may improve prevention. Disease Progression NIDDK is sponsoring a major study -- the Chronic Renal Insufficiency Cohort (CRIC) study -- to learn more about how kidney disease progresses. CRIC is following 6,000 adults with mild to moderate kidney disease. About half have diabetes. It is believed that some CRIC study participants' kidney function will decline more rapidly than others', and that some will develop cardiovascular disease while others won't. The goal of the study is to identify the factors linked to rapid decline of kidney function and the development of cardiovascular disease. The data and specimens collected from study participants will be available to other researchers who are studying kidney disease and cardiovascular disease. The CRIC study will allow future investigation into the role of genetic, environmental, behavioral, nutritional, and other factors in kidney disease.  Learn more about the CRIC Study.  Improving Transplants In the area of transplantation, researchers are working to develop new drugs that help the body accept donated organs. The goal is to help transplanted kidneys survive longer and work better. NIDDK scientists are also developing new techniques to improve the body's tolerance for foreign tissue even before the donated kidney is transplanted. This could help reduce or eliminate the need for drugs that suppress the immune system, which could reduce transplantation costs and complications. In the future, scientists may even develop an artificial kidney for implantation."}]}
{"messages": [{"role": "user", "content": "What is (are) Kidney Disease ?"}, {"role": "assistant", "content": "Kidney disease -- also known as chronic kidney disease (CKD) -- occurs when kidneys can no longer remove wastes and extra water from the blood or perform other functions as they should. According to the Centers for Disease Control and Prevention, more than 20 million Americans may have kidney disease. Many more are at risk. (Watch the video to learn more about kidney disease. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What causes Kidney Disease ?"}, {"role": "assistant", "content": "Kidney disease is most often caused by diabetes or high blood pressure. Each kidney contains about one million tiny filters made up of blood vessels. These filters are called glomeruli. Diabetes and high blood pressure damage these blood vessels, so the kidneys are not able to filter the blood as well as they used to. Usually this damage happens slowly, over many years. As more and more filters are damaged, the kidneys eventually stop working."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Kidney Disease? ?"}, {"role": "assistant", "content": "Diabetes and high blood pressure are the two leading risk factors for kidney disease. Both diabetes and high blood pressure damage the small blood vessels in your kidneys and can cause kidney disease -- without you feeling it.  There are several other risk factors for kidney disease. Cardiovascular (heart) disease is a risk factor. So is family history: if you have a mother, father, sister, or brother who has had kidney disease, then you are at increased risk. African Americans, Hispanics, and Native Americans tend to have a greater risk for kidney failure. This is mostly due to higher rates of diabetes and high blood pressure in these communities, although there may be other reasons. (Watch the video to learn more about the connection between heart disease and kidney disease. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Kidney Disease ?"}, {"role": "assistant", "content": "Kidney disease is often called a \"silent\" disease, because most people have no symptoms in early kidney disease. In fact, you might feel just fine until your kidneys have almost stopped working. Do NOT wait for symptoms! Blood and urine tests are the only way to check for kidney damage or measure kidney function. (Watch the video to learn more about the symptoms of kidney disease. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What is (are) Kidney Disease ?"}, {"role": "assistant", "content": "When you visit your doctor, here are questions to ask about your kidneys. - What is my GFR?   - What is my urine albumin result?   - What is my blood pressure?   - What is my blood glucose (for people with diabetes)? What is my GFR? What is my urine albumin result? What is my blood pressure? What is my blood glucose (for people with diabetes)?"}]}
{"messages": [{"role": "user", "content": "What are the treatments for Kidney Disease ?"}, {"role": "assistant", "content": "Treatments for early kidney disease include both diet and lifestyle changes and medications. Diet and lifestyle changes, such as eating heart healthy foods and exercising regularly to maintain a healthy weight, can help prevent the diseases that cause kidney damage. If you already have diabetes and/or high blood pressure, keeping these conditions under control can keep them from causing further damage to your kidneys. (Watch the video to learn more about dialysis decisions. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What are the treatments for Kidney Disease ?"}, {"role": "assistant", "content": "During your next health care visit, talk to your provider about your test results and how to manage your kidney disease. Below is a list of questions you may want to ask. Add any questions you think are missing, and mark those that are most important to you. Bring your list with you.   About your tests  - Did you check my kidney health with blood and urine tests?  -  What was my GFR? What does that mean?   - Has my GFR changed since last time?   - What is my urine albumin level? What does that mean?   - Has my urine albumin changed since the last time it was checked?   - Is my kidney disease getting worse?   - Is my blood pressure where it needs to be?   - Will I need dialysis?  - When should I talk to my family about dialysis or a kidney transplant?  Did you check my kidney health with blood and urine tests? What was my GFR? What does that mean? Has my GFR changed since last time? What is my urine albumin level? What does that mean? Has my urine albumin changed since the last time it was checked? Is my kidney disease getting worse? Is my blood pressure where it needs to be? Will I need dialysis? When should I talk to my family about dialysis or a kidney transplant? (Watch the video to learn more about dialysis decisions. To enlarge the videos on this page, click the brackets in the lower right-hand corner of the video screen. To reduce the videos, press the Escape (Esc) button on your keyboard.)  About treatment and self-care - What can I do to keep my disease from getting worse?   - Do any of my medicines or doses need to be changed?   - Do I need to change what I eat? Am I eating the right amount of protein, salt (sodium), potassium, and phosphorus?   - Will you refer me to a dietitian for diet counseling?   - When will I need to see a nephrologist (kidney specialist)?   - What do I need to do to protect my veins?  What can I do to keep my disease from getting worse? Do any of my medicines or doses need to be changed? Do I need to change what I eat? Am I eating the right amount of protein, salt (sodium), potassium, and phosphorus? Will you refer me to a dietitian for diet counseling? When will I need to see a nephrologist (kidney specialist)? What do I need to do to protect my veins? (Watch the video to learn more about lifestyle and diet changes to make with kidney disease.) About complications - What other health problems may I face because of my kidney disease?   - Should I be looking for any symptoms? If so, what are they?  What other health problems may I face because of my kidney disease? Should I be looking for any symptoms? If so, what are they?  If you're told that you need renal replacement therapy (dialysis or a transplant) - How do I decide which treatment is right for me?   - How do I prepare for dialysis?   - What is an AV fistula?   - How soon do I begin preparing?  - How can my family help me?  How do I decide which treatment is right for me? How do I prepare for dialysis? What is an AV fistula? How soon do I begin preparing? How can my family help me?"}]}
{"messages": [{"role": "user", "content": "What is (are) Kidney Disease ?"}, {"role": "assistant", "content": "When your kidneys fail, they are no longer able to filter blood and remove waste from your body well enough to maintain health. Kidney failure causes harmful waste and excess fluid to build up in your body. Your blood pressure may rise, and your hands and feet may swell. Since the kidneys are not working well, the goal is to find treatments that can replace kidney function in order to maintain health. There are two main options for this: dialysis and transplantation."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Kidney Disease ?"}, {"role": "assistant", "content": "Dialysis is a treatment to filter wastes and water from your blood. There are two major forms of dialysis: hemodialysis and peritoneal dialysis. (Watch the video to learn more about dialysis. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) In hemodialysis, blood is run through a filter outside of your body and the clean blood is returned to the body. Hemodialysis is usually done at a dialysis center three times a week, but it can also be done at home. Each session usually lasts between three and four hours. Peritoneal dialysis is another way to remove wastes from your blood. This kind of dialysis uses the lining of your abdominal cavity (the space in your body that holds organs like the stomach, intestines, and liver) to filter your blood. It works by putting a special fluid into your abdomen that absorbs waste products in your blood as it passes through small blood vessels in this lining. This fluid is then drained away. A key benefit of peritoneal dialysis is that it can be done at home, while you sleep.  Get more information about dialysis."}]}
{"messages": [{"role": "user", "content": "What is (are) Kidney Disease ?"}, {"role": "assistant", "content": "Instead of dialysis, some people with kidney failure -- including older adults -- may be able to receive a kidney transplant. This involves having a healthy kidney from another person surgically placed into your body. The new, donated kidney does the work that your two failed kidneys used to do. The donated kidney can come from an anonymous donor who has recently died, or from a living person -- usually a relative. But you might also be able to receive a kidney from an unrelated donor, including your spouse or a friend. (Watch the video to learn more about kidney transplantation. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Kidney transplantation is a treatment for kidney failure -- not a cure. You will need to see your healthcare provider regularly. And you will need to take medications for as long as you have your transplant to suppress your immune system so it doesn't reject the transplanted kidney."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Kidney Disease ?"}, {"role": "assistant", "content": "There are many researchers who are working on kidney disease. They are looking for ways to improve diagnosis, make treatments more effective, and make dialysis and transplantation work better. Several areas of research supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) hold great potential. Emphasis is being placed on research related to prevention and early intervention in kidney disease. Another focus is on the interaction between diabetes, kidney disease, and cardiovascular disease. Advances in treatments for diabetes and high blood pressure may help reduce the damage these conditions do to the kidneys in the first place. Research into how to predict who will develop kidney disease may improve prevention."}]}
{"messages": [{"role": "user", "content": "What is (are) Alzheimer's Disease ?"}, {"role": "assistant", "content": "Alzheimers disease is a brain disease that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. It begins slowly and gets worse over time. Currently, it has no cure. A Common Cause of Dementia Alzheimers disease is the most common cause of dementia among older people. Dementia is a loss of thinking, remembering, and reasoning skills that interferes with a persons daily life and activities. Dementia ranges in severity from the mild stage, when it is just beginning to affect a persons functioning, to the severe stage, when the person must depend completely on others for basic care. Estimates vary, but experts suggest that more than 5 million Americans may have Alzheimer's disease. Alzheimers is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people Risk Increases With Age In most people with Alzheimers, symptoms first appear in their mid-60s, and the risk of developing the disease increases with age. While younger people -- in their 30s, 40s, and 50s -- may get Alzheimer's disease, it is much less common. It is important to note that Alzheimer's disease is not a normal part of aging. The course of Alzheimers diseasewhich symptoms appear and how quickly changes occurvaries from person to person. The time from diagnosis to death varies, too. It can be as little as 3 or 4 years if the person is over 80 years old when diagnosed or as long as 10 years or more if the person is younger. Memory Problems: One of the First Signs Memory problems are typically one of the first signs of Alzheimers disease, though initial symptoms may vary from person to person. A decline in other aspects of thinking, such as finding the right words, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimers disease. People with Alzheimers have trouble doing everyday things like driving a car, cooking a meal, or paying bills. They may ask the same questions over and over, get lost easily, lose things or put them in odd places, and find even simple things confusing. Some people become worried, angry, or violent. Other Reasons for Memory Issues Not all people with memory problems have Alzheimers disease. Mild forgetfulness can be a normal part of aging. Some people may notice that it takes longer to learn new things, remember certain words, or find their glasses. Thats different from a serious memory problem, which makes it hard to do everyday things. Sometimes memory problems are related to health issues that are treatable. For example, medication side effects, vitamin B12 deficiency, head injuries, or liver or kidney disorders can lead to memory loss or possibly dementia. Emotional problems, such as stress, anxiety, or depression, can also make a person more forgetful and may be mistaken for dementia. Read more about causes of memory loss and how to keep your memory sharp. Mild Cognitive Impairment Some older people with memory or other thinking problems have a condition called mild cognitive impairment, or MCI. MCI can be an early sign of Alzheimers, but not everyone with MCI will develop Alzheimers disease. People with MCI have more memory problems than other people their age, but they can still take care of themselves and do their normal activities. Signs of MCI may include - losing things often  - forgetting to go to events and appointments  - having more trouble coming up with words than other people the same age. losing things often forgetting to go to events and appointments having more trouble coming up with words than other people the same age. If you or someone in your family thinks your forgetfulness is getting in the way of your normal routine, its time to see your doctor. Seeing the doctor when you first start having memory problems can help you find out whats causing your forgetfulness. Learn more about mild cognitive impairment (MCI).  What Happens to the Brain in Alzheimers? Alzheimer's disease is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles). Plaques and tangles in the brain are two of the main features of Alzheimer's disease. Another is the loss of connections between nerve cells (neurons) in the brain. Neurons send messages between different parts of the brain, and from the brain to muscles and organs in the body. It seems likely that damage to the brain starts 10 years or more before memory or other thinking problems become obvious. During the earliest stage of Alzheimers, people are free of symptoms, but harmful changes are taking place in the brain. The damage at first appears to take place in cells of the hippocampus, the part of the brain essential in forming memories. Abnormal protein deposits form plaques and tangles in the brain. Once-healthy nerve cells stop functioning, lose connections with each other, and die. As more nerve cells die, other parts of the brain begin to shrink. By the final stage of Alzheimers, damage is widespread, and brain tissue has shrunk significantly. Get more details about Alzheimers disease."}]}
{"messages": [{"role": "user", "content": "What causes Alzheimer's Disease ?"}, {"role": "assistant", "content": "There are two types of Alzheimers diseaseearly-onset and late-onset. Early-onset Alzheimers is a rare form of the disease that occurs in people age 30 to 60. It occurs in less than 5 percent of all people with Alzheimers. Almost all people with Alzheimers disease have late-onset Alzheimer's, which usually develops after age 60. Causes Not Fully Understood Scientists do not yet fully understand what causes Alzheimer's disease in most people. In early-onset Alzheimers, a genetic mutation is usually the cause. Late-onset Alzheimers arises from a complex series of brain changes that occur over decades. The causes probably include a mix of genetic, environmental, and lifestyle factors. These factors affect each person differently. Research shows that Alzheimers disease causes changes in the brain years and even decades before the first symptoms appear, so even people who seem free of the disease today may be at risk. Scientists are developing sophisticated tests to help identify who is most likely to develop symptoms of Alzheimers. Ultimately, they hope to prevent or delay dementia in these high-risk individuals. Risk Factors Some risk factors for Alzheimers, like age and genetics, cannot be controlled. Other factors that may play a role in the development of the diseasesuch as how much a person exercises or socializescan be changed. Lifestyle factors, such as diet and physical exercise, and long-term health conditions, like high blood pressure and diabetes, might also play a role in the risk of developing Alzheimers disease. For more information, see the chapter entitled Prevention. Older AgeThe Biggest Risk Factor Increasing age is the most important known risk factor for Alzheimer's disease. The number of people with the disease doubles every 5 years beyond age 65. Nearly half of people age 85 and older may have Alzheimers. These facts are significant because the number of older adults is growing. Genetics Genetics appears to play a part in both early- and late-onset Alzheimers disease. In early-onset Alzheimers, most cases are caused by specific genetic mutations permanent changes in genes that can be passed on from a parent to a child. This results in early-onset familial Alzheimers disease, or FAD. Most people with Alzheimers disease have late-onset Alzheimer's, in which symptoms appear in a persons mid-60s. No obvious family pattern is seen in most of these cases, but certain genetic factors appear to increase a persons risk. Many studies have linked the apolipoprotein E gene to late-onset Alzheimers. One form of this gene, APOE 4, increases a persons risk of getting the disease. But many people who get Alzheimers do not have the APOE 4 gene, and some people with the gene never get Alzheimers. Scientists have identified a number of other genes in addition to APOE 4 that may increase a persons risk for late-onset Alzheimers. Knowing about these genes can help researchers more effectively test possible treatments and prevention strategies in people who are at risk of developing Alzheimers -- ideally, before symptoms appear. Learn more about the genetics of Alzheimers disease."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Alzheimer's Disease ?"}, {"role": "assistant", "content": "Alzheimer's disease varies from person to person so not everyone will have the same symptoms. Also, the disease progresses faster in some people than in others. In general, though, Alzheimers takes many years to develop and becomes increasingly severe over time. Memory Problems -- A Common Early Sign Memory problems are typically one of the first signs of Alzheimers disease. However, not all memory problems are caused by Alzheimers. If you or someone in your family thinks your forgetfulness is getting in the way of your normal routine, its time to see your doctor. He or she can find out whats causing these problems. A person in the early (mild) stage of Alzheimers disease may - find it hard to remember things  - ask the same questions over and over  - get lost in familiar places  - lose things or put them in odd places  - have trouble handling money and paying bills  - take longer than normal to finish daily tasks  - have some mood and personality changes. find it hard to remember things ask the same questions over and over get lost in familiar places lose things or put them in odd places have trouble handling money and paying bills take longer than normal to finish daily tasks have some mood and personality changes. Other thinking problems besides memory loss may be the first sign of Alzheimers disease. A person may have - trouble finding the right words  - vision and spatial issues  - impaired reasoning or judgment. trouble finding the right words vision and spatial issues impaired reasoning or judgment.  See a chart that compares signs of Alzheimers disease with signs of normal aging. Later Signs of Alzheimers As Alzheimers disease progresses to the moderate stage, memory loss and confusion grow worse, and people may have problems recognizing family and friends. Other symptoms at this stage may include - difficulty learning new things and coping with new situations  - trouble carrying out tasks that involve multiple steps, like getting dressed  - impulsive behavior  - forgetting the names of common things   - hallucinations, delusions, or paranoia  - wandering away from home. difficulty learning new things and coping with new situations trouble carrying out tasks that involve multiple steps, like getting dressed impulsive behavior forgetting the names of common things hallucinations, delusions, or paranoia wandering away from home. Symptoms of Severe Alzheimers As Alzheimers disease becomes more severe, people lose the ability to communicate. They may sleep more, lose weight, and have trouble swallowing. Often they are incontinentthey cannot control their bladder and/or bowels. Eventually, they need total care. Benefits of Early Diagnosis An early, accurate diagnosis of Alzheimer's disease helps people and their families plan for the future. It gives them time to discuss care options, find support, and make legal and financial arrangements while the person with Alzheimers can still take part in making decisions. Also, even though no medicine or other treatment can stop or slow the disease, early diagnosis offers the best chance to treat the symptoms. How Alzheimers Is Diagnosed The only definitive way to diagnose Alzheimer's disease is to find out whether plaques and tangles exist in brain tissue. To look at brain tissue, doctors perform a brain autopsy, an examination of the brain done after a person dies. Doctors can only make a diagnosis of \"possible\" or probable Alzheimers disease while a person is alive. Doctors with special training can diagnose Alzheimer's disease correctly up to 90 percent of the time. Doctors who can diagnose Alzheimers include geriatricians, geriatric psychiatrists, and neurologists. A geriatrician specializes in the treatment of older adults. A geriatric psychiatrist specializes in mental problems in older adults. A neurologist specializes in brain and nervous system disorders. To diagnose Alzheimers disease, doctors may - ask questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality   - conduct tests to measure memory, problem solving, attention, counting, and language skills   - carry out standard medical tests, such as blood and urine tests   - perform brain scans to look for anything in the brain that does not look normal.  ask questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality conduct tests to measure memory, problem solving, attention, counting, and language skills carry out standard medical tests, such as blood and urine tests perform brain scans to look for anything in the brain that does not look normal. Test results can help doctors know if there are other possible causes of the person's symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, head injury, and blood-vessel disease in the brain can cause symptoms similar to those of Alzheimer's. Many of these other conditions can be treated successfully. New Diagnostic Methods Being Studied Researchers are exploring new ways to help doctors diagnose Alzheimers disease earlier and more accurately. Some studies focus on changes in a persons memory, language, and other mental functions. Others look at changes in blood, spinal fluid, and brain-scan results that may detect Alzheimers years before symptoms appear. Watch a video that explains changes in diagnostic guidelines for Alzheimers."}]}
{"messages": [{"role": "user", "content": "How to prevent Alzheimer's Disease ?"}, {"role": "assistant", "content": "Currently, no medicines or other treatments are known to prevent Alzheimers disease, but scientists are studying many possibilities. These possibilities include lifestyle factors such as exercise and physical activity, a healthy diet, and mentally stimulating activities. In addition to lifestyle factors, scientists have found clues that some long-term health conditions, like heart disease, high blood pressure, and diabetes, are related to Alzheimer's disease. Its possible that controlling these conditions will reduce the risk of developing Alzheimers. Exercise and Physical Activity Studies show that exercise and other types of physical activity are good for our hearts, waistlines, and ability to carry out everyday activities. Research suggests that exercise may also play a role in reducing risk for Alzheimers disease. Animal studies show that exercise increases both the number of small blood vessels that supply blood to the brain and the number of connections between nerve cells in older rats and mice. In addition, researchers have found that exercise raises the level of a nerve growth factor (a protein key to brain health) in an area of the brain that is important to memory and learning.  See suggestions for ways older adults can start or continue to exercise. Diet and Dietary Supplements A number of studies suggest that eating certain foods may help keep the brain healthyand that others can be harmful. A diet that includes lots of fruits, vegetables, and whole grains and is low in fat and added sugar can reduce the risk of heart disease and diabetes. Researchers are looking at whether a healthy diet also can help prevent Alzheimers. One study reported that people who ate a Mediterranean diet had a 28 percent lower risk of developing MCI (mild cognitive impairment) and a 48 percent lower risk of progressing from MCI to Alzheimers disease. (MCI often, but not always, leads to Alzheimers dementia.) A Mediterranean diet includes vegetables, legumes, fruits, cereals, fish, olive oil, and low amounts of saturated fats, dairy products, meat, and poultry. For more about healthy eating as you age , see  Eating Well As You Get Older. Other research has looked at the effect on brain health of several different vitamins and dietary supplements. One area of research focuses on antioxidants, natural substances that appear to fight damage caused by molecules called free radicals. Other studies are looking at resveratrol, a compound found in red grapes and red wine, as well as vitamins and other substances found in food. Chronic Diseases Age-related diseases and conditionssuch as vascular disease, high blood pressure, heart disease, and diabetesmay increase the risk of Alzheimers. Many studies are looking at whether this risk can be reduced by preventing or controlling these diseases and conditions. For example, one clinical trial is looking at how lowering blood pressure to or below current recommended levels may affect cognitive decline and the development of MCI and Alzheimers disease. Participants are older adults with high systolic (upper number) blood pressure who have a history of heart disease or stroke, or are at risk for those conditions. Diabetes is another disease that has been linked to Alzheimers. Past research suggests that abnormal insulin production contributes to Alzheimers-related brain changes. (Insulin is the hormone involved in diabetes.) Diabetes treatments have been tested in people with Alzheimers, but the results have not been conclusive. Keeping the Brain Active Keeping the mind sharpthrough social engagement or intellectual stimulationis associated with a lower risk of Alzheimers disease. Activities like working, volunteering, reading, going to lectures, and playing computer and other games are being studied to see if they might help prevent Alzheimers. One clinical trial is testing the impact of formal cognitive training, with and without physical exercise, in people with MCI to see if it can prevent or delay Alzheimers disease. Other trials are underway in healthy older adults to see if exercise and/or cognitive training (for example, a demanding video game) can delay or prevent age-related cognitive decline. Find out about things you can do that may keep your brain healthy."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alzheimer's Disease ?"}, {"role": "assistant", "content": "Medications Can Treat Symptoms There is no known cure for Alzheimer's disease, but there are medicines that can treat symptoms of the disease. Most Alzheimers medicines work best for people in the mild or moderate stages of the disease. For example, they can keep memory loss from getting worse for a time. Other medicines may help behavioral symptoms, such as trouble sleeping or feeling worried or depressed. All of these medicines may have side effects and may not work for everyone. A person with Alzheimer's should be under a doctor's care. He or she may see a primary care doctor or a specialist, such as a neurologist, geriatric psychiatrist, or geriatrician. The doctor can treat the person's physical and behavioral problems, answer questions, and refer the patient and caregiver to other sources of help. Medications for Alzheimers Currently, no treatment can stop Alzheimer's disease. However, four medications are used to treat its symptoms. These medicines may help maintain thinking, memory, and speaking skills for a limited time. They work by regulating certain chemicals in the brain. Most of these medicines work best for people in the early or middle stages of the disease. For people with mild to moderate Alzheimers, donepezil (Aricept), rivastigmine (Exelon), or galantamine (Razadyne) may help. Donepezil is also approved to treat symptoms of moderate to severe Alzheimer's. Another drug, memantine (Namenda), is used to treat symptoms of moderate to severe Alzheimers, although it also has limited effects. All of these medicines have possible side effects, including nausea, vomiting, diarrhea, and loss of appetite. You should report any unusual symptoms to a doctor right away. It is important to follow a doctor's instructions when taking any medication. Scientists are testing many new drugs and other treatments to see if they can help slow, delay, or prevent Alzheimers disease. Learn how Alzheimers medications work, how to take them, and where to find more information.  Managing Behavioral Symptoms Certain medicines and other approaches can help control the behavioral symptoms of Alzheimer's disease. These symptoms include sleeplessness, agitation, wandering, anxiety, anger, and depression. Treating these symptoms often makes people with Alzheimers disease more comfortable and makes their care easier for caregivers. See more about medications used to treat behavioral symptoms. Some medicines must be used with caution. Memory Aids Memory aids may help some people who have mild Alzheimers disease with day-to-day living. A calendar, list of daily plans, notes about simple safety measures, and written directions describing how to use common household items can be useful. Help for Caregivers Caring for a person with Alzheimers can have high physical, emotional, and financial costs. The demands of day-to-day care, changing family roles, and difficult decisions about placement in a care facility can be difficult. Sometimes, taking care of the person with Alzheimers makes caregivers feel good because they are providing love and comfort. At other times, it can be overwhelming. Changes in the person can be hard to understand and cope with. Here are some ways for caregivers of people with Alzheimers to get help. - Ask family and friends to help out in specific ways, like making a meal or visiting the person while they take a break.  - Join a caregivers support group.  - Use home health care, adult day care, and respite services. Ask family and friends to help out in specific ways, like making a meal or visiting the person while they take a break. Join a caregivers support group. Use home health care, adult day care, and respite services. For more information about caring for someone with Alzheimers disease, see  Alzheimer's Caregiving."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Alzheimer's Disease ?"}, {"role": "assistant", "content": "Research supported by the National Institutes of Health (NIH) and other organizations has expanded knowledge of brain function in healthy older people, identified ways that may lessen age-related cognitive decline, and deepened our understanding of Alzheimers. Many scientists and physicians are working together to untangle the genetic, biological, and environmental factors that might cause Alzheimers disease. This effort is bringing us closer to better managing and, ultimately, better treating and preventing this devastating disease. Types of Research Different types of researchbasic, translational, and clinical researchare conducted to better understand Alzheimers and find ways to treat, delay, or prevent the disease. - Basic research helps scientists gain new knowledge about a disease process, including how and why it starts and progresses.   - Translational research grows out of basic research. It creates new medicines, devices, or behavioral interventions aimed at preventing, diagnosing, or treating a disease.  - Clinical research is medical research involving people. It includes clinical studies, which observe and gather information about large groups of people. It also includes clinical trials, which test a medicine, therapy, medical device, or other intervention in people to see if it is safe and effective. Basic research helps scientists gain new knowledge about a disease process, including how and why it starts and progresses. Translational research grows out of basic research. It creates new medicines, devices, or behavioral interventions aimed at preventing, diagnosing, or treating a disease. Clinical research is medical research involving people. It includes clinical studies, which observe and gather information about large groups of people. It also includes clinical trials, which test a medicine, therapy, medical device, or other intervention in people to see if it is safe and effective.  See the latest Alzheimers Disease Progress Report to read about results of NIA-supported Alzheimers research. Basic Research Basic research seeks to identify the cellular, molecular, and genetic processes that lead to Alzheimers disease. Basic research has focused on two of the main signs of Alzheimers disease in the brain: plaques and tangles. Plaques are made of a protein called beta-amyloid and form abnormal clumps outside nerve cells in the brain. Tangles are made from a protein called tau and form twisted bundles of fibers within nerve cells in the brain. Scientists are studying how plaques and tangles damage nerve cells in the brain. They can see beta-amyloid plaques and tau tangles by making images of the brains of living people. Such imaging has led to clinical trials that are looking at ways to remove beta-amyloid from the human brain or halt its production before more brain damage occurs. Scientists are also exploring the very earliest brain changes in the disease process. Findings will help them better understand the causes of Alzheimers. As they learn more, they are likely to come up with better targets for further research. Over time, this might lead to more effective therapies to delay or prevent the disease. Genetics is another important area of basic research. Discovering more about the role of genes that increase or decrease the risk of developing Alzheimers will help researchers answers questions such as What makes the disease process begin? and Why do some people with memory and other thinking problems develop Alzheimers disease while others do not? Genetics research helps scientists learn how risk-factor genes interact with other genes and lifestyle or environmental factors to affect Alzheimers risk. This research also helps identify people who are at high risk for developing Alzheimers and can participate in clinical research on new prevention and treatment approaches. Translational Research Translational research allows new knowledge from basic research to be applied to a clinical research setting. An important goal of Alzheimers translational research is to increase the number and variety of potential new medicines and other interventions that are approved for testing in humans. Scientists also examine medicines approved to treat other diseases to see they might be effective in people with Alzheimers. The most promising interventions are tested in test-tube and animal studies to make sure they are safe and effective. Currently, a number of different substances are under development that may one day be used to treat or prevent the symptoms of Alzheimers disease and mild cognitive impairment. Clinical Research Clinical research is medical research involving people. It includes clinical studies, which observe and gather information about large groups of people. It also includes clinical trials, which test medicines, therapies, medical devices, or other interventions in people to see if they are safe and effective. Clinical trials are the best way to find out whether a particular intervention actually slows, delays, or prevents Alzheimers disease. Trials may compare a potential new treatment with a standard treatment or placebo (mock treatment). Or, they may study whether a certain behavior or condition affects the progress of Alzheimers or the chances of developing it. NIH, drug companies, and other research organizations are conducting many clinical trials to test possible new treatments that may - improve memory, thinking, and reasoning skills in people with Alzheimers or mild cognitive impairment  - relieve the behavior problems of Alzheimers, such as aggression and agitation  - delay the progression from mild cognitive impairment (MCI) to Alzheimers   - prevent Alzheimers disease. improve memory, thinking, and reasoning skills in people with Alzheimers or mild cognitive impairment relieve the behavior problems of Alzheimers, such as aggression and agitation delay the progression from mild cognitive impairment (MCI) to Alzheimers prevent Alzheimers disease. A wide variety of interventions are being tested in clinical trials. They include experimental drugs as well as non-drug approaches."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Alzheimer's Disease ?"}, {"role": "assistant", "content": "All types of people are needed to volunteer for Alzheimers research. People with Alzheimer's disease or MCI, those with a family history of Alzheimers, and healthy people with no memory problems and no family history of Alzheimers may be able to take part in clinical trials. Participants in clinical trials help scientists learn about the brain in healthy aging and in Alzheimers. Results of these trials are used to improve prevention and treatment methods. The Alzheimers Disease Education and Referral (ADEAR) Centers clinical trials finder makes it easy for people to find out about studies that are sponsored by the federal government and private companies, universities, and other organizations. It includes studies testing new ways to detect, treat, delay, and prevent Alzheimers disease, other dementias, and MCI. You can search for studies about a certain topic or in a certain geographic area by going to www.nia.nih.gov/alzheimers/clinical-trials. To find out more about Alzheimers clinical trials, talk to your health care provider or contact the ADEAR Center at 1-800-438-4380 or adear@nia.nih.gov. Also, visit its website at  www.nia.nih.gov/alzheimers/volunteer."}]}
{"messages": [{"role": "user", "content": "What is (are) Alzheimer's Disease ?"}, {"role": "assistant", "content": "Alzheimers disease is a brain disease that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. It begins slowly and gets worse over time. Currently, it has no cure. Alzheimers disease is the most common cause of dementia in older people.  Get more details about Alzheimer's disease."}]}
{"messages": [{"role": "user", "content": "What is (are) Alzheimer's Disease ?"}, {"role": "assistant", "content": "Dementia is a loss of thinking, remembering, and reasoning skills that interferes with a persons daily life and activities. Alzheimers disease is the most common cause of dementia among older people. Dementia ranges in severity from the mild stage, when it is just beginning to affect a persons functioning, to the severe stage, when the person must depend completely on others for care."}]}
{"messages": [{"role": "user", "content": "What is (are) Alzheimer's Disease ?"}, {"role": "assistant", "content": "Mild cognitive impairment, or MCI, is a condition that can be an early sign of Alzheimers diseasebut not everyone with MCI will develop Alzheimers. People with MCI can still take care of themselves and do their normal activities. Signs of MCI may include - losing things often  - forgetting to go to events and appointments  - having more trouble coming up with words than other people the same age. losing things often forgetting to go to events and appointments having more trouble coming up with words than other people the same age."}]}
{"messages": [{"role": "user", "content": "What is (are) Alzheimer's Disease ?"}, {"role": "assistant", "content": "Memory problems are typically one of the first signs of Alzheimers disease, though different people may have different initial symptoms. A decline in other aspects of thinking, such as finding the right words, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimers disease."}]}
{"messages": [{"role": "user", "content": "What is (are) Alzheimer's Disease ?"}, {"role": "assistant", "content": "Alzheimer's disease has three stages: early (also called mild), middle (moderate), and late (severe). A person in the early stage of Alzheimers may - find it hard to remember things  -  ask the same questions over and over  -  get lost in familiar places  -  lose things or put them in odd places  - have trouble handling money and paying bills  - take longer than normal to finish daily tasks. find it hard to remember things ask the same questions over and over get lost in familiar places lose things or put them in odd places have trouble handling money and paying bills take longer than normal to finish daily tasks. As Alzheimers disease progresses to the middle stage, memory loss and confusion grow worse, and people may have problems recognizing family and friends. Other symptoms are this stage include -  difficulty learning new things and coping with new situations  - trouble carrying out tasks that involve multiple steps, like getting dressed  -  impulsive behavior  - forgetting the names of common things  - hallucinations, delusions, or paranoia  - wandering away from home. difficulty learning new things and coping with new situations trouble carrying out tasks that involve multiple steps, like getting dressed impulsive behavior forgetting the names of common things hallucinations, delusions, or paranoia wandering away from home. As Alzheimers disease becomes more severe, people lose the ability to communicate. They may sleep more, lose weight, and have trouble swallowing. Often they are incontinentthey cannot control their bladder and/or bowels. Eventually, they need total care."}]}
{"messages": [{"role": "user", "content": "What causes Alzheimer's Disease ?"}, {"role": "assistant", "content": "Scientists do not yet fully understand what causes Alzheimer's disease in most people. In early-onset Alzheimers, which occurs in people between the ages of 30 and 60, a genetic mutation is usually the cause. Late-onset Alzheimers, which usually develops after age 60, arises from a complex series of brain changes that occur over decades. The causes probably include a mix of genetic, environmental, and lifestyle factors. These factors affect each person differently. Learn more about the genetics of Alzheimers disease.  Increasing age is the most important known risk factor for Alzheimer's disease. Lifestyle factors, such as diet and physical exercise, and long-term health conditions, like high blood pressure and diabetes, might also play a role in the risk of developing Alzheimers disease."}]}
{"messages": [{"role": "user", "content": "How to diagnose Alzheimer's Disease ?"}, {"role": "assistant", "content": "The only definitive way to diagnose Alzheimer's disease is to find out whether plaques and tangles exist in brain tissue. To look at brain tissue, doctors perform a brain autopsy, an examination of the brain done after a person dies. Doctors can only make a diagnosis of \"possible\" or probable Alzheimers disease while a person is alive. Doctors with special training can diagnose Alzheimer's disease correctly up to 90 percent of the time. Doctors who can diagnose Alzheimers include geriatricians, geriatric psychiatrists, and neurologists. A geriatrician specializes in the treatment of older adults. A geriatric psychiatrist specializes in mental problems in older adults. A neurologist specializes in brain and nervous system disorders. To diagnose Alzheimer's disease, doctors may - ask questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality  - conduct tests to measure memory, problem solving, attention, counting, and language skills   - carry out standard medical tests, such as blood and urine tests  - perform brain scans to look for anything in the brain that does not look normal. ask questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality conduct tests to measure memory, problem solving, attention, counting, and language skills carry out standard medical tests, such as blood and urine tests perform brain scans to look for anything in the brain that does not look normal."}]}
{"messages": [{"role": "user", "content": "How to diagnose Alzheimer's Disease ?"}, {"role": "assistant", "content": "An early, accurate diagnosis of Alzheimer's disease helps people and their families plan for the future. It gives them time to discuss care options, find support, and make legal and financial arrangements while the person with Alzheimers can still take part in making decisions. Also, even though no medicine or other treatment can stop or slow the disease, early diagnosis offers the best chance to treat the symptoms."}]}
{"messages": [{"role": "user", "content": "How to diagnose Alzheimer's Disease ?"}, {"role": "assistant", "content": "The time from diagnosis of Alzheimers disease to death varies. It can be as little as 3 or 4 years if the person is over 80 years old when diagnosed or as long as 10 years or more if the person is younger."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alzheimer's Disease ?"}, {"role": "assistant", "content": "Currently, no treatment can stop Alzheimer's disease. However, four medications are used to treat its symptoms. These medicines may help maintain thinking, memory, and speaking skills for a limited time. They work by regulating certain chemicals in the brain. Most of these medicines work best for people in the early or middle stages of the disease. For people with mild or moderate Alzheimer's, donepezil (Aricept), rivastigmine (Exelon), or galantamine (Razadyne) may help. Donepezil is also approved to treat symptoms of moderate to severe Alzheimer's. Another drug, memantine (Namenda), is used to treat symptoms of moderate to severe Alzheimer's, although it also has limited effects. All of these medicines have possible side effects. Learn how Alzheimers medications work, how to take them, and where to find more information. Certain medicines and other approaches can help control the behavioral symptoms of Alzheimer's disease. These symptoms include sleeplessness, agitation, wandering, anxiety, anger, and depression. See more about medications used to treat behavioral symptoms. Some medicines must be used with caution."}]}
{"messages": [{"role": "user", "content": "How to prevent Alzheimer's Disease ?"}, {"role": "assistant", "content": "Currently, no medicines or treatments are known to prevent Alzheimer's disease, but scientists are studying many possibilities. These possibilities include lifestyle factors such as exercise and physical activity, a healthy diet, and mentally stimulating activities. In addition to lifestyle factors, scientists have found clues that some long-term health conditions, like heart disease, high blood pressure, and diabetes, are related to Alzheimer's disease. Its possible that controlling these conditions will reduce the risk of developing Alzheimers."}]}
{"messages": [{"role": "user", "content": "How to prevent Alzheimer's Disease ?"}, {"role": "assistant", "content": "Research suggests that exercise may play a role in reducing risk for Alzheimers disease. Animal studies show that exercise increases both the number of small blood vessels that supply blood to the brain and the number of connections between nerve cells in older rats and mice. In addition, researchers have found that exercise raises the level of a nerve growth factor (a protein key to brain health) in an area of the brain that is important to memory and learning.  Learn more about the benefits of exercise for older adults. For more on specific exercises geared to the needs of older adults, visit Go4Life, the exercise and physical activity campaign from the National Institute on Aging."}]}
{"messages": [{"role": "user", "content": "How to prevent Alzheimer's Disease ?"}, {"role": "assistant", "content": "A number of studies suggest that eating certain foods may help keep the brain healthyand that others can be harmful. Researchers are looking at whether a healthy dietone that includes lots of fruits, vegetables, and whole grains and is low in fat and added sugarcan help prevent Alzheimers. For more information about healthy eating as you age, see  Eating Well As You Get Older."}]}
{"messages": [{"role": "user", "content": "How to prevent Alzheimer's Disease ?"}, {"role": "assistant", "content": "Keeping the mind sharpthrough social engagement or intellectual stimulationis associated with a lower risk of Alzheimers disease. Activities like working, volunteering, reading, going to lectures, and playing computer and other games are being studied to see if they might help prevent Alzheimers. But we do not know with certainty whether these activities can actually prevent Alzheimers.  Find out about things you can do that may keep your brain healthy."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Alzheimer's Disease ?"}, {"role": "assistant", "content": "Basic research helps scientists gain new knowledge about a disease process, including how and why it starts and progresses. In Alzheimers disease, basic research seeks to identify the cellular, molecular, and genetic processes that lead to the disease. For example, scientists are studying - the ways in which plaques and tangles damage nerve cells in the brain  - the very earliest brain changes in the disease process  - the role of Alzheimers risk-factor genes in the development of the disease  - how risk-factor genes interact with other genes and lifestyle or environmental factors to affect Alzheimers risk. the ways in which plaques and tangles damage nerve cells in the brain the very earliest brain changes in the disease process the role of Alzheimers risk-factor genes in the development of the disease how risk-factor genes interact with other genes and lifestyle or environmental factors to affect Alzheimers risk. See the latest Alzheimers Disease Progress Report to read about results of NIA-supported Alzheimers research."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Alzheimer's Disease ?"}, {"role": "assistant", "content": "Translational research grows out of basic research. It creates new medicines, devices, or behavioral interventions aimed at preventing, diagnosing, or treating a disease. An important goal of Alzheimers translational research is to increase the number and variety of potential new medicines and other interventions that are approved for testing in humans. Scientists also examine medicines approved to treat other diseases to see they might be effective in people with Alzheimers. The most promising interventions are tested in test-tube and animal studies to make sure they are safe and effective. Currently, a number of different substances are under development that may one day be used to treat the symptoms of Alzheimers disease or mild cognitive impairment. See the latest Alzheimers Disease Progress Report to read about results of NIA-supported Alzheimers research."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Alzheimer's Disease ?"}, {"role": "assistant", "content": "Clinical research is medical research involving people. It includes clinical studies, which observe and gather information about large groups of people. It also includes clinical trials, which test a medicine, therapy, medical device, or intervention in people to see if it is safe and effective. Clinical trials are the best way to find out whether a particular intervention actually slows, delays, or prevents Alzheimers disease. Trials may compare a potential new treatment with a standard treatment or placebo (mock treatment). Or, they may study whether a certain behavior or condition affects the progress of Alzheimers or the chances of developing it. See the latest Alzheimers Disease Progress Report to read about results of NIA-supported Alzheimers research."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Alzheimer's Disease ?"}, {"role": "assistant", "content": "People with Alzheimer's disease, those with mild cognitive impairment, those with a family history of Alzheimers, and healthy people with no memory problems who want to help scientists test new treatments may be able to take part in clinical trials. Participants in clinical trials help scientists learn about the brain in healthy aging as well as what happens in Alzheimers. Results of these trials are used to improve prevention and treatment methods. To find out more about Alzheimers clinical trials, talk to your health care provider or contact the Alzheimers Disease Education and Referral (ADEAR) Center at 1-800-438-4380. You can search for studies about a certain topic or in a certain geographic area by going to www.nia.nih.gov/alzheimers/clinical-trials."}]}
{"messages": [{"role": "user", "content": "What is (are) Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "An Inflammatory, Autoimmune Disease Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It can cause mild to severe symptoms. Rheumatoid arthritis not only affects the joints, but may also attack tissue in the skin, lungs, eyes, and blood vessels. People with rheumatoid arthritis may feel sick, tired, and sometimes feverish. Rheumatoid arthritis is classified as an autoimmune disease. An autoimmune disease occurs when the immune system turns against parts of the body it is designed to protect. Rheumatoid arthritis generally occurs in a symmetrical pattern. This means that if one knee or hand is involved, the other one is, too. It can occur at any age, but usually begins during a person's most productive years. Affects More Women Than Men Rheumatoid arthritis occurs much more frequently in women than in men. About two to three times as many women as men have the disease. Learn more about how rheumatoid arthritis occurs.  Effects Vary Rheumatoid arthritis affects people differently. Some people have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability. Although rheumatoid arthritis is primarily a disease of the joints, its effects are not just physical. Many people with rheumatoid arthritis also experience issues related to - depression, anxiety  - feelings of helplessness  - low self-esteem. depression, anxiety feelings of helplessness low self-esteem. Rheumatoid arthritis can affect virtually every area of a persons life from work life to family life. It can also interfere with the joys and responsibilities of family life and may affect the decision to have children. Treatment Can Help Fortunately, current treatment strategies allow most people with the disease to lead active and productive lives. These strategies include pain-relieving drugs and medications that slow joint damage, a balance between rest and exercise, and patient education and support programs. In recent years, research has led to a new understanding of rheumatoid arthritis and has increased the likelihood that, in time, researchers will find even better ways to treat the disease."}]}
{"messages": [{"role": "user", "content": "What causes Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Actual Cause Is Unknown Scientists believe that rheumatoid arthritis may result from the interaction of many factors such as genetics, hormones, and the environment. Although rheumatoid arthritis sometimes runs in families, the actual cause of rheumatoid arthritis is still unknown. Research suggests that a person's genetic makeup is an important part of the picture, but not the whole story. Some evidence shows that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people with an inherited tendency to develop the disease. However, a specific agent or agents are not yet known. Not Contagious It is important to note that rheumatoid arthritis is not contagious. A person cannot catch it from someone else.  Learn more about the causes of rheumatoid arthritis."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Swelling and Pain in the Joints Different types of arthritis have different symptoms. In general, people with most forms of arthritis have pain and stiffness in their joints. Rheumatoid arthritis is characterized by inflammation of the joint lining. This inflammation causes warmth, redness, swelling, and pain around the joints. A person also feels sick, tired, and sometimes feverish. Rheumatoid arthritis generally occurs in a symmetrical pattern. If one knee or hand is affected, the other one is also likely to be affected. Diagnostic Tests Rheumatoid arthritis can be difficult to diagnose in its early stages for several reasons. There is no single test for the disease. In addition, symptoms differ from person to person and can be more severe in some people than in others. Common tests for rheumatoid arthritis include - The rheumatoid factor test. Rheumatoid factor is an antibody that is present eventually in the blood of most people with rheumatoid arthritis However, not all people with rheumatoid arthritis test positive for rheumatoid factor, especially early in the disease. Also, some people who do test positive never develop the disease. The rheumatoid factor test. Rheumatoid factor is an antibody that is present eventually in the blood of most people with rheumatoid arthritis However, not all people with rheumatoid arthritis test positive for rheumatoid factor, especially early in the disease. Also, some people who do test positive never develop the disease. -  The citrulline antibody test. This blood test detects antibodies to cyclic citrullinated peptide (anti-CCP). This test is positive in most people with rheumatoid arthritis and can even be positive years before rheumatoid arthritis symptoms develop. When used with the rheumatoid factor test, the citrulline antibody test results are very useful in confirming a rheumatoid arthritis diagnosis.  The citrulline antibody test. This blood test detects antibodies to cyclic citrullinated peptide (anti-CCP). This test is positive in most people with rheumatoid arthritis and can even be positive years before rheumatoid arthritis symptoms develop. When used with the rheumatoid factor test, the citrulline antibody test results are very useful in confirming a rheumatoid arthritis diagnosis. Other common tests for rheumatoid arthritis include - the erythrocyte sedimentation rate, which indicates the presence of inflammation in the body  - a test for white blood cell count and  - a blood test for anemia.  the erythrocyte sedimentation rate, which indicates the presence of inflammation in the body a test for white blood cell count and a blood test for anemia. Diagnosis Can Take Time Symptoms of rheumatoid arthritis can be similar to those of other types of arthritis and joint conditions, and it may take some time to rule out other conditions. The full range of symptoms develops over time, and only a few symptoms may be present in the early stages. Learn more about how rheumatoid arthritis is diagnosed."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Most Symptoms Are Treatable Doctors use a variety of approaches to treat rheumatoid arthritis. The goals of treatment are to help relieve pain, reduce swelling, slow down or help prevent joint damage, increase the ability to function, and improve the sense of well-being. Current treatment approaches include - lifestyle modification  - medications  - surgery  - routine monitoring and ongoing care.  lifestyle modification medications surgery routine monitoring and ongoing care. Balance Rest and Exercise People with rheumatoid arthritis need a good balance between rest and exercise; they should rest more when the disease is active and exercise more when it is not. Rest helps to reduce active joint inflammation and pain and to fight fatigue. The length of time for rest will vary from person to person, but in general, shorter rest breaks every now and then are more helpful than long times spent in bed. Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Exercise can also help people sleep well, reduce pain, maintain a positive attitude, and manage weight. Exercise programs should take into account the persons physical abilities, limitations, and changing needs. Learn more about the health benefits of exercise for older adults.  More information about exercise and physical activity for older adults can be found at  Go4Life, the exercise and physical activity campaign from the National Institute on Aging. Reduce Stress People with rheumatoid arthritis face emotional challenges as well as physical ones. The emotions they feel because of the diseasefear, anger, and frustrationcombined with any pain and physical limitations can increase their stress level. Finding ways to reduce stress is important. Regular rest periods can help and so can relaxation, distraction, or visualization exercises. Exercise programs, participation in support groups, and good communication with the health care team are other ways to reduce stress. For more information on exercise classes, you may want to contact the Arthritis Foundation at 1-800-283-7800. Learn about relaxation techniques that may relieve tension. Eat a Healthful Diet Special diets, vitamin supplements, and other alternative approaches have been suggested for treating rheumatoid arthritis. Although such approaches may not be harmful, scientific studies have not yet shown any benefits. Special diets, vitamin supplements, and other alternative approaches have been suggested for treating rheumatoid arthritis. Although such approaches may not be harmful, scientific studies have not yet shown any benefits. See  Eating Well as You Get Older  for more about healthy eating. Reduce Stress on Joints Some people find using a splint for a short time around a painful joint reduces pain and swelling by supporting the joint and letting it rest. Splints are used mostly on wrists and hands, but also on ankles and feet. A doctor or a physical or occupational therapist can help a person choose a splint and make sure it fits properly. Other ways to reduce stress on joints include - self-help devices (for example, zipper pullers, long-handled shoe horns)  -  devices to help with getting on and off chairs, toilet seats, and beds  -  changes in the ways that a person carries out daily activities.  self-help devices (for example, zipper pullers, long-handled shoe horns) devices to help with getting on and off chairs, toilet seats, and beds changes in the ways that a person carries out daily activities. Medications Most people who have rheumatoid arthritis take medications. Some drugs only provide relief for pain; others reduce inflammation. Still others, called disease-modifying anti-rheumatic drugs or DMARDs, can often slow the course of the disease. - DMARDs  include methotrexate, leflunomide, sulfasalazine, and cyclosporine. DMARDs  include methotrexate, leflunomide, sulfasalazine, and cyclosporine. -  Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation for people with rheumatoid arthritis. Cortisone, hydrocortisone, and prednisone are some commonly used steroids.  Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation for people with rheumatoid arthritis. Cortisone, hydrocortisone, and prednisone are some commonly used steroids. - DMARDS called biologic response modifiers also can help reduce joint damage. These drugs include etanercept, infliximab, anakinra, golimumab, adalimumab, rituximab, and abatacept. DMARDS called biologic response modifiers also can help reduce joint damage. These drugs include etanercept, infliximab, anakinra, golimumab, adalimumab, rituximab, and abatacept. -   Another DMARD, tofacitinib, from a new class of drugs called jak kinase (JAK) inhibitors is also available.  Another DMARD, tofacitinib, from a new class of drugs called jak kinase (JAK) inhibitors is also available. Early treatment with powerful drugs and drug combinations -- including biologic response modifiers and DMARDs -- instead of single drugs may help prevent the disease from progressing and greatly reduce joint damage. Surgery In some cases, a doctor will recommend surgery to restore function or relieve pain in a damaged joint. Surgery may also improve a person's ability to perform daily activities. Joint replacement and tendon reconstruction are two types of surgery available to patients with severe joint damage. Routine Monitoring and Ongoing Care Regular medical care is important to monitor the course of the disease, determine the effectiveness and any negative effects of medications, and change therapies as needed. Monitoring typically includes regular visits to the doctor. It also may include blood, urine, and other laboratory tests and x rays. Monitor Osteoporosis Risk People with rheumatoid arthritis may want to discuss preventing osteoporosis with their doctors as part of their long-term, ongoing care. Osteoporosis is a condition in which bones become weakened and fragile. Having rheumatoid arthritis increases the risk of developing osteoporosis for both men and women, particularly if a person takes corticosteroids. Such patients may want to discuss with their doctors the potential benefits of calcium and vitamin D supplements or other treatments for osteoporosis. See What is Osteoporosis? to learn more about this disease."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Scientists are making rapid progress in understanding the complexities of rheumatoid arthritis. They are learning more about how and why it develops and why some people have more severe symptoms than others. Research efforts are focused on developing drugs that can reduce inflammation and slow or stop the disease with few side effects. Identifying Possible Triggers Some evidence shows that infectious agents, such as viruses and bacteria, may contribute to triggering rheumatoid arthritis in people with an inherited tendency to develop the disease. Investigators are trying to identify the infectious agents and understand how they work. This knowledge could lead to new therapies. Why More Women Than Men? Researchers are also exploring why so many more women than men develop rheumatoid arthritis. In the hope of finding clues, they are studying complex relationships between the hormonal, nervous, and immune systems in rheumatoid arthritis. For example, they are exploring whether and how the normal changes in the levels of steroid hormones such as estrogen and testosterone during a person's lifetime may be related to the development, improvement, or flares of the disease. Scientists are also examining why rheumatoid arthritis often improves during pregnancy. Learn more about current research on rheumatoid arthritis. Interested in Clinical Trials? The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at Clinical Trials.gov.  To see a list of current clinical trials on rheumatoid arthritis, type \"rheumatoid arthritis\" into the search box."}]}
{"messages": [{"role": "user", "content": "What is (are) Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It can cause mild to severe symptoms. People with rheumatoid arthritis may feel sick, tired, and sometimes feverish. Sometimes rheumatoid arthritis attacks tissue in the skin, lungs, eyes, and blood vessels. The disease generally occurs in a symmetrical pattern. If one knee or hand is involved, usually the other one is, too. It can occur at any age, but often begins between ages 40 and 60. About two to three times as many women as men have rheumatoid arthritis. Learn more about how rheumatoid arthritis occurs."}]}
{"messages": [{"role": "user", "content": "What causes Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Scientists believe that rheumatoid arthritis may result from the interaction of many factors such as genetics, hormones, and the environment. Although rheumatoid arthritis sometimes runs in families, the actual cause of rheumatoid arthritis is still unknown. Research suggests that a person's genetic makeup is an important part of the picture, but not the whole story. Some evidence shows that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people with an inherited tendency to develop the disease. The exact agent or agents, however, are not yet known. It is important to note that rheumatoid arthritis is not contagious. A person cannot catch it from someone else. Learn more about the causes of rheumatoid arthritis."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Rheumatoid arthritis is characterized by inflammation of the joint lining. This inflammation causes warmth, redness, swelling, and pain around the joints. The pain of rheumatoid arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint."}]}
{"messages": [{"role": "user", "content": "How to diagnose Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Rheumatoid arthritis can be difficult to diagnose in its early stages because the full range of symptoms develops over time, and only a few symptoms may be present in the early stages. As part of the diagnosis, your doctor will look for symptoms such as swelling, warmth, pain, and limitations in joint motion throughout your body. Your doctor may ask you questions about the intensity of your pain symptoms, how often they occur, and what makes the pain better or worse."}]}
{"messages": [{"role": "user", "content": "How to diagnose Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "There is no single, definitive test for rheumatoid arthritis. Common tests for rheumatoid arthritis include - The rheumatoid factor test. Rheumatoid factor is an antibody that is present eventually in the blood of most people with rheumatoid arthritis. However, not all people with rheumatoid arthritis test positive for rheumatoid factor, especially early in the disease. Also, some people who do test positive never develop the disease.  The rheumatoid factor test. Rheumatoid factor is an antibody that is present eventually in the blood of most people with rheumatoid arthritis. However, not all people with rheumatoid arthritis test positive for rheumatoid factor, especially early in the disease. Also, some people who do test positive never develop the disease. - The citrulline antibody test. This blood test detects antibodies to cyclic citrullinated peptide (anti-CCP). This test is positive in most people with rheumatoid arthritis and can even be positive years before rheumatoid arthritis symptoms develop. When used with the rheumatoid factor test, the citrulline antibody test results are very useful in confirming a rheumatoid arthritis diagnosis.  The citrulline antibody test. This blood test detects antibodies to cyclic citrullinated peptide (anti-CCP). This test is positive in most people with rheumatoid arthritis and can even be positive years before rheumatoid arthritis symptoms develop. When used with the rheumatoid factor test, the citrulline antibody test results are very useful in confirming a rheumatoid arthritis diagnosis. Other common tests for rheumatoid arthritis include - the erythrocyte sedimentation rate, which indicates the presence of inflammation in the body   - a test for white blood cell count   - a blood test for anemia.  the erythrocyte sedimentation rate, which indicates the presence of inflammation in the body a test for white blood cell count a blood test for anemia. X-rays are often used to determine the degree of joint destruction. They are not useful in the early stages of rheumatoid arthritis before bone damage is evident, but they can be used later to monitor the progression of the disease. Learn more about how rheumatoid arthritis is diagnosed."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Medication, exercise, and, in some cases, surgery are common treatments for this disease. Most people who have rheumatoid arthritis take medications. Some drugs only provide relief for pain; others reduce inflammation. People with rheumatoid arthritis can also benefit from exercise, but they need to maintain a good balance between rest and exercise. They should get rest when the disease is active and get more exercise when it is not. In some cases, a doctor will recommend surgery to restore function or relieve pain in a damaged joint. Several types of surgery are available to patients with severe joint damage. Joint replacement and tendon reconstruction are examples."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Most people who have rheumatoid arthritis take medications. Some drugs only provide relief for pain; others reduce inflammation. Still others, called disease-modifying anti-rheumatic drugs or DMARDs, can often slow the course of the disease. - DMARDs include methotrexate, leflunomide, sulfasalazine, and cyclosporine.   - Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation for people with rheumatoid arthritis. Cortisone, hydrocortisone, and prednisone are some commonly used steroids.   - DMARDs called biological response modifiers also can help reduce joint damage. These drugs include etanercept, infliximab, and anakinra.   - Another DMARD, tofacitinib, from a new class of drugs called jak kinase (JAK) inhibitors is also available.  DMARDs include methotrexate, leflunomide, sulfasalazine, and cyclosporine. Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation for people with rheumatoid arthritis. Cortisone, hydrocortisone, and prednisone are some commonly used steroids. DMARDs called biological response modifiers also can help reduce joint damage. These drugs include etanercept, infliximab, and anakinra. Another DMARD, tofacitinib, from a new class of drugs called jak kinase (JAK) inhibitors is also available. Early treatment with powerful drugs and drug combinations -- including biological response modifiers and DMARDs -- instead of single drugs may help prevent the disease from progressing and greatly reduce joint damage."}]}
{"messages": [{"role": "user", "content": "What is (are) Rheumatoid Arthritis ?"}, {"role": "assistant", "content": "Rest. People with rheumatoid arthritis need a good balance between rest and exercise; they should rest more when the disease is active and exercise more when it is not. Rest helps to reduce active joint inflammation and pain and to fight fatigue. The length of time for rest will vary from person to person, but in general, shorter rest breaks every now and then are more helpful than long times spent in bed. Exercise. Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Exercise can help people sleep well, reduce pain, maintain a positive attitude, and manage weight. Exercise programs should take into account the persons physical abilities, limitations, and changing needs. For more information on exercise classes, you may want to contact the Arthritis Foundation at 1-800-283-7800. Learn more about the health benefits of exercise for older adults.  More information about exercise and physical activity for older adults can be found at Go4Life, the exercise and and physical activity campaign from the National Institute on Aging. Diet. Special diets, vitamin supplements, and other alternative approaches have been suggested for treating rheumatoid arthritis. Although such approaches may not be harmful, scientific studies have not yet shown any benefits. An overall nutritious diet with the right amount of calories, protein, and calcium is important. Some people need to be careful about drinking alcoholic beverages because of the medications they take for rheumatoid arthritis. See Eating Well as You Get Older  to learn more about healthy eating.  Joint Care. Some people find that using a splint for a short time around a painful joint reduces pain and swelling by supporting the joint and letting it rest. Assistive devices may help reduce stress and lessen pain in the joints. Examples include zipper pullers and aids to help with moving in and out of chairs and beds.  Stress Reduction. Finding ways to reduce stress is important. Regular rest periods can help and so can relaxation, distraction, or visualization exercises. Exercise programs, participation in support groups, and good communication with the health care team are other ways to reduce stress.  Learn about relaxation techniques that may relieve tension."}]}
{"messages": [{"role": "user", "content": "What is (are) Hearing Loss ?"}, {"role": "assistant", "content": "Hearing loss is a common problem caused by noise, aging, disease, and heredity. Hearing is a complex sense involving both the ear's ability to detect sounds and the brain's ability to interpret those sounds, including the sounds of speech. Factors that determine how much hearing loss will negatively affect a persons quality of life include -  the degree of the hearing loss  -  the pattern of hearing loss across different frequencies (pitches)  -  whether one or both ears is affected  -  the areas of the auditory system that are not working normallysuch as the middle ear, inner ear, neural pathways, or brain  -  the ability to recognize speech sounds  - the history of exposures to loud noise and environmental or drug-related toxins that are harmful to hearing   - age.  the degree of the hearing loss the pattern of hearing loss across different frequencies (pitches) whether one or both ears is affected the areas of the auditory system that are not working normallysuch as the middle ear, inner ear, neural pathways, or brain the ability to recognize speech sounds the history of exposures to loud noise and environmental or drug-related toxins that are harmful to hearing age. A Common Problem in Older Adults Hearing loss is one of the most common conditions affecting older adults. Approximately 17 percent, or 36 million, of American adults report some degree of hearing loss. There is a strong relationship between age and reported hearing loss: 18 percent of American adults 45-64 years old, 30 percent of adults 65-74 years old, and 47 percent of adults 75 years old, or older, have a hearing impairment. Men are more likely to experience hearing loss than women. People with hearing loss may find it hard to have a conversation with friends and family. They may also have trouble understanding a doctor's advice, responding to warnings, and hearing doorbells and alarms. Types of Hearing Loss Hearing loss comes in many forms. It can range from a mild loss in which a person misses certain high-pitched sounds, such as the voices of women and children, to a total loss of hearing. It can be hereditary or it can result from disease, trauma, certain medications, or long-term exposure to loud noises. There are two general categories of hearing loss. - Sensorineural hearing loss occurs when there is damage to the inner ear or the auditory nerve. This type of hearing loss is usually permanent.  - Conductive hearing loss occurs when sound waves cannot reach the inner ear. The cause may be earwax build-up, fluid, or a punctured eardrum. Medical treatment or surgery can usually restore conductive hearing loss.  Sensorineural hearing loss occurs when there is damage to the inner ear or the auditory nerve. This type of hearing loss is usually permanent. Conductive hearing loss occurs when sound waves cannot reach the inner ear. The cause may be earwax build-up, fluid, or a punctured eardrum. Medical treatment or surgery can usually restore conductive hearing loss. What is Presbycusis? One form of hearing loss, presbycusis, comes on gradually as a person ages. Presbycusis can occur because of changes in the inner ear, auditory nerve, middle ear, or outer ear. Some of its causes are aging, loud noise, heredity, head injury, infection, illness, certain prescription drugs, and circulation problems such as high blood pressure. Presbycusis commonly affects people over 50, many of whom are likely to lose some hearing each year. Having presbycusis may make it hard for a person to tolerate loud sounds or to hear what others are saying. Tinnitus: A Common Symptom Tinnitus, also common in older people, is a ringing, roaring, clicking, hissing, or buzzing sound. It can come and go. It might be heard in one or both ears and be loud or soft. Tinnitus is a symptom, not a disease. It can accompany any type of hearing loss. It can be a side effect of medications. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus, but it can also be the result of a number of health conditions. If you think you have tinnitus, see your primary care doctor. You may be referred to an otolaryngologist -- a surgeon who specializes in ear, nose, and throat diseases -- (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine the appropriate treatment. Hearing Loss Can Lead to Other Problems Some people may not want to admit they have trouble hearing. Older people who can't hear well may become depressed or may withdraw from others to avoid feeling frustrated or embarrassed about not understanding what is being said. Sometimes older people are mistakenly thought to be confused, unresponsive, or uncooperative just because they don't hear well. Hearing problems that are ignored or untreated can get worse. If you have a hearing problem, you can get help. See your doctor. Hearing aids, special training, certain medicines, and surgery are some of the choices that can help people with hearing problems."}]}
{"messages": [{"role": "user", "content": "How to prevent Hearing Loss ?"}, {"role": "assistant", "content": "Causes of Hearing Loss Hearing loss happens for many reasons. Some people lose their hearing slowly as they age. This condition is called presbycusis. Doctors do not know why presbycusis happens, but it seems to run in families. Another cause is the ear infection otitis media, which can lead to long-term hearing loss if it is not treated. Hearing loss can also result from taking certain medications. \"Ototoxic\" medications damage the inner ear, sometimes permanently. Some antibiotics are ototoxic. Even aspirin at some dosages can cause problems, but they are temporary. Check with your doctor if you notice a problem while taking a medication. Heredity can cause hearing loss, but not all inherited forms of hearing loss take place at birth. Some forms can show up later in life. In otosclerosis, which is thought to be a hereditary disease, an abnormal growth of bone prevents structures within the ear from working properly. A severe blow to the head also can cause hearing loss. Loud Noise Can Cause Hearing Loss One of the most common causes of hearing loss is loud noise. Loud noise can permanently damage the inner ear. Loud noise also contributes to tinnitus, which is a ringing, roaring, clicking, hissing, or buzzing sound in the ears. Approximately 15 percent (26 million) of Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud sounds or noise at work or in leisure activities. Avoiding Noise-Induced Hearing Loss Noise-induced hearing loss is 100 percent preventable. You can protect your hearing by avoiding noises at or above 85 decibels in loudness, which can damage your inner ear. These include gas lawnmowers, snowblowers, motorcycles, firecrackers, and loud music. Lower the volume on personal stereo systems and televisions. When you are involved in a loud activity, wear earplugs or other hearing protective devices. Be sure to protect children's ears too. Although awareness of noise levels is important, you should also be aware of how far away you are from loud noise and how long you are exposed to it. Avoid noises that are too loud (85 decibels and above). Reduce the sound if you can, or wear ear protection if you cannot. Potential damage from noise is caused by the loudness of the sound and the amount of time you are exposed to it. If you experience tinnitus or have trouble hearing after noise exposure, then you have been exposed to too much noise. Other Ways to Prevent Hearing Loss There are other ways to prevent hearing loss. - If earwax blockage is a problem for you, ask you doctor about treatments you can use at home such as mineral oil, baby oil, glycerin, or commercial ear drops to soften earwax.  - If you suspect that you may have a hole in your eardrum, you should consult a doctor before using such products. A hole in the eardrum can result in hearing loss and fluid discharge.   - The ear infection otitis media  is most common in children, but adults can get it, too. You can help prevent upper respiratory infections -- and a resulting ear infection -- by washing your hands frequently.  - Ask your doctor about how to help prevent flu-related ear infections. If you still get an ear infection, see a doctor immediately before it becomes more serious.   - If you take medications, ask your doctor if your medication is ototoxic, or potentially damaging to the ear. Ask if other medications can be used instead. If not, ask if the dosage can be safely reduced. Sometimes it cannot. However, your doctor should help you get the medication you need while trying to reduce unwanted side effects.  If earwax blockage is a problem for you, ask you doctor about treatments you can use at home such as mineral oil, baby oil, glycerin, or commercial ear drops to soften earwax. If you suspect that you may have a hole in your eardrum, you should consult a doctor before using such products. A hole in the eardrum can result in hearing loss and fluid discharge. The ear infection otitis media  is most common in children, but adults can get it, too. You can help prevent upper respiratory infections -- and a resulting ear infection -- by washing your hands frequently. Ask your doctor about how to help prevent flu-related ear infections. If you still get an ear infection, see a doctor immediately before it becomes more serious. If you take medications, ask your doctor if your medication is ototoxic, or potentially damaging to the ear. Ask if other medications can be used instead. If not, ask if the dosage can be safely reduced. Sometimes it cannot. However, your doctor should help you get the medication you need while trying to reduce unwanted side effects."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Hearing Loss ?"}, {"role": "assistant", "content": "Don't Ignore Hearing Problems Some people have a hearing problem without realizing it. Others might think they have a problem, but are too embarrassed to tell their doctor, friends, or family. You can help identify a possible hearing problem by asking yourself some key questions and, if necessary, having your hearing checked by a doctor. If a hearing loss is ignored or untreated, it can get worse. But a hearing loss that is identified early can be helped through treatment, such as hearing aids, certain medications, and surgery. Do You Have A Hearing Problem? Ask yourself the following questions. If you answer \"yes\" to three or more of these questions, you could have a hearing problem and may need to have your hearing checked by a doctor. - Do I have a problem hearing on the telephone?  - Do I have trouble hearing when there is noise in the background?  - Is it hard for me to follow a conversation when two or more people talk at once?  - Do I have to strain to understand a conversation?  - Do many people I talk to seem to mumble or not speak clearly?  - Do I misunderstand what others are saying and respond inappropriately?  - Do I often ask people to repeat themselves?  - Do I have trouble understanding women and children when they talk?  - Do people complain that I turn the TV volume up too high?  - Do I hear a ringing, roaring, clicking, buzzing, or hissing sound a lot?  - Do some sounds seem too loud? Do I have a problem hearing on the telephone? Do I have trouble hearing when there is noise in the background? Is it hard for me to follow a conversation when two or more people talk at once? Do I have to strain to understand a conversation? Do many people I talk to seem to mumble or not speak clearly? Do I misunderstand what others are saying and respond inappropriately? Do I often ask people to repeat themselves? Do I have trouble understanding women and children when they talk? Do people complain that I turn the TV volume up too high? Do I hear a ringing, roaring, clicking, buzzing, or hissing sound a lot? Do some sounds seem too loud? Sudden sensorineural hearing loss, or sudden deafness, is a rapid loss of hearing. It can happen to a person all at once or over a period of up to 3 days. It should be considered a medical emergency. If you or someone you know experiences sudden sensorineural hearing loss, you should visit a doctor immediately. Who Should I See? The most important thing you can do if you think you have a hearing problem is to seek professional advice. There are several ways to do this. You may start with your primary care physician, an otolaryngologist, an audiologist, or a hearing aid specialist. Each has a different type of training and expertise. Each can be an important part of your hearing health care. An otolaryngologist  -- a surgeon who specializes in ear, nose, and throat diseases -- will try to find out why you have a hearing loss and offer treatment options. He or she will ask you for your medical history, ask if other family members have hearing problems, perform a thorough exam, and prescribe any needed tests. An audiologist is a health professional who can identify and measure hearing loss. The audiologist will use a device called an audiometer to test your ability to hear sounds of different loudness and pitch (where the sound falls on the scale, from high to low). The tests that an audiologist performs are painless. Audiologists do not prescribe medications or perform surgery. If you need a hearing aid, some audiologists are licensed to help you choose the right one. A hearing aid specialist (or hearing aid dispenser) is a licensed professional that can check your hearing, fit a hearing aid, counsel and rehabilitate, evaluate treatment for tinnitus, and help with swim molds, ear molds, and noise protectors."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Hearing Loss ?"}, {"role": "assistant", "content": "Your doctor can recommend strategies to help reduce the effects of a hearing loss. Scientists are studying ways to develop new, more effective methods to treat and prevent hearing loss. Hearing Aids A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear more in both quiet and noisy situations. However, only about one out of five people who would benefit from a hearing aid actually uses one. A hearing aid has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker. Types of Hearing Aids There are a number of different types of hearing aids to treat different kinds of hearing loss. Choosing one will depend on the kind of hearing loss you have, you lifestyle, and your own preferences. - Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn behind the ear and connected to a plastic earmold that fits inside the outer ear. The electronic parts are held in the case behind the ear. Sound travels from the hearing aid through the earmold and into the ear. BTE aids are used by people of all ages for mild to profound hearing loss. Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn behind the ear and connected to a plastic earmold that fits inside the outer ear. The electronic parts are held in the case behind the ear. Sound travels from the hearing aid through the earmold and into the ear. BTE aids are used by people of all ages for mild to profound hearing loss. - Open-fit hearing aids fit completely behind the ear with only a narrow tube inserted into the ear canal. This lets the ear canal remain open. Open-fit hearing aids may be a good choice for people with a buildup of earwax since this type of aid is less likely to be damaged by earwax. Some people may prefer the open-fit hearing aid because they do not perceive their voice as sounding plugged up.  Open-fit hearing aids fit completely behind the ear with only a narrow tube inserted into the ear canal. This lets the ear canal remain open. Open-fit hearing aids may be a good choice for people with a buildup of earwax since this type of aid is less likely to be damaged by earwax. Some people may prefer the open-fit hearing aid because they do not perceive their voice as sounding plugged up. - In-the-ear hearing aids fit completely inside the outer ear. The case holding the electronic components is made of hard plastic. Some in-the-ear hearing aids may also use a telecoil, which is a small magnetic coil that allows you to receive sound through the circuitry of the hearing aid, rather than through the microphone. You can use the telecoil when you use the telephone and when you are in public places that have installed induction loop systems, such as churches, schools, airports, and auditoriums. In-the-ear hearing aids fit completely inside the outer ear. The case holding the electronic components is made of hard plastic. Some in-the-ear hearing aids may also use a telecoil, which is a small magnetic coil that allows you to receive sound through the circuitry of the hearing aid, rather than through the microphone. You can use the telecoil when you use the telephone and when you are in public places that have installed induction loop systems, such as churches, schools, airports, and auditoriums. - Canal hearing aids fit into the ear canal and are available in two styles. The in-the-canal hearing aid is made to fit the size and shape of your ear canal. A completely-in-canal hearing aid is nearly hidden in the ear canal. Both types are used for mild to moderately severe hearing loss. Because they are small, canal aids may be difficult for a person to adjust and remove. In addition, canal aids have less space available for batteries and additional devices, such as a telecoil. They usually are not recommended for people with severe to profound hearing loss because their reduced size limits their power and volume.  Canal hearing aids fit into the ear canal and are available in two styles. The in-the-canal hearing aid is made to fit the size and shape of your ear canal. A completely-in-canal hearing aid is nearly hidden in the ear canal. Both types are used for mild to moderately severe hearing loss. Because they are small, canal aids may be difficult for a person to adjust and remove. In addition, canal aids have less space available for batteries and additional devices, such as a telecoil. They usually are not recommended for people with severe to profound hearing loss because their reduced size limits their power and volume. An audiologist or hearing aid specialist can help you determine if a hearing aid, or even two hearing aids, is the right treatment for you. Wearing two hearing aids may help balance sounds, improve your understanding of words in noisy situations, and make it easier to locate the source of sounds. Cochlear Implants If your hearing loss is severe and of a certain type, your doctor may suggest that you talk to an otolaryngologista surgeon who specializes in ear, nose, and throat diseasesabout a cochlear implant. A cochlear implant is a small electronic device that the surgeon places under the skin and behind the ear. The device picks up sounds, changes them to electrical signals, and sends them past the non-working part of the inner ear and on to the brain. A cochlear implant does not restore or create normal hearing. Instead, it can help people who are deaf or who have a severe hearing loss be more aware of their surroundings and understand speech, sometimes well enough to use the telephone. Learning to interpret sounds from the implant takes time and practice. A speech-language pathologist and audiologist can help you with this part of the process. Assistive Listening Devices Assistive listening devices devices can help you hear in certain listening environments. These can include telephone and cell phone amplifying devices, smart phone or tablet \"apps,\" and closed circuit systems (induction coil loops) in places of worship, theaters, and auditoriums. TV listening systems help you listen to the television or the radio without being bothered by other noises around you. Some hearing aids can be plugged into televisions or stereos to help you hear better. New and Improved Treatments Under Study Researchers are studying the causes of hearing loss as well as new treatments. For example, they are studying ways to improve hearing aids so that wearers can hear certain sounds more clearly even when a person is surrounded by background noise. They are also studying how to improve cochlear implants to enhance a person's ability to understand sounds. And they are conducting a study on twins aged 50 and over to determine the extent to which age-related hearing loss runs in families."}]}
{"messages": [{"role": "user", "content": "How many people are affected by Hearing Loss ?"}, {"role": "assistant", "content": "Approximately 17 percent, or 36 million, of American adults say that they have some degree of hearing loss. Hearing loss is a common condition in older adults. Roughly one-third of Americans 65 to 74 years of age and 47 percent of those 75 and older have hearing loss."}]}
{"messages": [{"role": "user", "content": "What is (are) Hearing Loss ?"}, {"role": "assistant", "content": "Presbycusis is common in older adults. Presbycusis comes on gradually as a person ages and mostly affects people over 50. Doctors do not know why presbycusis happens, but it seems to run in families. Presbycusis may make it hard for a person to tolerate loud sounds or to hear what others are saying. This type of hearing loss involves damage to the inner ear and is permanent. Tinnitus, also common in older people, is the ringing, roaring, clicking, hissing, or buzzing sound in the ears frequently caused by presbycusis, exposure to loud noise or certain medications. Tinnitus can accompany any type of hearing loss. It also can be a sign of other important health problems, too, such as allergies and problems in the heart and blood vessels. Tinnitus may come and go, or stop altogether."}]}
{"messages": [{"role": "user", "content": "What causes Hearing Loss ?"}, {"role": "assistant", "content": "Hearing loss can result from taking certain medications. \"Ototoxic\" medications damage the inner ear, sometimes permanently. Check with your doctor if you notice a problem while taking a medication."}]}
{"messages": [{"role": "user", "content": "How to prevent Hearing Loss ?"}, {"role": "assistant", "content": "Washing your hands frequently can help prevent upper respiratory infections, which can lead to an ear infection called otitis media. The ear infection otitis media can be a cause of long-term hearing loss. Also, ask your doctor about a yearly flu shot to help prevent flu-related ear infections. If you still get an ear infection, see a doctor immediately before it becomes more serious."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Hearing Loss ?"}, {"role": "assistant", "content": "Assistive Listening Devices  Assistive listening devices devices can help you hear in certain listening environments. These can include telephone and cell phone amplifying devices, smart phone or tablet \"apps,\" and closed circuit systems (induction coil loops) in places of worship, theaters, and auditoriums. TV listening systems help you listen to the television or the radio without being bothered by other noises around you. Some hearing aids can be plugged into televisions or stereos to help you hear better.  Cochlear Implant If your hearing loss is severe and of a certain type, your doctor may suggest that you talk to an otolaryngologist about a cochlear implant. An otolaryngologist is a surgeon who specializes in ear, nose, and throat diseases. A cochlear implant is a small electronic device that the surgeon places under the skin and behind the ear. The device picks up sounds, changes them to electrical signals, and sends them past the non-working part of the inner ear and on to the brain. Hearing through a cochlear implant sounds different from normal hearing, but it lets many people communicate orally in person and over the telephone, and perceive sounds in the environment."}]}
{"messages": [{"role": "user", "content": "How to prevent Hearing Loss ?"}, {"role": "assistant", "content": "Researchers funded by the National Institutes of Health are studying the causes of hearing loss as well as new treatments. For example, they are studying ways to improve hearing aids so that you can hear certain sounds more clearly even when you are surrounded by background noise. They are also working to to improve cochlear implants and develop diagnostic methods to determine who would benefit from two versus one cochlear implant, especially in young children. Finding ways to improve access to accessible and affordable hearing health care, including screening and assessment, hearing aid selection and fitting, and rehabilitation of hearing loss, is also a goal of currently funded research."}]}
{"messages": [{"role": "user", "content": "What is (are) Low Vision ?"}, {"role": "assistant", "content": "Everyday Tasks Are Challenging  Low vision means that even with regular glasses, contact lenses, medicine, or surgery, people find everyday tasks difficult to do. Reading the mail, shopping, cooking, seeing the TV, and writing can seem challenging. Millions of Americans lose some of their vision every year. Irreversible vision loss is most common among people over age 65. (Watch the video to learn more about low vision. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Not a Normal Part of Aging Losing vision is not just part of getting older. Some normal changes occur as we get older. However, these changes usually don't lead to low vision."}]}
{"messages": [{"role": "user", "content": "What causes Low Vision ?"}, {"role": "assistant", "content": "Eye Diseases and Health Conditions Most people develop low vision because of eye diseases and health conditions like macular degeneration, cataracts, glaucoma, and diabetes. Your eye care professional can tell the difference between normal changes in the aging eye and those caused by eye diseases. Injuries and Birth Defects A few people develop vision loss after eye injuries or from birth defects. Although vision that is lost usually cannot be restored, many people can make the most of the vision they have. How a Scene Looks to People With Normal and Low Vision Scene as viewed by a person with normal vision. Scene as viewed by a person with diabetic retinopathy. Scene as viewed by a person with age-related macular degeneration. Scene as viewed by a person with glaucoma. Scene as viewed by a person with cataracts."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Low Vision ?"}, {"role": "assistant", "content": "There are many signs that can signal vision loss. For example, even with your regular glasses, do you have difficulty - recognizing faces of friends and relatives?   - doing things that require you to see well up close, such as reading, cooking, sewing, fixing things around the house, or picking out and matching the color of your clothes?  - doing things at work or home because lights seem dimmer than they used to?  - reading street and bus signs or the names of stores? recognizing faces of friends and relatives? doing things that require you to see well up close, such as reading, cooking, sewing, fixing things around the house, or picking out and matching the color of your clothes? doing things at work or home because lights seem dimmer than they used to? reading street and bus signs or the names of stores? Early Diagnosis Is Important Vision changes like these could be early warning signs of eye disease. People over age 60 should have an eye exam through dilated pupils at least once a year. Usually, the earlier your problem is diagnosed, the better your chances of undergoing successful treatment and keeping your remaining vision. Regular dilated eye exams should be part of your routine health care. However, if you think your vision has recently changed, you should see your eye care professional as soon as possible."}]}
{"messages": [{"role": "user", "content": "What is (are) Low Vision ?"}, {"role": "assistant", "content": "Low vision is a visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery, that interferes with a person's ability to perform everyday activities. (Watch the video to learn more about low vision. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What causes Low Vision ?"}, {"role": "assistant", "content": "Low vision can result from a variety of diseases, disorders, and injuries that affect the eye. Many people with low vision have age-related macular degeneration, cataracts, glaucoma, or diabetic retinopathy. Age-related macular degeneration accounts for almost 45 percent of all cases of low vision."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Low Vision? ?"}, {"role": "assistant", "content": "People age 60 and older, as well as African Americans and Hispanics over age 45, are at higher risk. African Americans and Hispanics are at higher risk for low vision because they are at higher risk for developing diabetes and diabetic retinopathy, and African Americans are at a higher risk for developing glaucoma."}]}
{"messages": [{"role": "user", "content": "What is (are) Low Vision ?"}, {"role": "assistant", "content": "Many agencies and organizations in the community provide assistance and information to people who have low vision and to their families and caregivers. State agencies for the blind and visually impaired can make referrals to a variety of organizations that provide assistance. Such services include vision rehabilitation, recreation, counseling, and job training or placement. For assistance in finding agencies and organizations, contact: National Eye Institute  National Institutes of Health  2020 Vision Place  Bethesda, MD 20892-3655  Phone: 301-496-5248  E-mail: 2020@nei.nih.gov  Website:  http://www.nei.nih.gov/"}]}
{"messages": [{"role": "user", "content": "What is (are) COPD ?"}, {"role": "assistant", "content": "Chronic obstructive pulmonary disease, or COPD, is a progressive lung disease in which the airways of the lungs become damaged, making it hard to breathe. You may also have heard COPD called other names, like emphysema or chronic bronchitis. In people who have COPD, the airways that carry air in and out of the lungs are partially blocked, making it difficult to get air in and out. COPD is a major cause of death and illness throughout the world. It kills more than 120,000 Americans each year. That's one death every 4 minutes. How COPD Affects Airways The \"airways\" are the tubes that carry air in and out of the lungs through the nose and mouth. The airways of the lungs branch out like an upside-down tree. At the end of each branch are many small, balloon-like air sacs. In healthy people, the airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with air, like a small balloon, and when you breathe out, the balloon deflates and the air goes out. In people with COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air goes out of the airways because - The airways and air sacs lose their elasticity like an old rubber band.  - The walls between many of the air sacs are destroyed.  - The walls of the airways become thick and inflamed or swollen.  - Cells in the airways make more mucus or sputum than usual, which tends to clog the airways. The airways and air sacs lose their elasticity like an old rubber band. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed or swollen. Cells in the airways make more mucus or sputum than usual, which tends to clog the airways. COPD Develops Slowly, Has No Cure When COPD is severe, shortness of breath and other symptoms of COPD can get in the way of even the most basic tasks, such as doing light housework, taking a walk, even washing and dressing. COPD develops slowly, and it may be many years before you notice symptoms like feeling short of breath. Most of the time, COPD is diagnosed in middle-aged or older people. There is no cure for COPD. The damage to your airways and lungs cannot be reversed, but there are things you can do to control the disabling effects of the disease. COPD is not contagious. You cannot catch it from someone else."}]}
{"messages": [{"role": "user", "content": "What causes COPD ?"}, {"role": "assistant", "content": "Smoking Most cases of COPD develop over time, from breathing in fumes and other things that irritate the lungs. Some of the things that put you at risk for COPD include smoking, environmental exposure, and genetic factors. Cigarette smoking is the most common cause of COPD in the United States (either current or former smokers). Pipe, cigar, and other types of tobacco smoking can also cause COPD, especially if the smoke is inhaled. Environmental Exposure COPD can also occur in people who have had long-term exposure to things that can irritate your lungs, like chemical fumes, or dust from the environment or workplace. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD even if you have never smoked or had long-term exposure to harmful pollutants. Secondhand smoke is smoke in the air from other people smoking. Genetic Factors In a small number of people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. People who have this condition have low levels of alpha-1 antitrypsin (AAT)a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly. While very few people know if they have AAT deficiency, it is estimated that about 1 in every 1,600 people to about 1 in every 5,000 people have it. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants. Asthma Although uncommon, some people who have asthma can develop COPD. Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing. However, if not, COPD can develop."}]}
{"messages": [{"role": "user", "content": "How to prevent COPD ?"}, {"role": "assistant", "content": "If you have COPD, you can take these steps to prevent complications and control the disabling effects of the disease. - Quit smoking.   - Avoid exposure to pollutants and lung irritants.  - Take precautions against the flu.  - Talk to your doctor about the flu and pneumonia vaccines.  - See your doctor on a regular basis.   - Follow your treatments for COPD exactly as your doctor prescribes. Quit smoking. Avoid exposure to pollutants and lung irritants. Take precautions against the flu. Talk to your doctor about the flu and pneumonia vaccines. See your doctor on a regular basis. Follow your treatments for COPD exactly as your doctor prescribes. Quit Smoking If you smoke, the most important thing you can do to prevent more lung damage is to stop smoking. Quitting can help prevent complications and slow the progress of the disease. It is also important to stay away from people who smoke and places where you know there will be smokers. To help you quit, there are many online resources and several new aids available from your doctor or health care provider. The National Cancer Institute (NCI) has information on smoking cessation. Visit SmokeFree.gov , or check out NCI's  Clear Horizons,  a quit smoking guide for people 50+. You can also visit The American Lung Association, or call 1-800-QUIT NOW (1-800-784-8669). Avoid Exposure to Pollutants and Lung Irritants Try to stay away from other things that could irritate your lungs, like dust and strong fumes. Stay indoors when the outside air quality is poor. You should also stay away from places where there might be cigarette smoke. Take Precautions Against the Flu The flu (influenza) can cause serious problems for people who have COPD. Do your best to avoid crowds during flu season. In addition to avoiding people with the flu, remembering to wash and sanitize your hands can be one of the best ways to guard against getting sick. Talk to Your Doctor About the Flu (influenza) and Pneumonia Vaccines Talk with your doctor about getting a yearly flu shot and whether and when you should get the pneumonia vaccine. Flu shots can reduce your risk of getting the flu, and the pneumonia vaccine lowers your risk for pneumococcal pneumonia (NU-mo-KOK-al nu-MO-ne-ah) and its complications. Both of these illnesses are major health risks for people who have COPD. See Your Doctor Regularly See your doctor or health care provider regularly even if you are feeling fine. Make a list of your breathing symptoms and think about any activities that you can no longer do because of shortness of breath. Be sure to bring a list of all the medicines you are taking to each office visit. Follow Your Treatments Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of COPD ?"}, {"role": "assistant", "content": "Common Symptoms The most common symptoms of COPD are -  a cough that does not go away   - coughing up lots of sputum (mucus).  a cough that does not go away coughing up lots of sputum (mucus). These symptoms often start years before the flow of air in and out of the lungs is reduced. Not everyone who has a cough and sputum goes on to develop COPD. Other common symptoms of COPD include -  shortness of breath while doing activities you used to be able to do  -  wheezing (a whistling sound when you breathe)  - tightness in the chest.  shortness of breath while doing activities you used to be able to do wheezing (a whistling sound when you breathe) tightness in the chest. Getting a Diagnosis Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. If your doctor thinks you may have COPD, he or she will examine you, listen to your lungs, and ask you questions about your medical history, and what lung irritants you may have been around for long periods of time. The Spirometry Test To confirm a diagnosis of COPD, your doctor will use a breathing test called spirometry. The test is easy and painless and shows how much air you can breathe out and measures how fast you can breathe it out. In a spirometry test, you breathe hard into a large hose connected to a machine called a spirometer. When you breathe out, the spirometer measures how much air your lungs can hold and how fast you can blow air out of your lungs. Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms. Determining COPD Severity Based on this test, your doctor can determine if you have COPD and how severe it is. There are four levels of severity for COPD: - people at risk for COPD  - people with mild COPD  - people with moderate COPD  - people with severe COPD. people at risk for COPD people with mild COPD people with moderate COPD people with severe COPD. People at risk for developing COPD have a normal breathing test and mild symptoms such as chronic cough and sputum (mucus) production. People with mild COPD have mild breathing limitation. Symptoms may include a chronic cough and sputum (mucus) production. At this stage, you may not be aware that airflow in your lungs is reduced. People with moderate COPD have a breathing test that shows worsening airflow blockages. Symptoms may be worse than with mild COPD and you may experience shortness of breath while working hard, walking fast, or doing brisk activity. At this stage, you would seek medical attention. People with severe COPD have a breathing test that shows severe limitation of the airflow. People with severe COPD will be short of breath after just a little activity. In very severe COPD, complications like respiratory failure or signs of heart failure may develop. At this stage, quality of life is impaired and worsening symptoms may be life-threatening. Other Tests Other tests are used to rule out other causes of the symptoms. - Bronchodilator reversibility testing uses the spirometer and medications called bronchodilators to assess whether breathing problems may be caused by asthma. Bronchodilator reversibility testing uses the spirometer and medications called bronchodilators to assess whether breathing problems may be caused by asthma. -  A chest X-ray or a chest CT scan may also be ordered by your doctor. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms.  A chest X-ray or a chest CT scan may also be ordered by your doctor. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. - An arterial blood gas test is another test that is used. This blood test shows the oxygen level in the blood to see how severe your COPD is and whether you need oxygen therapy. An arterial blood gas test is another test that is used. This blood test shows the oxygen level in the blood to see how severe your COPD is and whether you need oxygen therapy."}]}
{"messages": [{"role": "user", "content": "What is (are) COPD ?"}, {"role": "assistant", "content": "Chronic obstructive pulmonary disease, or COPD, is a progressive lung disease in which the airways of the lungs become damaged, making it harder to breathe. With COPD, airways become blocked, making it harder to get air in and out."}]}
{"messages": [{"role": "user", "content": "What causes COPD ?"}, {"role": "assistant", "content": "COPD is a disease that slowly worsens over time, especially if you continue to smoke. If you have COPD, you are more likely to have lung infections, which can be fatal. If the lungs are severely damaged, the heart may be affected. A person with COPD dies when the lungs and heart are unable to function and get oxygen to the body's organs and tissues, or when a complication, such as a severe infection, occurs. Treatment for COPD may help prevent complications, prolong life, and improve a person's quality of life."}]}
{"messages": [{"role": "user", "content": "What causes COPD ?"}, {"role": "assistant", "content": "Cigarette smoking is the most common cause of COPD. Most people with COPD are smokers or have been smokers in the past. Breathing in other fumes and dusts over long periods of time can also lead to COPD. Pipe, cigar, and other types of tobacco smoking can cause COPD, especially if the smoke is inhaled. Exposure to secondhand smoke can play a role in causing COPD. Most people with COPD are at least 40 years old or around middle age when symptoms start."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of COPD ?"}, {"role": "assistant", "content": "The most common symptoms of COPD are a cough that does not go away and coughing up a lot of sputum (mucus). These symptoms may occur years before lung damage has reduced the flow of air in and out of the lungs. Other symptoms of COPD include shortness of breath, especially with exercise; wheezing (a whistling sound when you breathe); and tightness in the chest."}]}
{"messages": [{"role": "user", "content": "How to diagnose COPD ?"}, {"role": "assistant", "content": "To confirm a COPD diagnosis, a doctor will use a breathing test called spirometry. The test is easy and painless. It shows how well the lungs are working. The spirometer measures how much air the lungs can hold and how fast air is blown out of the lungs. Other tests, such as bronchodilator reversibility testing, a chest X-ray, and arterial blood gas test, may be ordered."}]}
{"messages": [{"role": "user", "content": "What are the treatments for COPD ?"}, {"role": "assistant", "content": "Treatment for COPD can be different for each person and is based on whether symptoms are mild, moderate or severe. Treatments include medication, pulmonary or lung rehabilitation, oxygen treatment, and surgery. There are also treatments to manage complications or a sudden onset of symptoms."}]}
{"messages": [{"role": "user", "content": "How to diagnose COPD ?"}, {"role": "assistant", "content": "If you have not been exercising regularly, you should get the advice of your doctor before starting. The symptoms of COPD are different for each person. People with mild COPD may not have much difficulty walking or exercising. As the symptoms of COPD get worse over time, a person may have more difficulty with walking and exercising. You should talk to your doctor about exercising and whether you would benefit from a pulmonary or lung rehabilitation program."}]}
{"messages": [{"role": "user", "content": "How to prevent COPD ?"}, {"role": "assistant", "content": "If you smoke, the most important thing you can do to prevent more lung damage is to stop smoking. It is also important to stay away from people who smoke and places where you know there will be smokers. Avoid exposure to pollutants like dust, fumes, and poor air quality, and take precautions to prevent flu and pneumonia. Following your doctor's instructions with medications and rehabilitative treatment can help alleviate COPD symptoms and control the disabling effects of the disease."}]}
{"messages": [{"role": "user", "content": "What are the treatments for COPD ?"}, {"role": "assistant", "content": "Bronchodilators and inhaled steroids are two medications used to treat COPD. Bronchodilators work by relaxing the muscles around the airways, opening them and making it easier to breathe. People with mild COPD take bronchodilators using an inhaler only when needed. Those with moderate or severe COPD may need more regular treatment. Inhaled steroids also are used for people with moderate or severe COPD in order to reduce swelling in the airways."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of COPD ?"}, {"role": "assistant", "content": "Call your doctor right away if your symptoms worsen suddenly. People with COPD may have symptoms that suddenly get worse. When this happens, you have a much harder time catching your breath. Symptoms that worsen suddenly can include sudden chest tightness, more coughing, a change in your sputum (mucus), or fever. Your doctor will look at things that may be causing these sudden symptoms. Sometimes the symptoms are caused by a lung infection."}]}
{"messages": [{"role": "user", "content": "What is (are) COPD ?"}, {"role": "assistant", "content": "More information on COPD is available at:  What is COPD? and at the  Learn More, Breathe Better Campaign  For information on quitting smoking, visit http://www.surgeongeneral.gov/tobacco/ or  Smokefree.gov. For information on the H1N1 flu and COPD, go to  The Centers for Disease Control and Prevention."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Age-related macular degeneration, also known as AMD, is an eye disease that affects the macula, a part of the retina. The retina sends light from the eye to the brain, and the macula allows you to see fine detail. AMD Blurs Central Vision AMD blurs the sharp central vision you need for straight-ahead activities such as reading, sewing, and driving. AMD causes no pain. How AMD Progresses In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes. AMD is a common eye condition among people age 50 and older. It is a leading cause of vision loss in older adults. Two Forms of AMD There are two forms of age-related macular degeneration -- dry and wet."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Age-related Macular Degeneration? ?"}, {"role": "assistant", "content": "Risk Increases With Age AMD is most common in older people, but it can occur during middle age. The risk increases with age. Other Risk Factors Other risk factors include - Smoking  - Obesity  - Race. Whites are much more likely to lose vision from AMD than African-Americans.  - Family history. People with a family history of AMD are at higher risk of getting the disease.  - Gender. Women appear to be at greater risk than men. Smoking Obesity Race. Whites are much more likely to lose vision from AMD than African-Americans. Family history. People with a family history of AMD are at higher risk of getting the disease. Gender. Women appear to be at greater risk than men."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "AMD is detected during a comprehensive eye exam that includes a visual acuity test, a dilated eye exam, and tonometry. Tests for AMD - The visual acuity test is an eye chart test that measures how well you see at various distances.  - In the dilated eye exam, drops are placed in your eyes to widen, or dilate, the pupils. Then, your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of AMD and other eye problems. After the exam, your close-up vision may remain blurred for several hours.  - With tonometry, an instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. The visual acuity test is an eye chart test that measures how well you see at various distances. In the dilated eye exam, drops are placed in your eyes to widen, or dilate, the pupils. Then, your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of AMD and other eye problems. After the exam, your close-up vision may remain blurred for several hours. With tonometry, an instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. Your eye care professional also may do other tests to learn more about the structure and health of your eye. The Amsler Grid During an eye exam, you may be asked to look at an Amsler grid, shown here. You will cover one eye and stare at a black dot in the center of the grid. While staring at the dot, you may notice that the straight lines in the pattern appear wavy. You may notice that some of the lines are missing. These may be signs of AMD. Because dry AMD can turn into wet AMD at any time, you should get an Amsler grid from your eye care professional. You could then use the grid every day to evaluate your vision for signs of wet AMD. The Fluorescein Angiogram Test If your eye care professional believes you need treatment for wet AMD, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your eye. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "If You Have Advanced AMD Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage. The National Eye Institute's Age-Related Eye Disease Study found that taking certain vitamins and minerals may reduce the risk of developing advanced AMD. Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these treatments is a cure for wet AMD. The disease and loss of vision may progress despite treatment. Laser Surgery Laser surgery uses a laser to destroy the fragile, leaky blood vessels. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is performed in a doctor's office or eye clinic. The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary. In some cases, vision loss may progress despite repeated treatments. Photodynamic Therapy With photodynamic therapy, a drug called verteporfin is injected into your arm. It travels throughout the body, including the new blood vessels in your eye. The drug tends to stick to the surface of new blood vessels. Next, the doctor shines a light into your eye for about 90 seconds. The light activates the drug. The activated drug destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, verteporfin does not destroy surrounding healthy tissue. Because the drug is activated by light, you must avoid exposing your skin or eyes to direct sunlight or bright indoor light for five days after treatment. Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed in a doctor's office. Photodynamic therapy slows the rate of vision loss. It does not stop vision loss or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary. You may need to be treated again. Drug Treatment for Wet AMD Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor. You will need multiple injections that may be given as often as monthly. The eye is numbed before each injection. After the injection, you will remain in the doctor's office for a while and your eye will be monitored. This drug treatment can help slow down vision loss from AMD and in some cases improve sight.  If You Have Low Vision    If you have lost some sight from AMD, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Many community organizations and agencies offer information about low vision counseling and training and other special services for people with visual impairments. Research on AMD The National Eye Institute is conducting and supporting a number of studies to learn more about AMD. For example, scientists are - studying the possibility of transplanting healthy cells into a diseased retina  - evaluating families with a history of AMD to understand genetic and hereditary factors that may cause the disease  - looking at certain anti-inflammatory treatments for the wet form of AMD studying the possibility of transplanting healthy cells into a diseased retina evaluating families with a history of AMD to understand genetic and hereditary factors that may cause the disease looking at certain anti-inflammatory treatments for the wet form of AMD This research should provide better ways to detect, treat, and prevent vision loss in people with AMD."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Age-related macular degeneration, or AMD, is a disease that blurs the sharp, central vision you need for straight-ahead activities such as reading, sewing, and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. AMD causes no pain."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. With wet AMD, loss of central vision can occur quickly. Wet AMD is considered to be advanced AMD and is more severe than the dry form."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision in the affected eye can be lost. If you have vision loss from dry AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you can still drive, read, and see fine details. You may notice changes in your vision only if AMD affects both eyes. If you experience blurry vision, see an eye care professional for a comprehensive dilated eye exam."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Dry AMD has three stages -- early AMD, intermediate AMD, and advanced dry AMD. All of these may occur in one or both eyes. People with early dry AMD have either several small drusen or a few medium-sized drusen. Drusen are yellow deposits under the retina which often are found in people over age 50. People with early AMD have no symptoms and no vision loss. People with intermediate dry AMD have either many medium-sized drusen or one or more large drusen. Some people see a blurred spot in the center of their vision. More light may be needed for reading and other tasks. In addition to drusen, people with advanced dry AMD have a breakdown of light-sensitive cells and supporting tissue in the macula. This breakdown can cause a blurred spot in the center of your vision. Over time, the blurred spot may get bigger and darker, taking more of your central vision. You may have difficulty reading or recognizing faces until they are very close to you."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Drusen are yellow deposits under the retina. They often are found in people over age 50. Your eye care professional can detect drusen during a comprehensive dilated eye exam."}]}
{"messages": [{"role": "user", "content": "What causes Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Drusen alone do not usually cause vision loss. In fact, scientists are unclear about the connection between drusen and AMD. They do know that an increase in the size or number of drusen raises a person's risk of developing either advanced dry AMD or wet AMD. These changes can cause serious vision loss."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition or other changes to your vision, contact your eye care professional at once. You need a comprehensive dilated eye exam."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected. One of the most common early signs of dry AMD is drusen. Drusen are yellow deposits under the retina. They often are found in people over age 50. Your eye care professional can detect drusen during a comprehensive dilated eye exam."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Age-related Macular Degeneration? ?"}, {"role": "assistant", "content": "AMD is most common in older people, but it can occur during middle age. The risk increases with age. Other risk factors include smoking, obesity, white race, family history of AMD, and female gender."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage, in which vision loss occurs."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "The AREDS formulation is a combination of antioxidants and zinc that is named for a study conducted by The National Eye Institute called the Age-Related Eye Disease Study, or AREDS. This study found that taking a specific high-dose formulation of antioxidants and zinc significantly reduced the risk of advanced AMD and its associated vision loss. Slowing AMD's progression from the intermediate stage to the advanced stage will save many people's vision."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "The daily amounts used by the study researchers were 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc as zinc oxide, and 2 milligrams of copper as cupric oxide. Copper was added to the AREDS formulation containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake."}]}
{"messages": [{"role": "user", "content": "How to prevent Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "There is no reason for those diagnosed with early stage AMD to take the AREDS formulation. The study did not find that the formulation helped those with early stage AMD. If you have early stage AMD, a comprehensive dilated eye exam every year can help determine if the disease is progressing. If early stage AMD progresses to the intermediate stage, discuss taking the formulation with your doctor."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "Wet AMD can be treated with laser surgery, photodynamic therapy, and drugs that are injected into the eye. None of these treatments is a cure for wet AMD. The disease and loss of vision may progress despite treatment."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "The National Eye Institute scientists are - studying the possibility of transplanting healthy cells into a diseased retina   - evaluating families with a history of AMD to understand genetic and hereditary factors that may cause the disease  - looking at certain anti-inflammatory treatments for the wet form of AMD. studying the possibility of transplanting healthy cells into a diseased retina evaluating families with a history of AMD to understand genetic and hereditary factors that may cause the disease looking at certain anti-inflammatory treatments for the wet form of AMD. This research should provide better ways to detect, treat, and prevent vision loss in people with AMD."}]}
{"messages": [{"role": "user", "content": "What is (are) Age-related Macular Degeneration ?"}, {"role": "assistant", "content": "National Eye Institute  National Institutes of Health  2020 Vision Place  Bethesda, MD 20892-3655  301-496-5248  E-mail: 2020@nei.nih.gov  www.nei.nih.gov Association for Macular Diseases  210 East 64th Street, 8th Floor  New York, NY 10021-7471  212-605-3719 Foundation Fighting Blindness  Executive Plaza 1, Suite 800  11435 Cronhill Drive  Owings Mill, MD 21117-2220  1-888-394-3937  410-785-1414 Macular Degeneration Partnership  6222 Wilshire Boulevard, Suite 260  Los Angeles, CA 90048  1-888-430-9898  310-623-4466  www.amd.org"}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Can Cause Vision Loss, Blindness Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina in the back of the eye. A healthy retina is necessary for good vision. If you have diabetic retinopathy, at first you may notice no changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes. Four Stages The four stages of diabetic retinopathy are - mild nonproliferative retinopathy  - moderate nonproliferative retinopathy  - severe nonproliferative retinopathy  - proliferative retinopathy. mild nonproliferative retinopathy moderate nonproliferative retinopathy severe nonproliferative retinopathy proliferative retinopathy. The first stage is mild nonproliferative retinopathy. At this earliest stage, there are small areas of balloon-like swelling in the retina's tiny blood vessels. The second stage is moderate nonproliferative retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked. The third stage is severe nonproliferative retinopathy. Many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas send signals to the body to grow new blood vessels for nourishment. The fourth stage is proliferative retinopathy. At this advanced stage, the signals sent by the retina for nourishment cause the growth of new blood vessels. These new blood vessels are abnormal and fragile. The new blood vessels grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result. Other Diabetic Eye Diseases In addition to diabetic retinopathy, other diabetic eye diseases that people with diabetes may face are cataract and glaucoma. See this graphic for a quick overview of diabetic eye disease, including how many people it affects, whos at risk, what to do if you have it, and how to learn more."}]}
{"messages": [{"role": "user", "content": "What causes Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Who Is at Risk? All people with diabetes -- both type 1 and type 2 -- are at risk for diabetic retinopathy. People with diabetes are also at increased risk for cataract and glaucoma. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression. How Vision Loss Occurs Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. Macular edema can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema. Macular edema can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema. Have Dilated Eye Exams The National Eye Institute (NEI) urges everyone with diabetes to have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.  Watch an animation to see what a comprehensive dilated eye exam includes."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Diabetic retinopathy often has no early warning signs. Don't wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year to detect the disease before it causes damage to your vision. Vision Changes May Indicate Bleeding In the early stages of diabetic retinopathy, you may not notice any changes in your vision. But if diabetic retinopathy reaches its final stage, proliferative retinopathy, bleeding can occur. If this happens, at first, you will see a few specks of blood, or spots, floating in your vision. If spots occur, see your eye care professional as soon as possible. Early Treatment is Important You may need treatment before more serious bleeding or hemorrhages occur causing vision loss or possibly blindness. Hemorrhages tend to happen more than once, often during sleep. See how to find an eye care professional.  Here is a list of questions to ask your eye care professional. Sometimes the spots clear without treatment, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs. If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be successful. Detection Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes a visual acuity test, dilated eye exam, and tonometry. A visual acuity test is an eye chart test that measures how well you see at various distances. During the dilated eye exam, your eye care professional checks your retina for early signs of the disease, including - leaking blood vessels  - retinal swelling such as macular edema  - pale, fatty deposits on the retina -- signs of leaking blood vessels  - damaged nerve tissue leaking blood vessels retinal swelling such as macular edema pale, fatty deposits on the retina -- signs of leaking blood vessels damaged nerve tissue Watch an animation showing what a comprehensive dilated eye exam involves. With tonometry, an instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Preventing Disease Progression During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. Treatment for Macular Edema Research found that that prompt treatment of macular edema with anti-VEGF drugs, with or without laser treatment, resulted in better vision than laser treatment alone or steroid injections. When injected into the eye, these drugs reduce fluid leakage and interfere with the growth of new blood vessels in the retina. In some cases, focal laser treatment is used along with the eye injections. Your doctor places up to several hundred small laser burns in the areas of the retina around the macula that are leaking. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed. Treatment for Diabetic Retinopathy Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.  Learn more about laser treatment.  Vitrectomy If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye. Scatter laser treatment and vitrectomy are effective in treating proliferative retinopathy and in reducing vision loss. Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.  Learn more about a vitrectomy.  Have Dilated Eye Exams The National Eye Institute (NEI) urges everyone with diabetes to have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.  Watch an animation to see what a comprehensive dilated eye exam includes.  Research The National Eye Institute, or NEI, is conducting and supporting research that seeks better ways to detect, treat, and prevent vision loss in people with diabetes. This research is conducted through studies in the laboratory and with patients. For example, researchers are studying drugs for the treatment of proliferative retinopathy that may reduce the need for laser surgery. A major study has shown that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. If you have diabetic retinopathy, at first you may notice no changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes. See this graphic for a quick overview of diabetic eye disease, including how many people it affects, whos at risk, what to do if you have it, and how to learn more."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetic Retinopathy ?"}, {"role": "assistant", "content": "The four stages of diabetic retinopathy are - mild nonproliferative retinopathy  - moderate nonproliferative retinopathy  - severe nonproliferative retinopathy  - proliferative retinopathy mild nonproliferative retinopathy moderate nonproliferative retinopathy severe nonproliferative retinopathy proliferative retinopathy Nonproliferative retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels. Moderate nonproliferative retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked. Severe nonproliferative retinopathy. Many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment. Proliferative retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Diabetic Retinopathy? ?"}, {"role": "assistant", "content": "All people with diabetes -- both type 1 and type 2 -- are at risk for diabetic retinopathy. People with diabetes are also at increased risk for cataract and glaucoma. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression. See how to find an eye care professional."}]}
{"messages": [{"role": "user", "content": "What causes Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Diabetic retinopathy often has no early warning signs. Don't wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.  Learn more about a comprehensive dilated eye exam."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Diabetic Retinopathy ?"}, {"role": "assistant", "content": "At first, you will see a few specks of blood, or spots, \"floating\" in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding or hemorrhaging occurs. Hemorrhages tend to happen more than once, often during sleep. Sometimes, the spots clear without treatment, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs. If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetic Retinopathy ?"}, {"role": "assistant", "content": "In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Research found that that prompt treatment of macular edema with anti-VEGF drugs, with or without laser treatment, resulted in better vision than laser treatment alone or steroid injections. When injected into the eye, these drugs reduce fluid leakage and interfere with the growth of new blood vessels in the retina. In some cases, focal laser treatment is used along with the eye injections. Your doctor places up to several hundred small laser burns in the areas of the retina around the macula that are leaking. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetic Retinopathy ?"}, {"role": "assistant", "content": "During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision. If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Both focal and scatter laser treatment are performed in your doctor's office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort. The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses. For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetic Retinopathy ?"}, {"role": "assistant", "content": "If you have a lot of blood in the center of the eye, or vitreous gel, you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart. A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Diabetic Retinopathy ?"}, {"role": "assistant", "content": "Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care. Although both treatments have high success rates, they do not cure diabetic retinopathy. Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Diabetic Retinopathy ?"}, {"role": "assistant", "content": "The National Eye Institute, or NEI, is conducting and supporting research that seeks better ways to detect, treat, and prevent vision loss in people with diabetes. This research is conducted through studies in the laboratory and with patients. For example, researchers are studying drugs for the treatment of proliferative retinopathy that may reduce the need for laser surgery."}]}
{"messages": [{"role": "user", "content": "What to do for Diabetic Retinopathy ?"}, {"role": "assistant", "content": "If you have diabetes, get a comprehensive dilated eye exam at least once a year. Proliferative retinopathy can develop without symptoms. If it gets to this advanced stage, you are at high risk for vision loss or even blindness. Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy. You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss. Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.  See this glossary for basic terms about diabetic retinopathy."}]}
{"messages": [{"role": "user", "content": "What is (are) Diabetic Retinopathy ?"}, {"role": "assistant", "content": "National Eye Institute  National Institutes of Health  2020 Vision Place  Bethesda, MD 20892-3655  301-496-5248  E-mail: 2020@nei.nih.gov  www.nei.nih.gov  Find eye health organizations that address diabetic eye disease."}]}
{"messages": [{"role": "user", "content": "What is (are) Depression ?"}, {"role": "assistant", "content": "Everyone feels blue or sad now and then, but these feelings don't usually last long and pass within a couple of days. When a person has depression, it interferes with daily life and normal functioning, and causes pain for both the person with depression and those who care about him or her. Doctors call this condition \"depressive disorder,\" or \"clinical depression.\" Depression in Older Adults Important life changes that happen as we get older may cause feelings of uneasiness, stress, and sadness. For instance, the death of a loved one, moving from work into retirement, or dealing with a serious illness can leave people feeling sad or anxious. After a period of adjustment, many older adults can regain their emotional balance, but others do not and may develop depression. Depression is a common problem among older adults, but it is NOT a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more physical ailments. However, when older adults do suffer from depression, it may be overlooked because they may be less willing to talk about feelings of sadness or grief, or they may show different, less obvious symptoms, and doctors may be less likely to suspect or spot it. Sometimes it can be difficult to distinguish grief from major depression. Grief after loss of a loved one is a normal reaction to the loss and generally does not require professional mental health treatment. However, grief that lasts for a very long time following a loss may require treatment. Test Depression and Suicide Though it is widely believed that suicide more often affects young people, suicide is a serious problem among older adults, too  particularly among older men  and depression is usually a major contributing factor. Adults 65 and older have a suicide rate that is higher than the rate for the national population, but there are some major differences between older men and women. While suicide rates for older women are somewhat lower than those for young and middle-aged women, rates among men 75 and older are higher than those for younger men. In fact, white men age 85 and older have the highest suicide rate in the United States. Types of Depression There are several types of depression. The most common types are major depressive disorder and dysthymic disorder. - Major depressive disorder, also called major depression or clinical depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, concentrate, eat, and enjoy activities he or she once liked. Major depression prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.   - Dysthymic disorder, also called dysthymia, is a less severe but more long-lasting form of depression. Dysthymia is characterized by symptoms lasting two years or longer that keep a person from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetime.  Major depressive disorder, also called major depression or clinical depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, concentrate, eat, and enjoy activities he or she once liked. Major depression prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life. Dysthymic disorder, also called dysthymia, is a less severe but more long-lasting form of depression. Dysthymia is characterized by symptoms lasting two years or longer that keep a person from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetime. Other types of depression include subsyndromal depression, psychotic depression. and bipolar depression. - Subsyndromal depression  is common among older adults. It includes less severe but clear symptoms of depression that fall short of being major depression or dysthymia. Having subsyndromal depression may increase a person's risk of developing major depression.  - Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).  - Bipolar depression, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changesfrom extreme highs (e.g., mania) to extreme lows (e.g., depression).  Subsyndromal depression  is common among older adults. It includes less severe but clear symptoms of depression that fall short of being major depression or dysthymia. Having subsyndromal depression may increase a person's risk of developing major depression. Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations). Bipolar depression, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changesfrom extreme highs (e.g., mania) to extreme lows (e.g., depression)."}]}
{"messages": [{"role": "user", "content": "What causes Depression ?"}, {"role": "assistant", "content": "Several lines of research have shown that depressive illnesses are disorders of the brain. But the exact causes for these illnesses are not yet clear and are still being studied. Changes in the Brain Imaging technologies show that the brains of people with depression look different or are working differently than those who do not have the illness. The areas of the brain that control moods, thinking, sleep, appetite, and behavior appear not to be functioning well. The scans also show very high or very low levels of important brain chemicals. But these images do not reveal WHY the depression has occurred. Many Possible Causes In general, there is no one cause or risk factor for depression. It most likely results from many factors, such as family history, life experiences, and environment. Older adults with depression may have had it when they were younger, or they may have a family history of the illness. They may also be going through difficult life events, such as losing a loved one, a difficult relationship with a family member or friend, or financial troubles. For older adults who experience depression for the first time later in life, other factors may be at play. Depression may be related to changes that occur in the brain and body as a person ages. For example, some older adults who are at risk for illnesses such as heart disease or stroke may have hardening and inflammation of the blood vessels, and blood may not be able to flow normally to the body's organs, including the brain. Over time, this blood vessel disease and restricted blood flow can damage nearby brain tissue and harm the nerve connections that help different parts of the brain communicate with each other. If this happens, an older adult with no family history of depression may develop what some doctors call \"vascular depression.\" Older adults may also experience depression as a result of brain changes caused by illnesses such as Alzheimers disease or Parkinsons disease. This type of depression can appear in the early stages of these diseases, before many symptoms appear. Depression Can Occur With Other Illnesses Depression can also co-occur with other serious medical illnesses such as diabetes, cancer, and Parkinson's disease. Depression can make these conditions worse, and vice versa. Sometimes, medications taken for these illnesses may cause side effects that contribute to depression. Because many older adults face these illnesses along with various social and economic difficulties, some health care professionals may wrongly conclude that these problems are the cause of the depression -- an opinion often shared by patients themselves. All these factors can cause depression to go undiagnosed or untreated in older people. Yet, treating the depression will help an older adult better manage other conditions he or she may have."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Depression ?"}, {"role": "assistant", "content": "Common Symptoms There are many symptoms associated with depression, and some will vary depending on the individual. However, some of the most common symptoms are listed below. If you have several of these symptoms for more than two weeks, you may have depression. - feeling nervous or emotionally \"empty\"  - feelings of excessive guilt or worthlessness  - tiredness or a \"slowed down\" feeling  - restlessness and irritability  - feeling like life is not worth living  - sleep problems, including trouble getting to sleep, wakefulness in the middle of the night, or sleeping too much  - eating more or less than usual, usually with unplanned weight gain or loss  - having persistent headaches, stomach-aches or other chronic pain that does not go away when treated  - loss of interest in once pleasurable activities, including sex  - frequent crying  - difficulty focusing, remembering or making decisions  - thoughts of death or suicide, or a suicide attempt feeling nervous or emotionally \"empty\" feelings of excessive guilt or worthlessness tiredness or a \"slowed down\" feeling restlessness and irritability feeling like life is not worth living sleep problems, including trouble getting to sleep, wakefulness in the middle of the night, or sleeping too much eating more or less than usual, usually with unplanned weight gain or loss having persistent headaches, stomach-aches or other chronic pain that does not go away when treated loss of interest in once pleasurable activities, including sex frequent crying difficulty focusing, remembering or making decisions thoughts of death or suicide, or a suicide attempt Is it Depression or Something Else? The first step to getting appropriate treatment is to visit a doctor. Certain medications taken for other medical conditions, vitamin B12 deficiency, some viruses, or a thyroid disorder can cause symptoms similar to depression. If an older adult is taking several medications for other conditions and is depressed, seeing a doctor is especially important. A doctor can rule out medications or another medical condition as the cause of the depression by doing a complete physical exam, interview, and lab tests. If these other factors can be ruled out, he or she may refer you to a mental health professional, such as a psychologist, counselor, social worker, or psychiatrist. Some doctors called geriatric psychiatrists and clinical geropsychologists are specially trained to treat depression and other mental illnesses in older adults. The doctor or mental health professional will ask about the history of your symptoms, such as when they started, how long they have lasted, their severity, whether they have occurred before, and if so, whether they were treated and how. He or she will then diagnose the depression and work with you to choose the most appropriate treatment."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Depression ?"}, {"role": "assistant", "content": "Treating Older Adults Studies show that the majority of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy or a combination of both. In addition, research has indicated that treating depression in older adults often improves the outcomes of co-existing medical conditions. Some research has also suggested that the risk for developing depression in people who have had a stroke may be reduced if they receive preventative treatment with an antidepressant or talk therapy. Special Considerations However, there are some special considerations that doctors must take into account when treating older adults. The commonly prescribed medications for depression may not work well for some older adults because they may interact unfavorably with other medications being taken for other conditions. Some older adults with depression may also have some problems thinking clearly, and these individuals often respond poorly to the drugs. Which Form of Treatment Is Most Effective? Many older adults prefer to get counseling or psychotherapy for depression rather than add more medications to those they are already taking for other conditions. Research suggests that for older adults, psychotherapy is just as likely to be an effective first treatment for depression as taking an antidepressant. There is a great deal of evidence indicating that cognitive-behavioral therapy (CBT), including a version called problem solving therapy, may be an especially useful type of psychotherapy for treating older adults and improving their quality of life. However, a practical issue to consider when deciding on treatment is that it may be harder for many older people to find or be able to travel to meetings with a well-trained psychotherapist than to get a prescription for antidepressant medication from their primary care doctor. Also, some research suggests that treatment with medication may be more effective if the depression is quite severe or if the older adult is coping with other serious illnesses. Overall, research has suggested that, when possible, a combination of medication and psychotherapy treatment is likely to be most effective in treating depression in older adults and, in particular, for reducing the number of new episodes. Late-Life Depression is Often Undiagnosed Despite progress in treatment research, late-life depression often goes undiagnosed or is inadequately treated in older adults. In fact, several studies have found that up to 75 percent of older adults who die by suicide had visited their primary care doctors within one month of their deaths. Collaborative or comprehensive care may lead to better treatment results. Collaborative Care The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) offered antidepressant medication and/or psychotherapy to depressed older adults, along with a \"care manager\" -- a social worker, nurse or psychologist -- who monitored their symptoms, side effects of medication, and progress. The study found that those participants who had case-managed care got better more quickly, had longer periods without depression, and in general responded better to treatment than those who did not have case-managed care. Another study called the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) trial also found that collaborative care was more effective than usual care, and was less expensive over the long run as well. Improving Diagnosis of Depression Several studies are looking at ways to help older adults get better access to depression treatment. One is developing and testing an education and intervention program to help primary care clinics and providers identify and treat late-life depression. Another study found that depressed older adults who had a \"care manager\" monitor their symptoms, side effects, and progress got better more quickly -- and stayed better longer -- than those who did not have case-managed care. Still other projects are investigating ways of improving older adults engagement in and ability to follow treatment plans for depression. Researchers are also looking at ways to -  better understand the relationship between other medical illnesses and depression   - integrate treatment for depression with treatments for other medical conditions a person may have  - produce a quicker response to treatment   - develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies)  - help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression. better understand the relationship between other medical illnesses and depression integrate treatment for depression with treatments for other medical conditions a person may have produce a quicker response to treatment develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies) help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression. Findings from these and other studies will provide important information for doctors to treat late-life depression. In a Crisis? Get Help! If you are in a crisis... If you are thinking about harming yourself or attempting suicide, tell someone who can help immediately. - Call your doctor.  - Call 911 for emergency services.  - Go to the nearest hospital emergency room.  - Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to be connected to a trained counselor at a suicide crisis center nearest you. Call your doctor. Call 911 for emergency services. Go to the nearest hospital emergency room. Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to be connected to a trained counselor at a suicide crisis center nearest you."}]}
{"messages": [{"role": "user", "content": "What is (are) Depression ?"}, {"role": "assistant", "content": "Depression is more than just feeling blue or sad. It is an illness. When you have depression, it interferes with daily life and normal functioning, and causes pain for both you and those who care about you."}]}
{"messages": [{"role": "user", "content": "What is (are) Depression ?"}, {"role": "assistant", "content": "Major depressive disorder, also called major depression or clinical depression, is characterized by a combination of symptoms that interfere with your ability to work, sleep, concentrate, eat, and enjoy activities you once liked. Major depression keeps a person from functioning normally. Dysthymic disorder, or dysthymia, is a less severe but sometimes more long-lasting form of depression. It is characterized by symptoms lasting two years or longer that keep you from functioning normally or feeling well. Subsyndromal depression, affecting many older adults, includes real symptoms of depression that are less severe than major depression or dysthymia. Having sybsydromal depression may increase your risk of developing major depression. Psychotic depression  occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations). Bipolar depression  also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changesfrom extreme highs (e.g., mania) to extreme lows (e.g., depression)."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Depression? ?"}, {"role": "assistant", "content": "The risk factors for depression are family history, life experiences, and environment. If you have depression, you may have experienced it when you were younger, and may have a family history of the illness. You may also be going through difficult life events, such as physical or psychological trauma, losing a loved one, a difficult relationship with a family member or friend, or financial troubles. Any of these stressful experiences can lead to depression. For older adults who experience depression for the first time later in life, other factors may be at play. Depression may be related to changes that occur in the brain and body as a person ages. For example, some older adults who are at risk for illnesses such as heart disease or stroke may have hardening and inflammation of the blood vessels, and blood may not be able to flow normally to the body's organs, including the brain. Over time, this blood vessel disease and restricted blood flow can damage nearby brain tissue and harm the nerve connections that help different parts of the brain communicate with each other. If this happens, an older adult with no family history of depression may develop what some doctors call \"vascular depression.\" Older adults may also experience depression as a result of brain changes caused by illnesses such as Alzheimers disease or Parkinsons disease. This type of depression can appear in the early stages of these diseases, before many symptoms appear."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Depression ?"}, {"role": "assistant", "content": "Symptoms of depression often vary depending upon the person. Common symptoms include - feeling nervous or emotionally empty  - tiredness or a \"slowed down\" feeling  - feeling guilty or worthless  - restlessness and irritability  - feeling like life is not worth living  - sleep problems such as insomnia, oversleeping or wakefulness in the middle of the night   - eating more or less than usual, usually with unplanned weight gain or loss  - having persistent headaches, stomach-aches or other chronic pain that does not go away when treated  - loss of interest in once pleasurable activities  - frequent crying  - difficulty focusing, remembering or making decisions  - thoughts of death or suicide. feeling nervous or emotionally empty tiredness or a \"slowed down\" feeling feeling guilty or worthless restlessness and irritability feeling like life is not worth living sleep problems such as insomnia, oversleeping or wakefulness in the middle of the night eating more or less than usual, usually with unplanned weight gain or loss having persistent headaches, stomach-aches or other chronic pain that does not go away when treated loss of interest in once pleasurable activities frequent crying difficulty focusing, remembering or making decisions thoughts of death or suicide."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Depression ?"}, {"role": "assistant", "content": "Medications called antidepressants work to normalize brain chemicals called neurotransmitters, notably serotonin, norepinephrine, and dopamine. Scientists studying depression have found that these chemicals, and possibly others, are involved in regulating mood, but they are unsure of exactly how they work.  Newer Antidepressants. The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), citalopram (Celexa) and several others. Similar to SSRIs are serotonin and norepinephrine reuptake inhibitors (SNRIs) and include venlafaxine (Effexor) and duloxetine (Cymbalta). Another newer antidepressant bupropion (Wellbutrin) is neither an SSRI nor an SNRI but is popular as well.  Older Antidepressants.  Older antidepressants, called tricyclics and monoamine oxidase inhibitors (MAOIs), are still used sometimes, too. However, these older antidepressants are not as popular as the newer ones because they tend to have more side effects. However, medications affect everyone differently so talk with your doctor to decide which type is best for you.  Practical Considerations. People taking MAOIs must follow strict food and medicine restrictions to avoid potentially serious interactions. If you take an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid. MAOIs can also react with SSRIs to produce a serious condition called \"serotonin syndrome,\" which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life threatening conditions. MAOIs should not be taken with SSRIs. Caution is required when combining any serotonergic medication (not just MAOIs) with SSRIs. For example, in 2006 the FDA issued specific warnings against using triptans that are commonly-prescribed to treat migraine headaches together with SSRIs or SNRIs. Using these medications together can cause serotonin syndrome."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Depression ?"}, {"role": "assistant", "content": "A bushy, wild-growing plant with yellow flowers, St John's wort has been used for centuries in many folk and herbal remedies. It is commonly used in Europe to treat mild depression, and it is a top-seller in the United States as well. In a study funded by the National Institutes of Health, the herb was found to be no more effective than a placebo (sugar pill) in treating adults suffering from major depression. Other research has shown that St. John's wort can interact unfavorably with other drugs. The herb interferes with certain drugs used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. Because of these potential interactions, older adults should always consult with their doctors before taking any herbal supplement. Another product sold as a dietary supplement, S-adenosyl methionine (SAMe), has shown promise in controlled trials as helpful when added to an SSRI antidepressant that is only partially effective."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Depression ?"}, {"role": "assistant", "content": "Several studies are looking at ways to help older adults get better access to depression treatment. One is developing and testing an education and intervention program to help primary care clinics and providers identify and treat late-life depression. Another study found that depressed older adults who had a \"care manager\" monitor their symptoms, side effects, and progress got better more quickly -- and stayed better longer -- than those who did not have case-managed care. Still other projects are investigating ways of improving older adults engagement in and ability to follow treatment plans for depression. Researchers are also looking at ways to -  better understand the relationship between other medical illnesses and depression  - integrate treatment for depression with treatments for other medical conditions a person may have  - produce a quicker response to treatment  - develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies)  - help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression.  better understand the relationship between other medical illnesses and depression integrate treatment for depression with treatments for other medical conditions a person may have produce a quicker response to treatment develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies) help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression."}]}
{"messages": [{"role": "user", "content": "What is (are) Problems with Smell ?"}, {"role": "assistant", "content": "Our sense of smell helps us enjoy life. We delight in the aromas of our favorite foods or the fragrance of flowers. Our sense of smell also is a warning system, alerting us to danger signals such as a gas leak, spoiled food, or a fire. Any loss in our sense of smell can have a negative effect on our quality of life. It also can be a sign of more serious health problems. Aging and Smell Loss Problems with smell increase as people get older, and they are more common in men than women. In one study, nearly one-quarter of men ages 6069 had a smell disorder, while about 11 percent of women in that age range reported a problem. Many older people are not even aware that they have a problem with their sense of smell because the changes occur gradually over several years. They may not even notice that they are experiencing a loss of smell until there is an incident in which they don't detect food that has spoiled or the presence of dangerous smoke. How Our Sense of Smell Works The sense of smell, or olfaction, is part of our chemical sensing system, along with the sense of taste. Normal smell occurs when odors around us, like the fragrance of flowers or the smell of baking bread, stimulate the specialized sensory cells, called olfactory sensory cells. Olfactory sensory cells are located in a small patch of tissue high inside the nose. Odors reach the olfactory sensory cells in two pathways. The first pathway is by inhaling, or sniffing, through your nose. When people think about smell, they generally think of this pathway. The second pathway is less familiar. It is a channel that connects the roof of the throat region to the nose. When we chew our food, aromas are released that access olfactory sensory cells through this channel. If you are congested due to a head cold or sinus infection, this channel is blocked, which temporarily affects your ability to appreciate the flavors of food. Types of Smell Disorders People who experience smell disorders either have a decrease in their ability to smell or changes in the way they perceive odors. Total smell loss is relatively rare, but a decrease in the sense of smell occurs more often, especially in older adults. A decreased sense of smell may be temporary and treatable with medication. There are several types of smell disorders depending on how the sense of smell is affected. -  Some people have hyposmia, which occurs when their ability to detect certain odors is reduced.   - Other people can't detect odor at all, which is called anosmia.   - Sometimes a loss of smell can be accompanied by a change in the perception of odors. This type of smell disorder is called dysosmia. Familiar odors may become distorted, or an odor that usually smells pleasant instead smells foul.   - Still others may perceive a smell that isn't present at all, which is called phantosmia.   - Smell loss due to aging is called presbyosmia.  Some people have hyposmia, which occurs when their ability to detect certain odors is reduced. Other people can't detect odor at all, which is called anosmia.  Sometimes a loss of smell can be accompanied by a change in the perception of odors. This type of smell disorder is called dysosmia. Familiar odors may become distorted, or an odor that usually smells pleasant instead smells foul. Still others may perceive a smell that isn't present at all, which is called phantosmia.  Smell loss due to aging is called presbyosmia. Smell Loss May Signal Other Conditions Problems with our chemical senses may be a sign of other serious health conditions. A smell disorder can be an early sign of Parkinsons disease, Alzheimers disease, or multiple sclerosis. It can also be related to other medical conditions, such as obesity, diabetes, hypertension, and malnutrition. Getting a diagnosis early will help an individual deal better with the underlying condition or disease. Smell and Taste Smell and taste are closely linked in the brain, but are actually distinct sensory systems. True tastes are detected by taste buds on the tongue and the roof of the mouth, as well as in the throat region, and are limited to sweet, salty, sour, bitter, savory and perhaps a few other sensations. The loss of smell is much more common than the loss of taste, and many people mistakenly believe they have a problem with taste, when they are really experiencing a problem with their sense of smell. A loss in taste or smell is diagnosed by your doctor using special taste and smell tests. Smell Loss and Eating Habits When smell is impaired, people usually have problems appreciating the subtle flavors of food, and say that food is less enjoyable. Some people change their eating habits. Some may eat too little and lose weight while others may eat too much and gain weight. Either way, there may be a long-term impact on one's overall health. Loss of smell may also cause us to eat too much sugar or salt to make our food taste better. This can be a problem for people with certain medical conditions, such as diabetes or high blood pressure. In severe cases, loss of smell can lead to depression. Hazards of Smell Loss Research shows that people with a total or partial loss of smell are almost twice as likely as people with normal smell to have certain kinds of accidents. The most common types of accidents in order of frequency involve - cooking   - eating or drinking spoiled foods or toxic substances   - failing to detect gas leaks or fires  cooking eating or drinking spoiled foods or toxic substances failing to detect gas leaks or fires If you think you have a problem with your sense of smell, see your doctor."}]}
{"messages": [{"role": "user", "content": "What causes Problems with Smell ?"}, {"role": "assistant", "content": "Problems with smell happen for many reasons, some clearer than others. Loss of smell may be permanent or temporary, depending on the cause. Effects of Aging As with vision and hearing, people gradually lose their ability to smell as they get older. Smell that declines with age is called presbyosmia and is not preventable. Age is only one of the many reasons that problems with smell can occur. Most people who develop a problem with smell have recently had an illness or injury. Common Causes The common causes of smell disorders are -  sinus and upper respiratory infections   - aging   - smoking  - nasal polyps   - head injury   - allergies  - hormonal disturbances  - dental problems  - exposure to certain chemicals   - numerous medications   - radiation for treatment of head and neck cancers  - diseases of the nervous system. sinus and upper respiratory infections aging smoking nasal polyps head injury allergies hormonal disturbances dental problems exposure to certain chemicals numerous medications radiation for treatment of head and neck cancers diseases of the nervous system. Sinus and Upper Respiratory Infections. The most common causes of smell problems are the common cold and chronic nasal or sinus infection. Respiratory infections such as the flu can lead to smell disorders. Swollen sinuses and nasal passages often result in problems with smell because the odors in the air do not have good access to the olfactory sensory cells. These conditions may cause total or partial loss of smell. The problem usually diminishes or goes away when the underlying medical condition clears up. Aging. Problems with smell become more common as people get older. A person's sense of smell generally declines when he or she is over 60. Smoking. Tobacco smoking is the most concentrated form of pollution that most people are exposed to. It impairs the ability to identify and enjoy odors. Nasal Polyps. Loss of smell can be caused by nasal polyps, which are small, non-cancerous growths in the nose or sinuses that can block the ability of odors to reach olfactory sensory cells high up in the nose. In rare cases, benign non-malignant tumors grow on the olfactory nerves leading to the brain, causing a loss of smell. Previous surgery or trauma to the head can impair your sense of smell because the olfactory nerves may be cut, blocked, or physically damaged. Automobile accidents are among the most frequent causes of trauma to the face and head. Allergies. If your smell disorder is caused by allergies and seasonal nasal congestion, you should avoid allergens, such as ragweed, grasses, and pet dander. Exposure to Certain Chemicals. Sometimes exposure to certain chemicals, such as insecticides and solvents, can permanently damage the sense of smell. Medications.  If you are taking certain medicines, you may notice a change in your ability to smell. Certain medications, including some common antibiotics and antihistamines, can cause problems with smell. The sense of smell usually returns to normal when you stop taking the medicine. Radiation Treatment.  People with head and neck cancers who receive radiation treatment to the nose and mouth regions commonly experience problems with their sense of smell and taste as an unfortunate side effect. Older people who have lost their larynx or voice box commonly complain of poor ability to smell and taste. Diseases of the Nervous System. Sometimes a problem with smell can be a sign of a more serious health problem. This might include diseases of the nervous system, such as Parkinson's disease or Alzheimer's disease. Loss of smell may be the first sign that something is wrong. Check with your doctor if you've been experiencing a problem with your sense of smell for a while. You may be able to prevent or get early treatment for a more serious health problem."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Problems with Smell ?"}, {"role": "assistant", "content": "A Reduced Sense of Smell There are several types of smell disorders depending on how the sense of smell is affected. People who have smell disorders experience either a loss in their ability to smell or changes in the way they perceive odors. Some people have hyposmia, which occurs when their ability to detect certain odors is reduced. This smell disorder is common in people who have upper respiratory infections or nasal congestion. This is usually temporary and goes away when the infection clears up. If You Can't Detect Odor at All Other people can't detect odor at all, which is called anosmia. This type of smell disorder is sometimes the result of head trauma in the nose region, usually from an automobile accident or chronic nasal or sinus infections. It can sometimes be caused by aging. In rare cases, anosmia is inherited. If Your Sense of Smell Is Distorted Sometimes a loss of smell can be accompanied by a change in the perception of odors. This type of smell disorder is called dysosmia. Familiar odors may become distorted, or an odor that usually smells pleasant instead smells foul. Sometimes people with this type of smell disorder also experience headaches, dizziness, shortness of breath, or anxiety. Still others may perceive a smell that isn't present at all, which is called phantosmia. Questions To Ask Yourself If you think you have a problem with your sense of smell, try to identify and record the circumstances at the time you first noticed the problem. Ask yourself the following questions: - When did I first become aware of it?  - Did I have a cold or the flu?  - Did I have a head injury?  - Was I exposed to air pollutants, pollens, pet dander, or dust to which I might be allergic?   - Is this a recurring problem?   - Does it come at any special time, like during the hay fever season? When did I first become aware of it? Did I have a cold or the flu? Did I have a head injury? Was I exposed to air pollutants, pollens, pet dander, or dust to which I might be allergic? Is this a recurring problem? Does it come at any special time, like during the hay fever season? Bring this information with you when you visit your physician. Also, be prepared to tell him or her about your general health and any medications you are taking. Talking With Your Doctor Diagnosis by a doctor is important to identify and treat the underlying cause of a potential smell disorder. Your doctor may refer you to an otolaryngologist, a specialist in diseases of the ear, nose, and throat. An accurate assessment of a smell disorder will include, among other things, - a physical examination of the ears, nose, and throat   - a review of your health history, such as exposure to toxic chemicals or injury, and   - a smell test supervised by a health care professional. a physical examination of the ears, nose, and throat a review of your health history, such as exposure to toxic chemicals or injury, and a smell test supervised by a health care professional. Tests for Smell Disorders Some tests measure the smallest amount of odor you can detect. You also may receive a \"scratch and sniff\" test to determine how well you can identify various odors from a list of possibilities. In this test, the odor is embedded in a circular pad on a piece of paper and released when scratched. In this way, doctors can determine whether a person has a decreased ability to smell (hyposmia), the inability to detect any odors (anosmia), or another kind of smell disorder. In some cases, your doctor may need to perform a nasal examination with a nasal endoscope, an instrument that illuminates and magnifies the areas of the nose where the problem may exist. This test can help identify the area and extent of the problem and help your doctor select the right treatment. If your doctor suspects that upper regions of the nose and nasal sinuses that can't be seen by an endoscope are involved, he or she may order a specialized X-ray procedure, usually a CT scan, to look further into the nose and sinuses. When to See the Doctor If you think you have a smell disorder, see your doctor. Diagnosis of a smell disorder is important because once the cause is found, your doctor may be able to treat your smell disorder. Many types of smell problems are reversible, but if they are not, counseling and self-help techniques may help you cope."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Problems with Smell ?"}, {"role": "assistant", "content": "Relief is Possible Although there is no treatment for presbyosmia -- loss of smell due to aging -- relief from smell disorders is possible for many older people. Depending on the cause of your problem with smell, your doctor may be able to treat it or suggest ways to cope with it. Recovering the Ability To Smell Some people recover their ability to smell when they recover from the illness causing their loss of smell. Some people recover their sense of smell spontaneously, for no obvious reason. Other common causes of smell loss, such as the common cold or seasonal allergies, are usually temporary. Smell is regained by waiting for the illness to run its course. In some cases, nasal obstructions, such as polyps, can be removed to restore airflow through the nasal passages and restore the sense of smell. If your smell disorder cant be successfully treated, you might want to seek counseling to help you adjust. Ask About Your Medications Sometimes a certain medication causes a smell disorder, and improvement occurs when the medicine causing the problem is stopped or changed. If you take medications, ask your doctor if they can affect your sense of smell. If so, ask if you could substitute other medications or reduce the dose. Your doctor will work with you to get the medicine you need while trying to reduce unwanted side effects. Medications That May Help Your doctor may suggest oral steroid medications such as prednisone, which is usually used for a short period of time, or topical steroid sprays, which can be used for longer periods of time. Antibiotics are also used to treat nasal infections. The effectiveness of both steroids and antibiotics depends greatly on the severity and duration of the nasal swelling or infection. Often relief is temporary. Occasionally, the sense of smell returns to normal on its own without any treatment. Steps You Can Take If you have a problem with smell, there are some things you can do. - Wait it out. If you have had a cold with a stuffy nose, chances are in a few days your sense of smell will return. However, you should not wait to see your doctor if you think something more serious has caused your loss of smell or you have had the problem for a while. Loss of smell can sometimes mean a more serious condition exists.  Wait it out. If you have had a cold with a stuffy nose, chances are in a few days your sense of smell will return. However, you should not wait to see your doctor if you think something more serious has caused your loss of smell or you have had the problem for a while. Loss of smell can sometimes mean a more serious condition exists. - Sweat it out. If your nose is stuffed up from a cold, sometimes mild exercise or the steam from a hot shower may open up your nasal passages. Sweat it out. If your nose is stuffed up from a cold, sometimes mild exercise or the steam from a hot shower may open up your nasal passages. - Stop smoking. Smoking causes long-term damage to your sense of smell. If you quit smoking, you may notice some improvement. To get free help quitting, visit  www.Smokefree.gov Stop smoking. Smoking causes long-term damage to your sense of smell. If you quit smoking, you may notice some improvement. To get free help quitting, visit  www.Smokefree.gov - Check with your doctor. If your sense of smell seems to have disappeared or changed, or if you've noticed the problem for a while, see your doctor for help. Sometimes, especially with a sinus infection, taking antibiotics for a short period of time may remedy the problem. If there is a blockage or you have a chronic sinus condition, outpatient surgery may be called for.  Check with your doctor. If your sense of smell seems to have disappeared or changed, or if you've noticed the problem for a while, see your doctor for help. Sometimes, especially with a sinus infection, taking antibiotics for a short period of time may remedy the problem. If there is a blockage or you have a chronic sinus condition, outpatient surgery may be called for. If Your Smell Loss Is Permanent If you do not regain your sense of smell, there are things you should do to ensure your safety. Take extra precautions to avoid eating food that may have spoiled. If you live with other people, ask them to smell the food to make sure it is fresh. People who live alone should discard food if there is a chance it is spoiled. Other home safety measures include installing smoke alarms and gas detectors. For those who wish to have additional help, there may be support groups in your area. These are often associated with smell and taste clinics in medical school hospitals. Some online bulletin boards also allow people with smell disorders to share their experiences. Not all people with smell disorders will regain their sense of smell, but most can learn to live with it. Ongoing Research The National Institute on Deafness and Other Communication Disorders (NIDCD) supports basic and clinical investigations of smell and taste disorders at its laboratories in Bethesda, Md. and at universities and chemosensory research centers across the country. These chemosensory scientists are exploring how to -  promote the regeneration of sensory nerve cells   - understand the effects of the environment (such as gasoline fumes, chemicals, and extremes of humidity and temperature) on smell and taste   - prevent the effects of aging on smell and taste   - develop new diagnostic tests for taste and smell disorders   - understand associations between smell disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses.  promote the regeneration of sensory nerve cells understand the effects of the environment (such as gasoline fumes, chemicals, and extremes of humidity and temperature) on smell and taste prevent the effects of aging on smell and taste develop new diagnostic tests for taste and smell disorders understand associations between smell disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses."}]}
{"messages": [{"role": "user", "content": "What is (are) Problems with Smell ?"}, {"role": "assistant", "content": "Smell is part of our chemical sensing system. Our sense of smell is the ability to detect odors in our environment through our nose, like the fragrance of flowers or the smell of baking bread. Smell is also the ability to detect food odors or aromas released in our mouths when we chew, which then flow from the roof of the throat region to the nose. Congestion blocks this flow and impacts our appreciation of the flavor of food."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Problems with Smell ?"}, {"role": "assistant", "content": "People who experience smell disorders either have a decrease in their ability to smell or changes in the way they perceive odors. Total smell loss is relatively rare, but a decrease in the sense of smell occurs more often, especially in older adults. There are several types of smell disorders depending on how the sense of smell is affected. - Some people have hyposmia, which occurs when their ability to detect certain odors is reduced.  - Other people can't detect odor at all, which is called anosmia.   - Sometimes a loss of smell can be accompanied by a change in the perception of odors. This type of smell disorder is called dysosmia. Familiar odors may become distorted, or an odor that usually smells pleasant instead smells foul.   - Still others may perceive a smell that isn't present at all, which is called phantosmia.   - Smell loss due to aging is called presbyosmia.  Some people have hyposmia, which occurs when their ability to detect certain odors is reduced. Other people can't detect odor at all, which is called anosmia. Sometimes a loss of smell can be accompanied by a change in the perception of odors. This type of smell disorder is called dysosmia. Familiar odors may become distorted, or an odor that usually smells pleasant instead smells foul. Still others may perceive a smell that isn't present at all, which is called phantosmia. Smell loss due to aging is called presbyosmia."}]}
{"messages": [{"role": "user", "content": "What causes Problems with Smell ?"}, {"role": "assistant", "content": "Most people who have a problem with smell have recently had an illness or injury. The most common causes are upper respiratory infections, such as the common cold, and chronic sinus or nasal disease. Other common causes are -  aging   - smoking  - nasal polyps   - head injury   - allergens such as ragweed, grasses, and pet dander  - hormonal disturbances  - dental problems  - exposure to certain chemicals such as insecticides or solvents   - medications such as antibiotics or antihistamines   - radiation for treatment of head and neck cancers  - diseases of the nervous system such as Parkinsons disease or Alzheimers disease.  aging smoking nasal polyps head injury allergens such as ragweed, grasses, and pet dander hormonal disturbances dental problems exposure to certain chemicals such as insecticides or solvents medications such as antibiotics or antihistamines radiation for treatment of head and neck cancers diseases of the nervous system such as Parkinsons disease or Alzheimers disease."}]}
{"messages": [{"role": "user", "content": "How to prevent Problems with Smell ?"}, {"role": "assistant", "content": "Problems with smell that occur with aging are not preventable. However, you can protect yourself against other causes of smell loss with these steps. - Treat Sinus and Nasal Conditions. Swollen sinuses and nasal passages may cause total or partial loss of smell. Your doctor may prescribe an antibiotic or anti-inflammatory drug to reduce nasal swelling from chronic sinus infections, a major cause of smell loss. Treat Sinus and Nasal Conditions. Swollen sinuses and nasal passages may cause total or partial loss of smell. Your doctor may prescribe an antibiotic or anti-inflammatory drug to reduce nasal swelling from chronic sinus infections, a major cause of smell loss. -  Prevent Upper Respiratory Infections. Colds and respiratory infections such as the flu can lead to smell disorders. Wash your hands frequently, especially during the winter months, and get a flu shot every year. For more information about the flu vaccine, visit  Key Facts About Seasonal Flu Vaccine Prevent Upper Respiratory Infections. Colds and respiratory infections such as the flu can lead to smell disorders. Wash your hands frequently, especially during the winter months, and get a flu shot every year. For more information about the flu vaccine, visit  Key Facts About Seasonal Flu Vaccine - Avoid Allergens. Keep away from allergens such as ragweed, grasses, and pet dander that can cause seasonal allergies or nasal congestion.  Avoid Allergens. Keep away from allergens such as ragweed, grasses, and pet dander that can cause seasonal allergies or nasal congestion. - Avoid Head Injuries. Previous surgery or trauma to the head can impair your sense of smell because the olfactory nerves may be cut, blocked, or physically damaged. Always wear seatbelts when riding in a car and a helmet when bicycling. Avoid Head Injuries. Previous surgery or trauma to the head can impair your sense of smell because the olfactory nerves may be cut, blocked, or physically damaged. Always wear seatbelts when riding in a car and a helmet when bicycling. - Avoid Exposure to Toxic Chemicals. Avoid contact with chemicals that might cause smell problems such as paints, insecticides, and solvents, or wear a respirator if you cannot avoid contact. Avoid Exposure to Toxic Chemicals. Avoid contact with chemicals that might cause smell problems such as paints, insecticides, and solvents, or wear a respirator if you cannot avoid contact. - Review Your Medications. If you are taking medications such as antibiotics or antihistamines and notice a change in your sense of smell, talk to your doctor. You may be able to adjust or change your medicine to one that will not cause a problem with smell.  Review Your Medications. If you are taking medications such as antibiotics or antihistamines and notice a change in your sense of smell, talk to your doctor. You may be able to adjust or change your medicine to one that will not cause a problem with smell. - Dont Smoke. It impairs the ability to identify and enjoy odors. For free help to quit smoking, visit www.Smokefree.gov   Dont Smoke. It impairs the ability to identify and enjoy odors. For free help to quit smoking, visit www.Smokefree.gov  -  Treat Nasal Polyps If Necessary.  If you have nasal polyps, having them removed may restore smell.   Treat Nasal Polyps If Necessary.  If you have nasal polyps, having them removed may restore smell. -  Treat Other Conditions. If you have diabetes, thyroid abnormalities, certain vitamin deficiencies, or are malnourished and you experience a loss of smell or taste, tell your doctor. In some cases, when the condition that is causing the problem with smell is treated, the sense of smell returns.   Treat Other Conditions. If you have diabetes, thyroid abnormalities, certain vitamin deficiencies, or are malnourished and you experience a loss of smell or taste, tell your doctor. In some cases, when the condition that is causing the problem with smell is treated, the sense of smell returns."}]}
{"messages": [{"role": "user", "content": "What causes Problems with Smell ?"}, {"role": "assistant", "content": "In rare cases, certain medicines such as antibiotics or antihistamines may cause a change in your ability to smell. If you are taking these medications and notice a change in your sense of smell, talk to your doctor. You may be able to adjust or change your medicine to one that will not cause a problem with smell."}]}
{"messages": [{"role": "user", "content": "How to diagnose Problems with Smell ?"}, {"role": "assistant", "content": "Scientists have developed tests to determine the nature and extent of a person's smell disorder. Tests measure the smallest amount of odor patients can detect as well as how accurately a person can identify different smells. An easily administered \"scratch and sniff\" test allows a person to scratch pieces of paper treated to release different odors, sniff them, and try to identify each odor from a list of possibilities. In this way, doctors can determine whether a person has a decreased ability to smell (hyposmia), the inability to detect any odors (anosmia), or another kind of smell disorder. In some cases, your doctor may need to perform a nasal examination with a nasal endoscope, an instrument that illuminates and magnifies the areas of the nose where the problem may exist. This test can help identify the area and extent of the problem and help your doctor select the right treatment. If your doctor suspects that upper regions of the nose and nasal sinuses that can't be seen by an endoscope are involved, he or she may order a specialized X-ray procedure, usually a CT scan, to look further into the nose and sinuses."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Problems with Smell ?"}, {"role": "assistant", "content": "Depending on the cause of your smell disorder, your doctor may be able to treat your problem or suggest ways to cope with it. If a certain medication is the cause of the disorder, ask your doctor if you could substitute other medications or reduce the dose. Your doctor will work with you to get the medicine you need while trying to reduce unwanted side effects. Some patients with respiratory infections or allergies regain their sense of smell when the illness or condition is over. Often, correcting a general medical problem also can restore the sense of smell. For patients with nasal obstructions, such as polyps, or other inflammatory conditions of the nose or sinuses, medical treatments or surgery can restore the sense of smell. Occasionally, the sense of smell returns to normal on its own, without any treatment. Your doctor may suggest oral steroid medications such as prednisone, which is usually used for a short period of time, or topical steroid sprays, which can be used for longer periods of time. Antibiotics are also used to treat nasal infections. The effectiveness of both steroids and antibiotics depends greatly on the severity and duration of the nasal swelling or infection. Often relief is temporary."}]}
{"messages": [{"role": "user", "content": "What is (are) Problems with Smell ?"}, {"role": "assistant", "content": "You can help your doctor make a diagnosis by writing down important information about your problem beforehand and giving the information to your doctor during your visit. Write down answers to the following questions. - When did I first become aware of the problem?  - Did I have a cold or the flu?  - Did I have a head injury?   - Was I exposed to air pollutants, pollen, pet dander, or dust to which I might be allergic?  - Is this a recurring problem?  - Does it come at any special time, such as during the hay fever season? When did I first become aware of the problem? Did I have a cold or the flu? Did I have a head injury? Was I exposed to air pollutants, pollen, pet dander, or dust to which I might be allergic? Is this a recurring problem? Does it come at any special time, such as during the hay fever season?"}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Problems with Smell ?"}, {"role": "assistant", "content": "The National Institute on Deafness and Other Communication Disorders (NIDCD) supports basic and clinical investigations of smell and taste disorders at its laboratories in Bethesda, Md. and at universities and chemosensory research centers across the country. These chemosensory scientists are exploring how to - promote the regeneration of sensory nerve cells   - understand the effects of the environment (such as gasoline fumes, chemicals, and extremes of humidity and temperature) on smell and taste  - prevent the effects of aging on smell and taste   - develop new diagnostic tests for taste and smell disorders   - understand associations between smell disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses.  promote the regeneration of sensory nerve cells understand the effects of the environment (such as gasoline fumes, chemicals, and extremes of humidity and temperature) on smell and taste prevent the effects of aging on smell and taste develop new diagnostic tests for taste and smell disorders understand associations between smell disorders and changes in diet and food preferences in the elderly or among people with chronic illnesses."}]}
{"messages": [{"role": "user", "content": "What is (are) Breast Cancer ?"}, {"role": "assistant", "content": "How Tumors Form The body is made up of many types of cells. Normally, cells grow, divide and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous. Breast cancer occurs when malignant tumors form in the breast tissue. Who Gets Breast Cancer?  Breast cancer is one of the most common cancers in American women. It is most common among women between the ages of 45-85. (Watch the video to learn more about breast cancer survival rates. To enlarge the videos appearing on this page, click the brackets in the lower right-hand corner of the video screen. To reduce the videos, press the Escape (Esc) button on your keyboard.) Men can get breast cancer too, although they account for only 1 percent of all reported cases. Read more about breast cancer in men.  When Breast Cancer Spreads When cancer grows in breast tissue and spreads outside the breast, cancer cells are often found in the lymph nodes under the arm. If the cancer has reached these nodes, it means that cancer cells may have spread, or metastasized, to other parts of the body. When cancer spreads from its original location in the breast to another part of the body such as the brain, it is called metastatic breast cancer, not brain cancer. Doctors sometimes call this \"distant\" disease.  Learn about different kinds of breast cancer. Breast Cancer is Not Contagious Breast cancer is not contagious. A woman cannot \"catch\" breast cancer from other women who have the disease. Also, breast cancer is not caused by an injury to the breast. Most women who develop breast cancer do not have any known risk factors or a history of the disease in their families. Treating and Surviving Breast Cancer  Today, more women are surviving breast cancer than ever before. Nearly three million women are breast cancer survivors. (Watch the video to hear a woman discuss surviving breast cancer.) There are several ways to treat breast cancer, but all treatments work best when the disease is found early. As a matter of fact, when it is caught in its earliest stage, 98.5 percent of women with the disease are alive five years later. Every day researchers are working to find new and better ways to detect and treat cancer. Many studies of new approaches for women with breast cancer are under way. With early detection, and prompt and appropriate treatment, the outlook for women with breast cancer can be positive. To learn more about what happens after treatment, see  Surviving Cancer."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Breast Cancer? ?"}, {"role": "assistant", "content": "Some women develop breast cancer and others do not, and the risk factors for the disease vary. Breast cancer may affect younger women, but three-fourths of all breast cancers occur in women between the ages of 45 to 85. In Situ and Invasive Breast Cancer Researchers often talk about breast cancer in two ways: in situ and invasive. In situ refers to cancer that has not spread beyond its site of origin. Invasive applies to cancer that has spread to the tissue around it. This chart shows what the approximate chances are of a woman getting invasive breast cancer in her lifetime. Risk Factors Risk factors are conditions or agents that increase a person's chances of getting a disease. Here are the most common risk factors for breast cancer. -   Older age. The risk of breast cancer in a 70 year old woman is about 10 times that of a 30 year old woman, but risk decreases after age 85.  Older age. The risk of breast cancer in a 70 year old woman is about 10 times that of a 30 year old woman, but risk decreases after age 85. - Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter. Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter. - Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. - Never being pregnant or having your first child in your mid-30s or later. Never being pregnant or having your first child in your mid-30s or later. - Early menstruation. Having your first menstrual period before age 12. Early menstruation. Having your first menstrual period before age 12. - Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density.  Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density. -  Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer.  Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer. - Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. - Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy.  Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. - Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. - Gaining weight after menopause, especially after natural menopause and/or after age 60. Gaining weight after menopause, especially after natural menopause and/or after age 60. - Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease. Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease. - Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma. Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma. Five percent to 10 percent of all breast cancers are thought to be inherited. Get information about the BRCA1 and BRCA2 genetic mutations and testing for them. Warning Signs When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for. You can help safeguard your health by learning the following warning signs of breast cancer. -  a lump or thickening in or near the breast or in the underarm area  - a change in the size or shape of the breast  - a dimple or puckering in the skin of the breast  -  a nipple turned inward into the breast  -  fluid, other than breast milk, from the nipple, especially if it's bloody  - scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple)  - dimples in the breast that look like the skin of an orange. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast a dimple or puckering in the skin of the breast a nipple turned inward into the breast fluid, other than breast milk, from the nipple, especially if it's bloody scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple) dimples in the breast that look like the skin of an orange. Don't Ignore Symptoms You should see your doctor about any symptoms like these. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible. Some women believe that as they age, health problems are due to \"growing older.\" Because of this myth, many illnesses go undiagnosed and untreated. Don't ignore your symptoms because you think they are not important or because you believe they are normal for your age. Talk to your doctor."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Breast Cancer? ?"}, {"role": "assistant", "content": "What Is Cancer Prevention? Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer. When studying ways to prevent cancer, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor. Anything that decreases your chance of developing cancer is called a cancer protective factor. Risk Factors Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer. Different ways to prevent cancer are being studied, including - changing lifestyle or eating habits  - avoiding things known to cause cancer  - taking medicine to treat a precancerous condition or to keep cancer from starting.  changing lifestyle or eating habits avoiding things known to cause cancer taking medicine to treat a precancerous condition or to keep cancer from starting. (For more on risk factors, see the chapter on \"Risk Factors.\") Here are protective factors for breast cancer. Less Exposure to Estrogen Decreasing the length of time a woman's breast tissue is exposed to estrogen may help lower her risk of developing breast cancer. Exposure to estrogen is reduced in the following ways. -   Early pregnancy.  Estrogen levels are lower during pregnancy. Women who have a full-term pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35.  -  Breast-feeding. Estrogen levels may remain lower while a woman is breast-feeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed.  -  Surgical removal of the ovaries.  The ovaries make estrogen. The amount of estrogen made by the body can be greatly reduced by removing one or both ovaries. Also, drugs may be taken to lower the amount of estrogen made by the ovaries.  -  Late menstruation. Menstrual periods that start at age 14 or older decreases the number of years the breast tissue is exposed to estrogen.  - Early menopause. The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen.   Early pregnancy.  Estrogen levels are lower during pregnancy. Women who have a full-term pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35.  Breast-feeding. Estrogen levels may remain lower while a woman is breast-feeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed.  Surgical removal of the ovaries.  The ovaries make estrogen. The amount of estrogen made by the body can be greatly reduced by removing one or both ovaries. Also, drugs may be taken to lower the amount of estrogen made by the ovaries. Late menstruation. Menstrual periods that start at age 14 or older decreases the number of years the breast tissue is exposed to estrogen. Early menopause. The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen. Exercise Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight. Learn more about the benefits of exercise for older adults.  For exercises tailored to older adults, visit Go4Life, the exercise and physical activity campaign from the National Institute on Aging (NIA) at NIH. Estrogen-only Hormone Therapy After Hysterectomy Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogen-only therapy after menopause may decrease the risk of breast cancer. There is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy. Learn about menopausal hormone therapy and cancer. Selective Estrogen Receptor Modulators (SERMs) Tamoxifen and raloxifene belong to the family of drugs called selective estrogen receptor modulators (SERMs). SERMs act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues. Treatment with tamoxifen or raloxifene lowers the risk of breast cancer in postmenopausal women. Tamoxifen also lowers the risk of breast cancer in high-risk premenopausal women. With either drug, the reduced risk lasts for several years after treatment is stopped. Lower rates of broken bones have been noted in patients taking raloxifene. Prophylactic Mastectomy Some women who have a high risk of breast cancer may choose to have a prophylactic mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision.  Learn more about surgery to reduce the risk of breast cancer. Prophylactic Oophorectomy Premenopausal women who have a high risk of breast cancer due to certain changes in the BRCA1 and BRCA2 genes may choose to have a prophylactic oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Prophylactic oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Long-term effects include decreased sex drive, vaginal dryness, and decreased bone density. Unclear As Risk Factors It is not clear whether the following affect the risk of breast cancer. - Oral contraceptives. Taking oral contraceptives (\"the pill\") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Some oral contraceptives contain estrogen. Progestin-only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer.  - Environment. Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer.  Oral contraceptives. Taking oral contraceptives (\"the pill\") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Some oral contraceptives contain estrogen. Progestin-only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. Environment. Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer. For More Information Clinical trials are taking place in many parts of the country. Information about clinical trials can be found at  http://www.cancer.gov/clinicaltrials on the website of the National Cancer Institute (NCI). Check NCI's list of cancer clinical trials for breast cancer prevention trials that are now accepting patients."}]}
{"messages": [{"role": "user", "content": "How to diagnose Breast Cancer ?"}, {"role": "assistant", "content": "Most cancers in their early, most treatable stages do not cause any symptoms. That is why it's important to have regular tests to check for cancer long before you might notice anything wrong. Detecting Breast Cancer Through Screening When breast cancer is found early, it is more likely to be treated successfully. Checking for cancer in a person who does not have any symptoms is called screening. Screening tests for breast cancer include, among others, clinical breast exams and mammograms. Recent studies have shown that ultrasound and MRI's may also be useful complementary screening tools, particularly in women with mammograms that are not definitive. During a clinical breast exam, the doctor or other health care professional checks the breasts and underarms for lumps or other changes that could be a sign of breast cancer.  A mammogram is a special x-ray of the breast that often can detect cancers that are too small for a woman or her doctor to feel. (Watch the video to learn more about digital mammography and dense breasts. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Who Should Have a Mammography? Several studies show that mammography screening has reduced the number of deaths from breast cancer. However, some other studies have not shown a clear benefit from mammography. Scientists are continuing to examine the level of benefit that mammography can produce. The U.S. Preventive Services Task Force (USPSTF) recommends a screening mammography for women 50-74 years every two years.  Learn more about the USPSTF mammography recommendations here. Between 5 and 10 percent of mammogram results are abnormal and require more testing. Most of these follow-up tests confirm that no cancer was present. Worried about the cost of a mammogram? Learn about free and low-cost screenings. (Centers for Disease Control and Prevention) How Biopsies are Performed If needed, the most common follow-up test a doctor will recommend is called a biopsy. This is a procedure where a small amount of fluid or tissue is removed from the breast to make a diagnosis. A doctor might perform fine needle aspiration, a needle or core biopsy, or a surgical biopsy. - With fine needle aspiration, doctors numb the area and use a thin needle to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked out by a lab.  - For a needle biopsy, sometimes called a core biopsy, doctors use a needle to remove tissue from an area that looks suspicious on a mammogram but cannot be felt. This tissue goes to a lab where a pathologist examines it to see if any of the cells are cancerous.  - In a surgical biopsy, a surgeon removes a sample of a lump or suspicious area. Sometimes it is necessary to remove the entire lump or suspicious area, plus an area of healthy tissue around the edges. The tissue then goes to a lab where a pathologist examines it under a microscope to check for cancer cells.  With fine needle aspiration, doctors numb the area and use a thin needle to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked out by a lab. For a needle biopsy, sometimes called a core biopsy, doctors use a needle to remove tissue from an area that looks suspicious on a mammogram but cannot be felt. This tissue goes to a lab where a pathologist examines it to see if any of the cells are cancerous. In a surgical biopsy, a surgeon removes a sample of a lump or suspicious area. Sometimes it is necessary to remove the entire lump or suspicious area, plus an area of healthy tissue around the edges. The tissue then goes to a lab where a pathologist examines it under a microscope to check for cancer cells. Another type of surgical biopsy that removes less breast tissue is called an image-guided needle breast biopsy, or stereotactic biopsy. Eighty percent of U.S. women who have a surgical breast biopsy do not have cancer. However, women who have breast biopsies are at higher risk of developing breast cancer than women who have never had a breast biopsy. Other Detection Methods Magnetic resonance imaging, or MRI, and ultrasound are two other techniques which, as supplements to standard mammography, might help detect breast cancer with greater accuracy. Genetic Detection The most comprehensive study to date of gene mutations in breast cancer, published in September 2012, confirmed that there are four primary subtypes of breast cancer, each with its own biology. The four groups are called intrinsic subtypes of breast cancer and include HER2-enriched (HER2E), Luminal A (LumA), Luminal B (LumB) and Basal-like. The outlook for survival is different for each of these subtypes of breast cancer. Researchers found that one subtype, Basal-like breast cancer, shares many genetic features with a form of ovarian cancer, and that both may respond similarly to drugs that reduce tumor growth or target DNA repair. The authors hope that discovery of these mutations will be an important step in the effort to improve therapies for breast cancer. For the time being, there are no genetic tests that are commercially available based solely on these findings. Soon, however, knowing extensively which breast cancer gene mutations a woman has should help guide precision treatment."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "There are many treatment options for women with breast cancer. The choice of treatment depends on your age and general health, the stage of the cancer, whether or not it has spread beyond the breast, and other factors. If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes. Working With a Team of Specialists People with cancer often are treated by a team of specialists. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. (Watch the video about this breast cancer survivor's treatment. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Clinical Trials for Breast Cancer Some breast cancer patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is both safe and effective. Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. Women with breast cancer who are interested in taking part in a clinical trial should talk to their doctor. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. See a list of the current clinical trials on breast cancer."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "There are a number of treatments for breast cancer, but the ones women choose most often -- alone or in combination -- are surgery, hormone therapy, radiation therapy, and chemotherapy. What Standard Treatments Do Here is what the standard cancer treatments are designed to do. - Surgery takes out the cancer and some surrounding tissue.   - Hormone therapy keeps cancer cells from getting most of the hormones they need to survive and grow.  - Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors and some surrounding tissue.  -  Chemotherapy uses anti-cancer drugs to kill most cancer cells. Surgery takes out the cancer and some surrounding tissue. Hormone therapy keeps cancer cells from getting most of the hormones they need to survive and grow. Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors and some surrounding tissue.  Chemotherapy uses anti-cancer drugs to kill most cancer cells. Treatment for breast cancer may involve local or whole body therapy. Doctors use local therapies, such as surgery or radiation, to remove or destroy breast cancer in a specific area. Whole body, or systemic, treatments like chemotherapy, hormonal, or biological therapies are used to destroy or control cancer throughout the body. Some patients have both kinds of treatment. Treating Early-Stage Breast Cancer If you have early-stage breast cancer, one common treatment available to you is a lumpectomy combined with radiation therapy. A lumpectomy is surgery that preserves a woman's breast. In a lumpectomy, the surgeon removes only the tumor and a small amount of the surrounding tissue. The survival rate for a woman who has this therapy plus radiation is similar to that for a woman who chooses a radical mastectomy, which is complete removal of a breast. If Cancer Has Spread Locally If you have breast cancer that has spread locally -- just to other parts of the breast -- your treatment may involve a combination of chemotherapy and surgery. Doctors usually first shrink the tumor with chemotherapy and then remove it through surgery. Shrinking the tumor before surgery may allow a woman to avoid a mastectomy and keep her breast. In the past, doctors would remove a lot of lymph nodes near breast tumors to see if the cancer had spread. Some doctors also use a method called sentinel node biopsy. Using a dye or radioactive tracer, surgeons locate the first or sentinel lymph node closest to the tumor, and remove only that node to see if the cancer has spread. If Cancer Has Spread Beyond the Breast If the breast cancer has spread to other parts of the body, such as the lung or bone, you might receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. Radiation therapy may also be useful to control tumors in other parts of the body. Get more information about treatment options for breast cancer  and for  recurrent breast cancer."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Breast Cancer ?"}, {"role": "assistant", "content": "New Technologies Several new technologies offer hope for making future treatment easier for women with breast cancer. - Using a special tool, doctors can today insert a miniature camera through the nipple and into a milk duct in the breast to examine the area for cancer.  Using a special tool, doctors can today insert a miniature camera through the nipple and into a milk duct in the breast to examine the area for cancer. - Researchers are testing another technique to help women who have undergone weeks of conventional radiation therapy. Using a small catheter -- a tube with a balloon tip -- doctors can deliver tiny radioactive beads to a place on the breast where cancer tissue has been removed. This can reduce the therapy time to a matter of days. Researchers are testing another technique to help women who have undergone weeks of conventional radiation therapy. Using a small catheter -- a tube with a balloon tip -- doctors can deliver tiny radioactive beads to a place on the breast where cancer tissue has been removed. This can reduce the therapy time to a matter of days. New Drug Combination Therapies New drug therapies and combination therapies continue to evolve. - A mix of drugs may increase the length of time you will live or the length of time you will live without cancer. It may someday prove useful for some women with localized breast cancer after they have had surgery.  A mix of drugs may increase the length of time you will live or the length of time you will live without cancer. It may someday prove useful for some women with localized breast cancer after they have had surgery. - New research shows women with early-stage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence. New research shows women with early-stage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence. Treating HER2-Positive Breast Cancer Herceptin is a drug commonly used to treat women who have a certain type of breast cancer. This drug slows or stops the growth of cancer cells by blocking HER2, a protein found on the surface of some types of breast cancer cells. Approximately 20 to 25 percent of breast cancers produce too much HER2. These \"HER2 positive\" tumors tend to grow faster and are generally more likely to return than tumors that do not overproduce HER2. Results from clinical trials show that those patients with early-stage HER2 positive breast cancer who received Herceptin in combination with chemotherapy had a 52 percent decrease in risk in the cancer returning compared with patients who received chemotherapy treatment alone. Cancer treatments like chemotherapy can be systemic, meaning they affect whole tissues, organs, or the entire body. Herceptin, however, was the first drug used to target only a specific molecule involved in breast cancer. Another drug, Tykerb, was approved by the U.S. Food and Drug Administration for use for treatment of HER2-positive breast cancer. Because of the availability of these two drugs, an international trial called ALTTO was designed to determine if one drug is more effective, safer, and if taking the drugs separately, in tandem order, or together is better. Unfortunately, the results, released in 2014, showed that taking two HER2-targeted agents together was no better than taking one alone in improving survival. The TAILORx Trial In an attempt to further specialize breast cancer treatment, The Trial Assigning Individualized Options for Treatment, or TAILORx, enrolled 10,000 women to examine whether appropriate treatment can be assigned based on genes that are frequently associated with risk of recurrence of breast cancer. The goal of TAILORx is important because the majority of women with early-stage breast cancer are advised to receive chemotherapy in addition to radiation and hormonal therapy, yet research has not demonstrated that chemotherapy benefits all of them equally. TAILORx seeks to examine many of a woman's genes simultaneously and use this information in choosing a treatment course, thus sparing women unnecessary treatment if chemotherapy is not likely to be of substantial benefit to them."}]}
{"messages": [{"role": "user", "content": "What is (are) Breast Cancer ?"}, {"role": "assistant", "content": "The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous."}]}
{"messages": [{"role": "user", "content": "What is (are) Breast Cancer ?"}, {"role": "assistant", "content": "Breast cancer occurs when a malignant tumor forms in the breast tissue. The cancer can be found in the breast itself or in the ducts and lymph nodes that surround the breast."}]}
{"messages": [{"role": "user", "content": "What is (are) Breast Cancer ?"}, {"role": "assistant", "content": "When cancer spreads from its original location in the breast to another part of the body such as the brain, it is called metastatic breast cancer, not brain cancer. Doctors sometimes call this \"distant\" disease."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Breast Cancer? ?"}, {"role": "assistant", "content": "Did You Know: Breast Cancer Statistics? Breast cancer is one of the most common cancers in American women. It is most common among women between the ages of 45-85. Today, more women are surviving breast cancer than ever before. Over two million women are breast cancer survivors. (Watch the video to learn more about breast cancer survival rates. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Men can get breast cancer too, although they account for only one percent of all reported cases. Read more about breast cancer in men."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Breast Cancer ?"}, {"role": "assistant", "content": "When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for. You can help safeguard your health by learning the following warning signs of breast cancer. -  a lump or thickening in or near the breast or in the underarm area  - a change in the size or shape of the breast  - a dimple or puckering in the skin of the breast  -  a nipple turned inward into the breast  -  fluid, other than breast milk, from the nipple, especially if it's bloody  - scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple)  - dimples in the breast that look like the skin of an orange. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast a dimple or puckering in the skin of the breast a nipple turned inward into the breast fluid, other than breast milk, from the nipple, especially if it's bloody scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple) dimples in the breast that look like the skin of an orange. Don't Ignore Symptoms You should see your doctor about any symptoms like these. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible. Some women believe that as they age, health problems are due to \"growing older.\" Because of this myth, many illnesses go undiagnosed and untreated. Don't ignore your symptoms because you think they are not important or because you believe they are normal for your age. Talk to your doctor."}]}
{"messages": [{"role": "user", "content": "What is (are) Breast Cancer ?"}, {"role": "assistant", "content": "One definition of cure is being alive and free of breast cancer for 5 years. If the cancer is found early, a woman's chances of survival are better. In fact, nearly 98 percent of women who discover their breast cancer when it is near the site of origin and still small in size are alive 5 years later. However, women whose cancer is diagnosed at a late stage, after it has spread to other parts of the body, have only a 23.3 percent chance of surviving 5 years. To learn more about what happens after treatment, see Surviving Cancer."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Breast Cancer? ?"}, {"role": "assistant", "content": "Risk factors are conditions or agents that increase a person's chances of getting a disease. Here are the most common risk factors for breast cancer. - Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter.  - Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating.  - Never being pregnant or having your first child in your mid-30s or later.  - Early menstruation. Having your first menstrual period before age 12.  -  Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density.   -  Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer.   - Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast.  - Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy.   - Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises.  - Gaining weight after menopause, especially after natural menopause and/or after age 60.  - Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease.  - Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma.    Five percent to 10 percent of all breast cancers are thought to be inherited.    Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter. Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Never being pregnant or having your first child in your mid-30s or later. Early menstruation. Having your first menstrual period before age 12. Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density. Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer. Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. Gaining weight after menopause, especially after natural menopause and/or after age 60. Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease. Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma.    Five percent to 10 percent of all breast cancers are thought to be inherited.   Get information about the BRCA1 and BRCA2 genetic mutations and testing for them. This chart shows what the approximate chances are of a woman getting invasive breast cancer in her lifetime."}]}
{"messages": [{"role": "user", "content": "How to prevent Breast Cancer ?"}, {"role": "assistant", "content": "When studying ways to prevent breast cancer, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor. Anything that decreases your chance of developing cancer is called a cancer protective factor. Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer. Different ways to prevent cancer are being studied, including - changing lifestyle or eating habits  - avoiding things known to cause cancer  - taking medicine to treat a precancerous condition or to keep cancer from starting. changing lifestyle or eating habits avoiding things known to cause cancer taking medicine to treat a precancerous condition or to keep cancer from starting."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Breast Cancer ?"}, {"role": "assistant", "content": "When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for. You can help safeguard your health by learning the following warning signs of breast cancer. - a lump or thickening in or near the breast or in the underarm area  - a change in the size or shape of the breast  - ridges or pitting of the breast; the skin looks like the skin of an orange  - a change in the way the skin of the breast, areola, or nipple looks or feels; for example, it may be warm, swollen, red, or scaly  - nipple discharge or tenderness, or the nipple is pulled back or inverted into the breast. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast ridges or pitting of the breast; the skin looks like the skin of an orange a change in the way the skin of the breast, areola, or nipple looks or feels; for example, it may be warm, swollen, red, or scaly nipple discharge or tenderness, or the nipple is pulled back or inverted into the breast. You should see your doctor about any symptoms like these. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible."}]}
{"messages": [{"role": "user", "content": "What is (are) Breast Cancer ?"}, {"role": "assistant", "content": "A mammogram can often detect breast changes in women who have no signs of breast cancer. Often, it can find a breast lump before it can be felt. If the results indicate that cancer might be present, your doctor will advise you to have a follow-up test called a biopsy."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Breast Cancer? ?"}, {"role": "assistant", "content": "The risks of breast cancer screening tests include the following. - Finding breast cancer may not improve health or help a woman live longer. Screening may not help you if you have fast-growing breast cancer or if it has already spread to other places in your body. Also, some breast cancers found on a screening mammogram may never cause symptoms or become life-threatening. Finding these cancers is called overdiagnosis.  Finding breast cancer may not improve health or help a woman live longer. Screening may not help you if you have fast-growing breast cancer or if it has already spread to other places in your body. Also, some breast cancers found on a screening mammogram may never cause symptoms or become life-threatening. Finding these cancers is called overdiagnosis. - False-negative test results can occur. Screening test results may appear to be normal even though breast cancer is present. A woman who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if she has symptoms. False-negative test results can occur. Screening test results may appear to be normal even though breast cancer is present. A woman who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if she has symptoms. - False-positive test results can occur. Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isnt) is usually followed by more tests (such as biopsy), which also have risks.  False-positive test results can occur. Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isnt) is usually followed by more tests (such as biopsy), which also have risks. - Anxiety from additional testing may result from false positive results. In one study, women who had a false-positive screening mammogram followed by more testing reported feeling anxiety 3 months later, even though cancer was not diagnosed. However, several studies show that women who feel anxiety after false-positive test results are more likely to schedule regular breast screening exams in the future. Anxiety from additional testing may result from false positive results. In one study, women who had a false-positive screening mammogram followed by more testing reported feeling anxiety 3 months later, even though cancer was not diagnosed. However, several studies show that women who feel anxiety after false-positive test results are more likely to schedule regular breast screening exams in the future. - Mammograms expose the breast to radiation. Being exposed to radiation is a risk factor for breast cancer. The risk of breast cancer from radiation exposure is higher in women who received radiation before age 30 and at high doses. For women older than 40 years, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure.  Mammograms expose the breast to radiation. Being exposed to radiation is a risk factor for breast cancer. The risk of breast cancer from radiation exposure is higher in women who received radiation before age 30 and at high doses. For women older than 40 years, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure. - There may be pain or discomfort during a mammogram. During a mammogram, the breast is placed between 2 plates that are pressed together. Pressing the breast helps to get a better x-ray of the breast. Some women have pain or discomfort during a mammogram.  There may be pain or discomfort during a mammogram. During a mammogram, the breast is placed between 2 plates that are pressed together. Pressing the breast helps to get a better x-ray of the breast. Some women have pain or discomfort during a mammogram. Some women worry about radiation exposure, but the risk of any harm from a mammogram is actually quite small. The doses of radiation used are very low and considered safe. The exact amount of radiation used during a mammogram will depend on several factors. For instance, breasts that are large or dense will require higher doses to get a clear image. Learn more about the risks of breast cancer screening."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "You can seek conventional treatment from a specialized cancer doctor, called an oncologist. The oncologist will usually assemble a team of specialists to guide your therapy. Besides the oncologist, the team may include a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. You might also be eligible to enroll in a clinical trial to receive treatment that conventional therapies may not offer."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Breast Cancer ?"}, {"role": "assistant", "content": "Clinical trials are research studies on people to find out whether a new drug or treatment is both safe and effective. New therapies are tested on people only after laboratory and animal studies show promising results. The Food and Drug Administration sets strict rules to make sure that people who agree to be in the studies are treated as safely as possible. Clinical trials are taking place in many parts of the country. Information about clinical trials can be found at http://www.cancer.gov/clinicaltrials on the website of the National Cancer Institute (NCI). Check NCI's list of cancer clinical trials for breast cancer prevention trials that are now accepting patients."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "Once breast cancer has been found, it is staged. Staging means determining how far the cancer has progressed. Through staging, the doctor can tell if the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment. Staging will let the doctor know - the size of the tumor and exactly where it is in the breast.  - if the cancer has spread within the breast.  - if cancer is present in the lymph nodes under the arm.  - If cancer is present in other parts of the body. the size of the tumor and exactly where it is in the breast. if the cancer has spread within the breast. if cancer is present in the lymph nodes under the arm. If cancer is present in other parts of the body.  Read more details about the stages of breast cancer."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "Standard treatments for breast cancer include - surgery that takes out the cancer and some surrounding tissue  - radiation therapy that uses high-energy beams to kill cancer cells and shrink tumors and some surrounding tissue.  - chemotherapy that uses anti-cancer drugs to kill cancer most cells  - hormone therapy that keeps cancer cells from getting most of the hormones they need to survive and grow. surgery that takes out the cancer and some surrounding tissue radiation therapy that uses high-energy beams to kill cancer cells and shrink tumors and some surrounding tissue. chemotherapy that uses anti-cancer drugs to kill cancer most cells hormone therapy that keeps cancer cells from getting most of the hormones they need to survive and grow. (Watch the video to learn about one breast cancer survivor's story. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What is (are) Breast Cancer ?"}, {"role": "assistant", "content": "There are two types of breast-conserving surgery -- lumpectomy and partial mastectomy. - Lumpectomy is the removal of the tumor and a small amount of normal tissue around it. A woman who has a lumpectomy almost always has radiation therapy as well. Most surgeons also take out some of the lymph nodes under the arm. Lumpectomy is the removal of the tumor and a small amount of normal tissue around it. A woman who has a lumpectomy almost always has radiation therapy as well. Most surgeons also take out some of the lymph nodes under the arm. - Partial or segmental mastectomy is removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Often, surgeons remove some of the lymph nodes under the arm. In most cases, radiation therapy follows. Partial or segmental mastectomy is removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Often, surgeons remove some of the lymph nodes under the arm. In most cases, radiation therapy follows."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "Even if the surgeon removes all of the cancer that can be seen at the time of surgery, a woman may still receive follow-up treatment. This may include radiation therapy, chemotherapy, or hormone therapy to try to kill any cancer cells that may be left. Treatment that a patient receives after surgery to increase the chances of a cure is called adjuvant therapy."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells and shrink tumors. This therapy often follows a lumpectomy, and is sometimes used after mastectomy. During radiation therapy, a machine outside the body sends high-energy beams to kill the cancer cells that may still be present in the affected breast or in nearby lymph nodes. Doctors sometimes use radiation therapy along with chemotherapy, or before or instead of surgery."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "Chemotherapy is the use of drugs to kill cancer cells. A patient may take chemotherapy by mouth in pill form, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called whole body or systemic treatment if the drug(s) enter the bloodstream, travel through the body, and kill cancer cells throughout the body. Treatment with standard chemotherapy can be as short as two months or as long as two years. Targeted therapies, usually in pill form, have become more common and focus on either a gene or protein abnormality and usually have few adverse side-effects as they directly affect the abnormality and not other cells or tissues in the body. Sometimes chemotherapy is the only treatment the doctor will recommend. More often, however, chemotherapy is used in addition to surgery, radiation therapy, and/or biological therapy."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "Hormonal therapy keeps cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work. Sometimes it includes surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy can affect cancer cells throughout the body. Often, women with early-stage breast cancer and those with metastatic breast cancer -- meaning cancer that has spread to other parts of the body -- receive hormone therapy in the form of tamoxifen. Hormone therapy with tamoxifen or estrogens can act on cells all over the body. However, it may increase the chance of developing endometrial cancer. If you take tamoxifen, you should have a pelvic examination every year to look for any signs of cancer. A woman should report any vaginal bleeding, other than menstrual bleeding, to her doctor as soon as possible."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Breast Cancer ?"}, {"role": "assistant", "content": "Certain drugs that have been used successfully in other cancers are now being used to treat some breast cancers. A mix of drugs may increase the length of time you will live, or the length of time you will live without cancer. In addition, certain drugs like Herceptin and Tykerb taken in combination with chemotherapy, can help women with specific genetic breast cancer mutations better than chemotherapy alone."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "How Tumors Form The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong -- cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous. How Colorectal Cancer Develops Cancer of the colon or rectum is called colorectal cancer. The colon and the rectum are part of the large intestine, which is part of the digestive system. Colorectal cancer occurs when tumors form in the lining of the large intestine, also called the large bowel. Colorectal cancer accounts for almost ten percent of all cancer deaths in the United States. The risk of developing colorectal cancer rises after age 50. It is common in both men and women. Colorectal Cancer Can Spread Sometimes, cancer cells break away from the malignant tumor and enter the bloodstream or the lymphatic system where they travel to other organs in the body. Among other things, the lymphatic system transports white blood cells that fight infection. When cancer travels or spreads from its original location in the colon to another part of the body such as the liver, it is called metastatic colorectal cancer and not liver cancer. When colorectal cancer does spread, it tends to spread to the liver or lungs. Cure Rate for Early Detection Today there are more ways than ever to treat colorectal cancer. As with almost all cancers, the earlier it is found, the more likely that the treatment will be successful. If colon cancer is detected in its early stages, it is up to 90 percent curable."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Colorectal Cancer? ?"}, {"role": "assistant", "content": "Scientists don't know exactly what causes colorectal cancer, but they have been able to identify some risk factors for the disease. A risk factor is anything that increases your chances of getting a disease. Studies show that the following risk factors may increase a person's chances of developing colorectal cancer: age, polyps, personal history, family history, and ulcerative colitis. Age Colorectal cancer is more likely to occur as people get older. It is more common in people over the age of 50, but younger people can get it, too. In rare cases, it can occur in adolescence. Polyps Polyps are benign, or non-cancerous, growths on the inner wall of the colon and rectum. They are fairly common in people over age 50. Some types of polyps increase a person's risk of developing colorectal cancer. Not all polyps become cancerous, but nearly all colon cancers start as polyps. Diet The link between diet and colorectal cancer is not firmly established. There is evidence that smoking cigarettes and drinking 3 or more alcoholic beverages daily may be associated with an increased risk of colorectal cancer. Personal History Research shows that women with a history of cancer of the ovary, uterus, or breast have a somewhat increased chance of developing colorectal cancer. Also, a person who has already had colorectal cancer may develop this disease a second time. Family History The parents, siblings, and children of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves. This is especially true if the relative had the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more. Ulcerative colitis Ulcerative colitis is a condition in which there is a chronic break in the lining of the colon. Having this condition increases a person's chance of developing colorectal cancer. Genetic Mutations Researchers have identified genetic mutations, or abnormalities, that may be linked to the development of colon cancer. They are working to unravel the exact ways these genetic changes occur. Recent results from The Cancer Genome Atlas study of colorectal cancer point to several genes (BRAF and EGRF among others) that may increase risk. If You Have Risk Factors If you have one or more of these risk factors, it doesn't mean you will get colorectal cancer. It just increases the chances. You may wish to talk to your doctor about these risk factors. He or she may be able to suggest ways you can reduce your chances of developing colorectal cancer and plan an appropriate schedule for checkups."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Colorectal Cancer ?"}, {"role": "assistant", "content": "Most cancers in their early, most treatable stages don't cause any symptoms. That is why it is important to have regular tests to check for cancer even when you might not notice anything wrong. Common Signs and Symptoms When colorectal cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that people should watch for. Common signs and symptoms of colorectal cancer include: - a change in the frequency of bowel movements  - diarrhea, constipation, or feeling that the bowel does not empty completely  - either bright red or very dark blood in the stool  - stools that are narrower than usual  - general abdominal discomfort such as frequent gas pains, bloating, fullness, and/or cramps  - weight loss with no known reason  - constant tiredness  - vomiting a change in the frequency of bowel movements diarrhea, constipation, or feeling that the bowel does not empty completely either bright red or very dark blood in the stool stools that are narrower than usual general abdominal discomfort such as frequent gas pains, bloating, fullness, and/or cramps weight loss with no known reason constant tiredness vomiting These symptoms may be caused by colorectal cancer or by other conditions. It is important to check with a doctor if you have symptoms because only a doctor can make a diagnosis. Don't wait to feel pain. Early cancer usually doesn't cause pain. Lowering Your Risk Factors Lower your risk factors where possible. Colon cancer can be prevented if polyps that lead to the cancer are detected and removed. If colon cancer is found in its earliest stages, it is up to 90 percent curable. Tools for Early Detection Beginning at age 50, the following tools are all used for early detection. They can help identify pre-cancerous conditions. If you are younger than 50 and one of your first-degree relatives has had colon cancer, you should consult with your doctor. Tools used for early detection: - A fecal occult blood test, or FOBT, is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT can detect small amounts of bleeding. Newer, genetically-based stool tests are proving to be more accurate than older tests.  - A sigmoidoscopy is an examination of the rectum and lower colon -- or sigmoid colon -- using a lighted instrument called a sigmoidoscope.   - A colonoscopy is an examination of the rectum and the large intestine (but not the small intestine) using a lighted instrument called a colonoscope.   - A virtual colonoscopy, which requires the same preparation as a standard colonoscopy, is done with an external scanning machine as opposed to a device inserted into the colon, although the colon does need to be inflated with gas for proper scanning. A fecal occult blood test, or FOBT, is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT can detect small amounts of bleeding. Newer, genetically-based stool tests are proving to be more accurate than older tests. A sigmoidoscopy is an examination of the rectum and lower colon -- or sigmoid colon -- using a lighted instrument called a sigmoidoscope. A colonoscopy is an examination of the rectum and the large intestine (but not the small intestine) using a lighted instrument called a colonoscope. A virtual colonoscopy, which requires the same preparation as a standard colonoscopy, is done with an external scanning machine as opposed to a device inserted into the colon, although the colon does need to be inflated with gas for proper scanning."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Colorectal Cancer ?"}, {"role": "assistant", "content": "There are several treatment options for colorectal cancer, although most treatments begin with surgical removal of either the cancerous polyp or section of the colon. The choice of treatment depends on your age and general health, the stage of cancer, whether or not it has spread beyond the colon, and other factors. If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes. Working With a Team of Specialists A team of specialists often treats people with cancer. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. Clinical Trials for Colorectal Cancer Some colorectal cancer patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is safe and effective. Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. People with colorectal cancer who are interested in taking part in a clinical trial should talk with their doctor. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Click here to see a list of the current clinical trials on colorectal cancer. A separate window will open. Click the \"x\" in the upper right hand corner of the \"Clinical Trials\" window to return here."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Colorectal Cancer ?"}, {"role": "assistant", "content": "Treatments are available for all patients who have colon cancer. The choice of treatment depends on the size, location, and stage of the cancer and on the patient's general health. Doctors may suggest several treatments or combinations of treatments. Surgery Is the Most Common First Step in a Treatment Regimen The three standard treatments for colon cancer are surgery, chemotherapy, and radiation. Surgery, however, is the most common first step in the treatment for all stages of colon cancer. Surgery is an operation to remove the cancer. A doctor may remove the cancer using several types of surgery. Local Excision If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube up the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp, which is a small bulging piece of tissue, the operation is called a polypectomy. Colectomy If the cancer is larger, the surgeon will remove the cancer and a small amount of healthy tissue around it. This is called a colectomy. The surgeon may then sew the healthy parts of the colon together. Usually, the surgeon will also remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer. Colostomy If the doctor is not able to sew the two ends of the colon back together, an opening called a stoma is made on the abdomen for waste to pass out of the body before it reaches the rectum. This procedure is called a colostomy. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. But if the doctor needs to remove the entire lower colon or rectum, the colostomy may be permanent. Adjuvant Chemotherapy Even if the doctor removes all of the cancer that can be seen at the time of the operation, many patients receive chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy treatment after surgery -- to increase the chances of a cure -- is called adjuvant therapy. Researchers have found that patients who received adjuvant therapy usually survived longer and went for longer periods of time without a recurrence of colon cancer than patients treated with surgery alone. Patients age 70 and older benefited from adjuvant treatment as much as their younger counterparts. In fact, adjuvant therapy is equally as effective -- and no more toxic -- for patients 70 and older as it is for younger patients, provided the older patients have no other serious diseases. Adjuvant chemotherapy is standard treatment for patients whose cancer is operable and who are at high risk for a recurrence of the disease. Most cases of colon cancer occur in individuals age 65 and over. But studies have shown that older patients receive adjuvant chemotherapy less frequently than younger patients. Chemotherapy Chemotherapy is the use of anti-cancer drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. One form of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. The other form of chemotherapy is called targeted therapy because the drug affects only the factors that are causing the cancer and does not perturb the rest of the body. Radiation Therapy Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Most often, doctors use it for patients whose cancer is in the rectum. Doctors may use radiation before surgery to shrink a tumor in the rectum and make it easier to remove. Or, they may use it after surgery to destroy any cancer cells that remain in the treated area. The radiation may come from a machine or from implants placed directly into or near the tumor. Radiation that comes from a machine is called external radiation. Radiation that uses implants is known as internal radiation. Some patients have both kinds of therapy."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Colorectal Cancer ?"}, {"role": "assistant", "content": "Researchers continue to look at new ways to treat, diagnose, and prevent colorectal cancer. Many are testing other types of treatments in clinical trials. Advances in Treatments Studies have found that patients who took the drug Avastin, a targeted chemotherapy drug, with their standard chemotherapy treatment had a longer progression-free survival than those who did not take Avastin, but some studies have indicated that Avastin does not extend life. (The generic name for Avastin is bevacizumab.) Scientists are also working on vaccines therapies and monoclonal antibodies that may improve how patients' immune systems respond to colorectal cancers. Monoclonal antibodies are a single type of antibody that researchers make in large amounts in a laboratory. Surgical techniques have reduced the number of patients needing a permanent colostomy. A colostomy is an opening made in the abdomen for waste to pass out of the body before it reaches the rectum. In many cases, the surgeon can reconnect the healthy parts of the colon back together after removing the cancer. This way, the colon can function just as it did before. The PLCO Trial The National Cancer Institute's Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or PLCO Trial, recently provided results about the role of sigmoidoscopy in reducing deaths from colon and rectal cancers. The PLCO trial, involving 148,000 volunteers aged 55 to 74, compared two groups of people over a 10-year period and found that the group that received sigmoidoscopies had fewer deaths from colorectal cancer than those who did not get a sigmoidoscopy. NSAIDs and Polyp Formation Preventing colorectal cancer is a concern of many researchers. Studies have shown that non-steroidal anti-inflammatory drugs (NSAIDs) can keep large-bowel polyps from forming. Bowel polyps can start out benign, or non-cancerous, but can become cancerous. However, the effects that these drugs have on the heart and other parts of the body is of concern, therefore these drugs should only be used for prevention under a doctor's supervision. Genetic Research Genes involved in colorectal cancer continue to be identified and understood. Hereditary nonpolyposis colorectal cancer, or HNPCC, is one condition that causes people in a certain family to develop colorectal cancer at a young age. The discovery of four genes involved with this disease has provided crucial clues about the role of DNA repair in colorectal and other cancers. Scientists are continuing to identify genes associated with colon cancers that run in families. Using traditional screening methods on people from families that carry these genes may be another way to identify cancers at an early stage and cut deaths from colorectal cancer. Genetic screening of people at high risk may become more common in the near future Besides looking at genes in families, researchers in the The Cancer Genome Atlas study looked at the genes of actual colon tumors to better understand the contribution that genes make to cancer. By looking at the genetic composition of the tumor, researchers were able to identify new mutations (changes) in the genes that can lead to cancer, including the genes BRAF and EGRF."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means non-cancerous, or malignant, which means cancerous."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "Cancer of the colon or rectum is called colorectal cancer. The colon and the rectum are part of the large intestine, which is part of the digestive system. Colorectal cancer occurs when malignant tumors form in the lining of the large intestine, also called the large bowel."}]}
{"messages": [{"role": "user", "content": "How many people are affected by Colorectal Cancer ?"}, {"role": "assistant", "content": "Colorectal cancer accounts for almost ten percent of all cancer deaths in the United States. The risk of developing colorectal cancer rises after age 50. It is common in both men and women."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Colorectal Cancer? ?"}, {"role": "assistant", "content": "Studies show that the following risk factors may increase a person's chances of developing colorectal cancer: age, polyps, personal history, family history, and ulcerative colitis."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Colorectal Cancer? ?"}, {"role": "assistant", "content": "Yes. Ulcerative colitis is a condition in which there is a chronic break in the lining of the colon. It has been associated with an increased risk of colon cancer."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "Parents, siblings, or children of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves. This is especially true if the relative had the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Colorectal Cancer ?"}, {"role": "assistant", "content": "Possible signs of colorectal cancer include: - a change in the frequency of bowel movements   - diarrhea, constipation, or feeling that the bowel does not empty completely   - either bright red or very dark blood in the stool a change in the frequency of bowel movements diarrhea, constipation, or feeling that the bowel does not empty completely either bright red or very dark blood in the stool - stools that are narrower than usual  - general abdominal discomfort such as frequent gas pains, bloating, fullness, and/or cramps   - weight loss with no known reason  - constant tiredness  - vomiting stools that are narrower than usual general abdominal discomfort such as frequent gas pains, bloating, fullness, and/or cramps weight loss with no known reason constant tiredness vomiting"}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "Here are some of the tools used to detect colorectal cancer. - A fecal occult blood test, or FOBT, is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT can detect small amounts of bleeding. Newer, genetically-based stool tests are proving to be more accurate than older tests. A fecal occult blood test, or FOBT, is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT can detect small amounts of bleeding. Newer, genetically-based stool tests are proving to be more accurate than older tests. - A sigmoidoscopy is an examination of the rectum and lower colon -- or sigmoid colon -- using a lighted instrument called a sigmoidoscope. A sigmoidoscopy is an examination of the rectum and lower colon -- or sigmoid colon -- using a lighted instrument called a sigmoidoscope.  - A colonoscopy is an examination of the rectum and the large intestine (but not the small intestine) using a lighted instrument called a colonoscope. A colonoscopy is an examination of the rectum and the large intestine (but not the small intestine) using a lighted instrument called a colonoscope.  - A virtual colonoscopy, which requires the same preparation as a standard colonoscopy, is done with an external scanning machine as opposed to a device inserted into the colon. The colon does need to be inflated with gas for proper scanning. A virtual colonoscopy, which requires the same preparation as a standard colonoscopy, is done with an external scanning machine as opposed to a device inserted into the colon. The colon does need to be inflated with gas for proper scanning."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "Yes. In July 2008, the U.S. Preventive Services Task Force made its strongest ever recommendation for colorectal cancer screening: it suggested that all adults between ages 50 and 75 get screened, or tested, for the disease. The task force noted that various screening tests are available, making it possible for patients and their clinicians to decide which test is best for each person."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "The three standard treatments for colon cancer are surgery, chemotherapy, and radiation. Surgery, however, is the most common first step in the treatment for all stages of colon cancer. Surgery is an operation to remove the cancer. A doctor may remove the cancer using several types of surgery. For rectal cancer, radiation treatment also is an option."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "Several types of surgery are available for someone with colorectal cancer. If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube up the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp, which is a small bulging piece of tissue, the operation is called a polypectomy. If the cancer is larger, the surgeon will remove the cancer and a small amount of healthy tissue around it. This is called a colectomy. The surgeon may then sew the healthy parts of the colon together. Usually, the surgeon will also remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer. If the doctor is not able to sew the two ends of the colon back together, an opening called a stoma is made on the abdomen for waste to pass out of the body before it reaches the rectum. This procedure is called a colostomy. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. But if the doctor needs to remove the entire lower colon, the colostomy may be permanent."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Colorectal Cancer ?"}, {"role": "assistant", "content": "Even if the doctor removes all the cancer that can be seen at the time of the operation, many patients receive chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy treatment after surgery -- to increase the chances of a cure -- is called adjuvant therapy. Researchers have found that patients who received adjuvant therapy usually survived longer and went for longer periods of time without a recurrence of colon cancer than patients treated with surgery alone. Patients age 70 and older benefited from adjuvant treatment as much as their younger counterparts. In fact, adjuvant therapy is equally as effective -- and no more toxic -- for patients 70 and older as it is for younger patients, provided the older patients have no other serious diseases. Adjuvant chemotherapy is standard treatment for patients whose cancer is operable and who are at high risk for a recurrence of the disease. Most cases of colon cancer occur in individuals age 65 and over. But studies have shown that older patients receive adjuvant chemotherapy less frequently than younger patients."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Colorectal Cancer ?"}, {"role": "assistant", "content": "For surgery, the main side effects are short-term pain and tenderness around the area of the operation. For chemotherapy, the side effects depend on which drugs you take and what the dosages are. Most often the side effects include nausea, vomiting, and hair loss. For radiation therapy, fatigue, loss of appetite, nausea, and diarrhea may occur. There are many new drugs that have greatly reduced the degree of nausea that used to be experienced because of some of these treatments."}]}
{"messages": [{"role": "user", "content": "What is (are) Colorectal Cancer ?"}, {"role": "assistant", "content": "Various drugs are under study as possible treatments for colorectal cancer. A 2005 study found that patients who took the drug AvastinTM with their standard chemotherapy treatment had a longer progression-free survival than those who did not take Avastin, but the evidence is mixed on whether or not Avastin can extend life. (The generic name for Avastin is bevacizumab.) Scientists are also working on vaccine therapies and monoclonal antibodies that may improve how patients' immune systems respond to colorectal cancers. Monoclonal antibodies are a single type of antibody that researchers make in large amounts in a laboratory."}]}
{"messages": [{"role": "user", "content": "How to prevent Colorectal Cancer ?"}, {"role": "assistant", "content": "Scientists have done research on chemoprevention -- the use of drugs to prevent cancer from developing in the first place. Most of these studies have looked at people with high risk for the disease (where it runs in families) and not in the general population. For example, researchers have found that anti-inflammatory drugs helped keep intestinal tumors from forming, but serious side effects have been noted so researchers are proceeding cautiously. Studies have shown that non-steroidal anti-inflammatory drugs can keep large bowel polyps from forming. Bowel polyps can start out benign, or non-cancerous, but can become cancerous. Serious cardiac effects of these drugs have been noted so researchers are also proceeding cautiously in recommending these drugs for prevention."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Colorectal Cancer? ?"}, {"role": "assistant", "content": "Researchers are working hard to understand and identify the genes involved in colorectal cancer. Hereditary nonpolyposis colorectal cancer, or HNPCC, is one condition that causes people to develop colorectal cancer at a young age. The discovery of four genes involved with this disease has provided crucial clues about the role of DNA repair in colorectal and other cancers."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "A Brain Disorder Parkinson's disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination. It affects about half a million people in the United States although the numbers may be much higher. The average age of onset is 60 years, and the risk of developing Parkinson's goes up with age. Parkinson's disease was first described in 1817 by James Parkinson, a British doctor who published a paper on what he called \"the shaking palsy.\" In this paper, he described the major symptoms of the disease that would later bear his name. Four Main Symptoms Parkinson's disease belongs to a group of neurological conditions called movement disorders. The four main symptoms of Parkinson's are: - tremor, or trembling in hands, arms, legs, jaw, or head  - rigidity, or stiffness of the limbs and trunk  - bradykinesia, or slowness of movement  - postural instability, or impaired balance. tremor, or trembling in hands, arms, legs, jaw, or head rigidity, or stiffness of the limbs and trunk bradykinesia, or slowness of movement postural instability, or impaired balance. Parkinson's symptoms usually begin gradually and get worse over time. As the symptoms become more severe, people with the disorder may have difficulty walking, talking, or completing other simple tasks. They also experience non-motor, or movement, symptoms including mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue. Parkinson's disease not only affects the brain, but the entire body. While the brain involvement is responsible for the core features, other affected locations contribute to the complicated picture of Parkinson's. Parkinson's disease is both chronic, meaning it lasts for a long time, and progressive, meaning its symptoms grow worse over time. It is not contagious. Diagnosis Can Be Difficult About 60,000 Americans are diagnosed with Parkinson's disease each year. However, it's difficult to know exactly how many have it because many people in the early stages of the disease think their symptoms are due to normal aging and do not seek help from a doctor. Also, diagnosis is sometimes difficult because there are no medical tests that can diagnose the disease with certainty and because other conditions may produce symptoms of Parkinson's. For example, people with Parkinson's may sometimes be told by their doctors that they have other disorders, and people with diseases similar to Parkinson's may be incorrectly diagnosed as having Parkinson's. A persons good response to the drug levodopa may support the diagnosis. Levodopa is the main therapy for Parkinsons disease. Who Is at Risk? Both men and women can have Parkinsons disease. However, the disease affects about 50 percent more men than women. While the disease is more common in developed countries, studies also have found an increased risk of Parkinson's disease in people who live in rural areas and in those who work in certain professions, suggesting that environmental factors may play a role in the disorder. Researchers are focusing on additional risk factors for Parkinsons disease. One clear risk factor for Parkinson's is age. The average age of onset is 60 years and the risk rises significantly with advancing age. However, about 5 to 10 percent of people with Parkinson's have \"early-onset\" disease which begins before the age of 50. Early-onset forms of Parkinson's are often inherited, though not always, and some have been linked to specific gene mutations. Juvenile Parkinsonism In very rare cases, parkinsonian symptoms may appear in people before the age of 20. This condition is called juvenile parkinsonism. It is most commonly seen in Japan but has been found in other countries as well. It usually begins with dystonia (sustained muscle contractions causing twisting movements) and bradykinesia (slowness of movement), and the symptoms often improve with levodopa medication. Juvenile parkinsonism often runs in families and is sometimes linked to a mutated gene. Some Cases Are Inherited Evidence suggests that, in some cases, Parkinsons disease may be inherited. An estimated 15 to 25 percent of people with Parkinson's have a known relative with the disease. People with one or more close relatives who have Parkinson's have an increased risk of developing the disease themselves, but the total risk is still just 2 to 5 percent unless the family has a known gene mutation for the disease. A gene mutation is a change or alteration in the DNA or genetic material that makes up a gene. Researchers have discovered several genes that are linked to Parkinson's disease. The first to be identified was alpha-synuclein or SNCA. Inherited cases of Parkinsons disease are caused by mutations in the LRRK2, PARK2 or parkin, PARK7 or DJ-1, PINK1, or SNCA genes, or by mutations in genes that have not yet been identified."}]}
{"messages": [{"role": "user", "content": "What causes Parkinson's Disease ?"}, {"role": "assistant", "content": "A Shortage of Dopamine Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine, but when the neurons die or become impaired, they produce less dopamine. This shortage of dopamine causes the movement problems of people with Parkinson's. Dopamine is a chemical messenger, or neurotransmitter. Dopamine is responsible for transmitting signals between the substantia nigra and multiple brain regions. The connection between the substantia nigra and the corpus striatum is critical to produce smooth, purposeful movement. Loss of dopamine in this circuit results in abnormal nerve-firing patterns within the brain that cause impaired movement. Loss of Norepinephrine People with Parkinson's also have loss of the nerve endings that produce the neurotransmitter norepinephrine. Norepinephrine, which is closely related to dopamine, is the main chemical messenger of the sympathetic nervous system. The sympathetic nervous system controls many automatic functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain several of the non-movement features of Parkinson's, such as fatigue, irregular blood pressure, decreased gastric motility or movement of food through the digestive tract, and postural hypotension. Postural hypotension is a sudden drop in blood pressure when a person stands up from a sitting or lying-down position. It may cause dizziness, lightheadedness, and in some cases, loss of balance or fainting. Lewy Bodies in Brain Cells Many brain cells of people with Parkinson's contain Lewy bodies. Lewy bodies are unusual deposits or clumps of the brain protein alpha-synuclein, along with other proteins, which are seen upon microscopic examination of the brain. Researchers do not yet know why Lewy bodies form or what role they play in the development of Parkinson's. The clumps may prevent the cell from functioning normally, or they may actually be helpful, perhaps by keeping harmful proteins \"locked up\" so the cells can function. Genetic Mutations Although some cases of Parkinson's appear to be hereditary, and a few can be traced to specific genetic mutations, most cases are sporadic. Sporadic means the disease occurs randomly and does not seem to run in families. Many researchers now believe that Parkinson's disease results from a combination of genetic and environmental factors. Scientists have identified several genetic mutations associated with Parkinson's including mutations in the alpha-synuclein gene. They think that many more genes may be linked to the disorder. Studying the genes responsible for inherited cases of Parkinson's can help researchers understand both inherited and sporadic cases. The same genes and proteins that are altered in inherited cases may also be altered in sporadic cases by environmental toxins or other factors. Researchers also hope that discovering genes will help identify new ways of treating Parkinson's. Environmental Toxins Although researchers increasingly recognize the importance of genetics in Parkinson's disease, most believe environmental exposures increase a person's risk of developing the disease. Even in inherited cases, exposure to toxins or other environmental factors may influence when symptoms of the disease appear or how the disease progresses. There are a number of toxins that can cause parkinsonian symptoms in humans. Researchers are pursuing the question of whether pesticides and other environmental factors not yet identified also may cause Parkinson's disease. Viruses are another possible environmental trigger for Parkinson's. Mitochondria and Free Radicals Research suggests that mitochondria may play a role in the development of Parkinson's disease. Mitochondria are the energy-producing components of the cell and are major sources of free radicals. Free radicals are molecules that damage membranes, proteins, DNA, and other parts of the cell. This damage is called oxidative stress. Changes to brain cells caused by oxidative stress, including free radical damage to DNA, proteins, and fats, have been found in people with Parkinson's. Clinical studies now underway test whether agents thought to improve energy metabolism and decrease oxidative stress slow the progression of Parkinson's disease. Recent evidence suggests that mutations in genes linked to Parkinsons disease result in mitochondrial dysfunction. Buildup of Harmful Proteins Other research suggests that the cell's protein disposal system may fail in people with Parkinson's, causing proteins like alpha-synuclein to build up to harmful levels and trigger premature cell death. Additional studies have found that clumps of protein that develop inside brain cells of people with Parkinson's may contribute to the death of nerve cells, or neurons. However, the exact role of the protein deposits remains unknown. These studies also found that inflammation, because of protein accumulation, toxins or other factors, may play a role in the disease. However, the exact role of the protein deposits remains unknown. Researchers are exploring the possibility of vaccine development to decrease or prevent the accumulation of alpha-synuclein. While mitochondrial dysfunction, oxidative stress, inflammation, and many other cellular processes may contribute to Parkinson's disease, scientists still do not know what causes cells that produce dopamine to die. Genes Linked to Parkinsons Researchers have discovered several genes that are linked to Parkinson's disease. The first to be identified was alpha-synuclein or SNCA . Studies have found that Lewy bodies from people with the sporadic form of Parkinson's contain clumps of alpha-synuclein protein. This discovery revealed a possible link between hereditary and sporadic forms of the disease. Other genes linked to Parkinson's include PARK2, PARK7, PINK1, and LRRK2. PARK2, PARK7, and PINK1 cause rare, early-onset forms of the disease. Mutations in the LRRK2 gene are common in specific populations, including in people with Parkinson's in North Africa. Researchers are continuing to study the normal functions and interactions of these genes in order to find clues about how Parkinson's develops. They also have identified a number of other genes and chromosome regions that may play a role in Parkinson's, but the nature of these links is not yet clear. Whole genome wide association studies, or GWAS, of thousands of people with Parkinson's disease are now underway to find gene variants that allow for an increased risk of developing Parkinson's but are not necessarily causes of this disorder by themselves. A recent international study found that two genes containing mutations known to cause rare hereditary forms of Parkinsons disease are also associated with the more common sporadic form of the disease. This finding came from a GWAS which looked at DNA samples of European people who had Parkinsons disease and from those who did not have the disorder."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Parkinson's Disease ?"}, {"role": "assistant", "content": "Parkinson's disease does not affect everyone the same way. Symptoms of the disorder and the rate of progression differ among people with the disease. Sometimes people dismiss early symptoms of Parkinson's as the effects of normal aging. There are no medical tests to definitively diagnose the disease, so it can be difficult to diagnose accurately. Early Symptoms Early symptoms of Parkinson's disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting is slow and looks cramped or small. This very early period may last a long time before the more classic and obvious symptoms appear. Friends or family members may be the first to notice changes in someone with early Parkinson's. They may see that the person's face lacks expression and animation, a condition known as \"masked face,\" or that the person does not move an arm or leg normally. They also may notice that the person seems stiff, unsteady, or unusually slow. As the Disease Progresses As the disease progresses, symptoms may begin to interfere with daily activities. The shaking or tremor may make it difficult to hold utensils steady or read a newspaper. Tremor is usually the symptom that causes people to seek medical help. People with Parkinson's often develop a so-called parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward (called festination), and reduced swinging of the arms. They also may have trouble initiating or continuing movement, which is known as freezing. Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other. Four Primary Symptoms The four primary symptoms of Parkinson's are tremor, rigidity, slowness of movement (bradykinesia), and impaired balance (postural instability). - Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. It usually disappears during sleep or improves with a deliberate movement.   - Rigidity, or a resistance to movement, affects most people with Parkinson's. It becomes obvious when another person tries to move the individual's arm, such as during a neurological examination. The arm will move only in ratchet-like or short, jerky movements known as \"cogwheel\" rigidity.   - Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it may make simple tasks somewhat difficult. Activities once performed quickly and easily, such as washing or dressing, may take several hours.   - Postural instability, or impaired balance, causes people with Parkinson's to fall easily. They also may develop a stooped posture with a bowed head and droopy shoulders.  Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. It usually disappears during sleep or improves with a deliberate movement. Rigidity, or a resistance to movement, affects most people with Parkinson's. It becomes obvious when another person tries to move the individual's arm, such as during a neurological examination. The arm will move only in ratchet-like or short, jerky movements known as \"cogwheel\" rigidity. Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it may make simple tasks somewhat difficult. Activities once performed quickly and easily, such as washing or dressing, may take several hours. Postural instability, or impaired balance, causes people with Parkinson's to fall easily. They also may develop a stooped posture with a bowed head and droopy shoulders. Other Symptoms A number of other symptoms may accompany Parkinson's disease. Some are minor; others are not. Many can be treated with medication or physical therapy. No one can predict which symptoms will affect an individual person, and the intensity of the symptoms varies from person to person. Many people note that prior to experiencing motor problems of stiffness and tremor, they had symptoms of a sleep disorder, constipation, decreased ability to smell, and restless legs. Other symptoms include - depression  - emotional changes  - difficulty swallowing and chewing  - speech changes  - urinary problems or constipation  - skin problems, sleep problems  - dementia or other cognitive problems  - orthostatic hypotension (a sudden drop in blood pressure when standing up from a sitting or lying down position)  - muscle cramps and dystonia (twisting and repetitive movements)  - pain  - fatigue and loss of energy  - sexual dysfunction. depression emotional changes difficulty swallowing and chewing speech changes urinary problems or constipation skin problems, sleep problems dementia or other cognitive problems orthostatic hypotension (a sudden drop in blood pressure when standing up from a sitting or lying down position) muscle cramps and dystonia (twisting and repetitive movements) pain fatigue and loss of energy sexual dysfunction. A number of disorders can cause symptoms similar to those of Parkinson's disease. People with Parkinson's-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson's, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson's. Diagnosis Can Be Difficult There are currently no blood, or laboratory tests to diagnose sporadic Parkinson's disease. Diagnosis is based on a person's medical history and a neurological examination, but the disease can be difficult to diagnose accurately. Early signs and symptoms of Parkinson's may sometimes be dismissed as the effects of normal aging. A doctor may need to observe the person for some time until it is clear that the symptoms are consistently present. Improvement after initiating medication is another important hallmark of Parkinson's disease. Doctors may sometimes request brain scans or laboratory tests to rule out other diseases. However, computed tomography (CT) and magnetic resonance imaging (MRI) brain scans of people with Parkinson's usually appear normal. Recently, the FDA (Food and Drug Administration) has approved an imaging technique called DaTscan, which may help to increase accuracy of the diagnosis of Parkinsons disease. Since many other diseases have similar features but require different treatments, it is very important to make an exact diagnosis as soon as possible to ensure proper treatment."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Parkinson's Disease ?"}, {"role": "assistant", "content": "Deep Brain Stimulation Deep brain stimulation, or DBS, is a surgical procedure used to treat a variety of disabling disorders. It is most commonly used to treat the debilitating symptoms of Parkinsons disease. Deep brain stimulation uses an electrode surgically implanted into part of the brain. The electrodes are connected by a wire under the skin to a small electrical device called a pulse generator that is implanted in the chest. The pulse generator and electrodes painlessly stimulate the brain in a way that helps to stop many of the symptoms of Parkinson's such as tremor, bradykinesia, and rigidity. DBS is primarily used to stimulate one of three brain regions: the subthalamic nucleus, the globus pallidus, or the thalamus. Researchers are exploring optimal generator settings for DBS, whether DBS of other brain regions will also improve symptoms of Parkinsons disease, and also whether DBS may slow disease progression. Deep brain stimulation usually reduces the need for levodopa and related drugs, which in turn decreases dyskinesias and other side effects. It also helps to relieve on-off fluctuation of symptoms. People who respond well to treatment with levodopa tend to respond well to DBS. Unfortunately, older people who have only a partial response to levodopa may not improve with DBS. Complementary and Supportive Therapies A wide variety of complementary and supportive therapies may be used for Parkinson's disease. Among these therapies are standard physical, occupational, and speech therapies, which help with gait and voice disorders, tremors and rigidity, and decline in mental functions. Other supportive therapies include diet and exercise. Diet At this time there are no specific vitamins, minerals, or other nutrients that have any proven therapeutic value in Parkinson's disease. Some early reports have suggested that dietary supplements might protect against Parkinson's. Also, a preliminary clinical study of a supplement called coenzyme Q10 suggested that large doses of this substance might slow disease progression in people with early-stage Parkinson's. This supplement is now being tested in a large clinical trial. Other studies are being conducted to find out if caffeine, antioxidants, nicotine, and other dietary factors may help prevent or treat the disease. While there is currently no proof that any specific dietary factor is beneficial, a normal, healthy diet can promote overall well-being for people with Parkinson's disease, just as it would for anyone else. A high protein meal, however, may limit levodopa's effectiveness because for a time afterwards less levodopa passes through the blood-brain barrier. Exercise Exercise can help people with Parkinson's improve their mobility and flexibility. It can also improve their emotional well-being. Exercise may improve the brain's dopamine production or increase levels of beneficial compounds called neurotrophic factors in the brain. Other Therapies Other complementary therapies include massage therapy, yoga, tai chi, hypnosis, acupuncture, and the Alexander technique, which improves posture and muscle activity. There have been limited studies suggesting mild benefits from some of these therapies, but they do not slow Parkinson's disease and to date there is no convincing evidence that they help. However, this remains an active area of investigation."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Parkinson's Disease ?"}, {"role": "assistant", "content": "In recent years, research on Parkinson's has advanced to the point that halting the progression of the disease, restoring lost function, and even preventing the disease are all considered realistic goals. While the goal of preventing Parkinson's disease may take years to achieve, researchers are making great progress in understanding and treating it. Genetics Research One of the most exciting areas of Parkinson's research is genetics. Studying the genes responsible for inherited cases can help researchers understand both inherited and sporadic cases of the disease. Identifying gene defects can also help researchers -  understand how Parkinson's occurs  -  develop animal models that accurately mimic the death of nerve cells in humans  - identify new approaches to drug therapy  - improve diagnosis.  understand how Parkinson's occurs develop animal models that accurately mimic the death of nerve cells in humans identify new approaches to drug therapy improve diagnosis. Researchers funded by the National Institute of Neurological Disorders and Stroke are gathering information and DNA samples from hundreds of families with members who have Parkinson's and are conducting large-scale studies to identify gene variants that are associated with increased risk of developing the disease. They are also comparing gene activity in Parkinson's with gene activity in similar diseases such as progressive supranuclear palsy. In addition to identifying new genes for Parkinson's disease, researchers are trying to learn about the function of genes known to be associated with the disease, and about how gene mutations cause disease. Effects of Environmental Toxins Scientists continue to study environmental toxins such as pesticides and herbicides that can cause Parkinson's symptoms in animals. They have found that exposing rodents to the pesticide rotenone and several other agricultural chemicals can cause cellular and behavioral changes that mimic those seen in Parkinson's. Role of Lewy Bodies Other studies focus on how Lewy bodies form and what role they play in Parkinson's disease. Some studies suggest that Lewy bodies are a byproduct of a breakdown that occurs within nerve cells, while others indicate that Lewy bodies are protective, helping neurons \"lock away\" abnormal molecules that might otherwise be harmful. Identifying Biomarkers Biomarkers for Parkinson's -- measurable characteristics that can reveal whether the disease is developing or progressing -- are another focus of research. Such biomarkers could help doctors detect the disease before symptoms appear and improve diagnosis of the disease. They also would show if medications and other types of therapy have a positive or negative effect on the course of the disease. The National Disorders of Neurological Disorders and Stroke has developed an initiative, the Parkinsons Disease Biomarkers Identification Network (PD-BIN), designed specifically to address these questions and to discover and validate biomarkers for Parkinsons disease. Transcranial Therapies Researchers are conducting many studies of new or improved therapies for Parkinson's disease. Studies are testing whether transcranial electrical polarization (TEP) or transcranial magnetic stimulation (TMS) can reduce the symptoms of the disease. In TEP, electrodes placed on the scalp are used to generate an electrical current that modifies signals in the brain's cortex. In TMS, an insulated coil of wire on the scalp is used to generate a brief electrical current. Drug Discovery A variety of new drug treatments for Parkinson's disease are in clinical trials. Several MAO-B inhibitors including selegiline, lazabemide, and rasagiline, are being tested to determine if they have neuroprotective effects in people with Parkinsons disease. The National Institute of Neurological Disorders and Stroke has launched a broad effort to find drugs to slow the progression of Parkinson's disease, called NET-PD or NIH Exploratory Trials in Parkinson's Disease. The first studies tested several compounds; one of these, creatine, is now being evaluated in a larger clinical trial. The NET-PD investigators are testing a highly purified form of creatine, a nutritional supplement, to find out if it slows the decline seen in people with Parkinson's. Creatine is a widely used dietary supplement thought to improve exercise performance. Cellular energy is stored in a chemical bond between creatine and a phosphate. More recently, NET-PD has initiated pilot studies to test pioglitazone, a drug that has been shown to stimulate mitochondrial function. Because mitochondrial function may be less active in Parkinsons disease, this drug may protect vulnerable dopamine neurons by boosting mitochondrial function. Cell Implantation Another potential approach to treating Parkinson's disease is to implant cells to replace those lost in the disease. Starting in the 1990s, researchers conducting a controlled clinical trial of fetal tissue implants tried to replace lost dopamine-producing nerve cells with healthy ones from fetal tissue in order to improve movement and the response to medications. While many of the implanted cells survived in the brain and produced dopamine, this therapy was associated with only modest functional improvements, mostly in patients under the age of 60. Some of the people who received the transplants developed disabling dyskinesias that could not be relieved by reducing anti-parkinsonian medications. Stem Cells Another type of cell therapy involves stem cells. Some stem cells derived from embryos can develop into any kind of cell in the body, while others, called progenitor cells, are less flexible. Researchers are developing methods to improve the number of dopamine-producing cells that can be grown from embryonic stem cells in culture. Other researchers are also exploring whether stem cells from adult brains might be useful in treating Parkinson's disease. Recent studies suggest that some adult cells from skin can be reprogrammed to an embryonic-like state, resulting in induced pluripotent stem cells (iPSC) that may someday be used for treatment of Parkinsons. In addition, development and characterization of cells from people with sporadic or inherited Parkinsons may reveal information about cellular mechanisms of disease and identify targets for drug development. Gene Therapy A number of early clinical trials are now underway to test whether gene therapy can improve Parkinson's disease. Genes which are found to improve cellular function in models of Parkinson's are inserted into modified viruses. The genetically engineered viruses are then injected into the brains of people with Parkinson's disease. Clinical studies have focused on the therapeutic potential of neurotrophic factors, including GDNF and neurturin, and enzymes that produce dopamine. These trials will test whether the viruses, by lending to the production of the protective gene product, improve symptoms of Parkinson's over time. The National Institute of Neurological Disorders and Stroke also supports the Morris K. Udall Centers of Excellence for Parkinson's Disease Research program . These Centers, located across the USA, study cellular mechanisms underlying Parkinsons disease, identify and characterize disease-associated genes, and discover and develop potential therapeutic targets. The Centers' multidisciplinary research environment allows scientists to take advantage of new discoveries in the basic, translational and clinical sciences that could lead to clinical advances for Parkinsons disease."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "Parkinson's disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination. It currently affects about half a million people in the United States, although the numbers may be much higher. Parkinson's disease is both chronic, meaning it lasts for a long time, and progressive, meaning its symptoms grow worse over time. It is not contagious."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Parkinson's Disease ?"}, {"role": "assistant", "content": "Parkinson's belongs to a group of neurological conditions called movement disorders. The four main symptoms of Parkinson's disease are: - tremor, or trembling in hands, arms, legs, jaw, or head  - rigidity, or stiffness of the limbs and trunk  - bradykinesia, or slowness of movement  - postural instability, or impaired balance. tremor, or trembling in hands, arms, legs, jaw, or head rigidity, or stiffness of the limbs and trunk bradykinesia, or slowness of movement postural instability, or impaired balance. Other symptoms include depression, emotional changes, difficulty swallowing, speech changes, urinary problems, sleep problems, and dementia and other cognitive problems. Parkinson's symptoms usually begin gradually and get worse over time. As the symptoms become more severe, people with the disorder may have difficulty walking, talking, or completing other simple tasks. They also experience non-motor, or movement, symptoms including mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue. Parkinson's disease not only affects the brain, but the entire body. While the brain involvement is responsible for the core features, other affected locations contribute to the complicated picture of Parkinson's."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Parkinson's Disease? ?"}, {"role": "assistant", "content": "About 60,000 Americans are diagnosed with Parkinson's disease each year. The disease strikes about 50 percent more men than women. The average age of onset is 60 years, and the risk of developing the disease increases with age. Parkinson's disease is also more common in developed countries, possibly because of increased exposure to pesticides or other environmental toxins."}]}
{"messages": [{"role": "user", "content": "What causes Parkinson's Disease ?"}, {"role": "assistant", "content": "Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain that controls movement die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine, but once the neurons become impaired, they produce less dopamine and eventually die. It is this shortage of dopamine that causes the movement problems of people with Parkinson's."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "Dopamine is a brain chemical messenger, or neurotransmitter. It is responsible for transmitting signals between a brain region called the substantia nigra and multiple brain regions. The connection between the substantia nigra and the corpus striatum is critical to produce smooth, purposeful movement. Loss of dopamine results in abnormal nerve-firing patterns within the brain that cause impaired movement."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "Lewy bodies are unusual deposits or clumps of the brain protein alpha-synuclein, along with other proteins, which are seen upon microscopic examination of the brain. Many brain cells of people with Parkinson's disease contain Lewy bodies. Researchers do not yet know why Lewy bodies form or what role they play in the development of Parkinson's disease. The clumps may prevent the cell from functioning normally, or they may actually be helpful, perhaps by keeping harmful proteins \"locked up\" so that the cells can function."}]}
{"messages": [{"role": "user", "content": "How to diagnose Parkinson's Disease ?"}, {"role": "assistant", "content": "There are currently no blood or laboratory tests to diagnose sporadic Parkinson's disease. Diagnosis is based on a person's medical history and a neurological examination, but the disease can be difficult to diagnose accurately. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases. However, computed tomography (CT) and magnetic resonance imaging (MRI) brain scans of people with Parkinson's usually appear normal. Recently, the FDA (Food and Drug Administration) has approved an imaging technique called DaTscan, which may help to increase accuracy of the diagnosis of Parkinsons disease. Since many other diseases have similar features but require different treatments, it is very important to make an exact diagnosis as soon as possible to ensure proper treatment."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "The main therapy for Parkinson's disease is the drug levodopa, also called L-dopa. It is a simple chemical found naturally in plants and animals. Nerve cells use levodopa to make dopamine to replenish the brain's supply. Levodopa helps to reduce tremors and other symptoms of Parkinson's disease during the early stages of the disease. It allows most people with Parkinson's to extend the period of time in which they can lead relatively normal, productive lives."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "Carbidopa is a drug that is usually given along with levodopa. It delays the body's conversion of levodopa into dopamine until the levodopa reaches the brain. This prevents or reduces some of the side effects that often accompany levodopa therapy. Carbidopa also reduces the amount of levodopa needed."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Parkinson's Disease ?"}, {"role": "assistant", "content": "Yes. Other medications available to treat some symptoms and stages of Parkinson's disease include direct dopamine agonists, MAO-B inhibitors, COMT inhibitors, an anti-viral drug, and anticholinergics. Direct dopamine agonists are drugs that mimic the role of dopamine in the brain. They can be used in the early stages of the disease, or later on to give a more prolonged and steady dopaminergic effect in people who experience \"wearing off\" or \"on-off\" effects from taking the drug. Dopamine agonists are generally less effective than levodopa in controlling rigidity and bradykinesia. They can cause confusion in older adults. MAO-B inhibitors are another class of drugs that can reduce the symptoms of Parkinson's by causing dopamine to build up in surviving nerve cells. COMT inhibitors prolong the effects of levodopa by preventing the breakdown of dopamine. COMT inhibitors can usually make it possible to reduce a person's dose of levodopa. Amantadine, an old antiviral drug, can help reduce Parkinson's symptoms in the early stages of the disease, and again in later stages to treat dyskinesias. Anticholinergics can help reduce tremors and muscle rigidity."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Parkinson's Disease ?"}, {"role": "assistant", "content": "Doctors may prescribe a variety of medications to treat the non-motor symptoms of Parkinson's disease, such as depression and anxiety. Hallucinations, delusions, and other psychotic symptoms may be caused by some drugs prescribed for Parkinson's. Therefore, reducing or stopping those Parkinson's medications may make these symptoms of psychosis go away. A variety of treatment options, including medications, also are available to treat orthostatic hypotension, the sudden drop in blood pressure that occurs upon standing."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "Deep brain stimulation, or DBS, is a surgical procedure used to treat a variety of disabling disorders. It is most commonly used to treat the debilitating symptoms of Parkinsons disease. Deep brain stimulation uses an electrode surgically implanted into part of the brain. The electrodes are connected under the skin to a small electrical device called a pulse generator, implanted in the chest. The generator and electrodes painlessly stimulate the brain to help stop many Parkinson's symptoms such as tremor, bradykinesia, and rigidity. DBS is primarily used to stimulate one of three brain regions: the subthalamic nucleus, the globus pallidus, or the thalamus. Researchers are exploring optimal generator settings for DBS, whether DBS of other brain regions will also improve symptoms of Parkinsons disease, and also whether DBS may slow disease progression. Deep brain stimulation usually reduces the need for levodopa and related drugs, which in turn decreases dyskinesias and other side effects. It also helps to relieve \"on-off\" fluctuation of symptoms. People who respond well to treatment with levodopa, even if only for a short period, tend to respond well to DBS."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Parkinson's Disease ?"}, {"role": "assistant", "content": "Genetics is one of the most exciting areas of Parkinson's disease research. Studying the genes responsible for inherited cases can help researchers understand both inherited and sporadic cases of the disease. Sporadic means the disease occurs randomly and does not seem to run in families. Identifying gene defects can also help researchers - understand how the disease occurs   - develop animal models that accurately mimic the death of nerve cells in human Parkinson's disease  - identify new drug targets   - improve diagnosis. understand how the disease occurs develop animal models that accurately mimic the death of nerve cells in human Parkinson's disease identify new drug targets improve diagnosis."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "The Parkinsons Disease Biomarkers Identification Network, or PD-BIN, is an initiative developed by the National Institute of Neurological Disorders and Stroke to discover and validate biomarkers for Parkinsons disease. Biomarkers are measurable characteristics that can reveal whether the disease is developing or progressing. Biomarkers could help doctors detect Parkinsons disease before symptoms appear and improve diagnosis of the disorder."}]}
{"messages": [{"role": "user", "content": "What is (are) Parkinson's Disease ?"}, {"role": "assistant", "content": "The National Institute of Neurological Disorders and Stroke (NINDS) has launched a broad effort called NIH Exploratory Trials in Parkinson's Disease, or NET-PD, to find drugs to slow the progression of Parkinson's disease. The first studies tested several compounds. One of these, a nutritional supplement called creatine, is now being evaluated in a larger clinical trial to find out if it slows the clinical decline seen in people with Parkinson's disease. For more information on NET-PD trials visit: http://parkinsontrial.ninds.org."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Leukemia is a cancer of the blood cells. It is the most common type of blood cancer and affects 10 times as many adults as children. Most people diagnosed with leukemia are over 50 years old. Leukemia Starts in Bone Marrow Leukemia usually begins in the bone marrow, the soft material in the center of most bones where blood cells are formed. The bone marrow makes three types of blood cells, and each type has a special function. - White blood cells fight infection and disease.  - Red blood cells carry oxygen throughout the body.  - Platelets help control bleeding by forming blood clots. White blood cells fight infection and disease. Red blood cells carry oxygen throughout the body. Platelets help control bleeding by forming blood clots. In people with leukemia, the bone marrow produces abnormal white blood cells, called leukemia cells. At first, leukemia cells function almost normally. But over time, as more leukemia cells are produced, they may crowd out the healthy white blood cells, red blood cells, and platelets. This makes it difficult for the blood to carry out its normal functions. There are four common types of adult leukemia. Two are chronic, meaning they get worse over a longer period of time. The other two are acute, meaning they get worse quickly. - chronic lymphocytic leukemia  - chronic myeloid leukemia  - acute myeloid leukemia  - acute lymphocytic leukemia chronic lymphocytic leukemia chronic myeloid leukemia acute myeloid leukemia acute lymphocytic leukemia Chronic and Acute Leukemia Chronic lymphocytic leukemia, chronic myeloid leukemia, and acute myeloid leukemia are diagnosed more often in older adults. Of these, chronic lymphocytic leukemia is the most common. Acute lymphocytic leukemia is found more often in children. The symptoms for each type of leukemia differ but may include fevers, frequent infections, fatigue, swollen lymph nodes, weight loss, and bleeding and bruising easily. However, such symptoms are not sure signs of leukemia. An infection or another problem also could cause these symptoms. Only a doctor can diagnose and treat the problem. (Watch the video to learn how the rates of leukemia diagnosis vary by age. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)  Learn more about chronic lymphocytic leukemia.  Learn more about acute myeloid leukemia.  Other Cancers That Affect Blood Cells Myeloma and lymphoma are other types of cancer that affect blood cells, but these cancer cells are rarely found in the blood stream. Myeloma is the second most common form of blood cancer, and it affects plasma cells, a type of white blood cell that is found in the bone marrow. Lymphoma accounts for about five percent of all the types of cancer in the United States. It starts in the lymphatic system, which is part of the body's immune system. Both myeloma and lymphoma are more common among older adults and occur more often in men than women.  Learn more about myeloma.  Many Treatments Are Available There are many methods available to treat acute and chronic leukemia, and there are many new treatments being developed that are rapidly changing how numerous types of leukemia are treated. The types of treatments depend on the specific disease and how best to treat it. Some people receive a combination of treatments. Acute leukemia usually needs to be treated right away. But there are many different kinds of acute leukemia. Some respond well to treatment and can be cured in some cases, while others are more difficult to treat. Treatment for chronic leukemia can often control the disease and its symptoms and there are new treatments being developed that may prolong survival. Also, there are several treatments now available for chronic myeloid leukemia that can control the disease for a long time."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Leukemia? ?"}, {"role": "assistant", "content": "In many cases, no one knows why some people develop leukemia and others do not. However, scientists have identified some risk factors for the disease. A risk factor is anything that increases a person's chances of developing a disease. Most people who have known risk factors do not get leukemia, while many who do get the disease have none of these risk factors. Risk Factors Studies have identified the following risk factors for leukemia. - older age  -  male  - white  - working with certain chemicals  -  smoking  - exposure to very high levels of radiation  - certain health conditions  -  past treatment with chemotherapy or radiation therapy.  older age male white working with certain chemicals smoking exposure to very high levels of radiation certain health conditions past treatment with chemotherapy or radiation therapy. More than 65 percent of people diagnosed with leukemia are over 55. Disorders and Genetic Diseases Certain disorders and genetic diseases, such as Down syndrome, may increase the risk of leukemia. About 3 out of 10 people with a blood disorder known as myelodysplastic syndrome develop acute myeloid leukemia. In this disorder, as in leukemia, abnormal cells are formed in the bone marrow and too few healthy blood cells enter the bloodstream. Radiation Exposure People exposed to very high levels of radiation, such as the atomic bomb blast in Hiroshima, Japan or nuclear power plant accidents, also are at risk of developing leukemia. Studies of atomic blasts have estimated that survivors have a five and a half times greater risk of developing leukemia than the general public. Cancer Treatments Chemotherapy and radiation therapy have been helpful to a lot of people in the treatment of many forms of cancer, and indeed are often lifesaving. However, these therapies have been linked to the development of second cancers, including leukemia, many years after treatment, particularly in people who received intensive therapy early in their lives. Chemotherapy for a first cancer is a stronger risk factor for developing leukemia later than is radiation therapy. The combination of chemotherapy and radiation can significantly increase the risk of leukemia after a first cancer. Powerful cancer-fighting chemotherapy drugs, known as alkylating agents and epipodophyllotoxins, have been associated with leukemia. The dose given and length of treatment as well as other factors may contribute to a person's risk of developing leukemia. Acute myeloid leukemia is the most common type of cancer that has been linked to chemotherapy treatment. Radiation therapy may increase a person's chance of developing leukemia. Several factors influence this risk, such as the dose of radiation administered. A person's age at the time of therapy does not seem to be a risk factor for leukemia. Recently, researchers have gained a much greater understanding of the risk of second cancers due to earlier treatment exposures. They have been able to limit the effective doses given in primary cases so as to reduce the risk of a recurrence or second cancer."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Leukemia ?"}, {"role": "assistant", "content": "During the early stages of leukemia, there may be no symptoms. Many of the symptoms of leukemia don't become apparent until a large number of normal blood cells are crowded out by leukemia cells. Symptoms of Chronic and Acute Leukemia In chronic leukemia, symptoms develop gradually and, in the beginning, are generally not as severe as in acute leukemia. Chronic leukemia is usually found during a routine doctor's exam before symptoms are present. When symptoms appear, they generally are mild at first and gradually get worse, but sometimes they don't worsen until many years after an initial diagnosis. Recently, researchers discovered that abnormal white blood cells can be present in the blood of chronic lymphocytic leukemia patients a number of years before a diagnosis. This finding may lead to a better understanding of the cellular changes that occur in the earliest stages of the disease and how the disease progresses. In acute leukemia, symptoms usually appear and get worse quickly. People with this disease usually go to their doctor because they feel sick. White Blood Cell Levels May Be High People with leukemia may have very high levels of white blood cells, but because the cells are abnormal, they are unable to fight infection. Therefore, patients may develop frequent fevers or infections. A shortage of red blood cells, called anemia, can cause a person to feel tired. Not having enough blood platelets may cause a person to bleed and bruise easily. Some symptoms depend on where leukemia cells collect in the body. Leukemia cells can collect in many different tissues and organs, such as the digestive tract, kidneys, lungs, lymph nodes, or other parts of the body, including the eyes, brain, and testicles. Other Common Symptoms Other common symptoms of leukemia include headache, weight loss, pain in the bones or joints, swelling or discomfort in the abdomen (from an enlarged spleen), and swollen lymph nodes, especially in the neck or armpit. Symptoms of acute leukemia may include vomiting, confusion, loss of muscle control, and seizures. Some of the symptoms of leukemia are similar to those caused by the flu or other common diseases, so these symptoms are not sure signs of leukemia. It is important to check with your doctor if you have these symptoms. Only a doctor can diagnose and treat leukemia. Diagnosing Leukemia: Physical Exam, Blood Tests, Biopsy To find the cause of leukemia symptoms, the doctor will ask about medical history and conduct a physical exam. During the exam, the doctor will check for signs of disease such as lumps, swelling in the lymph nodes, spleen, and liver, or anything else that seems unusual. The doctor will need to do blood tests that check the levels and types of blood cells and look for changes in the shape of blood cells. The doctor also may look at certain factors in the blood to see if leukemia has affected other organs such as the liver or kidneys. Even if blood tests suggest leukemia, the doctor may look for signs of leukemia in the bone marrow by doing a biopsy before making a diagnosis. A biopsy is a procedure where a small amount of bone marrow is removed from a bone. A pathologist examines the sample under a microscope to look for abnormal cells. There are two ways the doctor can obtain bone marrow. In a bone marrow aspiration, marrow is collected by inserting a needle into the hipbone or another large bone and removing a small amount of bone marrow. A bone marrow biopsy is performed with a larger needle and removes bone marrow and a small piece of bone. If Leukemia Cells Are Found If leukemia cells are found in the bone marrow sample, the doctor may perform more tests to determine if the disease has spread to other parts of the body. The doctor may collect a sample of the fluid around the brain and spinal cord by performing a spinal tap and checking for leukemia cells or other signs of problems. Computed tomography (CT) scans, and ultrasounds are tests used to determine if leukemia has spread from the bone marrow. These tests produce pictures of the inside of the body. With these tests, the doctor looks for abnormalities such as enlarged organs or signs of infection."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Leukemia ?"}, {"role": "assistant", "content": "There are many treatment options for people with leukemia. The choice of treatment depends on your age and general health, the type of leukemia you have, whether or not it has spread outside the bone marrow, and other factors. If tests show that you have leukemia, you should talk with your doctor and make treatment decisions as soon as possible, although many patients with chronic lymphocytic leukemia do not require treatment for many years. Working With a Team of Specialists A team of specialists often treats people with leukemia. The team will keep the primary doctor informed about the patient's progress. The team may include a hematologist who is a specialist in blood and blood-forming tissues, a medical oncologist who is a specialist in cancer treatment, and a radiation oncologist who is a specialist in radiation therapy. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you or your doctor requests it. Clinical Trials for Leukemia Some leukemia patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is safe and effective and better than current treatments. Talk to your doctor if you are interested in taking part in a clinical trial. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Click here to search for current clinical trials on leukemia."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Leukemia ?"}, {"role": "assistant", "content": "Unlike other types of cancer, leukemia isn't a tumor that your doctor can surgically remove. Leukemia cells are produced in the bone marrow and travel throughout the body. The Goal of Treatment The goal of treatment for leukemia is to destroy the leukemia cells and allow normal cells to form in the bone marrow. Depending on the type and extent of the disease, patients may have chemotherapy, biological therapy, radiation therapy, or stem cell transplantation. Some patients receive a combination of treatments. Treatment depends on a number of factors, including the type of leukemia, the patient's age and general health, whether leukemia cells are present in the fluid around the brain or spinal cord, and whether the leukemia has been treated before. It also may depend on certain features of the leukemia cells and the patient's symptoms. Acute Leukemia or Chronic Leukemia? If a person has acute leukemia, they will need treatment right away. The purpose of treatment is to stop the rapid growth of leukemia cells and to bring about remission, meaning the cancer is under control. In many cases, a person will continue treatment after signs and symptoms disappear to prevent the disease from coming back. Some people with acute leukemia can be cured.  Learn more about treatments for acute myeloid leukemia.   Learn more about treatments for chronic lymphocytic leukemia. Chronic leukemia may not need to be treated until symptoms appear. Treatment can often control the disease and its symptoms. Types of Treatments Some, but not all, forms of treatment for leukemia include - chemotherapy  - biological therapy  -  radiation therapy.  chemotherapy biological therapy radiation therapy. Chemotherapy Chemotherapy uses drugs to kill cancer cells. This a common treatment for some types of leukemia. Chemotherapy may be taken by mouth in pill form, by injection directly into a vein, or through a catheter. If leukemia cells are found in the fluid around the brain or spinal cord, the doctor may inject drugs directly into the fluid to ensure that the drugs reach the leukemia cells in the brain. Biological Therapy Biological therapy uses special substances that improve the body's natural defenses against cancer. Some patients with chronic lymphocytic leukemia receive monoclonal antibodies, which are man-made proteins that can identify leukemia cells. Monoclonal antibodies bind to the cells and assist the body in killing them. Although monoclonal antibodies are being used to treat leukemia, researchers are studying more innovative ways to use them in treatment. Some antibodies are used alone to try to prompt the immune system to attack leukemia cells. Other antibodies are attached to substances that can deliver poison to cancer cells. These modified antibodies, called immunotoxins, deliver the toxins directly to the cancer cells. Lately, precision medicine trials have shown evidence that single targeted therapies taken in pill form can prolong survival. Radiation Therapy Radiation therapy uses high-energy X-rays to destroy cancer cells. A machine outside the body directs high-energy beams at the spleen, the brain, or other parts of the body where leukemia cells have collected. Radiation therapy is used primarily to control disease in bones that are at risk of fracture or at sites that are causing pain."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Leukemia ?"}, {"role": "assistant", "content": "Researchers are conducting clinical trials in many parts of the country. Clinical trials test an intervention such as a drug, therapy, medical device, or behavior in many people to see if it is safe and effective. Clinical trials already have led to advances, and researchers continue to search for more effective ways to treat and diagnose leukemia. They are studying various drugs, immunotherapy, targeted therapies, and other types of treatments. They are also studying the effectiveness of using combinations of treatments. Most importantly, researchers are gaining a greater understanding of the genes that are mutated in many types of leukemia and are developing targeted treatments to directly attack the mutations. One prime example is in acute myeloid leukemia (AML) where researchers have identified several genes that predict better or worse outcomes and are working to develop drugs targeted at these genes. Drug Research The drug imatinib (Gleevec) is important in the treatment of chronic myeloid leukemia. Imatinib targets an abnormal protein that is present in most leukemia cells. By blocking the abnormal protein, imatinib kills the leukemia cells, but it does not kill normal cells. However, imatinib stops working in some people with leukemia because the cells become resistant. Fortunately, two drugs, dasatinib (Sprycel) and nilotinib (Tasigna), are now used to treat people who stop responding to imatinib. These drugs work against the same abnormal protein targeted by imatinib, but in different ways. Immunotherapy Immunotherapy is a treatment that uses immune cells or antibodies to fight leukemia or stop it from getting worse. The idea is to zero in on leukemia cells so the treatment is less toxic to normal cells. Recently developed immunotherapies are showing real promise in a number of forms of leukemia. Vaccine Research Leukemia vaccines are not vaccines in the way that most people think of them. Unlike most vaccines, which help prevent diseases, leukemia vaccines are used to treat someone who already has cancer. A vaccine introduces a molecule called an antigen into the body. The immune system recognizes the antigen as a foreign invader and attacks it. Gene Therapy Gene therapy -- replacing, manipulating, or supplementing nonfunctional genes with healthy genes -- is being explored for treatment of leukemia. It is being studied as a way to stimulate a patient's immune system to kill leukemia cells and also to interfere with the production of proteins that cause cells to become cancerous. Learn more about ongoing leukemia research."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Cancer begins in cells, which make up the blood and other tissues. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process of creating a new cell goes wrong -- cells become abnormal and form more cells in an uncontrolled way."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Leukemia is a cancer of the blood cells. It usually begins in the bone marrow where blood cells are formed. In leukemia, the bone marrow produces abnormal white blood cells. Over time, as the number of abnormal white blood cells builds up in the blood, they crowd out healthy blood cells. This makes it difficult for the blood to carry out its normal functions."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Acute leukemia gets worse quickly. In chronic leukemia, symptoms develop gradually and are generally not as severe as in acute leukemia."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "There are four common types of leukemia. They are chronic lymphocytic leukemia, chronic myeloid leukemia, acute myeloid leukemia, and acute lymphocytic leukemia. Chronic lymphocytic leukemia, chronic myeloid leukemia, and acute myeloid leukemia are diagnosed more often in older adults. Acute lymphocytic leukemia is found more often in children. (Watch the video to learn how the rates of leukemia diagnosis vary by age. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Learn more about chronic lymphocytic leukemia.  Learn more about acute myeloid leukemia."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Myeloma and lymphoma are other types of blood cancers. Both are common among older adults and occur more often in men than women. Myeloma affects plasma cells, a type of white blood cells typically found in the bone marrow. Lymphoma starts in the lymphatic system, which is part of the body's immune system.  Learn more about myeloma."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Leukemia? ?"}, {"role": "assistant", "content": "For the most part, no one knows why some people develop leukemia and others do not. Most people who have known risk factors do not get leukemia, while many who get the disease do not have any risk factors. Studies have identified the following risk factors for leukemia. - older age  -  male  - white  - working with certain chemicals  -  smoking  - exposure to very high levels of radiation  - certain health conditions  -  past treatment with chemotherapy or radiation therapy.  older age male white working with certain chemicals smoking exposure to very high levels of radiation certain health conditions past treatment with chemotherapy or radiation therapy."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Leukemia ?"}, {"role": "assistant", "content": "Common symptoms of leukemia may include -  fevers  - frequent infections  - feeling weak or tired  -  headache  - bleeding and bruising easily  - pain in the bones or joints  -  swelling or discomfort in the abdomen (from an enlarged spleen)  -  swollen lymph nodes, especially in the neck or armpit  - weight loss.  fevers frequent infections feeling weak or tired headache bleeding and bruising easily pain in the bones or joints swelling or discomfort in the abdomen (from an enlarged spleen) swollen lymph nodes, especially in the neck or armpit weight loss. Symptoms of acute leukemia may include vomiting, confusion, loss of muscle control, and seizures."}]}
{"messages": [{"role": "user", "content": "How to diagnose Leukemia ?"}, {"role": "assistant", "content": "There are no standard or over-the-counter tests for leukemia. Your doctor can request lab analyses for leukemia that include blood tests that check the levels and types of blood cells and look for changes in the shape of blood cells. The doctor may also look for signs of leukemia in the bone marrow or the fluid around the brain or the spinal cord"}]}
{"messages": [{"role": "user", "content": "What are the treatments for Leukemia ?"}, {"role": "assistant", "content": "Treatment depends on a number of factors, including the type of leukemia, the patient's age and general health, where leukemia cells have collected in the body, and whether the leukemia has been treated before. Certain features of the leukemia cells and the patient's symptoms also may determine treatment options."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Leukemia ?"}, {"role": "assistant", "content": "Standard treatments for leukemia include chemotherapy, biological therapy, radiation therapy, and immunotherapy. Some patients receive a combination of treatments.  Learn more about treatments for acute myeloid leukemia.  Learn more about treatments for chronic lymphocytic leukemia."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Chemotherapy is a cancer treatment that uses drugs to kill cancer cells. This is the most common treatment for most types of leukemia. Chemotherapy may be taken by mouth in pill form, by injection directly into a vein, or through a catheter. If leukemia cells are found in the fluid around the brain or spinal cord, the doctor may inject drugs directly into the fluid to ensure that the drugs reach the leukemia cells in the brain."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Biological therapy is a treatment that uses a person's own immune system to fight leukemia. This therapy uses special substances to stimulate the immune system's ability to fight cancer. Some patients with chronic lymphocytic leukemia receive monoclonal antibodies, which are man-made proteins that can identify leukemia cells and help the body kill them."}]}
{"messages": [{"role": "user", "content": "What is (are) Leukemia ?"}, {"role": "assistant", "content": "Radiation therapy is a cancer treatment that uses high-energy x-rays to destroy cancer cells. Some patients receive radiation treatment that is directed at the whole body."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Leukemia ?"}, {"role": "assistant", "content": "Clinical trials are research studies in which new treatments -- drugs, diagnostics, procedures, vaccines, and other therapies -- are tested in people to see if they are safe, effective, and better than the current standard of care. Clinical trials often compare a new treatment with a standard treatment to determine which one gives better results. People with leukemia who are interested in taking part in a clinical trial should contact their doctor or go to  www.clinical trials.gov and search \"leukemia.\""}]}
{"messages": [{"role": "user", "content": "What are the treatments for Leukemia ?"}, {"role": "assistant", "content": "Researchers are studying various drugs, immunotherapies, and other types of treatments. Because leukemia is a complicated disease, researchers are also studying the effectiveness of using combinations of treatments. Following are a few examples of some areas of current research. The drug imatinib (Gleevec) is important in the treatment of chronic myeloid leukemia. However, imatinib stops working in some people with leukemia because the cells become resistant. Fortunately, two drugs, dasatinib (Sprycel) and nilotinib (Tasigna), are being used to treat people who stop responding to imatinib. Both are approved by the FDA for use in patients. These drugs work against the same abnormal protein targeted by imatinib, but in different ways. Gene therapy -- replacing, manipulating, or supplementing nonfunctional genes with healthy genes -- is being explored for treatment of leukemia. It is being studied as a way to stimulate a patient's immune system to kill leukemia cells and also to interfere with the production of proteins that cause cells to become cancerous.  Learn more about ongoing leukemia research."}]}
{"messages": [{"role": "user", "content": "What is (are) Lung Cancer ?"}, {"role": "assistant", "content": "How Tumors Form The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong and cells become abnormal, forming more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous. Lung cancer occurs when a tumor forms in the tissue of the lung. The Leading Cause of Cancer Death  Lung cancer is the leading cause of cancer death in men and women in the United States. Experts estimate that over 200,000 new cases of lung cancer will be diagnosed each year slightly more cases in men than women. Over 150,000 Americans die of the disease each year. Lung cancer occurs most often between the ages of 55 and 65. (Watch the videos on this page to learn more about lung cancer. To enlarge the videos, click the brackets in the lower right-hand corner of the video screen. To reduce the videos, press the Escape (Esc) button on your keyboard.) Two Major Types of Lung Cancer There are two major types of lung cancer -- non-small cell lung cancer and small cell lung cancer. Each type of lung cancer grows and spreads in different ways, and each is treated differently. - Non-small cell lung cancer is more common than small cell lung cancer.  - Small cell lung cancer grows more quickly and is more likely to spread to other organs in the body.  Non-small cell lung cancer is more common than small cell lung cancer. Small cell lung cancer grows more quickly and is more likely to spread to other organs in the body.  Learn more about non-small cell lung cancer.   Learn more about small cell lung cancer.  Lung Cancer Can Spread Lung cancer may spread to the lymph nodes or other tissues in the chest, including the lung opposite to where it originated. It may also spread to other organs of the body, such as the bones, brain, or liver. When cancer spreads from its original location in the lung to another part of the body such as the brain, it is called metastatic lung cancer, not brain cancer. Doctors sometimes call this distant disease. Smoking and Lung Cancer  Lung cancer would occur much less often if people did not smoke. The good news is that smoking is not as popular as it used to be. In 1965 about 42 percent of all adults smoked, but as of 2012, slightly less than 17 percent of people 18 and older smoked cigarettes. Also, since the 1990s there has been a steady drop in lung cancer deaths among men, mainly because fewer men are smoking, and since the turn of the century, lung cancer deaths in women have been slowly declining. Cigarette smoking rates had been dropping steadily in the 1990s and had started to level off at the start of the 21st century but the latest figures show a continued decline. The bad news is that other forms of tobacco use have shown some revival, but mainly in younger populations. The bad news is that smoking rates, which were dropping, have stopped declining in recent years. Smoking by young adults actually increased by 73 percent in the 1990s but has shown a downturn or leveling off in the past few years."}]}
{"messages": [{"role": "user", "content": "What causes Lung Cancer ?"}, {"role": "assistant", "content": "Tobacco Products and Cancer Using tobacco products has been shown to cause cancer. In fact, smoking tobacco, using smokeless tobacco, and being exposed regularly to secondhand tobacco smoke are responsible for a large number of cancer deaths in the U.S. each year. Cigarette Smoking Causes Lung Cancer Cigarette smoking is the number one cause of lung cancer. Scientists have reported widely on the link between cancer and smoking since the 1960s. Since then, study after study has provided more proof that cigarette smoking is the primary cause of lung cancer. Before cigarette smoking became popular after World War I, doctors rarely, if ever, saw patients with lung cancer. But today, lung cancer is the leading cause of death by cancer. Over 85 percent of people with lung cancer developed it because they smoked cigarettes. If You Smoke If you smoke cigarettes, you are at much higher risk for lung cancer than a person who has never smoked. The risk of dying from lung cancer is 23 times higher for men who smoke and 13 times higher for women who smoke than for people who have never smoked. Lung cancer can affect young and old alike.  Stopping smoking greatly reduces your risk for developing lung cancer. After you stop, your risk levels off. Ten years after the last cigarette, the risk of dying from lung cancer drops by 50 percent -- which does not mean, however, that risk is eliminated. (Watch the videos on this page to learn more about lung cancer, smoking and older adults. To enlarge the videos, click the brackets in the lower right-hand corner of the video screen. To reduce the videos, press the Escape (Esc) button on your keyboard.) Smoking cigars and pipes also puts you at risk for lung cancer. Cigar and pipe smokers have a higher risk of lung cancer than nonsmokers. Even cigar and pipe smokers who do not inhale are at increased risk for lung, mouth, and other types of cancer. The likelihood that a smoker will develop lung cancer is related to the age smoking began; how long the person smoked; the number of cigarettes, pipes, or cigars smoked per day; and how deeply the smoker inhaled.  Learn about lung cancer prevention. Other Factors That Increase Your Risk - Many studies suggest that non-smokers who are exposed to environmental tobacco smoke, also called secondhand smoke, are at increased risk of lung cancer. Secondhand smoke is the smoke that non-smokers are exposed to when they share air space with someone who is smoking. Tobacco smoke contains more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer. Since 1964, approximately 2,500,000 nonsmokers have died from health problems caused by exposure to secondhand smoke.   - Exposure to radon can put a person at risk for lung cancer, too. People who work in mines may be exposed to this invisible, odorless, and radioactive gas that occurs naturally in soil and rocks. It is also found in houses in some parts of the country. A kit available at most hardware stores allows homeowners to measure radon levels in their homes.   - Another substance that can contribute to lung cancer is asbestos. Asbestos has been used in shipbuilding, asbestos mining and manufacturing, insulation work, and brake repair, although products with asbestos have been largely phased out over the past several decades. If inhaled, asbestos particles can lodge in the lungs, damaging cells and increasing the risk for lung cancer.  Many studies suggest that non-smokers who are exposed to environmental tobacco smoke, also called secondhand smoke, are at increased risk of lung cancer. Secondhand smoke is the smoke that non-smokers are exposed to when they share air space with someone who is smoking. Tobacco smoke contains more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer. Since 1964, approximately 2,500,000 nonsmokers have died from health problems caused by exposure to secondhand smoke. Exposure to radon can put a person at risk for lung cancer, too. People who work in mines may be exposed to this invisible, odorless, and radioactive gas that occurs naturally in soil and rocks. It is also found in houses in some parts of the country. A kit available at most hardware stores allows homeowners to measure radon levels in their homes. Another substance that can contribute to lung cancer is asbestos. Asbestos has been used in shipbuilding, asbestos mining and manufacturing, insulation work, and brake repair, although products with asbestos have been largely phased out over the past several decades. If inhaled, asbestos particles can lodge in the lungs, damaging cells and increasing the risk for lung cancer. It's Never Too Late To Quit  Researchers continue to study the causes of lung cancer and to search for ways to prevent it. We already know that the best way to prevent lung cancer is to quit or never start smoking. The sooner a person quits smoking the better. Even if you have been smoking for many years, it's never too late to benefit from quitting. Get Free Help To Quit Smoking - Each U.S. state and territory has a free quit line to provide you with information and resources to help you quit smoking. To reach the quit line in your area, dial toll-free, 1-800-QUIT-NOW (1-800-784-8669). Each U.S. state and territory has a free quit line to provide you with information and resources to help you quit smoking. To reach the quit line in your area, dial toll-free, 1-800-QUIT-NOW (1-800-784-8669). - Talk with a smoking cessation counselor from the National Cancer Institute (NCI) for help quitting and for answers to smoking-related questions in English or Spanish. Call toll free within the United States, Monday through Friday 8:00 a.m. to 8:00 p.m. Eastern Time.1-877-44U-QUIT (1-877-448-7848) Talk with a smoking cessation counselor from the National Cancer Institute (NCI) for help quitting and for answers to smoking-related questions in English or Spanish. Call toll free within the United States, Monday through Friday 8:00 a.m. to 8:00 p.m. Eastern Time.1-877-44U-QUIT (1-877-448-7848) - Get free information and advice about quitting smoking through a confidential online text chat with an information specialist from the National Cancer Institute's Cancer Information Service. Visit LiveHelp, available Monday through Friday, 8:00 a.m. to 11:00 p.m. Eastern Time. Get free information and advice about quitting smoking through a confidential online text chat with an information specialist from the National Cancer Institute's Cancer Information Service. Visit LiveHelp, available Monday through Friday, 8:00 a.m. to 11:00 p.m. Eastern Time. You can also get help to quit smoking at these websites. - Smokefree.gov.  - Smokefree Women  Smokefree.gov. Smokefree Women For adults 50 and older, check out Quitting Smoking for Older Adults."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Lung Cancer ?"}, {"role": "assistant", "content": "Common Signs and Symptoms When lung cancer first develops, there may be no symptoms at all. But if the cancer grows, it can cause changes that people should watch for. Common signs and symptoms of lung cancer include: - a cough that doesn't go away and gets worse over time  - constant chest pain  - coughing up blood  - shortness of breath, wheezing, or hoarseness  - repeated problems with pneumonia or bronchitis  - swelling of the neck and face  - loss of appetite or weight loss  - fatigue. a cough that doesn't go away and gets worse over time constant chest pain coughing up blood shortness of breath, wheezing, or hoarseness repeated problems with pneumonia or bronchitis swelling of the neck and face loss of appetite or weight loss fatigue. These symptoms may be caused by lung cancer or by other conditions. It is important to check with a doctor if you have symptoms because only a doctor can make a diagnosis. Don't wait to feel pain. Early cancer usually doesn't cause pain. Tests for Lung Cancer To better understand a persons chance of developing lung cancer, a doctor first evaluates a person's medical history, smoking history, their exposure to environmental and occupational substances, and family history of cancer. The doctor also performs a physical exam and may order a test to take an image of the chest or other tests. Seeing a spot on an image is usually how a doctor first suspects that lung cancer may be present. If lung cancer is suspected, the doctor may order a test called sputum cytology. This is a simple test where, under a microscope, a doctor examines a sample of mucous cells coughed up from the lungs under a microscope to see if cancer is present. Biopsies to Detect Lung Cancer But to confirm the presence of lung cancer, the doctor must examine fluid or tissue from the lung. This is done through a biopsy -- the removal of a small sample of fluid or tissue for examination under a microscope by a pathologist. A biopsy can show whether a person has cancer. A number of procedures may be used to obtain this tissue. - Bronchoscopy -- The doctor puts a bronchoscope -- a thin, lighted tube -- into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.  - Needle Aspiration -- The doctor numbs the chest area and inserts a thin needle into the tumor to remove a sample of tissue.  - Thoracentesis - Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells.  - Thorascopy or Thoracotomy -- Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital. Bronchoscopy -- The doctor puts a bronchoscope -- a thin, lighted tube -- into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue. Needle Aspiration -- The doctor numbs the chest area and inserts a thin needle into the tumor to remove a sample of tissue. Thoracentesis - Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells. Thorascopy or Thoracotomy -- Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital. Other Tests Doctors use imaging methods such as a spiral CT scan (also commonly known as helical CT) to look for signs of cancer. A CT scan, also known as computerized tomography scan, is a series of detailed pictures of areas inside the body. Other tests can include removal of lymph nodes for examination under a microscope to check for cancer cells. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Lung Cancer ?"}, {"role": "assistant", "content": "There are many treatment options for lung cancer, mainly based on the extent of the disease. The choice of treatment depends on your age and general health, the stage of the cancer, whether or not it has spread beyond the lung, and other factors. If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes. Working With a Team of Specialists A team of specialists often treats people with cancer. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, a thoracic surgeon who is a specialist in operating on organs in the chest, including the lungs, and others. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. Clinical Trials for Lung Cancer Some lung cancer patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is safe and effective. Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. People with lung cancer who are interested in taking part in a clinical trial should talk with their doctor. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Click here to see a list of the current clinical trials on lung cancer. A separate window will open. Click the \"x\" in the upper right hand corner of the \"Clinical Trials\" window to return here."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Lung Cancer ?"}, {"role": "assistant", "content": "The choice of treatment depends on the type of lung cancer, whether it is non-small or small cell lung cancer, the size, location, the stage of the cancer, and the patient's general health. Doctors may suggest many different treatments or combinations of treatments to control the cancer and/or improve the patient's quality of life. What Standard Treatments Do Here are some of the most common treatments for lung cancer. - Surgery is an operation to remove the cancer. Depending on the location of the tumor, the surgeon may remove a small part of the lung, a lobe of the lung, or the entire lung and possibly even part of the ribcage to get to the lung.  - Chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body. Doctors use chemotherapy to control cancer growth and relieve symptoms. Anti-cancer drugs are given by injection; through a catheter, a long thin tube temporarily placed in a large vein; or in pill form.  - Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells.  - Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. An external machine delivers radiation to a limited area, affecting cancer cells only in that area. Doctors may use radiation before surgery to shrink a tumor or after surgery to destroy any cancer cells remaining in the treated area. Surgery is an operation to remove the cancer. Depending on the location of the tumor, the surgeon may remove a small part of the lung, a lobe of the lung, or the entire lung and possibly even part of the ribcage to get to the lung. Chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body. Doctors use chemotherapy to control cancer growth and relieve symptoms. Anti-cancer drugs are given by injection; through a catheter, a long thin tube temporarily placed in a large vein; or in pill form. Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells. Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. An external machine delivers radiation to a limited area, affecting cancer cells only in that area. Doctors may use radiation before surgery to shrink a tumor or after surgery to destroy any cancer cells remaining in the treated area. Treating Non-Small Cell Lung Cancer Doctors treat patients with non-small cell lung cancer in several ways, and surgery is a common treatment. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Doctors may also use radiation therapy and chemotherapy to slow the progress of the disease and to manage symptoms.  See more information about treatments for non-small cell lung cancer. Treating Small Cell Lung Cancer Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment for small cell lung cancer may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body, such as in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer. Some patients with small cell lung cancer have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial irradiation or PCI, is given to prevent tumors from forming in the brain. See more information about treatments for small cell lung cancer."}]}
{"messages": [{"role": "user", "content": "what research (or clinical trials) is being done for Lung Cancer ?"}, {"role": "assistant", "content": "Researchers continue to look at new ways to combine, schedule, and sequence the use of chemotherapy, surgery, and radiation to treat lung cancer. Today, some of the most promising treatment approaches incorporate precision medicine. This approach first looks to see what genes may be mutated that are causing the cancer, and once these genes are identified, specific drugs may be available that target the mutations and treat the cancer directly without the harsh side-effects often found with conventional chemotherapy. Researchers are also constantly trying to come up with new ways to find and diagnose lung cancer in order to catch it and treat it in its earliest stages. The National Lung Screening Trial, or NLST, showed conclusively that spiral CT reduced the risk of dying by 20 percent compared to those who received a chest x-ray among heavy smokers Get more information on current lung cancer research."}]}
{"messages": [{"role": "user", "content": "What is (are) Lung Cancer ?"}, {"role": "assistant", "content": "The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong -- cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, meaning not cancerous, or malignant, meaning cancerous."}]}
{"messages": [{"role": "user", "content": "What is (are) Lung Cancer ?"}, {"role": "assistant", "content": "Lung cancer occurs when malignant tumors form in the tissue of the lung. The lungs are a pair of sponge-like organs. The right lung has three sections, called lobes, and is larger than the left lung, which has two lobes."}]}
{"messages": [{"role": "user", "content": "What is (are) Lung Cancer ?"}, {"role": "assistant", "content": "There are two major types of lung cancer -- non-small cell lung cancer and small cell lung cancer. Each type of lung cancer grows and spreads in different ways, and each is treated differently. Non-small cell lung cancer is more common than small cell lung cancer. It generally grows and spreads slowly.  Learn more about non-small cell carcinoma.  Small cell lung cancer,  sometimes called oat cell cancer, grows more quickly and is more likely to spread to other organs in the body.  Learn more about small cell carcinoma."}]}
{"messages": [{"role": "user", "content": "What causes Lung Cancer ?"}, {"role": "assistant", "content": "Cigarette smoking is the number one cause of lung cancer. Scientists have reported widely on the link between cancer and smoking since the 1960s. Since then, study after study has provided more proof that cigarette smoking is the primary cause of lung cancer. Before cigarette smoking became popular after World War I, doctors rarely, if ever, saw patients with lung cancer. But today, lung cancer is the leading cause of death by cancer. Over 85 percent of people with lung cancer developed it because they smoked cigarettes. Using tobacco products has been shown to cause many types of cancer. In fact, smoking tobacco, using smokeless tobacco, and being exposed regularly to second-hand tobacco smoke are responsible for a large number of cancer deaths in the U.S. each year."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Lung Cancer? ?"}, {"role": "assistant", "content": "Risk factors that increase your chance of getting lung cancer include - cigarette, cigar, and pipe smoking, which account for well over half of all cases of lung cancer  - secondhand smoke  - family history  - HIV infection  - environmental risk factors  - beta carotene supplements in heavy smokers. cigarette, cigar, and pipe smoking, which account for well over half of all cases of lung cancer secondhand smoke family history HIV infection environmental risk factors beta carotene supplements in heavy smokers."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Lung Cancer? ?"}, {"role": "assistant", "content": "If you smoke cigarettes, you are at much higher risk for lung cancer than a person who has never smoked. The risk of dying from lung cancer is 23 times higher for men who smoke and 13 times higher for women who smoke than for people who have never smoked. Stopping smoking greatly reduces your risk for developing lung cancer. But after you stop, the risk goes down slowly. Ten years after the last cigarette, the risk of dying from lung cancer drops by 50 percent. Each U.S. state and territory has a free quitline to provide you with information and resources to help you quit smoking. To reach the quitline in your area, dial toll-free, 1-800-QUIT-NOW. (Watch the video to learn about the effect smoking can have on an older adult's health. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What causes Lung Cancer ?"}, {"role": "assistant", "content": "Some studies suggest that non-smokers who are exposed to environmental tobacco smoke, also called secondhand smoke, are at increased risk of lung cancer. Secondhand smoke is the smoke that non-smokers are exposed to when they share air space with someone who is smoking. Tobacco smoke contains more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer. Since 1964, approximately 2,500,000 nonsmokers have died from health problems caused by exposure to secondhand smoke.  Learn more about the effects of secondhand smoke.  Learn more about the chemicals found in cigarettes."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Lung Cancer? ?"}, {"role": "assistant", "content": "Quitting smoking not only cuts the risk of lung cancer, it cuts the risks of many other cancers as well as heart disease, stroke, other lung diseases, and other respiratory illnesses. Each U.S. state and territory has a free quitline to provide you with information and resources to help you quit smoking. To reach the quitline in your area, dial toll-free, 1-800-QUIT-NOW. (Watch the video to learn about the benefits of quitting smoking when you're older. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)  Learn more about the effects of smoking on your health."}]}
{"messages": [{"role": "user", "content": "Who is at risk for Lung Cancer? ?"}, {"role": "assistant", "content": "Another substance that can contribute to lung cancer is asbestos. Asbestos is used in shipbuilding, asbestos mining and manufacturing, insulation work, and brake repair, but many products that contain asbestos have been phased out over the past several decades. If inhaled, asbestos particles can lodge in the lungs, damaging cells and increasing the risk for lung cancer."}]}
{"messages": [{"role": "user", "content": "What are the symptoms of Lung Cancer ?"}, {"role": "assistant", "content": "The possible signs of lung cancer are: - a cough that doesn't go away and gets worse over time  - constant chest pain  - coughing up blood  - shortness of breath, wheezing, or hoarseness  - repeated problems with pneumonia or bronchitis  - swelling of the neck and face  - loss of appetite or weight loss  - fatigue. a cough that doesn't go away and gets worse over time constant chest pain coughing up blood shortness of breath, wheezing, or hoarseness repeated problems with pneumonia or bronchitis swelling of the neck and face loss of appetite or weight loss fatigue."}]}
{"messages": [{"role": "user", "content": "What is (are) Lung Cancer ?"}, {"role": "assistant", "content": "A person who has had lung cancer once is more likely to develop a second lung cancer compared to a person who has never had lung cancer. Second cancers arise in a different site than the original cancer. If the original cancer returns after treatment, it is considered recurrent, not a second cancer. Quitting smoking after lung cancer is diagnosed may prevent the development of a second lung cancer."}]}
{"messages": [{"role": "user", "content": "How to diagnose Lung Cancer ?"}, {"role": "assistant", "content": "Doctors can perform several tests to stage lung cancer. Staging means finding out how far the cancer has progressed. The following tests are used to stage lung cancer: - Computerized tomography or CAT scan is a computer linked to an x-ray machine that creates a series of detailed pictures of areas inside the body. Computerized tomography or CAT scan is a computer linked to an x-ray machine that creates a series of detailed pictures of areas inside the body. - Magnetic resonance imaging, or MRI, is a powerful magnet linked to a computer that makes detailed pictures of areas inside the body.  - Radionuclide scanning uses a mildly radioactive substance to show whether cancer has spread to other organs, such as the liver. Magnetic resonance imaging, or MRI, is a powerful magnet linked to a computer that makes detailed pictures of areas inside the body. Radionuclide scanning uses a mildly radioactive substance to show whether cancer has spread to other organs, such as the liver. - A bone scan uses a small amount of a radioactive substance to show whether cancer has spread to the bones.  - A mediastinoscopy or mediastinotomy can help show whether the cancer has spread to the lymph nodes in the chest by removing a tissue sample. The patient receives a general anesthetic for this procedure. A bone scan uses a small amount of a radioactive substance to show whether cancer has spread to the bones. A mediastinoscopy or mediastinotomy can help show whether the cancer has spread to the lymph nodes in the chest by removing a tissue sample. The patient receives a general anesthetic for this procedure."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Lung Cancer ?"}, {"role": "assistant", "content": "- Surgery is an operation to remove the cancer. Depending on the location of the tumor, the surgeon may remove a small part of the lung, a lobe of the lung, or the entire lung. Surgery is an operation to remove the cancer. Depending on the location of the tumor, the surgeon may remove a small part of the lung, a lobe of the lung, or the entire lung. - Conventional chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body. Doctors use chemotherapy to control cancer growth and relieve symptoms. Anti-cancer drugs are given by injection; through a catheter, a long thin tube temporarily placed in a large vein; or in pill form. Conventional chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body. Doctors use chemotherapy to control cancer growth and relieve symptoms. Anti-cancer drugs are given by injection; through a catheter, a long thin tube temporarily placed in a large vein; or in pill form. - Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. An external machine delivers radiation to a limited area, affecting cancer cells only in that area. Doctors may use radiation therapy before surgery to shrink a tumor or after surgery to destroy any cancer cells remaining in the treated area. Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. An external machine delivers radiation to a limited area, affecting cancer cells only in that area. Doctors may use radiation therapy before surgery to shrink a tumor or after surgery to destroy any cancer cells remaining in the treated area."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Lung Cancer ?"}, {"role": "assistant", "content": "Doctors treat patients with non-small cell lung cancer in several ways, and surgery is a common treatment. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Doctors may also use radiation therapy and chemotherapy to slow the progress of the disease and to manage symptoms. See more on treatments for non-small cell lung cancer."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Lung Cancer ?"}, {"role": "assistant", "content": "Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed, so chemotherapy is usually the best choice. See more on treatments for small cell lung cancer."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Lung Cancer ?"}, {"role": "assistant", "content": "Researchers continue to look at new ways to combine, schedule, and sequence the use of chemotherapy, surgery, and radiation to treat lung cancer. Targeted therapy, using drugs that go directly to a gene mutation and repair or block the mutation from causing cancer, are the current gold standard for treating some types of lung cancer. Get more information on current lung cancer research."}]}
{"messages": [{"role": "user", "content": "What are the treatments for Lung Cancer ?"}, {"role": "assistant", "content": "Researchers are working to develop drugs called \"molecularly targeted agents\" which kill cancer cells by targeting key molecules involved in cancer cell growth."}]}
{"messages": [{"role": "user", "content": "What is (are) Urinary Incontinence ?"}, {"role": "assistant", "content": "Urinary incontinence means a person leaks urine by accident. Urinary incontinence is a common bladder problem as people age. Women are more likely than men to leak urine. If this problem is happening to you, there is help. Urinary incontinence can often be controlled. Talk to your health care provider about what you can do. Types of Urinary Incontinence There are different types of urinary incontinence. - Stress urinary incontinence happens when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. Its the most common type of bladder control problem in younger and middle-age women. It may begin around the time of menopause. Stress urinary incontinence happens when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. Its the most common type of bladder control problem in younger and middle-age women. It may begin around the time of menopause. - Urgency urinary incontinence happens when people have a sudden need to urinate and arent able to hold their urine long enough to get to the toilet.  Urgency urinary incontinence happens when people have a sudden need to urinate and arent able to hold their urine long enough to get to the toilet. - Mixed urinary incontinence is a mix of stress and urgency urinary incontinence. You may leak urine with a laugh or sneeze at one time. At another time, you may leak urine because you have a sudden urge to urinate that you cannot control. Mixed urinary incontinence is a mix of stress and urgency urinary incontinence. You may leak urine with a laugh or sneeze at one time. At another time, you may leak urine because you have a sudden urge to urinate that you cannot control. - Overflow urinary incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of urinary incontinence. Overflow urinary incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of urinary incontinence. - Functional urinary incontinence occurs in many older people who have a problem getting to the toilet in time. They may not make it in time because of arthritis or other disorders that make it hard to move quickly. Functional urinary incontinence occurs in many older people who have a problem getting to the toilet in time. They may not make it in time because of arthritis or other disorders that make it hard to move quickly."}]}
{"messages": [{"role": "user", "content": "What causes Urinary Incontinence ?"}, {"role": "assistant", "content": "Why Does Urine Leak? The body stores urine in the bladder, which is a hollow organ, much like a balloon. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder dont work the way they should, urine can leak. Short Periods of Leaking Sometimes urinary incontinence happens for a little while. Short periods of leaking urine can happen because of - urinary tract infections   - constipation  - some medicines.  urinary tract infections constipation some medicines. Longer Periods of Leaking  When leaking urine lasts longer, it may be due to - weak bladder muscles  - weak pelvic floor muscles  - overactive bladder muscles  - damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinsons disease  - blockage from an enlarged prostate in men  - diseases or conditions, such as arthritis, that may make it difficult to get to the bathroom in time  - pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak. weak bladder muscles weak pelvic floor muscles overactive bladder muscles damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinsons disease blockage from an enlarged prostate in men diseases or conditions, such as arthritis, that may make it difficult to get to the bathroom in time pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak. (Watch the video to learn how aging affects the bladder. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "How to diagnose Urinary Incontinence ?"}, {"role": "assistant", "content": "The first step in treating urinary incontinence is to see a health care provider. He or she will give you a physical exam and take your medical history. The provider will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or have had surgery. Your provider also may do a number of tests. These might include - urine tests  - tests that measure how well you empty your bladderusually by ultrasound. urine tests tests that measure how well you empty your bladderusually by ultrasound. In addition, your health care provider may ask you to keep a daily diary of when you urinate and when you leak urine. Your family provider may also send you to a urologist or urogynecologist, doctors who specialize in urinary tract problems Get tips on choosing a health care provider. (Watch the video above to learn more about what to expect when seeking care for a bladder problem. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)"}]}
{"messages": [{"role": "user", "content": "What are the treatments for Urinary Incontinence ?"}, {"role": "assistant", "content": "Today, there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first. Types of Treatments If lifestyle changes and bladder training dont help, your health care provider may suggest medical treatments. Medical treatments may include the following. - Medicines. If you have urgency urinary incontinence, your provider may prescribe a medicine to calm bladder muscles and nerves. These calming medicines help keep bladder muscles and nerves from making you urinate when youre not ready. Medicines for urgency urinary incontinence come as pills, liquid, creams, or patches. No medicines treat stress urinary incontinence. Medicines. If you have urgency urinary incontinence, your provider may prescribe a medicine to calm bladder muscles and nerves. These calming medicines help keep bladder muscles and nerves from making you urinate when youre not ready. Medicines for urgency urinary incontinence come as pills, liquid, creams, or patches. No medicines treat stress urinary incontinence. - Medical devices. Some women may be able to use a medical device to help prevent leaking. One medical device -- called a urethral insert -- blocks the urethra for a short time to prevent leaking when it is most likely to happen, such as during physical activity. Another device -- called a pessary -- is put in the vagina to help hold up the bladder if you have a prolapsed bladder or vagina (when the vagina or bladder has shifted out of place).  Medical devices. Some women may be able to use a medical device to help prevent leaking. One medical device -- called a urethral insert -- blocks the urethra for a short time to prevent leaking when it is most likely to happen, such as during physical activity. Another device -- called a pessary -- is put in the vagina to help hold up the bladder if you have a prolapsed bladder or vagina (when the vagina or bladder has shifted out of place). - Nerve stimulation. Nerve stimulation sends mild electric current to the nerves around the bladder that help control urination. Sometimes nerve stimulation can be done at home, by placing an electrode in the vagina or anus. Or, it may require minor surgery to place an electrode under the skin on the leg or lower back.  Nerve stimulation. Nerve stimulation sends mild electric current to the nerves around the bladder that help control urination. Sometimes nerve stimulation can be done at home, by placing an electrode in the vagina or anus. Or, it may require minor surgery to place an electrode under the skin on the leg or lower back. - Surgery. Sometimes surgery can help fix the cause of urinary incontinence. Surgery may give the bladder and urethra more support or help keep the urethra closed during coughing or sneezing.  Surgery. Sometimes surgery can help fix the cause of urinary incontinence. Surgery may give the bladder and urethra more support or help keep the urethra closed during coughing or sneezing."}]}
{"messages": [{"role": "user", "content": "What is (are) Urinary Incontinence ?"}, {"role": "assistant", "content": "Urinary incontinence means a person leaks urine by accident. Urinary incontinence is a common bladder problem as people age. Women are more likely than men to leak urine. If this problem is happening to you, there is help. Urinary incontinence can often be controlled. Talk to your health care provider about what you can do. Learn about urinary incontinence in women. Learn about urinary incontinence in men."}]}
{"messages": [{"role": "user", "content": "What is (are) Urinary Incontinence ?"}, {"role": "assistant", "content": "There are different types of urinary incontinence. Stress urinary incontinence happens when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. Its the most common type of bladder control problem in younger and middle-age women. It may begin around the time of menopause. Urgency urinary incontinence happens when people have a sudden need to urinate and arent able to hold their urine long enough to get to the toilet. Mixed urinary incontinence is a mix of stress and urgency urinary incontinence. You may leak urine with a laugh or sneeze at one time. At another time, you may leak urine because you have a sudden urge to urinate that you cannot control. Overflow urinary incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of urinary incontinence. Functional urinary incontinence occurs in many older people who have a problem getting to the toilet in time. They may not make it in time because of arthritis or other disorders that make it hard to move quickly. Learn about urinary incontinence in men. Learn about urinary incontinence in women."}]}