Category Archives: Uncategorized

Jet Lag

What is jet lag? — Jet lag is a condition that causes sleep problems, tiredness, and other symptoms. It happens in people who fly across several time zones, especially when they fly east. The more time zones a person crosses, the more likely he or she is to get jet lag.

Jet lag gets better on its own as a person adjusts to the new time zone. But this can take several days. The farther from home a person is, the longer it takes to get over jet lag.

What are the symptoms of jet lag? — The symptoms include:

Sleep problems, such as problems falling or staying asleep

Feeling tired or sleepy in the daytime

Having trouble thinking, concentrating, or doing normal activities

Stomach problems, such as constipation

Feeling sick or having less energy than normal

Should I see a doctor or nurse? — If you think you had jet lag in the past, talk to your doctor or nurse before going on a long airline flight. He or she can help you figure out ways to avoid jet lag.

How can I prevent jet lag? — Here are a few things you can try:

Stay awake and sleep at certain times. This can help your body adjust to the new time zone. For example, you can:

Stay up until it’s dark if you fly west – Only go to sleep when it gets dark. If you go sightseeing, try to do it during the day.

Avoid bright morning light if you fly east – Go outside as much as possible in the afternoon. If you go sightseeing outdoors, try to do it in the afternoon until your body adjusts to the new time zone.

Eat meals at mealtime in the new time zone – For example, if you normally eat lunch at noon, eat at noon in the new time zone (not noon at home).

Get some exercise, but not right before you are supposed to go to sleep.

Can supplements or medicines help with jet lag? — Yes. A supplement called “melatonin” can help with sleep problems from jet lag when you fly east. Melatonin is a hormone that is naturally made by a gland in the brain. Taking extra melatonin can help your body adjust to a new time zone. You can buy melatonin pills in a store or pharmacy without a prescription. The usual dose is 5 milligrams after dark each night, about half an hour before you want to go to sleep.

If you want to try melatonin, tell your doctor or nurse. He or she can tell you if it is safe for you. If you take warfarin (brand names: Coumadin, Jantoven) or medicine to help with epilepsy, melatonin might not be safe for you. Tell your doctor or nurse about all medicines and supplements you take, including over-the-counter medicines. You should start taking melatonin the night you arrive, at bedtime. You can take melatonin for up to 5 nights in the new time zone. After that, you are not likely to need it. Only adults should take melatonin. Doctors don’t know if it helps with jet lag in children. Avoid drinking alcohol while you are taking melatonin.

Does melatonin cause side effects? — Some people have side effects from melatonin. These can include:

Feeling sleepy in the daytime

Dizziness or confusion


Loss of appetite, nausea, and other stomach problems

But these side effects are very similar to jet lag. So doctors are not sure if they are really side effects of melatonin or just jet lag symptoms.

Heart Block

What is heart block? — Heart block is a condition that affects the electrical system that controls the heartbeat. Mild types of heart block can cause your heart to beat more slowly than normal or to skip beats. More serious types can cause your heart to stop beating. Without emergency treatment, serious heart block can be fatal.

What causes heart block? — Heart block happens when the electrical signals that tell the heart to beat either get slowed down or stopped. Most people with heart block get it from a disease, surgery, or medicine that damaged their heart. In rare cases, people are born with heart block.

What are the symptoms of heart block? — The symptoms depend on the type of heart block a person has. There are 3 types of heart block:

First degree – This is the mildest type of heart block. Often, people with this type have no symptoms.

Second degree – This type is more serious than first degree. Symptoms include:


Feeling dizzy

Feeling tired

Trouble breathing

Chest pain

Third degree – This is the most serious type of heart block. It can cause the same symptoms as second degree, but they will be more severe. In some cases, third degree heart block can be life threatening.

Is there a test for heart block? — Yes. Your doctor or nurse will probably do a test called an electrocardiogram (also called an “ECG” or “EKG”). This test measures the electrical activity in your heart (figure 1).

You might also need other tests to see if another condition is causing your slow heartbeat.

Should I see a doctor or nurse? — If you have trouble breathing or have chest pain that lasts for more than a few minutes, call for an ambulance (in the US and Canada, dial 9-1-1).

If you do not have these problems, but you often notice your heart beating slowly or skipping beats, talk to your doctor or nurse.

How is heart block treated? — The treatment depends on the type of heart block you have. Often, people who have first degree heart block do not need treatment. But people who have third degree heart block and some people who have second degree heart block need a pacemaker. A pacemaker is a device that goes under the skin near a person’s heart. It sends electrical signals to the heart that help it beat at a normal rate.

Can heart block be prevented? — People who have heart disease are more likely to get heart block. Doing things that keep your heart healthy can help prevent heart disease. This includes:

Eating a healthy diet. This involves eating lots of fruits and vegetables and low-fat dairy products, but not a lot of meat or fatty foods.

Walking or doing a physical activity on most days of the week.

Losing weight, if you are overweight.


DKA – Diabetic Ketoacidosis

What is diabetic ketoacidosis? — Diabetic ketoacidosis is a serious problem that happens to people with diabetes when chemicals called “ketones” build up in their blood. It can happen to people with either type 1 or type 2 diabetes, but it is more likely to affect people with type 1. That’s because people with type 1 make little or no insulin, a hormone that allows the body to use sugar as a source of energy. Normally, the body breaks down sugar as a source of energy. But in people with diabetes who do not make any insulin, the body is unable to use sugar. When the body can’t use sugar, it burns fat as a source of energy. But burning fat can cause the body to make too many ketones. When ketones build up in the blood, they can be toxic. What causes diabetic ketoacidosis? — People can get diabetic ketoacidosis for a few reasons: ●They are not getting treated for diabetes (possibly because they don’t know they have it) and so their body is breaking down fat. ●They have a major illness or health problem, such a heart attack or infection. ●They take certain medicines or illegal drugs. ●They don’t take their insulin as directed. ●Their insulin pump does not work correctly. What are the symptoms of diabetic ketoacidosis? — The symptoms can include: ●Feeling very thirsty and drinking a lot ●Urinating a lot, including at night ●Nausea or vomiting ●Belly pain ●Feeling tired or having trouble thinking clearly ●Having breath that smells sweet or fruity ●Weight loss Should I see a doctor or nurse? — See your doctor or nurse right away if you have the symptoms listed above. Also, see your doctor or nurse if your blood sugar levels keep being higher than they should be. Is there a test for diabetic ketoacidosis? — Yes. If the doctor or nurse thinks you have diabetic ketoacidosis, he or she will order several blood tests, including tests to check your blood sugar and ketone levels. He or she will also check your urine for ketones. These tests can show whether you have diabetic ketoacidosis. Because diabetic ketoacidosis can cause problems with the heart, you might also need an electrocardiogram. That is a test to measure the electrical activity in the heart. How is diabetic ketoacidosis treated? — Treatment is done at the hospital and can include: ●Fluids and electrolytes – When dealing with diabetic ketoacidosis, the body loses a lot of fluids. It also loses electrolytes, chemicals such as sodium and potassium, that keep cells working normally. As part of treatment for the condition, doctors must replace lost fluids and electrolytes. ●Insulin – When the body has enough insulin, it can use sugar as fuel and it does not need to break down fat. Can diabetic ketoacidosis be prevented? — You can reduce your chances of getting diabetic ketoacidosis by:●Taking your insulin exactly as directed ●Taking your insulin exactly as directed ●Measuring your blood sugar often to make sure it is not too high or too low    

Paracentesis – procedure to remove fluid inside the abdomen. is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites . Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.

Why It Is Done

Paracentesis may be done to:
  • Find the cause of fluid buildup in the belly.
  • Diagnose an infection in the peritoneal fluid.
  • Check for certain types of cancer, such as liver cancer.
  • Remove a large amount of fluid that is causing pain or trouble breathing or that is affecting how the kidneys or the intestines (bowel) are working.
  • Check for damage after a belly injury.

How To Prepare

Before you have paracentesis done, tell your doctor if you: Other blood tests may be done before a paracentesis to make sure that you do not have any bleeding or clotting problems. You will empty your bladder before the procedure. You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

How It Is Done

This procedure may be done in your doctor’s office, an emergency room, or the X-ray department of a hospital, or at your bedside in the hospital.
If a large amount of fluid is going to be taken out during the procedure, you may lie on your back with your head raised. People who have less fluid taken out may sit up. The site where your doctor will put the needle is cleaned with a special soap and draped with sterile towels.Your doctor puts a numbing medicine into your belly. Once the area is numb, your doctor will gently and slowly put the paracentesis needle in where the extra fluid is likely to be. Your doctor will be careful to not poke any blood vessels or the intestines. If your test is done in the X-ray department, an ultrasound may be used to show where the fluid is in your belly. If a large amount of fluid is present, the paracentesis needle may be hooked by a small tube to a vacuum bottle for the fluid to drain into it. Generally, up to 4 L (1 gal) of fluid is taken out. If your doctor needs to remove a larger amount of fluid, you may be given fluids through an intravenous line (IV) in a vein in your arm. This fluid is needed to prevent low blood pressure or shock. It is important that you lie completely still during the procedure unless you are asked to change positions to help drain the fluid. When the fluid has drained, the needle is taken out and a bandage is placed over the site. After the test, your pulse, blood pressure, and temperature are watched for about an hour. You may be weighed and the distance around your belly may be measured before and after the test. Paracentesis takes about 20 to 30 minutes. It will take longer if a large amount of fluid is taken out. You can do your normal activities after the test unless your doctor tells you not to.

How It Feels

You may feel a brief, sharp sting when the numbing medicine is given. When the paracentesis needle is put into your belly, you may feel a temporary sharp pain or pressure.
You may feel dizzy or lightheaded if a large amount of fluid is taken out. Tell your doctor if you do not feel well during the test.After the procedure, you may have some clear fluid draining from the site, especially if a large amount of fluid was taken out. The drainage will get less in 1 to 2 days. A small gauze pad and bandage may be needed. Ask your doctor how much drainage to expect.


There is a very small chance that the paracentesis needle may poke the bladder, bowel, or a blood vessel in the belly. If cancer cells are present in the peritoneal fluid, there is a small chance that the cancer cells may be spread in the belly. If a large amount of fluid is removed, there is a small chance that your blood pressure could drop to a low level. This could lead to shock. If you go into shock, IV fluids or medicines, or both, may be given to help return your blood pressure to normal. There is also a small chance that removing the peritoneal fluid may affect how your kidneys work. If this is a concern, IV fluids may be given during the paracentesis.

After the test Call your doctor immediately if you have:

  • A fever higher than 100°F (38°C).
  • Severe belly pain.
  • More redness or tenderness in your belly.
  • Blood in your urine.
  • Bleeding or a lot of drainage from the site.


Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites . The fluid taken from your belly will be sent to a lab to be studied and looked at under a microscope. Results will be ready in a few hours.
Normal: No infection, cancer, or abnormal values are found.
Abnormal: Several tests may be done on the fluid.
  • Cell counts. A high number of white blood cells (WBCs) in the fluid may mean inflammation, infection (peritonitis), or cancer is present. A high WBC count and a high count of WBCs called polymorphonuclear leukocytes (PMNs) may mean there is an infection inside the belly called spontaneous bacterial peritonitis (SBP).
  • Serum-ascites albumin gradient (SAAG). The SAAG compares the level of protein in the fluid to the level of protein in the blood. High protein levels in the fluid may mean cancer,tuberculosisnephrotic syndrome, orpancreatitis. Low protein levels in the fluid may mean cirrhosis or clots in veins of the liver are present.
  • Culture. A culture can be done on the fluid to see whether bacteria or other infectious organisms are present.
  • Lactate dehydrogenase (LDH). High levels of the enzyme LDH may mean infection or cancer is present.
  • Cytology. Abnormal cells in the fluid may mean cancer is present.
  • Amylase. High levels of amylase may mean pancreatitis or that there is a hole in the intestine.
  • Glucose. Low levels of glucose may mean infection.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:
  • Using blood thinners (anticoagulants) or aspirin, which can increase the chance of bleeding.
  • Having blood, bile, urine, or feces in the fluid sample.
  • Not being able to stay still during the test.
  • Being obese.
  • Having scars inside the belly (adhesions) from any belly surgery in the past.

What To Think About

Sometimes doctors use fluids put into the belly to check for injuries. This is called peritoneal lavage. During this procedure, a doctor uses a paracentesis needle to put a salt (saline) fluid into the belly. The fluid is then taken out through the same needle. If the fluid that comes out is bloody, the bleeding is probably being caused by an injury inside the belly.