Vascular system

This is information on Health psychology.  This is reprinted in large part from the University of Virginia's website.  I've added to it.

The vascular system, also called the circulatory system, is made up of the vessels that carry blood and lymph through the body. The arteries and veins carry blood throughout the body, delivering oxygen and nutrients to the body tissues and taking away tissue waste matter. The lymph vessels carry lymphatic fluid (a clear, colorless fluid containing water and blood cells). The lymphatic system helps to protect and maintain the fluid environment of the body by filtering and draining lymph away from each region of the body.

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The vessels of the blood circulatory system are:

• arteries - blood vessels that carry oxygenated blood away from the heart to the body.
• veins - blood vessels that carry blood from the body back into the heart.
• capillaries - tiny blood vessels between arteries and veins that distribute oxygen-rich blood to the body.
• arterioles-smaller arteries
• venules-smaller veins

Blood moves through the circulatory system as a result of being pumped out by the heart. Blood leaving the heart through the arteries is saturated with oxygen. The arteries break down into smaller and smaller branches in order to bring oxygen and other nutrients to the cells of the body's tissues and organs. As blood moves through the capillaries, the oxygen and other nutrients move out into the cells, and waste matter from the cells moves into the capillaries. As the blood leaves the capillaries, it moves through the veins, which become larger and larger to carry the blood back to the heart.

In addition to circulating blood and lymph throughout the body, the vascular system functions as an important component of other body systems. Examples include:

• respiratory system
  As blood flows through the capillaries in the lungs, carbon dioxide is given up and oxygen is picked up. The carbon dioxide is expelled from the body through the lungs, and the oxygen is taken to the body tissues by the blood.
• digestive system
  As food is digested, blood flows through the intestinal capillaries and picks up nutrients, such as glucose (sugar), vitamins, and minerals. These nutrients are delivered to the body tissues by the blood.
• kidneys and urinary system
  Waste materials from the body tissues are filtered out from the blood as it flows through the kidneys. The waste material then leaves the body in the form of urine.
• temperature control
  Regulation of the body's temperature is assisted by the flow of blood among the different parts of the body. Heat is produced by the body's tissues as they go through the processes of breaking down nutrients for energy, making new tissue, and giving up waste matter.

What is vascular disease?

A vascular disease is a condition that affects the arteries and/or veins. Most often, vascular disease affects blood flow, either by blocking or weakening blood vessels, or by damaging the valves that are found in veins. Organs and other body structures may be damaged by vascular disease as a result of decreased or completely blocked blood flow.

What causes vascular disease?

Causes of vascular disease include:

• atherosclerosis
  Atherosclerosis (a build-up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery) is the most common cause of vascular disease.
  
  It is unknown exactly how atherosclerosis begins or what causes it. Atherosclerosis is a slow, progressive, vascular disease that may start as early as childhood. However, the disease has the potential to progress rapidly. It is generally characterized by the accumulation of fatty deposits along the innermost layer of the arteries. If the disease process progresses, plaque formation may take place. This thickening narrows the arteries and can decrease blood flow or completely block the flow of blood to organs and other body tissues and structures.
• embolus/thrombus
  A blood vessel may be blocked by an embolus (a tiny mass of debris that moves through the bloodstream) or a thrombus (a blood clot).
• inflammation
  In general, inflammation of blood vessels is referred to as vasculitis, which includes a range of disorders. Inflammation may lead to narrowing and/or blockage of blood vessels.
• trauma/injury
  Trauma or injury involving the blood vessels may lead to inflammation or infection, which can damage the blood vessels and lead to narrowing and/or blockage.

What are the effects of vascular disease?

Because the functions of the blood vessels include supplying all organs and tissues of the body with oxygen and nutrients, removal of waste products, fluid balance, and other functions, conditions that affect the vascular system may affect the part(s) of the body supplied by a particular vascular network, such as the coronary arteries of the heart.

Examples of the effects of vascular disease include:

• coronary vascular disease - heart attack, angina (chest pain)
• cerebrovascular disease - stroke, transient ischemic attack (a sudden or a temporary loss of blood flow to an area of the brain, usually lasting less than five minutes but not longer than 24 hours, with complete recovery)
• peripheral arterial disease - claudication (limping because of pain in the thigh, calf, and/or buttocks that occurs when walking), critical limb ischemia (lack of oxygen to the limb/leg at rest)
• vascular disease of the great vessels - aortic aneurysm (a bulging, weakened area in the wall of a blood vessel resulting in an abnormal widening or ballooning), coarctation of the aorta (narrowing of the aorta, the largest artery in the body), Takayasu's arteritis (a rare inflammatory disease affecting the aorta and its branches)
• thoracic vascular disease - thoracic aortic aneurysm (a bulging, weakened area in the wall of a blood vessel resulting in an abnormal widening or ballooning in the thoracic, or chest, portion of the aorta)
• abdominal vascular disease - abdominal aortic aneurysm (a bulging, weakened area in the wall of a blood vessel resulting in an abnormal widening or ballooning in the abdominal portion of the aorta)
• peripheral vascular disease - deep vein thrombosis (Also called DVT; a blood clot in a deep vein located within the muscles of the leg), varicose veins
• lymphatic vascular diseases - lymphedema (swelling caused by interruption of the normal drainage pattern in the lymph nodes)
• vascular diseases of the lungs - Wegener's granulomatosis (an uncommon disease in which the blood vessels are inflamed; mainly affects the respiratory tract and the kidneys), angiitis (inflammation of blood vessels), hypertensive pulmonary vascular disease (high blood pressure in the lungs' blood circulation due to vascular conditions)
• renal (kidney) vascular diseases - renal artery stenosis (blockage of a renal artery), fibromuscular dysplasia (a condition that weakens the walls of medium-sized arteries and occurs predominantly in young women of childbearing age)
• genitourinary vascular diseases - vascular erectile dysfunction (impotence)

Because vascular conditions and diseases may involve more than one of the body's systems at a time, many types of physicians treat vascular problems. Specialists in vascular medicine and/or surgery work closely with physicians in other specialties, such as internal medicine, interventional radiology, cardiology, and others to ensure comprehensive care of patients with vascular conditions.  

People with vascular conditions are often on multiple medications and feel overwhelmed with the number of specialists, the risks associated with the disease processes, and the amount of information being presented to them.  Health psychologists can help break down the conditions into usable pieces working with the patient to understand the disease process, the medications, the risks and benefits of treatment options, and develop systems to manage special diets, exercise regimes, and medication compliance.  They can work with physicians to set up target systems and reporting to improve documentation and assist with compliance and communication.  They can help with symptom tracking to reduce risks.  Online information can provide direct patient assistance with multiple medications and drug/drug interactions as well as drug/herb or drug/food interactions.  Research on clinical trials for new treatments or new tests can also be provided for either patients or physicians.

Immunine Disorders

This is part of a series of articles on health psychology.

The body has great defenses to prevent disease.  These include it's physical design with organ placement and the skin covering as well as chemical and metabolic activities designed to ward off changes in cell abnormalities and disease.  With all this in place things still go awry and the body will sometimes have the immune system designed to protect us go haywire and start attacking itself instead.

Immune system problems require a great deal of medical understanding on the part of patients for them to cooperate in treatment.  Health psychologists can provide this understanding.

Our understanding of the immune system today is relatively small.  General scientists, microbiologists, immunologists, geneticists, and others have really been highly focused on the immune system since the big financial push to research Acquired Immune Deficiency Syndrome back in the 1980's.  Added to that were big financial pushes to research specific diseases such as cancer and autoimmune disorders in the 1990's. 

The immune system is based on complex interactions between the skin, the gastrointestinal system, the blood, and bone marrow.  Each of these produces changes to circulating cells which help to protect the body and keep it functioning optimally.  When some cells recognize abnormal cells are present such as viruses or bacteria, these cells signal the brain to produce cells to attack these abnormal cells.  They will produce chemicals like antibodies to make fighting these types of abnormal cells easier should they show up in the future.  They will send compliments which will speed the up the bodies response to antibodies.  They will send cells to clear up cellular debris.  They will thin or thicken the fat in the blood to assist to assist with the speed of reaching to infected or abnormal areas and produce inflammatory chemicals to help with defending the body.  Physicians will prescribe chemicals like antibiotics, antivirals, and anti-inflammatory agents to assist in the body's natural process.  These medications will reduce the risk of complications and reduce the possibility of death from these disorders.

Sometimes the diseases, like the virus responsible for HIV and AIDS, will set up inside a cell and trick the cells into thinking it's functioning normally by creating a protective shell around it.  It then changes chemicals and send out material to trick other cells into functioning in the same manner.  Sometimes the body will have a difficult time in switching off after fighting an infection and will turn on other organs or appropriately functioning cells causing an autoimmune disorder.  Sometimes the body's defenses will just get overrun.  Sometimes the bacteria or viruses mutate into forms that we have no medications to treat.  Sometimes the abnormal cells will grow rapidly and incorrectly becoming cancerous.

By understanding what the medical condition is, what medications are being used for, how medications work, and how the immune system functions, it's possible for the health psychologist to help the patient be informed about treatment options and to take a more active role in treatment.

My husband had a cold.  It didn't go away after a couple of weeks.  He went to his doctor who prescribed an antibiotic for what was presumed correctly to be a bacterial infection.  Immediately after starting the antibiotic he felt sicker.  But he wasn't running a fever.  He wasn't sure what was happening.  So I explained what happens when there is a sudden influx of antibodies to kill off cells.  As the bacterial cells die people get symptoms.  They sweat and get chilled.  They may have diarrhea, bloating, frequent urination, and nausea.  They feel hot or cold.  These symptoms last for a few days as the bacteria are being suddenly killed off and flushed from the body.  There are no changes in actual temperature or blood pressure suggesting a worsening of infection.  The antibiotics are doing their job.  Complements are being released to help speed up the body's recognition of the offending cells and storing that in cell memory so the cells that kill off bacteria will be able to more easily recognize this bacteria should it recur.  If the antibiotic is not completely used there is the possibility that the body will only be able to kill off the weak cells while the strong cells will grow and multiply and become resistant to that medication.  If the antibiotic is trying to fight off a viral infection rather than a bacterial infection it will not be effective.  After 10 days on the antibiotic his symptoms were gone.  My input was only a couple of sentences to explain that feeling worse was a normal part of the antibiotic doing it's job and how to tell if his infection was worsening.  He was able to stay on the antibiotic and let it complete it's job and recover.

Undiagnosed Illness

This is another post in a series on medical psychology.

Nothing is more frustrating than knowing you are sick and not knowing what is wrong.  It frustrates both patients and doctors alike.  After about six visits doctors may start to either doubt their ability to provide assistance or will become uncomfortable with the ambiguity of the situation.  Some physicians will handle the lack of a diagnosis by referring to another physician, and some will start to limit contact with the patient.  The visit will become shorter and the physician may become more irritable.  In some cases they will refuse services outright.  At the same time patients will become more demanding of answers and treatments, irritated with the physician, upset with the ambiguity and getting increasingly demanding.  In some cases patients will explore alternative treatments, look up symptoms online, and try various folk remedies for symptom relief or ask neighbors, friends, and people in chat rooms to provide assistance.  Both for the peace of mind of the physician and for the peace of mind of the patient a health psychologist can provide assistance.

For the physician, the health psychologist has tools to manage the patient's ambiguity.  They can clarify the symptoms being reported and can put the symptoms being reported into medical terminology.  Health psychologists can provide assistance for diagnostic clarification.  They can help the physician recognize that, apart from what was drilled into them in medical school, they are not expected to know everything about every patient.  Some illnesses present in unusual ways.  Some patients are not able to report symptoms adequately.  Some illnesses have not been discovered.  Some things just take time to figure out. 

For the patient, the health psychologist has tools to help the patient organize the symptoms into medical decision trees, to understand symptoms, to manage anxiety, to manage depression and pain, and to be able to help with making decisions about health information, research, clinical trials, alternative treatments, and folk remedies and herbal care.  The health psychologist can help to differentiate symptoms that are medical in nature from those that are psychological in nature. 

I met a woman who was a frequent user of herbal medicines to help with her symptoms.  Her local clerk at the health food and herb store was her functioning pharmacist.  She had lots of symptoms she was treating with herbs and supplements.  She had the idea that because herbs and supplements are classified as "natural" they are somehow safer than pharmaceutic products.  So I got a book out for her--the Physicians Desk Reference for Herbal Medicines.  I started by showing her how to look up the medicines she was taking.  She was taking herbal medicines for diarrhea, constipation, inflammation, and colic.  These interact and conflict with one another.  Without knowing the effects or methods of actions of these "natural" products, she was making herself much sicker.  We also talk about the skills and education of the clerk at the health food store versus the skills and experience of a pharmacist trained in herbal medicine.  We talked about the protections to consumers about licensed professionals.  We talked about the difference between herbal products and companies and the difference between herbs and pharmaceutical medicines.  Different companies use different parts of herbs with different potencies.  The herb and supplement industry is regulated differently than the pharmaceutical industry.  Some pharmaceutical medications are derived from plant medicines but they are manufactured for stability, consistency and quality.  Some people choose to grow their own herbs for medicinal use so they can control the plants, soil, and growing conditions.  As we talked about all that she began understanding that the mixture of herbal products was causing some of her symptoms and she had an inadequate understanding of what she was doing when she decided to take herbs.  She decided to gradually discontinue all the supplements and see how her body was functioning.  Over a period of a couple of months her health improved significantly and she stopped being symptomatic.  Since her treating doctor had never known she was using herbs he had never suspected that her use of herbal medicines was causing her symptoms.  Her undiagnosed condition turned out to be all due to side effects of herbal medications.

A patient came to see me because of hallucinations of spiders.  He saw spiders all the time, especially against white backgrounds.  He had been tried by his doctor on an anti-psychotic medication but the visions of spiders continued.  Visual hallucinations are atypical for psychiatric problems and are far more likely with medical problems.  So we talked about his history in depth.  The spider visions followed his eye movements and were far more consistent with visual field floaters than hallucinatory events.  Ocular floaters often are a consequence of head trauma.  He had a history of a head injury with a minor loss of consciousness.  The review of symptoms of head injury confirmed a diagnosis of post-concussive syndrome.  The patient completed a couple of formal questionnaires and the results were forwarded to his treating physician.  We were able to help him connect with a neurologist for follow-up and to online support groups to help him and his family deal with his residual symptoms.

For some people with unusual diagnoses the conditions are both rare and serious.  I met a woman who suddenly stopped being able to function.  She couldn't sit down in a chair because she couldn't decide which chair to sit in.  She couldn't eat because she couldn't decide what food to eat first.  Her medical doctor thought she had become suddenly mentally ill.  She wasn't responding to psychiatric medication.  She was referred to me for an evaluation.  Her symptoms were consistent with an unusual neurological disorder sometimes associated with a toxic condition otherwise associated with a loss of functioning in the front and side parts of the brain.  She was sent for neurological testing which confirmed the diagnosis of loss of brain volume in the frontal and temporal lobes (frontal-temporal dementia).  As a health psychologist I could help her family make decisions about her care, help with information about hospice care, conservatorships and end of life decision making. 

Health and medical psychologists can provide a wide variety of services to both physicians and patients dealing with undiagnosed illness or unusual symptoms or illnesses not responding as expected to conventional treatments.  They can provide information and resource directly to physicians, patients and family members about research, symptom identification, and options.  They can help manage or eliminate the ambiguity and stress inherent in not having a diagnosis.

Technology and Learning Disabilities

My brother had a head injury as a young child.  It was a standing joke in the family.  "Were you dropped on your head as a kid or what?...Well yes I was.  Actually it was a large seashell that fell off the wall and dented my skull."  So he has problems reading.  He can read.  It's just painfully show and he says all the letters get mixed up in his head.

I did a couple of things with him while I was up at his house.  I showed him the Text-to-speech feature of my Kindle.  I also showed him the text-to-speech feature of my Mac laptop.  Then I lost my voice.  Completely.  So he talked and I talked back to him in a computer voice from my laptop.  He could read things I'd written in portable document files (.pdf) and I could type single lines of text and answer his questions.  The computer did all the reading to him and speaking for me.  My voice came back.  I turned the speech function off.

There are lots of things technology can do to help people with learning problems and there's a wide variety of computer types of devices that can be used.  I can send PDF files via email to my Kindle book reader.  I can change the size of the type on the books I download.  I can have the Kindle speak in a male or female voice with slow or fast rate of speech.  On my Mac I can change the screen colors, change the size of type, have the computer talk, have designated keys.  I can hook up programs that will allow the computer to type while I talk over headphones.  I can have email sent to my smart phone from my laptop.  I can send it to a wireless printer and have it print.  I can have it calculate with applications.  I have an iTouch with applications.  There are applications that will calculate, let me read books, help me stay focused on tasks, and let me stay in touch with people for support.


Some people have difficulty reading.  Computer-based accommodations for Dyslexia may not require specialized hardware or software. For example, a person with Dyslexia can benefit from regularly using built-in word processor features such as spell checking, grammar checking, font size and color changes.  Lots of people have difficulty seeing certain colors.  Many word processing programs also include the ability to outline thoughts, providing alternative visual formats, and ways to emphasize information that may compensate for difficulty in organizing words and ideas.  Additionally, color-coded text options and outline capabilities present in many word processing programs are useful tools for those with difficulty sorting and sequencing information found in text.  A word processor can also be used as a compensatory tool for a person with dysgraphia (difficulty writing). Use of a keyboard may be a viable alternative for an individual who has difficulty expressing his thoughts via handwriting.An individual who can take in information through listening much better than by reading may benefit from using a reading system. These systems allow text on screen (document, web page, or email) to be read aloud through the computer's sound card. A scanner and Optical Character Recognition (OCR) software (e.g., Freedom Scientific's WYNN or Kurzweil 3000) adds the feature of reading printed text. Hard copy text is placed on the scanner where it is converted into a digital image. This image is then converted to a text file, making the characters recognizable by the computer. The computer can then read the words back using a speech synthesizer and simultaneously present the words on screen.

Assistance with reading in technology includes options such as highlighting a word, sentence, or paragraph using contrasting colors. Increasing the size of the text displayed on the screen as well as changing text color can increase reading comprehension for some people with specific learning disabilities.

Some individuals have difficulty organizing and integrating thoughts and ideas while writing. Concept mapping software allows for visual representation of ideas and concepts. These representations are presented in a physical manner and can be connected with arrows to show the relationship between ideas. These graphically represented ideas can be linked, rearranged, color coded, and matched with a variety of icons to suit the need of the user. Concept mapping software can be used as a structure for starting and organizing such diverse writing projects as poetry, term papers, resumes, schedules, or even computer programs. Some programs will allow you to easily go from text to linked shapes, to formal outline and back.

People with Dyslexia often spell phonetically, making use of word prediction or spell checking software less useful. Devices (e.g., Franklin Electronic Dictionary ™) or software (YakYak ™) that renders phonetic spelling into correctly spelled words may be useful tools.

Spelling words correctly while typing can be a challenge for some people with Dyslexia. Word prediction programs prompt the user with a list of most likely word choices based upon what has been typed so far. Rather than experiencing the frustration of remembering the spelling of a word, the writer can refer to the predictive list, choose the desired word and continue with the expression of thoughts and ideas.

Speech recognition products provide appropriate tools for individuals with a wide range of learning disabilities. Speech recognition software takes the spoken word via a microphone and converts it to machine-readable format. The user speaks into a microphone either with pauses between words (discrete speech) or in a normal talking manner (continuous speech). The discrete product, although slower, is often the better choice for those with LDs because errors can be identified as they occur. Making corrections after the fact using continuous speech requires proficient reading skills. Speech recognition technology requires that the user have moderately good reading comprehension to correct the program's text output.

Organizing schedules and information is difficult for some people with dyslexia or a non-verbal learning disorder. Personal Information Managers (PIMs) such as a Palm Pilot or Casio  or organizational software such as Microsoft Outlook  or Lotus Organizer or calendar systems can accommodate these disabilities.

A talking calculator is an appropriate tool for people with Dyscalculia (impaired calculation skills). The synthesized voice output of a talking calculator provides feedback to the user that helps them identify any input errors. Additionally, hearing the calculated answer can provide a check against the transposition of numbers commonly reversed in reading by people with Dyslexia or Dyscalculia.

Not all assistive technology for people with LDs is computer-based. The use of common office supplies such as Post-It Notes™ and highlighter pens provide elegantly simple means of sorting and prioritizing thoughts, ideas, and concepts. Often, tools of one's own making provide the most effective and comfortable accommodations for learning difficulties.  Setting up index cards, laminating them and attaching magnetic backs allow for use on household appliance to keep track of multiple step tasks.

When deciding to purchase software, hardware, or even low-tech materials to help someone with a disability it's important to get input from the person who will be using the materials.  All learning problems are individual to a large degree and what works for one person may not work for another.   It's important for the disabled person to get hands on experience with anything they want to try.

Diabetes

This is the third in an ongoing series on medical conditions treated by health psychologists.

Diabetes runs in my family.  My mother died of cardiac complications of the disease.  My brother is insulin dependent.  My aunt has type II diabetes but also uses insulin to control her blood sugar.  I have impaired glucose tolerance but do not have diabetes. 

There are a couple of types of diabetes.  Type 1 diabetes is insulin dependent diabetes.  It's likely a genetic condition in which either the pancreas stops manufacturing insulin or doesn't make enough insulin.  Type 1 diabetes happens most often in children and young adults but can appear at any age. Symptoms may include:

• Being very thirsty
• Urinating often
• Feeling very hungry or tired
• Losing weight without trying
• Having sores that heal slowly
• Having dry, itchy skin
• Losing the feeling in your feet or having tingling in your feet
• Having blurry eyesight 

Type 1 diabetes is treated with insulin.  It requires monitoring levels of blood sugar and managing their levels with diet, exercise, and insulin.

Type 2 diabetes is acquired over time as the body fails to manage blood sugar adequately. 
Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age—even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, being physically active, taking aspirin daily—for some—and controlling blood pressure and cholesterol.  The physical symptoms for type 1 and type 2 diabetes are the same.  There are medical tests that can differentiate the two types.

Health psychologists work with physicians, dietitians, physical therapists, and others to help people manage the complexities of the changes in diet, medication use, and exercise.

After my brother had a heart attack, he got overwhelmed with his health and I got an email from my sister-in-law talking about her frustration with him.  I drove up to Sonoma, CA where he lives, and he and I went food shopping.  I helped him with making food choices to understand the impact of the foods he eats on his heart, blood sugar and cholesterol.  We brought the food back to his house and I helped him to prepare a meal.  We talked about how his blood sugar works.  We had a discussion about glycemic index and how carbohydrates get broken down in a rapid or slow manner.  We talked about his usual diet and what kinds of foods he likes to eat.  We spent a long time talking about taste.  He was depressed because he felt like he had to have a diet that was restrictive.  I showed him how his current diet was extremely restrictive (he was eating the same foods on a daily basis) and the diet I was talking about would be to introduce him to new foods that were both sweet tasting and healthy.  I helped him fix a meal of carbohydrates that will be slowly broken down and lean protein.  He likes vegetables.  He gardens.  He has access to some of the freshest produce right from his backyard.  He has access to the farmer's markets in Sonoma, an area of California known for farms.  We talked about how he could walk to the store from his house.  It's less than a mile.  He had become afraid to exercise following his heart attack.  We talked about his symptoms during the heart attack.  We talked about the fact that he'd had symptoms for hours prior to realizing he was having a heart attack.  It wasn't sudden and it wasn't triggered by exercise.  We walked to the store and walked back.  I helped him manage his anxiety so he could return to a simple exercise program of walking which would help his diabetes and reduce his risk of another heart attack or a stroke.  Within a month his requirements for insulin reduced and he was placed on a "rainbow scale" of insulin rather than a fixed insulin dose.  He could regulate his insulin level more finely based on his blood sugar at testing.  He bought a juicer on his own and started walking to work a distance of 3 miles.  He lost about 35 pounds over the course of a year.  Although I only worked with him for a couple of days at that visit, the gains he made lasted for years afterwards.

Health psychologists routinely work to help people understand how to manage the medical complexities and psychological difficulties of chronic health conditions.  If you think you might have diabetes check with your doctor for an evaluation.

Headaches

This is part two in a series on medical conditions treated by health psychologists.

There are several types of different headaches.  Tension-type, Migraine, and Cluster are the most common.

The International Headache Society describes tension-type headache as infrequent episodes of headache that last minutes to days. The pain is usually occurs on both sides of the head and has a pressing or tightening quality. Tension-type headache  usually does not worsen with physical activity. Nausea is usually not a symptom.   Sensitivity to light (photophobia) or sensitivity to sound (phonophobia) may be present.  Tension-type headaches are the most common type of headache and 30% to 78% of people may experience them in their lifetime.  Some people have frequent tension-type headaches causing them to become disabled.  Most people with this type of headache have the headache infrequently.  Infrequent tension-type headaches occur once a month or so and are mild to moderate in severity.


Migraine headaches are less common than tension-type headaches.  They effect 6% of men and 18% of women.  Most people who have migraines are women.  Most women start having migraines after they start menstruating.  Up to 10% of children can have migraines as well.  Migraine is described as a recurrent headache lasting 4-72 hours and often has unilateral pulsating or throbbing pain, moderate to severe intensity pain, nausea or photophobia. The pain of migraine can be made worse by routine physical activity.  Migraines are often preceded by neurological symptoms called an "aura" with changes in speech, movement, vision, sense of taste or smell.  The auras can change from one migraine attack to another.  The headaches last from 4 to 72 hours without treatment.


Cluster headaches occur in about 1% of the population and are distinct from migraine and tension-type headaches on several levels. Most of the cluster headache sufferers are men with onset between ages of 20-40.  Cluster headaches are characterized by severe, unilateral pain that is around the eye or along the side of the head.  The headaches last from 15 to 180 minutes and occur once every other day to up to 8 times daily.  Attacks are associated with eyes watering on the same side of the head that the pain is located. Patients may also experience nasal congestion, runny nose, forehead and facial sweating, dropping eyelids or eyelid swelling.  Pain from a cluster headache is usually severe and people may be restless or agitated due to the pain.  This type of headache may be hereditary.  Headaches may be provoked or triggered by alcohol, histimines, nitroglycerine, or other medications.  The headaches occur in clusters often daily or several times a day and then cease for weeks, months or years, between attacks.

Other causes of headaches are less common.

Medication overuse headache or rebound headache is often a daily chronic headache that occurs with medications used to treat headaches in about 1.4% of the population.  Ergot, triptan, opioid or butalbital analgesics and non-steroidal antiinflammatory agents (NSAIDS).


New daily persisting headache is a chronic daily headache that continues without remission for more than 3 months.  These headaches are usually evaluated by CT, MRI, or MRA scans.


Hemicrania Continua is a daily continuous headache that remits only with treatment by indomethicin.  There are eye symptoms with tearing and swelling and the nose may run or be congested.  It impacts one side of the face and head only.


Post-concussive headache follows head or head and neck injuries in conditions like whiplash and concussion.  These headaches start off severe and may involve sensitivity to light and sound, dizziness, loss of balance, nausea and vomiting.  Over time they remit.  The headaches can recur up to about 5 years post injury.  Headaches may last longer when there is a history of multiple concussions.


Dental problems like temporomandibular joint disease (TMJ) can cause headaches.  The headache pain in precipitated by jaw movements.  When the jaw disorder is treated the headaches remit within 3 months and does not recur.


Sexual headaches or orgasmic headaches occur with sexual activity or orgasm.  These headaches may be the result of vascular changes or hormonal changes or they may be benign headaches related to movement and stretching of muscles.  The headache pain can be severe and there is sensitivity to light and movement.  Because these types of headaches can be associated with problems with blood vessels or high blood pressure it's important to have them evaluated by a physician.


Thunder clap headaches are severe sudden excruciating painful headaches.  These start suddenly and represent a torn blood vessel.  These headaches represent medical emergencies and need to be evaluated in an emergency room.  People will describe these as feeling like they were kicked in the head.  They may have a stiff neck.  The headache peaks within 60 seconds it may improve over the next hour or may worsen with signs of loss of consciousness.  There may be nausea and vomiting.


Ice cream headaches also known as cold induced headaches are triggered by anything cold like ice cream in the back of the mouth or roof of the mouth.  The headache is intense and goes away as the cold sensation stops.


Hot dog headache is also known as nitrate headache.  It's cause by nitrates in foods like cured meats such as hot dogs.  Again as soon as the food is digested the headache stops.


Migraine equivalents are episodic pain conditions without headache pain.  This type of headache can feature neurological symptoms or non-neurological symptoms, such as abdominal pain, vertigo, even emotional outbursts, depression or panic. The word "equivalent" suggests that sufferers instead of a headache, are having some other equivalent troubling symptom. This condition is much more common in children and can resemble stroke-like symptoms which are a numbness or tingling on the arm - absent of any headache. Also younger children often complain of an upset stomach without any headache. This can often also be a migraine equivalent. Once the child has  thrown up, there is often an easing up and relief of the headache symptoms. This headache type is experienced in the stomach where there are a lot of receptor sites for the neurotransmitter serotonin.

 
Health and medical psychologists can help patients understand their type of headache.  Help them classify symptoms for diagnosis.  Help them manage medications.  Help them understand the distinctions between classes of medications.  Set up food lists to avoid triggers.  And help them with pain management techniques.

If you have a new type of headache or a severe headache you should seek medical advice.

Asthma

This is the start of a series on chronic medical conditions. 

Health psychologists started working with several chronic illnesses, stress, pain, weight loss, headaches, physical conditioning back in the 1970's.  In the past 40 years the knowledge of those illnesses and conditions have grown exponentially.

Asthma is a chronic illness that impacts breathing.  About 1.8 million people have been diagnosed with asthma.  Asthma causes breathing difficulty by constricting the airways in the lungs and by causing swelling or inflammation in the airways.  This causes difficulty with being able to exhale without wheezing, gasping, feeling short of breath or coughing.

Medical treatment involves relieving the constriction and decreasing the inflammation of the airways and getting the symptoms manageable.  There are short acting medication, anti-inflammatory medications, vasodilators, and some other types of medications used to both relieve symptoms rapidly and to prevent symptoms from returning.

Psychological treatment involves managing the complexities of the illness, the side effects of medication, identifying triggers, and managing depression, anxiety and stress which accompanies the illness.

Let me give an example of a woman I'll call Sara.  She's had breathing problems for the past 25 years.  She is on two types of medication.  She has a rescue inhaler she uses four times a day.  She has a preventive inhaler she uses as directed twice a day.  She smokes cigarettes 2 to 3 times a week.  She has a nebulizer at home for breathing treatments but it's been broken for years.  She gets her primary treatment in emergency rooms.  She has no idea about what causes her asthma.  She's afraid to go anywhere or do anything.  The asthma attacks both frighten and embarrass her.  She thinks people will believe she is sick and contagious, so she avoids people.

She and I chatted about her rescue inhaler.  She knows she's supposed to inhale deeply twice each time she uses it.  But she's frightened and inhales only shallowly and uses the second inhalation very little.  So she ends up using a rescue inhaler far too frequently, getting signs of toxicity, and feeling poorly when she uses it.  She has never heard of a peak flow meter.  When I described the plastic tube that measures breathing on exhalation, she had seen that in her doctor's office and in the emergency room but didn't have one.  Her use of her rescue inhaler or visits to the emergency room were based on her feeling short of breath not on any information about how her breathing was.  So she started a list for her doctor.  Item one:  Can I get a Peak flow meter?

She has no idea about what triggers her asthma attacks.  They seem to come at random.  So she has homework:  Keep a list of where you are when you feel short of breath, time of day, and what you are doing at the time.  Single sheet of paper, three columns, one week work of data.

Her nebulizer is broken.  Item two for her doctor:  Can I get a new nebulizer?  That's likely to stop the need for frequent trips to emergency rooms for routine health care.  She's never been hospitalized overnight for asthma.  She's never been intubated.  She's getting routine home health care or outpatient care that's needed on an urgent basis from an emergency room that provides the most expensive type of care available.  She's exposed to bacterial and viral illnesses unnecessarily.  Her condition doesn't need to be treated in an emergency room. She requires urgent care, not emergency care.

Her physician doesn't take time with her.  She's chronically ill.  She's not understanding her health care.  She returns frequently not getting better.  Her doctor spends less and less time with her.  She's changed doctors often.  They are all the same to her.  Both she and her doctor are frustrated.  Health psychologists spend between 40 and 60 minutes at a visit on average.  A primary care physician spends 15 to 30 minutes on average.  On follow up, primary care doctors spend less time.

She smokes.  Her asthma makes her anxious.  She smokes because paradoxically, smoking decreases anxiety.  Unfortunately, smoking is a common trigger for asthma attacks.  Even if she's only smoking 3 to 5 cigarettes a day she needs to stop.  She needs a stop smoking plan, a stress reduction plan, and a better way to manage anxiety.

She's overweight.  She doesn't exercise because she's afraid of getting an asthma attack.  Asthma can be triggered by exercise.  It can be triggered by foods.  It can be triggered by the environment.  She doesn't know what's causing her asthma to be triggered.  That list will help her determine her triggers.  She can exercise in her home, or outside carefully, monitoring her chest constriction.  She may need to premedicate with her inhaler prior to exercise.  She may need to change her diet.  Someone like me can help with both of those.

Because I provide boutique services I can go to people's homes.  I help them set up the lists.  I can assist with setting up support services.  I can go with them to their medical doctor's appointments.  I can go with them if they need to go to an emergency room.  Treatment is expensive for that amount of personalization.  It's not covered by insurance.  It's time consuming.  But she stops needing frequent doctor visits.  She gets better control over her asthma.  She loses weight and stops smoking.  She stops paying for cigarettes.  She's not seeing her doctors as much, so co-pays for her physician are reduced.  Her medication use is lessened and those expenses are reduced.   Boutique health psychology is offered in some large cities.  I live in Los Angeles.  It's not uncommon in this area, but it's still not that common.  For most people, getting control over a chronic illness is well worth the expense and the time.