sequelae

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

Over time, having too much glucose in your blood can cause complications, including:

• Eye disease, due to changes in fluid levels, swelling in the tissues, and damage to the blood vessels in the eyes
• Foot problems, caused by damage to the nerves and reduced blood flow to your feet
• Gum disease and other dental problems, because a high amount of blood sugar in your saliva helps harmful bacteria grow in your mouth. The bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause gum disease and bad breath. Other types cause tooth decay and cavities.
• Heart disease and stroke, caused by damage to your blood vessels and the nerves that control your heart and blood vessels
• Kidney disease, due to damage to the blood vessels in your kidneys. Many people with diabetes develop high blood pressure. That can also damage your kidneys.
• Nerve problems (diabetic neuropathy), caused by damage to the nerves and the small blood vessels that nourish your nerves with oxygen and nutrients
• Sexual and bladder problems, caused by damage to the nerves and reduced blood flow in the genitals and bladder
• Skin conditions, some of which are caused by changes in the small blood vessels and reduced circulation. People with diabetes are also more likely to have infections, including skin infections.

If you have diabetes, you need to watch out for blood sugar levels that are very high (hyperglycemia) or very low (hypoglycemia). These can happen quickly and can become dangerous. Some of the causes include having another illness or infection and certain medicines. They can also happen if you don't get the right amount of diabetes medicines. To try to prevent these problems, make sure to take your diabetes medicines correctly, follow your diabetic diet, and check your blood sugar regularly.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Every pregnancy has some risk of problems, but there are certain conditions and health issues that can raise that risk, such as:

• A health condition you had before you got pregnant
• A health condition you develop during pregnancy
• A pregnancy with more than one baby
• A health problem that happened during a previous pregnancy and could happen again
• Substance use during pregnancy
• Being over age 35

Any of these can affect your health, the health of your baby, or both.

If you have a chronic condition, you should talk to your health care provider about how to minimize your risk before you get pregnant. Once you are pregnant, you may need a health care team to monitor your pregnancy. Some common conditions that can complicate a pregnancy include:

• High blood pressure
• Kidney problems
• Autoimmune diseases
• Obesity
• HIV
• Cancer
• Infections

Other conditions that may make pregnancy risky can develop during pregnancy - for example, gestational diabetes and Rh incompatibility. Good prenatal care can help detect and treat them.

Some symptoms, such as nausea, back pain, and fatigue, are common during pregnancy. Sometimes it is hard to know what is normal. Call your health care provider if something is bothering or worrying you.

Sickle cell disease (SCD) is a group of inherited red blood cell disorders. If you have SCD, there is a problem with your hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen throughout the body. With SCD, the hemoglobin forms into stiff rods within the red blood cells. This changes the shape of the red blood cells. The cells are supposed to be disc-shaped, but this changes them into a crescent, or sickle, shape.

The sickle-shaped cells are not flexible and cannot change shape easily. Many of them burst apart as they move through your blood vessels. The sickle cells usually only last 10 to 20 days, instead of the normal 90 to 120 days. Your body may have trouble making enough new cells to replace the ones that you lost. Because of this, you may not have enough red blood cells. This is a condition called anemia, and it can make you feel tired.

The sickle-shaped cells can also stick to vessel walls, causing a blockage that slows or stops the flow of blood. When this happens, oxygen can't reach nearby tissues. The lack of oxygen can cause attacks of sudden, severe pain, called pain crises. These attacks can occur without warning. If you get one, you might need to go to the hospital for treatment.

The cause of SCD is a defective gene, called a sickle cell gene. People with the disease are born with two sickle cell genes, one from each parent.

If you are born with one sickle cell gene, it's called sickle cell trait. People with sickle cell trait are generally healthy, but they can pass the defective gene on to their children.

In the United States, most of the people with SCD are African Americans:

• About 1 in 13 Black or African American babies are born with sickle cell trait
• About 1 in every 365 Black or African American babies are born with sickle cell disease

SCD also affects some people who come from Hispanic, southern European, Middle Eastern, or Asian Indian backgrounds.

People with SCD start to have signs of the disease during the first year of life, usually around 5 or 6 months of age. Early symptoms of SCD may include:

• Painful swelling of the hands and feet
• Fatigue or fussiness from anemia
• A yellowish color of the skin (jaundice) or the whites of the eyes (icterus)

The effects of SCD vary from person to person and can change over time. Most of the signs and symptoms of SCD are related to complications of the disease. They may include severe pain, anemia, organ damage, and infections.

A blood test can show if you have SCD or sickle cell trait. All states now test newborns as part of their screening programs, so treatment can begin early.

People who are thinking about having children can have the test to find out how likely it is that their children will have SCD.

Health care providers can also diagnose SCD before a baby is born. That test uses a sample of amniotic fluid (the liquid in the sac surrounding the baby) or tissue taken from the placenta (the organ that brings oxygen and nutrients to the baby).

Treatments for SCD include:

• Bone marrow or stem cell transplantation, which can cure SCD. Because these transplants are risky and can have serious side effects, they are usually only used in children with severe SCD. For the transplant to work, the bone marrow must be a close match. Usually, the best donor is a brother or sister.
• Gene therapies to treat SCD in people who are 12 years and older and have had repeated sickle cell crises. These new therapies involve taking some of your blood stem cells and either adding new DNA to them or changing their existing DNA. Then these cells are given back to you, and they can make a type of hemoglobin that is healthy. This can reduce the complications of SCD, including the SCD crises.
• Treatments that can help relieve symptoms and lessen complications, including:
  • Antibiotics to try to prevent infections in younger children
  • Pain relievers for acute or chronic pain
  • Hydroxyurea, a medicine that has been shown to reduce or prevent several SCD complications. It increases the amount of fetal hemoglobin in the blood. This medicine is not right for everyone; talk to your provider about whether you should take it. This medicine is not safe during pregnancy.
  • Blood transfusions for severe anemia. If you have had some serious complications, such as a stroke, you may have transfusions to prevent more complications.
  • Other treatments for specific complications, such as medicines to lower blood pressure and vitamins to treat a vitamin deficiency.

To stay as healthy as possible, make sure that you:

• Get regular medical care
• Get your routine vaccinations
• Live a healthy lifestyle
• Avoid situations that may set off a pain crisis

NIH: National Heart, Lung, and Blood Institute

Atherosclerosis is a condition in which plaque builds up inside your arteries. Plaque is a sticky substance made up of cholesterol, fat, blood cells, calcium, and other substances found in the blood. Over time, plaque hardens and causes your arteries to narrow. That limits the flow of oxygen-rich blood to your body.

Some people may confuse atherosclerosis and arteriosclerosis, but they are not the same thing:

• Arteriosclerosis is hardening of the arteries, which means that the arteries thicken and become less flexible. It can have several different causes.
• Atherosclerosis, which develops from plaque buildup, is a common type of arteriosclerosis.

Atherosclerosis can affect most of the arteries in the body. It has different names, based on which arteries are affected:

• Coronary artery disease (CAD) is plaque buildup in the arteries of your heart.
• Peripheral artery disease (PAD) is plaque buildup in the arteries that carry blood away from the heart to other parts of the body. It most often affects the arteries of your legs, but it can also affect the arteries of your arms or pelvis.
• Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to the brain.
• Renal artery stenosis is plaque buildup in the arteries that supply blood to your kidneys.
• Vertebral artery disease is plaque buildup in the arteries that supply blood to the back of your brain.
• Mesenteric artery ischemia is plaque buildup in the arteries that supply your intestines with blood.

Plaque often starts to build up during childhood and gets worse with age. The exact cause is unknown, but researchers believe that this buildup happens when there is damage to the arteries. This damage may be caused by unhealthy lifestyle habits, medical conditions, and your genes.

You may be more likely to develop atherosclerosis if you:

• Have certain medical conditions, including:
  • High blood pressure
  • High blood cholesterol
  • Diabetes
  • Metabolic syndrome
  • Inflammatory diseases such as rheumatoid arthritis and psoriasis
• Have a family history of high blood cholesterol
• Eat a lot of foods high in saturated fats
• Smoke or chew tobacco
• Are older - the risk increases after age 45 men and age 55 in women

In the early stages, atherosclerosis often does not cause any symptoms. You may first notice some symptoms at times when your body needs more oxygen. For example, this could be when you are having physical or emotional stress.

Your symptoms will depend on which arteries are affected and how much blood flow is blocked:

• With coronary artery disease, the symptoms may include angina (a type of chest pain), palpitations (racing or pounding heart), and shortness of breath.
• With carotid artery disease, you may have a bruit. This is a whooshing sound that your health care provider hears when using a stethoscope. You could also have a transient ischemic attack (TIA), sometimes called a mini-stroke.
• With peripheral artery disease, you may have pain, aching, heaviness, or cramping in the legs when walking or climbing stairs.
• With vertebral artery disease, you may have problems with thinking and memory, weakness or numbness on one side of the body or face, and vision trouble. You could also have a transient ischemic attack.
• With mesenteric artery ischemia, the symptoms can include severe pain after meals, weight loss, and diarrhea.

For men, erectile dysfunction (ED) is an early warning sign that you may be at higher risk for atherosclerosis and its complications. If you have ED, talk with your provider about your risk of plaque buildup.

Atherosclerosis can cause other health problems, or complications. For example, if a plaque bursts, a blood clot may form. The clot could block the artery completely or travel to another part of the body. Other possible complications can vary, depending on which arteries are affected. For example, blockages in different parts of the body can lead to complications such as a heart attack, stroke, vascular dementia, or limb loss.

To find out if you have atherosclerosis, your provider:

• Will ask about your medical and family health history
• Will ask about your lifestyle and risk factors for plaque buildup in the arteries
• Will do a physical exam, which will include listening to your heart and the blood flow in your arteries
• Will likely order tests, such as blood tests and heart health tests

If you have atherosclerosis, your provider will work with you to create a treatment plan that works for you. Your plan will depend on which arteries are affected, how much the blood flow is blocked, and what other medical conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes.
• Medicines to:
  • Manage your risk factors.
  • Treat atherosclerosis or its complications.
  • Treat any medical conditions you have that can worsen plaque buildup.
• Procedures or surgeries to treat diseases or complications that were caused by plaque buildup. The specific type of procedure or surgery will depend on which arteries are affected.
• Cardiac rehabilitation, if you have had certain complications from atherosclerosis.

There are steps you can take to try to prevent atherosclerosis:

• Choose heart-healthy foods, such fruits, vegetables, and whole grains. Limit foods that are high in saturated fats, salt, and added sugars.
• Do regular physical activity. But before you start an exercise program, ask your provider what level of physical activity is right for you.
• Aim for a healthy weight.
• Limit how much alcohol you drink. Drinking less is better for health than drinking more. Men should limit their intake to 2 drinks or less in a day. Women should drink 1 drink or less per day.
• Manage stress.
• If you smoke, quit smoking.
• Avoid secondhand smoke.
• Get enough good-quality sleep.

NIH: National Heart, Lung, and Blood Institute

Crohn's disease is a chronic (long-lasting) disease that causes inflammation in your digestive tract. It can affect any part of your digestive tract, which runs from your mouth to your anus. But it usually affects your small intestine and the beginning of your large intestine.

Crohn's disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

The cause of Crohn's disease is unknown. Researchers think that an autoimmune reaction may be one cause. An autoimmune reaction happens when your immune system attacks healthy cells in your body. Genetics may also play a role, since Crohn's disease can run in families.

Stress and eating certain foods don't cause the disease, but they can make your symptoms worse.

There are certain factors that may raise your risk of Crohn's disease:

• Family history of the disease. Having a parent, child, or sibling with the disease puts you at higher risk.
• Smoking. This may double your risk of developing Crohn's disease.
• Certain medicines, such as antibiotics, birth-control pills, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. These may slightly increase your chance of developing Crohn's.
• A high-fat diet. This may also slightly increase your risk of Crohn's.

The symptoms of Crohn's disease can vary, depending where and how severe your inflammation is. The most common symptoms include:

• Diarrhea
• Cramping and pain in your abdomen
• Weight loss

Some other possible symptoms are:

• Anemia, a condition in which you have fewer red blood cells than normal
• Eye redness or pain
• Fatigue
• Fever
• Joint pain or soreness
• Nausea or loss of appetite
• Skin changes that involve red, tender bumps under the skin

Stress and eating certain foods such as carbonated (fizzy) drinks and high-fiber foods may make some people's symptoms worse.

Crohn's disease can cause other problems, including:

• Intestinal obstruction, a blockage in the intestine
• Fistulas, abnormal connections between two parts inside of the body
• Abscesses, pus-filled pockets of infection
• Anal fissures, small tears in your anus that may cause itching, pain, or bleeding
• Ulcers, open sores in your mouth, intestines, anus, or perineum
• Malnutrition, when your body does not get the right amount of vitamins, minerals, and nutrients it needs
• Inflammation in other areas of your body, such as your joints, eyes, and skin

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A family history
• A physical exam, including:
  • Checking for bloating in your abdomen.
  • Listening to sounds within your abdomen using a stethoscope.
  • Tapping on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged.
• Various tests, including:
  • Blood and stool tests.
  • A colonoscopy.
  • An upper GI endoscopy, a procedure in which your provider uses a scope to look inside your mouth, esophagus, stomach, and small intestine.
  • Diagnostic imaging tests, such as a CT scan or an upper GI series. An upper GI series uses a special liquid called barium and x-rays. Drinking the barium will make your upper GI tract more visible on an x-ray.

There is no cure for Crohn's disease, but treatments can decrease inflammation in your intestines, relieve symptoms, and prevent complications. Treatments include medicines, bowel rest, and surgery. No single treatment works for everyone. You and your provider can work together to figure out which treatment is best for you:

• Medicines for Crohn's include various medicines that decrease the inflammation. Many of these medicines do this by reducing the activity of your immune system. Certain medicines can also help with symptoms or complications, such as nonsteroidal anti-inflammatory drugs and anti-diarrheal medicines. If your Crohn's causes an infection, you may need antibiotics.
• Bowel rest involves drinking only certain liquids or not eating or drinking anything. This allows your intestines to rest. You may need to do this if your Crohn's disease symptoms are severe. You get your nutrients through drinking a liquid, a feeding tube, or an intravenous (IV) tube. You may need to do bowel rest in the hospital, or you may be able to do it at home. It will last for a few days or up to several weeks.
• Surgery can treat complications and reduce symptoms when other treatments are not helping enough. The surgery will involve removing a damaged part of your digestive tract to treat:
  • Fistulas
  • Bleeding that is life threatening
  • Intestinal obstructions
  • Side effects from medicines when they threaten your health
  • Symptoms when medicines do not improve your condition

Changing your diet can help reduce symptoms. Your provider may recommend that you make changes to your diet, such as:

• Avoiding carbonated drinks
• Avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
• Drinking more liquids
• Eating smaller meals more often
• Keeping a food diary to help identify foods that cause problems

In some cases, your provider may ask you to go on a special diet, such as a diet that is:

• High calorie
• Lactose free
• Low fat
• Low fiber
• Low salt

If you are not absorbing enough nutrients, you may need to take nutritional supplements and vitamins.

National Institute of Diabetes and Digestive and Kidney Diseases

Diverticula are small pouches, or sacs, that bulge outward through weak spots in your colon. They mostly form in the lower part of the colon. Diverticulosis is a condition in which you have these pouches. Most people who have diverticulosis do not have symptoms or problems. But sometimes the pouches can cause symptoms or become inflamed.

Diverticulitis is the name for the condition you have when one or more of the pouches get inflamed. Diverticulitis may come on suddenly. It can sometimes cause serious health problems.

Diverticular disease is a condition that happens when the pouches cause:

• Chronic (long-term) symptoms
• Diverticular bleeding
• Diverticulitis or diverticulitis complications

Researchers aren't sure what causes diverticulosis and diverticulitis. They think certain factors may play a role in causing or increasing the risk for these conditions, including:

• Your genetics. Certain genes may make some people more likely to develop the conditions.
• Lifestyle factors such as:
  • Diets low in fiber and high in red meat
  • Lack of physical activity
  • Taking certain medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids
  • Having obesity
  • Smoking

Researchers are also looking at other possible factors that may play a role in these conditions. Those factors include bacteria or stool (poop) getting caught in a pouch in your colon and changes in the microbiome in the intestines. Your microbiome is made up of the bacteria and other organisms in your intestines.

Diverticulosis is common, especially as people age. More than one-third of U.S. adults between the ages of 50 and 59 have diverticulosis. More than two-thirds who are over age 80 have it. Most of those people will not have symptoms or problems. But some of them will develop diverticulitis.

Diverticulosis usually doesn't cause symptoms. But some people can have chronic symptoms such as:

• Bloating
• Constipation or diarrhea
• Cramping or painin the lower abdomen (belly)

Diverticulitis may cause acute symptoms such as:

• Abdominal pain, most often in the lower left side of your abdomen
• Constipation or diarrhea
• Fevers and chills
• Nausea or vomiting

The pain caused by diverticulitis is usually severe and comes on suddenly. Less often, the pain may be mild and worsen over several days.

Some people with diverticulosis and diverticulitis may develop serious health problems (complications). Diverticular bleeding happens when a small blood vessel within the wall of a pouch bursts. The bleeding may be severe and sometimes even life-threatening.

People with diverticulitis can also develop serious problems such as:

• Abscess, a painful, swollen, pus-filled area caused by infection
• Fistula, an abnormal opening or passage between the colon and another part of the body, such as the bladder or vagina
• Intestinal obstruction, a partial or total blockage that keeps food, fluids, air, or stool from moving through your intestines
• Perforation, or a hole, in your colon
• Peritonitis, an infection of the lining of the abdominal cavity

Diverticulosis may be found when your health care provider is doing tests for another reason. Diverticulitis is usually found when you are having an acute attack.

To make a diagnosis, your provider will review your medical history, do a physical exam, and order tests. The tests may include:

• Blood tests
• Stool tests
• Imaging tests such as CT scan, ultrasound, or MRI
• Colonoscopy

f your diverticulosis is causing chronic symptoms, your provider may recommend:

• High-fiber foods or fiber supplements
• Antibiotics
• Medicines to reduce inflammation
• Probiotics

If you have diverticulitis without complications, your provider may recommend treatment at home. However, you probably need treatment in the hospital if you have severe diverticulitis, diverticulitis with complications, or a high risk for complications.

Treatments for diverticulitis may include:

• Antibiotics, except for very mild cases.
• A clear liquid diet for a short time to rest the colon. Your provider may suggest slowly adding solid foods to your diet as your symptoms improve.
• Medicines for pain. This is usually acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may increase the chance of diverticulitis complications.
• Antispasmodic medicines to relieve spasms.

If your diverticulitis doesn't improve with treatment or if it causes complications, you may need surgery to remove part of your colon.

Your provider may recommend lifestyle changes to prevent diverticulitis:

• Eating a diet high in fiber and low in red meat
• Being physically active on a regular basis
• Not smoking (and quitting smoking if you are a smoker)
• Reaching and maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The flu, also called influenza, is a respiratory infection caused by viruses. Each year, millions of Americans get sick with the flu. Sometimes it causes mild illness. But it can also be serious or even deadly, especially for people over 65, newborn babies, and people with certain chronic illnesses.

The flu is caused by flu viruses that spread from person to person. When someone with the flu coughs, sneezes, or talks, they spray tiny droplets. These droplets can land in the mouths or noses of people who are nearby. Less often, a person may get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes.

Symptoms of the flu come on suddenly and may include:

• Fever or feeling feverish/chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue (tiredness)

Some people may also have vomiting and diarrhea. This is more common in children.

Sometimes people have trouble figuring out whether they have a cold or the flu. There are differences between them:

Sometimes people say that they have a "flu" when they really have something else. For example, "stomach flu" isn't the flu; it's gastroenteritis.

Some people who get the flu will develop complications. Some of these complications can be serious or even life-threatening. They include:

• Bronchitis
• Ear infection
• Sinus infection
• Pneumonia
• Inflammation of the heart (myocarditis), brain (encephalitis), or muscle tissues (myositis, rhabdomyolysis)

The flu also can make chronic health problems worse. For example, people with asthma may have asthma attacks while they have flu.

Certain people are more likely to have complications from the flu, including:

• Adults 65 and older
• Pregnant women
• Children younger than 5
• People with certain chronic health conditions, such as asthma, diabetes, and heart disease

To diagnose the flu, health care providers will first do a medical history and ask about your symptoms. There are several tests for the flu. For the tests, your provider will swipe the inside of your nose or the back of your throat with a swab. Then the swab will be tested for the flu virus.

Some tests are quick and give results in 15-20 minutes. But these tests are not as accurate as other flu tests. These other tests can give you the results in one hour or several hours.

Most people with the flu recover on their own without medical care. People with mild cases of the flu should stay home and avoid contact with others, except to get medical care.

But if you have symptoms of flu and are in a high risk group or are very sick or worried about your illness, contact your health care provider. You might need antiviral medicines to treat your flu. Antiviral medicines can make the illness milder and shorten the time you are sick. They also can prevent serious flu complications. They usually work best when you start taking them within 2 days of getting sick.

The best way to prevent the flu is to get a flu vaccine every year. But it's also important to have good health habits like covering your cough and washing your hands often. This can help stop the spread of germs and prevent the flu.

Centers for Disease Control and Prevention

After any operation, you'll have some side effects. There is usually some pain with surgery. There may also be swelling and soreness around the area that the surgeon cut. Your surgeon can tell you which side effects to expect.

There can also be complications. These are unplanned events linked to the operation. Some complications are infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions.

Your surgeon can tell you how you might feel and what you will be able to do - or not do - the first few days, weeks, or months after surgery. Some other questions to ask are:

• How long you will be in the hospital
• What kind of supplies, equipment, and help you might need when you go home
• When you can go back to work
• When it is ok to start exercising again
• Are they any other restrictions in your activities

Following your surgeon's advice can help you recover as soon as possible.

Agency for Healthcare Research and Quality

Childbirth is the process of giving birth to a baby. It includes labor and delivery. Usually everything goes well, but problems can happen. They may cause a risk to the mother, baby, or both. Some of the more common childbirth problems include:

• Preterm (premature) labor, when your labor starts before 37 completed weeks of pregnancy
• Premature rupture of membranes (PROM), when your water breaks too early. If labor does not start soon afterwards, this can raise the risk of infection.
• Problems with the placenta, such as the placenta covering the cervix, separating from the uterus before birth, or being attached too firmly to the uterus
• Labor that does not progress, meaning that labor is stalled. This can happen when
  • Your contractions weaken
  • Your cervix does not dilate (open) enough or is taking too long to dilate
  • The baby is not in the right position
  • The baby is too big or your pelvis is too small for the baby to move through the birth canal
• Abnormal heart rate of the baby. Often, an abnormal heart rate is not a problem. But if the heart rate gets very fast or very slow, it can be a sign that your baby is not getting enough oxygen or that there are other problems.
• Problems with the umbilical cord, such as the cord getting caught on the baby's arm, leg, or neck. It's also a problem if cord comes out before the baby does.
• Problems with the position of the baby, such as breech, in which the baby is going to come out feet first
• Shoulder dystocia, when the baby's head comes out, but the shoulder gets stuck
• Perinatal asphyxia, which happens when the baby does not get enough oxygen in the uterus, during labor or delivery, or just after birth
• Perineal tears, tearing of your vagina and the surrounding tissues
• Excessive bleeding, which can happen when the delivery causes tears to the uterus or if you are not able to deliver the placenta after you give birth to the baby
• Post-term pregnancy, when your pregnancy lasts more than 42 weeks

If you have problems in childbirth, your health care provider may need to give you medicines to induce or speed up labor, use tools to help guide the baby out of the birth canal, or deliver the baby by Cesarean section.

NIH: National Institute of Child Health and Human Development

Paget's disease of bone is a chronic bone disorder. Normally, there is a process in which your bones break down and then regrow. In Paget's disease, this process is abnormal. There is excessive breakdown and regrowth of bone. Because the bones regrow too quickly, they are bigger and softer than normal. They may be misshapen and easily fractured (broken). Paget's usually affects just one or a few bones.

Researchers do not know for sure what causes Paget's disease. Environmental factors may play a role. In some cases, the disease runs in families, and several genes have been linked to the disease.

The disease is more common in older people and those of northern European heritage. If you have a close relative who has Paget's, you are much more likely to have it.

Many people do not know that they have Paget's, because it often has no symptoms. When there are symptoms, they are similar to those of arthritis and other disorders. The symptoms include:

• Pain, which may be due to the disease or to arthritis, which can be a complication of Paget's
• Headaches and hearing loss, which can happen when Paget's disease affects the skull
• Pressure on the nerves, which can happen when Paget's disease affects the skull or spine
• Increased head size, bowing of a limb, or curvature of the spine. This can happen in advanced cases.
• Hip pain, if Paget's disease affects the pelvis or thighbone
• Damage to the cartilage of your joints, which may lead to arthritis

Usually, Paget's disease gets worse slowly over time. It does not spread to normal bones.

Paget's disease can lead to other complications, such as:

• Arthritis, because the misshapen bones can cause increased pressure and more wear and tear on the joints
• Heart failure. In severe Paget's disease, the heart has to work harder to pump blood to affected bones. Heart failure is more likely if you also have hardening of the arteries.
• Kidney stones, which can happen when the excessive breakdown of the bone leads to extra calcium in the body
• Nervous system problems, since the bones can cause pressure on the brain, spinal cord, or nerves. There may also be reduced blood flow to the brain and spinal cord.
• Osteosarcoma, cancer of the bone
• Loose teeth, if Paget's disease affects the facial bones
• Vision loss, if Paget's disease in the skull affects the nerves. This is rare.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• An x-ray of the affected bones. Paget's disease is almost always diagnosed using x-rays.
• An alkaline phosphatase blood test
• A bone scan

Sometimes the disease is found by accident when one of these tests is done for another reason.

To avoid complications, it is important to find and treat Paget's disease early. The treatments include:

• Medicines. There are several different medicines to treat Paget's disease. The most common type is bisphosphonates. They help reduce bone pain and stop or slow down the progress of the disease.
• Surgery is sometimes needed for certain complications of the disease. There are surgeries to
  • Allow fractures (broken bones) to heal in a better position
  • Replace joints such as the knee and hip when there is severe arthritis
  • Realign a deformed bone to reduce the pain in weight-bearing joints, especially the knees
  • Reduce pressure on a nerve, if enlargement of the skull or spine injuries effects the nervous system

Diet and exercise do not treat Paget's, but they can help to keep your skeleton healthy. If you do not have kidney stones, you should make sure to get enough calcium and vitamin D through your diet and supplements. Besides keeping your skeleton healthy, exercise can prevent weight gain and maintain the mobility of your joints. Talk with your health care provider before you start a new exercise program. You need to make sure that the exercise does not put too much stress on the affected bones.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases