What Kind of Doctor Treats a Patient With Behçet's Disease?

Because the disease affects different parts of the body, a patient probably will see several different doctors. It may be helpful to both the doctors and the patient for one doctor to manage the complete treatment plan. This doctor can coordinate the treatments and monitor any side effects from the various medications that the patient takes.

A rheumatologist (a doctor specializing in arthritis and other inflammatory disorders) often manages a patient's treatment and treats joint disease. The following specialists also treat other symptoms that affect the different body systems:

Gynecologist – treats genital sores in women
Urologist – treats genital sores in men and women
Dermatologist – treats genital sores in men and women and skin and mucous membrane problems
Ophthalmologist – treats eye inflammation
Gastroenterologist – treats digestive tract symptoms
Hematologist – treats disorders of the blood
Neurologist – treats central nervous system symptoms


SOURCE: http://www.niams.nih.gov/Health_Info/Behcets_Disease/default.asp#beh_f

Behçet's Syndrome

http://webcache.googleusercontent.com/search?q=cache:krntTaa3xWAJ:www.mdguidelines.com/behcets-syndrome+behcet's+syndrome+weight+loss&cd=4&hl=en&ct=clnk&gl=us


Medical Codes

ICD-9-CM: 136, 136.1

Definition

Behçet's syndrome is a chronic disease characterized by a group of symptoms that affects multiple body systems. Although the musculoskeletal, gastrointestinal, and the central nervous system are most often involved, the syndrome can affect every system in the body in many different ways.

The classic three symptoms of Behçet's syndrome include ulcerations in the mouth (apthous ulcers), genital ulcers, and inflammation of an area around the pupil of the eye called the uvea. The syndrome may also affect the lungs, causing aneurysms; the joints, causing arthritis; the gastrointestinal system, causing ulcers or inflammatory bowel disease; and the brain, causing headaches, confusion, strokes, and personality changes. Optic disc damage (glaucoma) may cause blindness. The disease may also involve the meninges, which may develop into meningitis. The condition may cause memory loss and impaired speech, balance, and movement.

The disease generally is chronic, with outbreaks typically lasting several weeks, followed by periods of remission and relapse. Infections or environmental factors may cause onset of the disease.
Risk: Behçet's syndrome has a genetic predisposition, but not everyone with the gene (HLA-B51) will necessarily contract the disease. About 5% of cases are hereditary ("Behçet's Disease"). Behçet's syndrome usually affects individuals in their twenties or thirties, although it can occur at any age. The condition affects men twice as often as women ("NINDS").

Incidence and Prevalence: The disease is uncommon in the US. It affects approximately 15,000 to 20,000 people each year, with many more going undiagnosed ("What is Behçet's Disease?"). Behçet's syndrome is seen most frequently in Japan, Turkey, and Israel ("NINDS").


Source: Medical Disability Advisor



Diagnosis

History: Weight loss or headaches may precede onset of the disease. Some of the first symptoms individuals report include painful, recurrent sores in the mouth, followed by genital lesions. Eye inflammation also is common and can cause blurry vision. Individuals may also complain of ulcerated sores that may appear anywhere on the skin, most especially on the legs and upper torso. Varying symptoms may develop over a period of weeks or years and could include abdominal discomfort, uncontrolled eye movements (nystagmus), joint pain, joint stiffness and swelling, and convulsions.

Physical exam: The exam may reveal pus-filled blisters, often in the mouth or genital areas. Painful nodes may form in response to minor injuries. Inflammation of the iris (iritis), uvea (uveitis), or cornea (keratitis) of the eye may be seen, along with pus in the anterior chamber. The optic nerve may become inflamed, resulting in blindness. Blood vessels may protrude from inflammation (aneurysms), causing blockages (thrombophlebitis) or rupture.

Tests: For some individuals, placing a sterile or saline-filled needle in the skin will cause a positive reaction that looks like a rash or reddish circle surrounding the prick (pathergy test), indicating hypersensitivity. Laboratory tests may show elevated white blood cell counts, sedimentation rates, and antibody levels but will not specifically identify Behçet's syndrome.


Source: Medical Disability Advisor



Treatment

Behçet's syndrome is treated according to the symptoms manifested, since there is no known cure for the disease. Mouth rinses can be used to treat oral sores. Topical drugs (corticosteroids) may reduce inflammation created by the disease in areas such as the skin, eyes, and joints. High doses of oral corticosteroids may alleviate central nervous system symptoms and uveitis, which sometimes result from Behçet's syndrome. Immunosuppressive drugs help control the overactive immune system and thus reduce inflammation; they have serious side effects that require regular monitoring. Other drugs that attack and destroy certain types of cells (cytotoxic) may also be used for uveitis. Drugs that disperse blood clots (anticoagulants) may be given for thrombosis, another possible manifestation of the disease. Surgery may be required for extreme conditions, such as intestinal perforations, that may result from Behçet's syndrome.

Source: Medical Disability Advisor



Prognosis

Behçet's disease is chronic and incurable. Because of the many manifestations of the disease, it is difficult to characterize the ultimate outcome. Outbreaks usually last several weeks, occurring more frequently in early stages of the disease. Cumulative effects through the years may have serious consequences, the most common of which is eye damage and possible blindness.

Source: Medical Disability Advisor



Rehabilitation

Medical approaches generally are thought to be the most effective treatment for the numerous, varied symptoms of Behçet's syndrome. Individuals with joint pain and stiffness might benefit from rehabilitation therapy recommended for those afflicted with arthritis.

Source: Medical Disability Advisor



Complications

Possible severe complications include paralysis, blindness, strokes, heart trouble, and destruction of protective tissue surrounding the brain (aseptic meningitis).

Source: Medical Disability Advisor



Return to Work (Restrictions / Accommodations)

Individuals should avoid heat, humid conditions, and chemicals, which may irritate the skin and eyes. Depending on the severity and type of symptoms, larger computer screens might assist those with visual impairment. For individuals with joint pain or stiffness, easy accessibility to work stations may be needed. Keyboards and seating may need to be positioned to ease discomfort. Moderate exertion and rest periods may be necessary.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.
Regarding diagnosis:

Does individual have a genetic predisposition to the syndrome?
Does individual have mouth ulcers?
Has individual had recent weight loss or headaches?
Has individual developed genital lesions?
Does individual have eye inflammation? Blurry vision?
Have blood vessels developed aneurysms from the inflammation?
Are ulcerated sores present on the upper torso and legs?
Is abdominal discomfort present? Swelling? Uncontrolled eye movement?
Does individual have joint pain or stiffness?
Does individual have convulsions?
Were blood tests done? Pathergy test?
Were conditions with similar symptoms ruled out?
Regarding treatment:

Was individual able to control symptoms?
Were corticosteroids helpful? Were cytotoxic drugs used?
Were anticoagulants necessary?
Was it necessary for individual to have surgery?
How long does an outbreak last? How frequent?
Regarding prognosis:

Can individual's employer accommodate any necessary restrictions?
Does individual have any conditions, such as heart trouble or aseptic meningitis that may affect ability to recover?
Have any complications developed such as paralysis, blindness, or stroke?
Source: Medical Disability Advisor



References

Cited

"Behcet's Disease." Johns Hopkins Vasculitis Center. American Psychiatric Association. 24 Sep. 2004 .
"What is Behcet's Disease?" American Behcet's Disease Association. 24 Sep. 2004 .

"NINDS Behcet's Disease Information Page." National Institute of Neurological Disorders and Stroke. National Institutes of Health (NIH). 24 Sep. 2004 .

Source: Medical Disability Advisor

How do you make a lower-case Ê in PortuguÊse?

You can hold down Alt while typing 136 into the number pad on the right hand side of the keyboard: ê.

ê is Alt + 136
° is Alt = 248....



é = 130
à = 133
è = 138
ç = 135
ã = 0227
ô = 147
õ = 0245
â = 0226
ñ = 0241

Microchimerism

http://en.wikipedia.org/wiki/Microchimerism


This fascinated me...

Relationship with autoimmune diseases and breast cancer

Microchimerism has been implicated in autoimmune diseases. Independent studies repeatedly suggested that microchimeric cells of fetal origin may be involved in the pathogenesis of systemic sclerosis.[1][4] Moreover, microchimeric cells of maternal origin may be involved in the pathogenesis of a group of autoimmune diseases found in children, i.e. juvenile idiopathic inflammatory myopathies (one example would be juvenile dermatomyositis).[5] Microchimerism has now been further implicated in other autoimmune diseases, including systemic lupus erythematosus.[6] Contrarily, an alternative hypothesis on the role of microchimeric cells in lesions is that they may be facilitating tissue repair of the damaged organ.[7]
Moreover, fetal immune cells have also been frequently found in breast cancer stroma as compared to samples taken from healthy women. It is not clear, however, whether fetal cell lines promote the dvelopment of tumors or, contrarily, protect women from developing breast carcinoma.

Interpreting ANA values of the Lupus test

http://webcache.googleusercontent.com/search?q=cache:ytAndXMDXiUJ:www.uklupus.co.uk/ana.html+ana+test+lupus&cd=4&hl=en&ct=clnk&gl=us

ANA stands for Antinuclear Antibody. This literally means 'substance against the cell nucleus'. The nucleus is the 'headquarters' of the living cell, therefore the ANA can damage or destroy cells & tissues.

95%-98% of patients with SLE will have a positive ANA test, but the majority of people with a positive ANA test do not have SLE. A positive ANA test can be found in many conditions, including Sjogren's Syndrome, scleroderma, rheumatoid arthritis, & mixed connective tissue disease. Many normal healthy people will also have a positive ANA test. Therefore a positive ANA test, on it's own, does not mean that person has lupus.

Because of this, the physician has to look very carefully at the titer (number) & pattern of the ANA test. The titer shows how many times the technician had to mix fluid from the patient's blood to get a sample free of ANAs. Thus a titer of 1:640 shows a greater concentration of ANA than 1:320 or 1:160, since it took 640 dilutions of the plasma before ANA was no longer detected. The apparent great difference between various titers can be misleading. Since each dilution involves doubling the amount of test fluid, it is not surprising that titers increase rapidly. In fact, the difference between titers of 1:160 & 1:320 is only a single dilution. And it doesn't necessarily represent a major difference in disease activity.

ANA titers go up & down during the course of the disease, & may or may not reflect disease activity. Therefore it is not always possible to tell from the titer how severe a person's lupus is.

A titer of 1:80 or lower is usually considered negative.

The pattern of the ANA is studied by microscope. The technician examines a specially prepared slide that shows where antibodies attack the nucleus. Certain antibodies attack certain areas of the nucleus, producing four specific patterns.

The rim (peripheral) pattern is the most specific pattern for lupus, while the homogeneous (diffuse) pattern is the most common pattern seen. The remaining patterns are the speckled and nucleolar patterns. In some cases the pattern helps the doctor decide which of the autoimmune diseases is causing the problem and which treatment program is appropriate.

Because a positive ANA test can be found in other diseases as well as SLE, the physician will use a positive ANA test as only one factor in determining whether or not a patient has lupus. A positive ANA test does not mean that a person has lupus. The physician needs to find other clinical features such as butterfly rashes, arthritis, pleurisy, blood abnormalities, kidney disease, etc., in addition to a positive ANA test before making a diagnosis of SLE.

The reliability of the ANA test depends upon the laboratory. Many variables can interfere with the test & give false numbers. The accuracy of the test can also vary, depending on many factors, such as the strength of the fluorescent antibody, or even the quality of the microscope used.

Once a patient is found to be ANA positive, the physician may want to further investigate which antigen in the nucleus is responsible for the positive ANA test. The knowledge of which antigen is responsible for the positive ANA test can sometimes be helpful in determining which disease is present. For instance, antibodies to DNA (the protein that makes up the body's genetic code) are found primarily in SLE. Levels of these antibodies in the blood can be useful to the physician in following the course of lupus, especially in patients with kidney disease. Anti-DNA levels, however, do not always perfectly match the clinical course of lupus kidney disease. Antibodies to histones (DNA packaging proteins) may be very helpful in determining whether a patient has drug-induced lupus. These antibodies may be found in SLE as well. Antibodies to Sm antigen are found almost exclusively in lupus, & when present, help to clinch the diagnosis of SLE. Antibodies to RNP (ribonucleoprotein) are found in a variety of connective tissue diseases. When present in very high levels, they are indicative of mixed connective tissue disease, a condition with features of SLE, polymyositis, and scleroderma. Antibodies to SS-A are found in both lupus and Sjogren's syndrome and are sometimes associated with babies who are born with neonatal lupus.

4 Foods You Should Never Eat

http://virgilaponte.com/2010/01/23/4-foods-you-should-never-eat/

I couldn't find an author listed, but I assume it's Virgil Aponte.

4 Foods You Should Never Eat
Brought to you by The Truth About Six Pack Abs
4 Foods to NEVER eat by Mike Geary
Two of these foods (or drink) below, I would NEVER eat all, and the other 2, I would only eat in very small quantities.
If you want to stop struggling with bodyfat, and also have superior health, these foods should be minimized or eliminated.
I’ll explain more…

1. Soy

Despite being heavily marketed and promoted as a “health food” by the multi billion dollar soy industry, this food has more drawbacks than it does benefits. In fact, I would label soymilk, isolated soy protein, and tofu as junk foods.
And don’t even get me started on the excess estrogenic compounds in processed soy…
if you want to increase your belly fat, keep pounding down that soymilk and tofu! A small amount unprocessed soy, such as edamame, is not a big deal… especially if it’s organic.
And small amounts of fermented soy such as tempe and miso are ok too (because the fermentation reduces anti-nutrients in soy)…
but try to minimize/eliminate most other forms of soy…
and that includes soybean oil, which is in almost ALL processed foods, commercial salad dressings, etc.
My comments: I personally use soy milk, almond milk & hemp milk from time to time.
I do this sometimes at smoothie bars because no one offers Raw Milk which is my milk of choice.
If it’s at home Raw Milk is the best base for my Protein Shakes.
Best of all is that it’s not processed at all and only has 1 simple ingredient: Milk!
While Soy, Hemp, Almond Milk etc… is touted as healthy it does have questionable ingredients unless you make it yourself (which some people do by the way).

2. Wheat

Most people don’t realize this, but a large % of the total population has at least some degree of intolerance to digesting wheat… particularly the high gluten content of wheat.
Most people are not full blown Celiacs (who need to avoid wheat entirely), but the majority of people would find improvements to their health and bodyfat by testing eliminating wheat for several weeks, and taking note of how they feel, look, and their measurements.
I know it’s a hard thing to do since a HUGE portion of the modern western diet is made from wheat products, but I’ve found it’s quite easy to do at home once you get used to it.
Dining out is a different story.
Personally, I choose to almost entirely avoid wheat in all of my meals at home.
I only dine out occasionally, or on vacations, so that’s the only time when I eat wheat.
My comments: I fall smack right into this this club and need to avoid wheat as much as I can. Too bad for me that I love bread and I also love penne pasta with pesto sauce! I also love a good steak so I guess things balance out
Most tests I’ve taken show that I am gluten intolerant which is why I have to avoid wheat as much as possible.
I found this out using the ALCAT TEST
You can also simply avoid wheat for a few weeks and see how you feel.

3. Soda or sweetened drinks (including commercial juices)

This is one that I personally choose to NEVER consume!
Even on cheat days, vacations, or dining out, I think this stuff is pure evil enough to never even touch.
If you care about your body at all, there’s just no reason to consume soda in any amount.
It’s pure sugar (or worse, high fructose corn syrup), has ZERO nutrition, and has many other issues related to the additives, acids, etc.
In addition, the consumption of this calorically-dense but nutritionally-absent liquid actually makes your body crave more food, because you consumed calories without consuming any nutrients.
It also spikes your blood sugar out of whack causing wild blood sugar swings and additional cravings.
I’m always amazed how many people tell me that they are desperately trying to lose wt, but yet I see them drinking a soda.
I don’t get it.

4. Anything deep fried (or anything with trans fats)

You would think the entire population should know by now how dangerous consuming trans fats really is… yet people ignore these dangers and scarf down deep fried foods like french fries, corn chips, and donuts every day.
If you study some of the biochemical reactions that take place in the body of humans after consuming trans fats, you would realize this is essentially a poison.
It’s not a poison that’s going to kill you immediately, but it’s a poison that causes inflammation throughout the body, and even detrimentally affects all of your cell membranes (remember from bio101 that your cell membranes need fats for their composition, and trans fats disrupt healthy cell membranes).
I’ve found that if I can get people to view trans fats as the true POISON that they really are, they finally realize the importance of avoiding them ENTIRELY… and to stop poisoning their kids too by allowing them to eat deep fried foods (especially important for kids to avoid trans fats since it can impair development

Mississippi Online Services

http://www.mississippi.gov/online_services_sub_sub_all.jsp?Category_ID=52

Prescription Assistance

https://syndication.pparx.org/SelectMedication.php

Agoraphobia Symptoms

http://psychcentral.com/disorders/sx29.htm

celiac-disease-cases-doubling-every-15-years

http://pagingdrgupta.blogs.cnn.com/2010/09/28/celiac-disease-cases-doubling-every-15-years/?hpt=Sbin