UNIT 5

PREVENTIVE HEALTH CARE

Osteoporosis:
What is Osteoporosis?
Osteoporosis literally means ‘bones with holes’. It occurs when bones lose
minerals such as calcium more quickly than the body can replace them. They
become less dense, lose strength and break more easily.
Osteoporosis and bone growth
Bone is constantly being broken down and renewed. It is living tissue that needs
adequate calcium, exercise to maintain strength, just like muscle.
In the early years of life, more bone is made than is broken down, resulting in bone
growth. By the end of your teens, bone growth has been completed and by about
25 to 30 years of age, peak bone mass is achieved.
Sex hormones, such as oestrogen and testosterone, have a fundamental role in
maintaining bone strength in men and women. The fall in oestrogen that occurs
during menopause results in accelerated bone loss. During the first five years after
menopause, the average woman loses up to 10 per cent of her total body bone
mass.
Diagnosis of osteoporosis
Currently, the most reliable way to diagnose osteoporosis is to measure bone
density with a dual-energy absorptiometry scan or DXA. A DXA scan is a short,
painless scan that measures the density of your bones, usually at the hip and spine
and, in some cases, the forearm.
You can qualify for a Medicare rebate for a DXA scan if you:
have previously been diagnosed with osteoporosis
have had one or more fractures due to osteoporosis
are aged 70 years or over
have a chronic condition, including rheumatoid arthritis, coeliac disease or liver
disease
have used corticosteroids for a long time.
Risk factors for osteoporosis
There are many risk factors for osteoporosis, some of which you cannot change,
such as being female, and having a direct relative who has had an osteoporotic
fracture.
Other risk factors include:
inadequate amounts of dietary calcium
low vitamin D levels
cigarette smoking or alcohol intake of more than two standard drinks per day
lack of physical activity
early menopause (before the age of 45)
loss of menstrual period if it is associated with reduced production of oestrogen.
Prevention of osteoporosis
Throughout life women and men can take simple steps to support bone
health:
eat calcium-rich foods as part of a general healthy diet which includes fresh fruit,
vegetables and whole grains
absorb enough vitamin D
avoid smoking and
limit alcohol consumption
do regular weight-bearing and strength-training activities.
Calcium-rich diet and osteoporosis
Enjoying a healthy, balanced diet with a variety of foods and an adequate intake of
calcium is a vital step to building and maintaining strong, healthy bones. If there is
not enough calcium in the blood, your body will take calcium from your bones.
Making sure you have enough calcium in your diet is an important way to preserve
your bone density.
Vitamin D and osteoporosis
Vitamin D is important because it helps your body absorb the calcium in your diet.
We obtain most of our vitamin D from the sun, and there are recommendations for
the amount of safe sun exposure for sufficient vitamin D production, depending on
your skin type, geographical location in Australia and the season.
Vitamin D can also be found in small quantities in foods such as:
fatty fish (salmon, herring, mackerel)
liver
eggs
fortified foods such as low-fat milks and margarine.
Exercise to prevent osteoporosis
Weight-bearing exercise encourages bone density and improves balance so falls
are reduced. It does not treat established osteoporosis. Consult your doctor before
starting a new exercise program, especially if you have been sedentary, are over 75
years of age or have a medical condition.
General recommendations include:
Choose weight-bearing activities such as brisk walking, jogging, tennis, netball or
dance. While non-weight-bearing exercises, such as swimming and cycling, are
excellent for other health benefits, they do not promote bone growth
Lifestyle changes to protect against osteoporosis
Be guided by your doctor, but general recommendations for lifestyle changes may
include:
stop smoking – smokers have lower bone density than non-smokers
get some sun – exposure of some skin to the sun needs to occur on most days of
the week to allow enough vitamin D production (but keep in mind the
recommendations for sun exposure and skin cancer prevention)
drink alcohol in moderation, if at all – excessive alcohol consumption increases
the risk of osteoporosis. Drink no more than two standard drinks per day and have
at least two alcohol-free days per week
limit caffeinated drinks – excessive caffeine can affect the amount of calcium
that our body absorbs. Drink no more than two to three cups per day of cola, tea or
coffee.

Diabetes
Diabetes is a condition that happens when your blood sugar (glucose) is too high. It
develops when your pancreas doesn’t make enough insulin or any at all, or when
your body isn’t responding to the effects of insulin properly. Diabetes affects
people of all ages. Most forms of diabetes are chronic (lifelong), and all forms are
manageable with medications and/or lifestyle changes.
Glucose (sugar) mainly comes from carbohydrates in your food and drinks. It’s
your body’s go-to source of energy. Your blood carries glucose to all your body’s
cells to use for energy.
What are the types of diabetes?
There are several types of diabetes. The most common forms include:
Type 2 diabetes: With this type, your body doesn’t make enough insulin and/or
your body’s cells don’t respond normally to the insulin (insulin resistance). This is
the most common type of diabetes. It mainly affects adults, but children can have it
as well.
Prediabetes: This type is the stage before Type 2 diabetes. Your blood glucose
levels are higher than normal but not high enough to be officially diagnosed with
Type 2 diabetes.
Type 1 diabetes: This type is an autoimmune disease in which your immune
system attacks and destroys insulin-producing cells in your pancreas for unknown
reasons. Up to 10% of people who have diabetes have Type 1. It’s usually
diagnosed in children and young adults, but it can develop at any age.
Gestational diabetes: This type develops in some people during pregnancy.
Gestational diabetes usually goes away after pregnancy. However, if you have
gestational diabetes, you’re at a higher risk of developing Type 2 diabetes later in
life.
How common is diabetes?
Diabetes is common. Approximately 37.3 million people in the United States have
diabetes, which is about 11% of the population. Type 2 diabetes is the most
common form, representing 90% to 95% of all diabetes cases.
About 537 million adults across the world have diabetes. Experts predict this
number will rise to 643 million by 2030 and 783 million by 2045.

Symptoms and Causes

Symptoms of diabetes include increased thirst, frequent urination and slow-
healing cuts and sores.
What are the symptoms of diabetes?
Symptoms of diabetes include:
Increased thirst (polydipsia) and dry mouth.
Frequent urination.
Fatigue.
Blurred vision.
Unexplained weight loss.
Numbness or tingling in your hands or feet.
Slow-healing sores or cuts.
Frequent skin and/or vaginal yeast infections.
What causes diabetes?
Too much glucose circulating in your bloodstream causes diabetes, regardless of
the type. However, the reason why your blood glucose levels are high differs
depending on the type of diabetes.
Causes of diabetes include:
Insulin resistance
Autoimmune disease
Hormonal imbalances
Pancreatic damage
Genetic mutations
Management and Treatment
Managing Diabetes
How is diabetes managed?
Diabetes is a complex condition, so its management involves several strategies. In
addition, diabetes affects everyone differently, so management plans are highly
individualized.
The four main aspects of managing diabetes include:
Blood sugar monitoring: Monitoring your blood sugar (glucose) is key to
determining how well your current treatment plan is working. It gives you
information on how to manage your diabetes on a daily — and sometimes even
hourly — basis.
You can monitor your levels with frequent checks with a glucose meter and finger
stick and/or with a continuous glucose monitor (CGM). You and your healthcare
provider will determine the best blood sugar range for you.
Oral diabetes medications: Oral diabetes medications (taken by mouth) help
manage blood sugar levels in people who have diabetes but still produce some
insulin — mainly people with Type 2 diabetes and prediabetes.
People with gestational diabetes may also need oral medication. There are several
different types. Metformin is the most common.
Insulin: People with Type 1 diabetes need to inject synthetic insulin to live and
manage diabetes. Some people with Type 2 diabetes also require insulin. There are
several different types of synthetic insulin.
They each start to work at different speeds and last in your body for different
lengths of time. The four main ways you can take insulin include injectable insulin
with a syringe (shot), insulin pens, insulin pumps and rapid-acting inhaled insulin.
Diet: Meal planning and choosing a healthy diet for you are key aspects of
diabetes management, as food greatly impacts blood sugar.
If you take insulin, counting carbs in the food and drinks you consume is a large
part of management. The amount of carbs you eat determines how much insulin
you need at meals. Healthy eating habits can also help you manage your weight
and reduce your heart disease risk.
Exercise: Physical activity increases insulin sensitivity (and helps reduce insulin
resistance), so regular exercise is an important part of management for all people
with diabetes.
Due to the increased risk for heart disease, it’s also important to maintain a
healthy:
Weight.
Blood pressure.
Cholesterol.
Prevention
How can I prevent diabetes?
You can’t prevent autoimmune and genetic forms of diabetes. But there are some
steps you can take to lower your risk for developing prediabetes, Type 2 diabetes
and gestational diabetes, including:
Eat a healthy diet, such as the Mediterranean diet.
Get physically active. Aim for 30 minutes a day at least five days a week.
Work to achieve a weight that’s healthy for you.
Manage your stress.
Limit alcohol intake.
Get adequate sleep (typically 7 to 9 hours) and seek treatment for sleep disorders.
Quit smoking.
Take medications as directed by your healthcare provider to manage existing risk
factors for heart disease.

Atherosclerosis
Atherosclerosis is the gradual buildup of plaque in the walls of your arteries.
Arteries are blood vessels that carry oxygen-rich blood to organs and tissues
throughout your body. Plaque (atheroma) is a sticky substance made of fat,
cholesterol, calcium and other substances.
How common is atherosclerosis?
Atherosclerosis is very common. The complications of plaque buildup (including
heart attacks and strokes) are the leading cause of death worldwide.
In America, about half of people age 45 to 84 have atherosclerosis but aren’t aware
of it, according to the U.S. National Institutes of Health.
Symptoms and Causes
Infographic showing several warning signs of atherosclerosis, chest discomfort, leg
cramps and shortness of breath.
If you have warning signs of atherosclerosis, tell a healthcare provider. Early
treatment can lower your risk of life-threatening complications.
What are the symptoms?
Atherosclerosis symptoms often don’t start until an artery is very narrow or
blocked. Many people don’t know they have plaque buildup until they have a
medical emergency like a heart attack or stroke.
You may notice symptoms of atherosclerosis if your artery is more than 70%
blocked. You can have symptoms in different parts of your body, depending on the
location of the blockage. Affected locations may include:
Heart
Coronary artery disease (CAD, which can lead to a heart attack) happens in the
arteries that supply blood to your heart.
You may experience:
Shortness of breath (dyspnea) during light physical activity.
Chest pain or discomfort (angina).
Pain in your back, shoulders, neck, arms or belly.
Feeling dizzy or lightheaded.
Heart palpitations.
Fatigue.
Nausea or vomiting that may feel like indigestion.
Digestive system
Mesenteric ischemia happens when you don’t have enough blood flow in parts of
your digestive system. You may experience:
Pain or cramping in your belly (abdomen) after eating.
Bloating, nausea and vomiting.
Diarrhea.
Unintentional weight loss due to “food fear” (fear of pain after eating).
Legs and feet
Peripheral artery disease (PAD) refers to poor blood flow in the arteries in your
limbs.
You may experience:
Muscle pain (intermittent claudication).
Burning or aching pain in your feet and toes when you rest, especially when lying
flat.
Changes in skin color (like redness).
Cool skin on your feet.
Frequent skin and soft tissue infections, often in your legs or feet.
Sores on your feet or toes that don’t heal.
Kidneys
With renal artery stenosis (narrowing of the arteries that take blood to your
kidneys), you may experience:
Markedly elevated blood pressure that doesn’t respond to multiple medications.
Changes in how often you pee.
Swelling (edema).
Feeling drowsy or tired.
Skin that feels dry, itchy or numb.
Headaches.
Unexplained weight loss.
Nausea, vomiting or loss of appetite.
Brain
With carotid artery disease, the first symptoms are usually a transient ischemic
attack (TIA) or stroke.
You may experience:
Dizziness.
Drooping on one side of your face.
Loss of feeling, loss of muscle strength or weakness on one side of your body.
Severe headache.
Slurred speech or difficulty forming words.
Vision loss in one eye. You may notice a dark shade coming down over your field
of sight.
What causes atherosclerosis?
Researchers believe atherosclerosis causes may include:
High LDL cholesterol and triglyceride levels.
Tobacco products.
High blood pressure.
Diabetes.
What are the risk factors for atherosclerosis?
There are many risk factors for atherosclerosis. You may be able to change some
of these risk factors, but not others (like age).
Risk factors include:
Being older than age 45 (for people assigned male at birth or AMAB).
Being older than age 55 (for people assigned female at birth or AFAB).
Family history of premature cardiovascular disease. This means a close biological
family member who’s AMAB received a cardiovascular disease diagnosis before
age 45. Or, one who’s AFAB got a diagnosis before age 55.
Diabetes.
High blood pressure (hypertension).
High cholesterol (hyperlipidemia), especially high LDL cholesterol or high levels
of a specific lipoprotein called lipoprotein (a).
Metabolic syndrome.
Smoking or tobacco use.
Lack of physical activity.
Eating foods high in saturated fat, trans fat, sodium and sugar.
Management and Treatment
How is atherosclerosis treated?
Atherosclerosis treatment includes lifestyle changes, medications, procedures or
surgeries. Depending on the location of your atherosclerosis, you may see a
cardiologist (heart), nephrologist (kidneys), neurologist (brain and spine) or
vascular surgeon (blood vessels).
Your healthcare providers will develop a plan based on your needs. Common
treatment goals include:
Lowering your risk of blood clots.
Preventing complications like a heart attack or stroke.
Easing symptoms.
Helping you develop patterns of eating that support your heart and blood vessels.
Slowing or stopping plaque buildup in your arteries.
Improving blood flow by widening your arteries or bypassing (avoiding)
blockages.
Lifestyle changes
Lifestyle changes may lower your risk of complications. Your provider will create
a plan specific to your needs. General tips include:
Avoid all tobacco products (including smoking and vaping).
Follow a heart-healthy eating plan like the Mediterranean Diet.
Build physical activity into your daily routine.
Medications
Medications target risk factors for plaque buildup and may help slow the
progression of atherosclerosis. Your provider may prescribe medications that lower
your blood pressure or cholesterol, manage your blood sugar levels and prevent
blood clots.
Procedures or surgeries
Various minimally invasive procedures and complex surgeries can help people
with severe blockages or a high risk of complications. Common treatment options
include:
Angioplasty.
Atherectomy.
Carotid endarterectomy.
Coronary artery bypass grafting (CABG).
Peripheral artery bypass.
Stent placement.
Vascular disease bypass.
Prevention
Can atherosclerosis be prevented?
You may not be able to prevent atherosclerosis. But you can reduce your risk and
lessen the effects of the disease. Here are some steps you can take:
Eat foods low in saturated fat, trans fat, cholesterol, sodium (salt) and sugar.
Get regular physical activity. Start with short walks and build up to 30 minutes a
day most days of the week.
Keep a weight that’s healthy for you. Ask your provider what that should be.
Manage any health conditions, especially diabetes, high blood pressure and high
cholesterol.
Don’t use tobacco products.
Have a yearly checkup with a healthcare provider.

High Blood Pressure (Hypertension)

High blood pressure is when the force of blood pushing against your artery walls is
consistently too high. This damages your arteries over time and can lead to serious
complications like heart attack and stroke. “Hypertension” is another word for this
common condition.
Blood pressure (BP) is the measurement of the pressure or force of blood pushing
against blood vessel walls. Your BP reading has two numbers:
The top number is the systolic blood pressure, which measures the pressure on
your artery walls when your heart beats or contracts.
The bottom number is the diastolic blood pressure. This measures the pressure on
your artery walls between beats when your heart is relaxing.
Healthcare providers measure blood pressure in millimeters of mercury (mmHg).
Definitions of high blood pressure vary slightly depending on where you live.
In the U.S., healthcare providers define high blood pressure (hypertension) as:
A top number (systolic blood pressure) of at least 130 mmHg, and/or
A bottom number (diastolic blood pressure) of at least 80 mmHg.
In Europe, healthcare providers define hypertension as:
A top number of at least 140 mmHg, and/or
A bottom number of at least 90 mmHg.
How common is high blood pressure?
High blood pressure is very common. It affects 47% of adults in the U.S. This
equals about 116 million people. Of those, 37 million have a blood pressure of at
least 140/90 mmHg.
High blood pressure caused or contributed to over 670,000 deaths in the U.S. in
2020.
The World Health Organization estimates that globally, over 1.2 billion people
ages 30 to 79 have hypertension. About 2 in 3 of those individuals live in low- or
middle-income countries.
Symptoms and Causes
What are the signs and symptoms of high blood pressure?
Usually, high blood pressure causes no signs or symptoms. That’s why healthcare
providers call it a “silent killer.” You could have high blood pressure for years and
not know it. In fact, the World Health Organization estimates that 46% of adults
with hypertension don’t know they have it.
When your blood pressure is 180/120 mmHg or higher, you may experience
symptoms like headaches, heart palpitations or nosebleeds. Blood pressure this
high is a hypertensive crisis that requires immediate medical care
What are the types of high blood pressure?
Your provider will diagnose you with one of two types of high blood pressure:
Primary hypertension. Causes of this more common type of high blood pressure
(about 90% of all adult cases in the U.S.) include aging and lifestyle factors like
not getting enough exercise.
Secondary hypertension. Causes of this type of high blood pressure include
different medical conditions or a medication you’re taking.
What causes hypertension?
Primary hypertension doesn’t have a single, clear cause. Usually, many
factors come together to cause it. Common causes include:
Unhealthy eating patterns (including a diet high in sodium).
Lack of physical activity.
High consumption of beverages containing alcohol.
Secondary hypertension has at least one distinct cause that healthcare
providers can identify. Common causes of secondary hypertension include:
Certain medications, including immunosuppressant’s, NSAIDs and oral
contraceptives (the pill).
Kidney disease.
Obstructive sleep apnea.
Primary aldosteronism (Conn’s syndrome).
Recreational drug use (including amphetamines and cocaine).
Renal vascular diseases, which are conditions that affect blood flow in your
kidneys’ arteries and veins. Renal artery stenosis is a common example.
Tobacco use (including smoking, vaping and using smokeless tobacco).
What are the risk factors for high blood pressure?
Risk factors that make you more likely to have high blood pressure include:
Having biological family members with high blood pressure, cardiovascular
disease or diabetes.
Being over age 55.
Being Black.
Having certain medical conditions, including chronic kidney disease, metabolic
syndrome, obstructive sleep apnea or thyroid disease.
Having overweight or obesity.
Not getting enough exercise.
Eating foods high in sodium.
Smoking or using tobacco products.
Drinking too much.

Top number Bottom number

Category And/or
(systolic BP) (diastolic BP)

Normal blood
Less than 120 mmHg AND Less than 80 mmHg
pressure

Elevated blood
120 to 129 mmHg AND Less than 80 mmHg
pressure

Stage 1 hypertension 130 to 139 mmHg OR 80 to 89 mmHg

Stage 2 hypertension 140 mmHg or higher OR 90 mmHg or higher

What are the treatments for high blood pressure?
High blood pressure treatments include lifestyle changes and medications.
Healthcare providers recommend treatment based on your blood pressure readings,
the causes of your high blood pressure and your underlying conditions.
Lifestyle changes to lower your blood pressure
You may be wondering if you can lower your blood pressure naturally. Yes, in
some cases, it’s possible to lower your blood pressure without medication. For
example, your provider may recommend starting with lifestyle changes if you have
elevated blood pressure or stage 1 hypertension.
Sometimes, providers recommend lifestyle changes along with medications to
lower your blood pressure.
Medications to lower your blood pressure
Four classes of blood pressure medications are “first-line” (most effective and
commonly prescribed) when starting treatment:
Angiotensin-converting enzyme (ACE) inhibitors block the production of the
angiotensin II hormone, which the body naturally uses to manage blood pressure.
When the medicine blocks angiotensin II, your blood vessels don’t narrow.
Angiotensin II receptor blockers (ARBs) block this same hormone from binding
with receptors in the blood vessels. ARBs work the same way as ACE inhibitors to
keep blood vessels from narrowing.
Calcium channel blockers prevent calcium from entering the muscle cells of your
heart and blood vessels, allowing these vessels to relax.
Diuretics (water or fluid pills) flush excess sodium from your body, reducing the
amount of fluid in your blood. People often take diuretics with other high blood
pressure medicines, sometimes in one combined pill.
Prevention
Can I prevent high blood pressure?
Fortunately, there are things you can do to reduce your risk of developing high
blood pressure. These include:
Follow a healthy eating plan. This is an important step in keeping your blood
pressure normal. The DASH diet (Dietary Approaches to Stop Hypertension)
emphasizes adding fruits, vegetables and whole grains to your diet.
Cut down on sodium. To prevent hypertension, you should reduce the amount of
sodium in your diet. Try to keep it below 1,500 milligrams a day.
Keep a healthy weight. Going hand-in-hand with a proper diet is keeping a weight
that’s healthy for you. Losing excess weight with diet and exercise will help lower
your blood pressure to healthier levels.
Keep active. Even simple physical activities, such as walking, can lower your
blood pressure (and your weight).
Drink alcohol in moderation. Having more than one drink a day (for women or
people assigned female at birth) or more than two drinks a day (for men or people
assigned male at birth) can raise blood pressure. One drink is defined as 1 ounce
(oz) of alcohol, 5 ounces of wine or 12 ounces of beer.

Arthritis
Arthritis is a disease that causes damage in your joints. Joints are places in your
body where two bones meet.
Some joints naturally wear down as you age. Lots of people develop arthritis after
that normal, lifelong wear and tear. Some types of arthritis happen after injuries
that damage a joint. Certain health conditions also cause arthritis.
Arthritis can affect any joint, but is most common in people’s:
Hands and wrists.
Knees.
Hips.
Feet and ankles.
Shoulders.
Lower back (lumbar spine).
Types of arthritis
There are more than 100 different types of arthritis. Some of the most
common types include:
Osteoarthritis: Wear and tear arthritis.
Rheumatoid arthritis: Arthritis that happens when your immune system
mistakenly damages your joints.
Gout: Arthritis that causes sharp uric acid crystals to form in your joints.
Ankylosing spondylitis: Arthritis that affects joints near your lower back.
Psoriatic arthritis: Arthritis that affects people who have psoriasis.
Juvenile arthritis: Arthritis in kids and teens younger than 16.
Depending on which type of arthritis you have, it can break down the natural tissue
in your joint (degeneration) or cause inflammation (swelling). Some types cause
inflammation that leads to degeneration.
Arthritis is extremely common. Experts estimate that more than one-third of
Americans have some degree of arthritis in their joints.
Osteoarthritis is the most common type. Studies have found that around half of all
adults will develop osteoarthritis at some point.
Symptoms and Causes
There are more than 100 types of arthritis, but they share several common signs
and symptoms.
The most common signs and symptoms of arthritis usually affect your joints and
your ability to use them.
What are arthritis symptoms and signs?
The most common arthritis symptoms and signs include:
Joint pain.
Stiffness or reduced range of motion (how far you can move a joint).
Swelling (inflammation).
Skin discoloration.
Tenderness or sensitivity to touch around a joint.
A feeling of heat or warmth near your joints.
Where you experience symptoms depends on which type of arthritis you have, and
which of your joints it affects.
Some types of arthritis cause symptoms in waves that come and go called flares or
flare-ups. Others make your joints feel painful or stiff all the time, or after being
physically active.
What is the main cause of arthritis?
What causes arthritis varies depending on which type you have:
Osteoarthritis happens naturally as you age — a lifetime of using your joints can
eventually wear down their cartilage cushioning.
You may develop gout if you have too much uric acid in your blood
(hyperuricemia).
Your immune system can cause arthritis (including rheumatoid arthritis) when it
damages your joints by mistake.
Certain viral infections (including COVID-19) can trigger viral arthritis.
Sometimes, arthritis happens with no cause or trigger. Providers call this idiopathic
arthritis.
What are the risk factors?
Anyone can develop arthritis, but some factors may make you more likely to,
including:
Tobacco use: Smoking and using other tobacco products increases your risk.
Family history: People whose biological family members have arthritis are more
likely to develop it.
Activity level: You might be more likely to have arthritis if you aren’t physically
active regularly.
Other health conditions: Having autoimmune diseases, obesity or any condition
that affects your joints increases the chances you’ll develop arthritis.
What is arthritis treatment?
There’s no cure for arthritis, but your healthcare provider will help you find
treatments that manage your symptoms. Which treatments you’ll need depend on
what’s causing the arthritis, which type you have and which joints it affects.
The most common arthritis treatments include:
Over-the-counter (OTC) anti-inflammatory medicine like NSAIDs or
acetaminophen.
Corticosteroids (prescription anti-inflammatory medicine, including cortisone
shots).
Disease-modifying antirheumatic drugs (DMARDs) if you have rheumatoid or
psoriatic arthritis.
Physical therapy or occupational therapy can help you improve your strength,
range of motion and confidence while you’re moving.
Surgery (usually only if nonsurgical treatments don’t relieve your symptoms).
How do I prevent arthritis?
Some forms of arthritis happen naturally or because of health conditions you can’t
change, so there’s not always a way to prevent it. However, you can lower your
chances of developing arthritis by:
Avoiding tobacco products.
Following a diet and exercise plan that’s healthy for you.
Doing low-impact exercise.
Always wearing proper protective equipment for any activity that could damage
your joints.

Cancer
Cancer is a large group of diseases with one thing in common: They happen when
normal cells become cancerous cells that multiply and spread. Your genes send
instructions to your cells — like when to start and stop growing, for example.
Normal cells follow these instructions, but cancer cells ignore them.
Cancer is the second most common cause of death in the U.S. But fewer people are
dying of cancer now than 20 years ago. Early detection and innovative treatments
are curing cancer and helping people with cancer live longer.
Types of cancer
There are over 100 types of cancer. Healthcare providers categorize them
according to where they start in your body and the type of tissue they affect. There
are three broad cancer classifications:
Solid cancers: This is the most common type of cancer, making up about 80% to
90% of all cases. This includes carcinoma that forms in epithelial tissue (like your
skin, breast, colon and lungs) and sarcoma that forms in bone and connective
tissues.
Blood cancers: These are cancers that start in your blood cells or lymphatic
system. Examples include leukemia, lymphoma and multiple myeloma.
Mixed: Cancers that involve two classifications or subtypes. Examples include
carcinosarcoma and adenosquamous carcinoma.
The most common cancers in the U.S. are:
Breast cancer.
Lung cancer.
Prostate cancer.
Colorectal cancer.
Blood cancers.
Symptoms and Causes
What are the symptoms of cancer?
Symptoms of cancer vary from person to person. They depend on what type of
cancer you have and how advanced it is.
General cancer symptoms may include:
Fatigue.
Fever that occurs mostly at night.
Loss of appetite.
Night sweats.
Persistent pain.
Skin changes, particularly moles that change shape and size or new moles.
Unexplained weight loss.
In some cases, cancer may cause organ-specific additional symptoms. This
may include:
Blood in your pee or stool.
Change in the shape, color or size of skin mole.
Coughing up blood.
New lumps or bumps.
Risk factors
There isn’t one single cause for cancer. Rather, certain things can increase your
chance of developing it, like:
Family history. If you have close biological family members (parents, siblings,
grandparents) who have cancer, you have a higher risk of developing it.
Smoking. Smoking tobacco or using e-cigarettes increases your chance of
developing lung, esophageal, pancreatic and oral cancer.
Environmental factors. Exposure to toxins in your environment, like asbestos,
pesticides and radon, can eventually lead to cancer.
Malnutrition. High-fat or high-sugar foods can increase your risk for many types
of cancer. You’re also more vulnerable to disease if you don’t get enough physical
activity.
Hormone therapy. Women and people assigned female at birth (AFAB) taking
hormone replacement therapy may have an increased risk for breast cancer and
uterine cancer.
Radiation exposure. Ultraviolet (UV) radiation from the sun significantly
increases your risk of developing skin cancer. Over-exposure to radiation therapy
can also be a risk factor.
Cancer stage determined?
Healthcare providers use cancer staging systems to plan treatment and develop a
prognosis or expected outcome.
Most cancers have four stages. The specific stage is determined by a few different
factors, including the tumor’s size and location.
Stage I-III (1-3) (early-stage or locally advanced) usually describes cancer when it
has grown directly into surrounding tissue or has spread to nearby lymph nodes.
Stage IV (4) (or metastatic) means that cancer cells have spread to distant areas of
your body through your bloodstream or lymphatic system.
Cancer treated
Healthcare providers may use several different treatments, sometimes combining
treatments based on your situation. Common cancer treatments include:
Surgery: Can remove cancerous tumors that haven’t spread.
Chemotherapy: Destroys cancer cells with powerful drugs in pill form or
intravenously (through a needle into a vein).
Radiation therapy: Kills cancer cells with high dosages of radiation.
Immunotherapy: Engages your immune system to fight the disease.
Targeted therapy: Targets the genetic mutations (changes) that turn healthy cells
into cancer cells.
Hormone therapy: Blocks cancer-causing hormones. For example, people
assigned male at birth who have prostate cancer might receive hormones to lower
testosterone, which can contribute to prostate cancer.
Bone marrow transplant: Replaces damaged blood stem cells with healthy ones.
Cancer treatments can cause several side effects. These side effects vary depending
on which treatment you have and how your body tolerates it. If you develop side
effects during your cancer treatment, let your healthcare provider know. They may
be able to give you recommendations or medications that can help.
Prevention
Can cancer be prevented?
You can’t always prevent cancer, especially when unavoidable risk factors
cause it. But there are things you can do to lower your risk:
If you smoke or use tobacco, try to stop. Ask a healthcare provider about smoking
cessation programs that can help you quit tobacco.
Follow a nutrition plan that’s healthy for you.
Include physical activity in your daily routine.
Avoid environmental toxins like asbestos and pesticides.
Protect yourself against sun damage.
Have regular cancer screenings.

Anemia
Anemia is a blood disorder that happens when you don’t have enough red blood
cells or your red blood cells don’t work as they should. Some types of anemia are
inherited, but people may also acquire or develop the condition during their
lifetimes.
Symptoms and Causes
What are the symptoms of anemia?
Fatigue — feeling too tired to manage your activities — is the most noticeable
anemia symptom. Other symptoms may include:
Chest pain.
Dizziness.
Frequent infections.
Heart palpitations.
Headache.
Pallor (skin color that’s paler than usual).
Pulsatile tinnitus.
Shortness of breath (dyspnea).
What causes anemia?
Many things can cause it. For example, iron-deficiency anemia is the most
common type of anemia. You can develop this type if you don’t get enough iron
from the food you eat, or if you lose blood from an injury or illness. Healthcare
providers classify anemia as being acquired or inherited.
Acquired anemias include:
Anemia of chronic disease: You can develop this condition if you have an illness
that causes chronic inflammation, making it hard for your body to use the iron it
needs to make red blood cells.
Autoimmune hemolytic anemia: In this case, your immune system attacks your
red blood cells.
Macrocytic anemia and megaloblastic anemia: These are types of anemia that
develop when your bone marrow makes unusually large red blood cells. Certain
medical conditions and vitamin deficiencies may cause these types of anemia.
Healthcare providers may call these conditions vitamin deficiency anemia.
Normocytic anemia: In this type, you have fewer red blood cells than usual. There
are many causes of normocytic anemia.
Pernicious anemia: This condition, which is one of the causes of vitamin B12
deficiency, is an autoimmune condition that prevents your body from absorbing
vitamin B12.
You can also develop anemia if you have certain chronic diseases. Anemia may be
a symptom or complication of the following:
Autoimmune diseases.
Cancer.
Inflammatory bowel disease (IBD).
Kidney disease.
Liver disease.
Thyroid disease.
What are the complications of anemia?
Chronic anemia can cause serious medical issues like heart attack, heart failure and
organ damage. Chronic anemia is anemia that healthcare providers don’t diagnose
and treat or that continues despite treatment.
Management and Treatment
How is anemia treated?
Your treatment will vary depending on the cause. If you have anemia because you
have an underlying condition, your provider will treat that condition. But they may
also do the following treatments specifically for anemia. Treatments may include
dietary supplements or medications.
Dietary supplements
Your provider may recommend the following supplements for anemia:
Iron supplements: This supplement comes in capsules or tablets that you can take
by mouth with a glass of water.
Folic acid supplements: Vitamin B9 (folate) is an essential vitamin that helps
your body form red blood cells and DNA, which are the building blocks of your
body.
Vitamin B12 supplements: Vitamin B12 supplements support the production of
healthy red blood cells.
Medications
Providers may prescribe medications for anemia, including:
Erythropoietin: This medication helps your bone marrow to produce more blood
stem cells.
Immunosuppressants: If you have anemia because of an autoimmune disorder,
your provider may prescribe medication that keeps your immune system from
attacking your red blood cells.
Procedures
In some cases, your provider may recommend:
Blood transfusion to replace red blood cells.
Stem cell (bone marrow) transplant to replace unhealthy blood stem cells with
healthy ones.
Surgery to treat internal bleeding that’s causing anemia.
Prevention
Can anemia be prevented?
You may be able to prevent the most common type of anemia, iron-deficiency
anemia, by including iron-rich foods in your everyday meals and snacks. But there
are other types of anemia you can’t prevent, including inherited disorders.

Kidney Disease
Kidney Disease
Kidney disease can affect your body’s ability to clean your blood, filter extra water
out of your blood, and help control your blood pressure. It can also affect red blood
cell production and vitamin D metabolism needed for bone health.
When your kidneys are damaged, waste products and fluid can build up in your
body. That can cause swelling in your ankles, nausea, weakness, poor sleep, and
shortness of breath. Without treatment, the damage can get worse and your kidneys
may eventually stop working. That’s serious, and it can be life-threatening.
Kidney Functions
Healthy kidneys:
Keep a balance of water and minerals (such as sodium, potassium, and
phosphorus) in your blood
Remove waste from your blood after digestion, muscle activity, and exposure to
chemicals or medications
Make renin, which your body uses to help manage your blood pressure
Make a chemical called erythropoietin, which prompts your body to make red
blood cells
Make an active form of vitamin D, needed for bone health and other bodily
functions
Filter all the blood in your body every 30 minutes.
Stage GFR (mL/min) What It Means
Your kidneys are working
Stage 1 90 and higher well but you have signs of
mild kidney damage.
Your kidneys are working
Stage 2 60 to 89 well but you have more signs
of mild kidney damage.
Your kidneys aren’t working
as well as they should and
show mild to moderate
Stage 3a 45 to 59 damage. This is the most
common stage. You may
notice symptoms at this
stage.
Your kidneys show moderate
damage and don’t work as
well as they should. With the
Stage 3b 30 to 44
right treatment, many people
can stay in this stage and
never advance to stage 4.
You have very poor kidney
function; your kidneys are
Stage 4 15 to 29
severely damaged and close
to not working.
Your kidneys are very close
to failing or have stopped
Stage 5 Less than 15 working. You may need
kidney dialysis or a kidney
transplant at this stage.

Types of Kidney Disease

Chronic kidney disease (CKD)
CKD is a condition where your kidneys can't filter toxins or extra fluid from your
blood as well as they should. While the condition can vary in how serious it is,
CKD usually gets worse over time. Treatment can slow the progression of the
disease.
If left untreated, CKD may lead to kidney failure. At this stage, called end-stage
renal disease (ESRD), the condition must be treated by dialysis or kidney
transplant. Diabetes and high blood pressure are the leading causes of CKD.
It's estimated that 1 in 7 adult Americans have the condition. But 40% of those
with serious chronic kidney disease aren't aware they have the condition.
Other common forms of kidney disease include:
Polycystic kidney disease. This genetic disorder causes cysts (fluid-filled sacs) to
grow on your kidneys, limiting their ability to filter waste from your blood.
Lupus nephritis. Lupus is an autoimmune disease, meaning your immune system
attacks healthy cells. Lupus nephritis is when your immune system attacks your
kidneys.
Interstitial nephritis. This condition happens when you have a bad reaction to a
medicine that limits your kidneys' ability to filter toxins. If you stop the medicine,
your kidney health should improve.
Glomerulonephritis (glomerular disease). Glomeruli are the thousands of tiny
filters that remove waste from your blood in your kidneys. This condition damages
them, and your kidneys can't function as well. Inflammation in the glomeruli can
happen after a strep infection, as well.
APOL1-mediated kidney disease. Normally, the APOL1 gene helps make an
immune system protein, but if you inherit a mutated version of the gene from both
parents, you may be more at risk for kidney disease. You may be more likely to
have this gene mutation if you identify as Black, African American, Afro-
Caribbean, or Latina/Latino.
Long-lasting viral illnesses. HIV and AIDS, hepatitis B, and hepatitis C may
cause kidney disease.
Pyelonephritis. This is a urinary tract infection within the kidneys, which can
result in scarring as the infection heals. It can lead to kidney damage if it happens
several times.
Kidney Disease Causes
Acute kidney disease causes: If your kidneys suddenly stop working, doctors call it
acute kidney injury or acute renal failure. The main causes are:
Not enough blood flow to the kidneys
Direct damage to the kidneys
Urine backed up in the kidneys
Those things can happen when you:
Have a traumatic injury with blood loss, such as being in a car wreck
Are dehydrated or your muscle tissue breaks down, sending too much kidney-toxic
protein into your bloodstream
Go into shock because you have a severe infection called sepsis
Have an enlarged prostate or kidney stones that block your urine flow
Take certain drugs or are around certain toxins that directly damage the kidney
Have complications during a pregnancy, such as eclampsia and preeclampsia
Kidney Disease Symptoms
Your kidneys are very adaptable. They can compensate for some of the problems
that can happen when you have kidney disease. So if your kidney damage gets
worse slowly, your symptoms will reveal themselves slowly over time. In fact, you
may not feel symptoms until your disease is advanced.
You might have:
High blood pressure
Nausea and vomiting
Loss of appetite
A metallic taste in your mouth
Fatigue
Weakness
Trouble thinking
Sleep issues
Muscle twitches and cramps
Swelling in your feet and ankles
Itching that won't go away
Chest pain if fluid builds up around the lining of the heart
Shortness of breath if fluid builds up in the lungs
Medications for kidney disease
Depending on the cause of your kidney disease, you may be prescribed one or
more medications. Medications your nephrologist may prescribe include:
An angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor
blocker (ARB) to lower your blood pressure.
Phosphate binder if your kidneys can’t eliminate phosphate.
A diuretic to help your body eliminate extra fluid.
Medications to lower cholesterol levels.
Erythropoietin to build red blood cells if you’re anemic.
Vitamin D and calcitriol to prevent bone loss.
kidney disease be prevented
Seeing your healthcare provider on a regular basis throughout your life is a good
start for preventing kidney disease. About 1 in every 3 people in the United States
is at risk for kidney disease. People at high risk may have regular tests to check for
CKD so it’s detected as early as possible. Some other things you can do to prevent
CKD are:
Manage your high blood pressure.
Manage your blood sugar if you have diabetes.
Eat a well-balanced diet.
Don’t smoke or use tobacco.
Be active for 30 minutes at least five days a week.
Maintain a healthy weight.
Take nonprescription pain relievers only as directed. Taking more than directed
can damage your kidneys.
Limit alcohol-containing beverages.
 Colorectal (Colon) Cancer

Colon (colorectal) cancer starts in your colon (large intestine), the long tube that
helps carry digested food to your rectum and out of your body.
Colon cancer develops from certain polyps or growths in the inner lining of your
colon. Healthcare providers have screening tests that detect precancerous polyps
before they can become cancerous tumors. Colon cancer that’s not detected or
treated may spread to other areas of your body. Thanks to screening tests, early
treatment and new kinds of treatment, fewer people are dying from colon cancer.
Who is affected by colon cancer?
Colon cancer is the third most common cancer diagnosed in people in the U.S.
According to the U.S. Centers for Disease Control and Prevention (CDC), men and
people assigned male at birth (AMAB) are slightly more likely to develop colon
cancer than women and people assigned female at birth (AFAB). Colon cancer
affects more people who are Black than people who are members of other ethnic
groups or races.
Colon cancer typically affects people age 50 and older. Over the past 15 years,
however, the number of people age 20 to 49 with colon cancer has increased by
about 1.5% each year. Medical researchers aren’t sure why this is happening.
Symptoms and Causes
Common symptoms of colon cancer include:
Blood on or in your stool (poop): Talk to a healthcare provider if you notice
blood in the toilet after you poop or after wiping, or if your poop looks dark or
bright red. It’s important to remember blood in poop doesn’t mean you have colon
cancer. Other things — from hemorrhoids to anal tears to eating beets — may
change your poop’s appearance. But it’s always better to check with a healthcare
provider any time you notice blood in or on your stool.
Persistent changes in your bowel habits (how you poop): Talk to a healthcare
provider if you have persistent constipation and/or diarrhea, or if you feel as if you
still need to poop after going to the bathroom.
Abdominal (belly) pain: Talk to a healthcare provider if you have belly pain with
no known cause, that doesn’t go away or hurts a lot. Many things may cause belly
pain, but it’s always best to check with a healthcare provider if you have unusual
or frequent belly pain.
Bloated stomach: Like belly pain, there are many things that may make you feel
bloated. Talk to a healthcare provider if your bloated belly lasts for more than a
week, gets worse or you have other symptoms like vomiting or blood in or on your
poop.
Unexplained weight loss: This is a noticeable drop in your body weight when
you’re not trying to lose weight.
Vomiting: Talk to a healthcare provider if you’ve been vomiting periodically for
no known reason or if you vomit a lot in 24 hours.
Fatigue and feeling short of breath: These are symptoms of anemia. Anemia
may be a sign of colon cancer.

How do healthcare providers stage colon cancer?

Healthcare providers use the TNM cancer staging system developed by the
American Joint Committee on Cancer to stage colon cancer.
There are five stages of colon cancer. Three of the four stages have three sub-
stages. The colon cancer staging system includes the following:
Stage 0: Healthcare providers may refer to this as carcinoma in situ. When they
do, they’re talking about abnormal or precancerous cells in your mucosa, the
innermost layer of your colon wall.
Stage I: Stage I colorectal cancer has grown into the wall of your intestine but
hasn’t spread beyond the muscular coat or into close lymph nodes.
Stage II: The cancer has spread farther into the wall of your intestine but hasn’t
spread to nearby lymph nodes. There are three types of Stage II colon cancer:
Stage IIA: Cancer has spread through most of your colon wall but hasn’t grown
into the wall’s outer layer.
Stage IIB: Cancer has spread into the outer layer of your colon wall or through the
wall.
Stage IIC: Cancer has spread to a nearby organ.
Stage III: In this stage, colon cancer has spread to your lymph nodes. Like Stage II
colon cancer, there are three sub-stages of Stage III colon cancer:
Stage IIIA: There’s cancer in the first or second layers of your colon wall and it’s
spread to one to four lymph nodes.
Stage IIIB: The cancer affects more layers of your colon wall but only affects one
to three lymph nodes. Cancer that affects fewer colon wall layers but has spread to
four or more lymph nodes is also a stage IIIB colon cancer.
Stage IIIC: There’s cancer in the outer layer or the next outermost layer of your
colon and in four or more lymph nodes. Cancer that’s spread into a nearby organ
and one or more lymph nodes is also a stage IIIC colon cancer.
Stage IV: Cancer has spread (metastasized) to other areas of your body, such as
your liver, lungs or ovaries:
Stage IVA: In this stage, cancer has spread to one organ or to lymph nodes that are
farther or more distant from your colon.
Stage IVB: The cancer has moved to more than one distant organ and more lymph
nodes.
Stage IVC: Cancer affects distant organs, lymph nodes and abdominal tissue.
Surgery is the most common colon cancer treatment. There are different
colon cancer surgeries and procedures:
Polypectomy: This surgery removes cancerous polyps.
Partial colectomy: This is also called colon resection surgery. Surgeons remove
the section of your colon that contains a tumor and some surrounding healthy
tissue. They’ll reconnect healthy colon sections in a procedure called anastomosis.
Surgical resection with colostomy: Like a colectomy, surgeons remove the
section of your colon that contains a tumor. In this surgery, however, they can’t
connect healthy colon sections. Instead, they do a colostomy. In a colostomy, your
bowel is moved to an opening in your abdominal wall so your poop is collected in
a bag.
Radiofrequency ablation: This procedure uses heat to destroy cancer cells.

Prevention
You may not be able to prevent colon cancer, but you can reduce your risk of
developing the condition by managing risk factors:
Avoid tobacco. If you smoke and want help quitting, talk to a healthcare provider
about smoking cessation programs.
Use moderation when you drink beverages containing alcohol.
Maintain a healthy weight.
Eat a healthy diet. Add fruit and vegetables to your diet and cut back on red meat
processed foods, and high-fat and high-calorie foods. Drinking coffee may lower
your risk of developing colon cancer.
Keep track of your family medical history.Colon cancer can run in families. Tell
your healthcare provider if your biological parents, siblings or children have colon
cancer or an advanced polyp or if any of your family has cancer before age 45.
Follow colon cancer screening guidelines. Ask your healthcare provider when
you should have colon cancer screening. If you have chronic irritable bowel
disease or a family history of colon cancer, your healthcare provider may
recommend you start screening earlier than age 45.