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Sleep Apnea

What Is Sleep Apnea?

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.


Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, there are no blood tests for the condition.

Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. The blockage may cause shallow breathing or breathing pauses.

When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children may have enlarged tonsil tissues in their throats, which can lead to obstructive sleep apnea.

Take a survey to assess your risk of Sleep Apnea

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Peripheral Arterial Disease

What Is Peripheral Arterial Disease?

Peripheral arterial disease (P.A.D.) is a disease in which plaque (plak) builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.

When plaque builds up in the body's arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses on P.A.D. that affects blood flow to the legs.

Overview Blocked blood flow to your legs can cause pain and numbness. It also can raise your risk of getting an infection in the affected limbs. Your body may have a hard time fighting the infection.

If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.

If you have leg pain when you walk or climb stairs, talk with your doctor. Sometimes older people think that leg pain is just a symptom of aging. However, the cause of the pain could be P.A.D. Tell your doctor if you're feeling pain in your legs and discuss whether you should be tested for P.A.D.

Smoking is the main risk factor for P.A.D. If you smoke or have a history of smoking, your risk of P.A.D. increases up to four times. Other factors, such as age and having certain diseases or conditions, also increase your risk of P.A.D.

Take a survey to assess your risk of P.A.D.

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Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin to meet its needs.

Urination and thirst are increased, and people lose weight when they are not trying to.
Diabetes damages the nerves and causes problems with sensation.
Diabetes damages blood vessels and increases the risk of heart attack, stroke, and kidney failure.
Doctors diagnose diabetes by measuring blood sugar levels.
People with diabetes need to follow a low-sugar, low-fat diet, exercise, and usually take drugs.

Insulin, a hormone released from the pancreas, controls the amount of sugar in the blood. When people eat or drink, food is broken down into materials, including the simple sugar glucose, that the body needs to function. Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells, it is converted to energy, which is either used immediately or stored as fat or glycogen until it is needed.

The levels of sugar in the blood vary normally throughout the day. They rise after a meal and return to normal within about 2 hours after eating. Once the levels of sugar in the blood return to normal, insulin production decreases. The variation in blood sugar levels is usually within a narrow range, about 70 to 110 milligrams per deciliter (mg/dL) of blood. If people eat a large amount of carbohydrates, the levels may increase more. People older than 65 years tend to have slightly higher levels, especially after eating.

If the body does not produce enough insulin to move the sugar into the cells, the resulting high levels of sugar in the blood and the inadequate amount of sugar in the cells together produce the symptoms and complications of diabetes.

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Advanced Lipid Testing

70-89% of sudden cardiac deaths occur in men
The annual incidence is 3-4 times higher in men than in women
However, 50% of men and 64% of women who died suddenly of CHD had no previous symptoms of disease
You can change the statistics with advanced cardiovascular diagnostics

Half the patients with coronary artery disease in the United States have blood cholesterol levels similar to those of people who have not developed the disease.
There has been a monumental shift in the scientific understanding of the role of cholesterol in metabolic disorders and coronary heart disease (CHD). Metrolina Medical Associates offers custom panels of tests beyond the conventional lipid panel. We can personalize treatment based on a comprehensive patient profile including various cholesterol components, advanced risk factors, genetic and other biomarkers.

This approach allows earlier detection of disease, more targeted treatments and ultimately fewer heart attacks, strokes and vascular events. Diseases of the heart and vascular system remain the major cause of morbidity and mortality in the developed world and are rapidly overtaking other diseases in developing countries. National and international guidelines for intervention have focused on LDL, the major carrier of cholesterol in the circulation. The association of cholesterol with coronary heart disease has been long recognized, as evidenced by the early 1900s experimental production of atherosclerosis in rabbits fed a diet high in cholesterol.

Cholesterol, even though an essential element of cell membranes and precursor to the necessary steroid hormones and vitamin D, has engendered a negative or pathological connotation; e.g., its presence was first recognized and measured in gall stones followed by the association with atherosclerosis and cardiovascular disease.

When the lipoprotein carriers were first recognized in the mid-1900s, it must have seemed logical to measure LDL and the other lipoproteins in terms of their cholesterol content, because assays existed for cholesterol, which were subsequently adapted for serum assays. Hence, the many subsequent epidemiology and intervention studies focused on LDL-cholesterol as the primary atherogenic factor. Mainstream practice today continues to follow this precedent.

Nevertheless, subsequent studies have shown clearly that the protein constituents, e.g., Apolipoprotein B (ApoB), the major protein of LDL, and Apo A-1, the major protein of the primarily protective HDL fraction, are better indicators of risk association and response to treatment. Furthermore, it is now recognized that each of the major lipoprotein classes is heterogenous, with a variety of sub-particle classes and other constituents, characterization of which can improve the estimation of CVD risk.

Other contributors to cardiovascular disease, such as metabolic disorders and consequent inflammation, have been recognized as contributing to disease progression. This developing awareness provides the foundation for advanced testing of cardiovascular risk factors and biomarkers. Such advanced tests can substantially clarify contributors to cardiovascular disease and improve management of patients. Mainstream treatment guidelines focus on the statin class of cholesterol-lowering drugs, which have been proven in many studies to be effective in decreasing incidence of various manifestations of cardiovascular disease. The statins have become the standard of care and are widely prescribed and increasingly more effective. Nevertheless, even high-dose therapies with the newer most effective statins leave a residual risk. Some patients will continue to progress and suffer events in spite of apparently effective treatment.

Statins tend to lower cholesterol across the range of LDL particles and may leave substantial amounts of the more atherogenic small, dense LDL particles. Combination therapies with niacin, fibrates and other compounds may have differential and additive effect in further relieving the residual risk.

For more information download this document.

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Obesity is an excess proportion of total body fat. A person is considered obese when his or her weight is 20% or more above normal weight. The most common measure of obesity is the body mass index or BMI. A person is considered overweight if his or her BMI is between 25 and 29.9; a person is considered obese if his or her BMI is over 30.
"Morbid obesity" means that a person is either 50%-100% over normal weight, more than 100 pounds over normal weight, has a BMI of 40 or higher, or is sufficiently overweight to severely interfere with health or normal function.

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Read the How to Get Through the Holidays article > >

What Causes Obesity?

Obesity occurs when a person consumes more calories than he or she burns. For many people this boils down to eating too much and exercising too little. But there are other factors that also play a role in obesity. These may include:

• Age. As you get older, your body's ability to metabolize food slows down and you do not require as many calories to maintain your weight. This is why people note that they eat the same and do the same activities as they did when they were 20 years old, but at age 40, gain weight.

• Gender. Women tend to be more overweight than men. Men have a higher resting metabolic rate (meaning they burn more energy at rest) than women, so men require more calories to maintain their body weight. Additionally, when women become postmenopausal, their metabolic rate decreases. That is partly why many women gain weight after menopause.

• Genetics. Obesity (and thinness) tends to run in families. In a study of adults who were adopted as children, researchers found that participating adult weights were closer to their biological parents' weights than their adoptive parents'. The environment provided by the adoptive family apparently had less influence on the development of obesity than the person's genetic makeup. In fact, if your biological mother is heavy as an adult, there is approximately a 75% chance that you will be heavy. If your biological mother is thin, there is also a 75% chance that you will be thin. Nevertheless, people who feel that their genes have doomed them to a lifetime of obesity should take heart. Many people genetically predisposed to obesity do not become obese or are able to lose weight and keep it off.

• Environmental factors. Although genes are an important factor in many cases of obesity, a person's environment also plays a significant role. Environmental factors include lifestyle behaviors such as what a person eats and how active he or she is.

• Physical activity. Active individuals require more calories than less active ones to maintain their weight. Additionally, physical activity tends to decrease appetite in obese individuals while increasing the body's ability to preferentially metabolize fat as an energy source. Much of the increase in obesity in the last 20 years is thought to have resulted from the decreased level of daily physical activity.

• Psychological factors. Psychological factors also influence eating habits and obesity. Many people eat in response to negative emotions such as boredom, sadness, or anger. People who have difficulty with weight management may be facing more emotional and psychological issues; about 30% of people who seek treatment for serious weight problems have difficulties with binge eating. During a binge-eating episode, people eat large amounts of food while feeling they can't control how much they are eating.

• Illness. Although not as common as many believe, there are some illnesses that can cause obesity. These include hormone problems such as hypothyroidism (poorly acting thyroid slows metabolism), depression, and some rare diseases of the brain that can lead to overeating. Medication. Certain drugs, such as steroids and some antidepressants, may cause excessive weight gain.

To Learn About Weight Loss

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Hypertension is the term used to describe high blood pressure.
Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body.
Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.

The top number is your systolic pressure.

It is considered high if it is over 140 most of the time.
It is considered normal if it is below 120 most of the time.
The bottom number is your diastolic pressure.
It is considered high if it is over 90 most of the time.
It is considered normal if it is below 80 most of the time.

Pre-hypertension may be considered when your:

Top number (systolic blood pressure) is between 120 and 139 most of the time, or
Bottom number (diastolic blood pressure) is between 80 and 89 most of the time

If you have pre-hypertension, you are more likely to develop high blood pressure.
If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.

See also: Blood pressure

Causes, incidence, and risk factors

Many factors can affect blood pressure, including:

How much water and salt you have in your body
The condition of your kidneys, nervous system, or blood vessels
The levels of different body hormones

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.

You have a higher risk of high blood pressure if you:

Are African American
Are obese
Are often stressed or anxious
Eat too much salt in your diet
Have a family history of high blood pressure
Have diabetes

Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to:

Alcohol abuse
Autoimmune disorders such as periarteritis nodosa
Chronic kidney disease
Coarctation of the aorta
Cocaine use
Diabetes (if it causes kidney damage)
Endocrine disorders, such as adrenal tumors (pheochromocytoma, aldosteronism), thyroid disorders, and Cushing syndrome
Appetite suppressants
Birth control pills
Certain cold medications
Migraine medications

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Coronary Artery Disease

Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease.

Causes, incidence, and risk factors

Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and other substances form a plaque build-up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms, usually when you are active.
Coronary heart disease (CHD) is the leading cause of death in the United States for men and women.

Many things increase your risk for heart disease:

Men in their 40s have a higher risk of CHD than women. But as women get older (especially after they reach menopause), their risk increases to almost equal that of a man's risk. See: Heart disease and women

Bad genes (heredity) can increase your risk. You are more likely to develop the condition if someone in your family has a history of heart disease -- especially if they had it before age 50. Your risk for CHD goes up the older you get.

Diabetes is a strong risk factor for heart disease. High blood pressure increases your risks of coronary artery disease and heart failure. Abnormal cholesterol levels: your LDL ("bad") cholesterol should be as low as possible, and your HDL ("good") cholesterol should be as high as possible to reduce your risk of CHD. Metabolic syndrome refers to high triglyceride levels, high blood pressure, excess body fat around the waist, and increased insulin levels. People with this group of problems have an increased chance of getting heart disease. Smokers have a much higher risk of heart disease than nonsmokers. Chronic kidney disease can increase your risk. Already having atherosclerosis or hardening of the arteries in another part of your body (examples are stroke and abdominal aortic aneurysm) increases your risk of having coronary heart disease. Other risk factors include alcohol abuse, not getting enough exercise, and having excessive amounts of stress. Higher-than-normal levels of inflammation-related substances, such as C-reactive protein and fibrinogen are being studied as possible indicators of an increased risk for heart disease. Increased levels of a chemical called homocysteine, an amino acid, are also linked to an increased risk of a heart attack.


Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms. Chest pain or discomfort (angina) is the most common symptom.

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Alzheimer’s Disease

Dementia is a loss of brain function that occurs with certain diseases. Alzheimer's disease (AD), is one form of dementia that gradually gets worse over time. It affects memory, thinking, and behavior.
Memory impairment, as well as problems with language, decision-making ability, judgment, and personality, are necessary features for the diagnosis.

Causes, incidence, and risk factors

Age and family history are risk factors for AD.

As you get older, your risk of developing AD goes up. However, developing Alzheimer's disease is not a part of normal aging.
Having a close blood relative, such as a brother, sister, or parent who developed AD increases your risk.
Having certain combination of genes for proteins that appear to be abnormal in Alzheimer's disease also increases your risk.

Other risk factors that are not as well proven include:

Longstanding high blood pressure
History of head trauma
Female gender

There are two types of AD -- early onset and late onset.

In early onset AD, symptoms first appear before age 60. Early onset AD is much less common than late onset. However, it tends to progress rapidly. Early onset disease can run in families. Several genes have been identified.
Late onset AD, the most common form of the disease, develops in people age 60 and older. Late onset AD may run in some families, but the role of genes is less clear.

The cause of AD is not entirely known, but is thought to include both genetic and environmental factors. A diagnosis of AD is made when certain symptoms are present, and by making sure other causes of dementia are not present.
The only way to know for certain that someone has AD is to examine a sample of their brain tissue after death. The following changes are more common in the brain tissue of people with AD:

"Neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up the cell)
"Neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells, and protein)
"Senile plaques" (areas where products of dying nerve cells have accumulated around protein).

When nerve cells (neurons) are destroyed, there is a decrease in the chemicals that help nerve cells send messages to one another (called neurotransmitters). As a result, areas of the brain that normally work together become disconnected.

The buildup of aluminum, lead, mercury, and other substances in the brain is no longer believed to be a cause of AD.


Dementia symptoms include difficulty with many areas of mental function, including:

Emotional behavior or personality
Cognitive skills (such as calculation, abstract thinking, or judgment)

Dementia usually first appears as forgetfulness.

Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging, and the development of AD. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops AD. Symptoms of MCI include:

Forgetting recent events or conversations
Difficulty performing more than one task at a time
Difficulty solving problems
Taking longer to perform more difficult activities

The early symptoms of AD can include:

Language problems, such as trouble finding the name of familiar objects
Misplacing items
Getting lost on familiar routes
Personality changes and loss of social skills
Losing interest in things previously enjoyed, flat mood
Difficulty performing tasks that take some thought, but used to come easily, such as balancing a checkbook, playing complex games (such as bridge), and learning new information or routines

As the AD becomes worse, symptoms are more obvious and interfere with your ability to take care of yourself. Symptoms can include:

Forgetting details about current events
Forgetting events in your own life history, losing awareness of who you are
Change in sleep patterns, often waking up at night
Difficulty reading or writing
Poor judgment and loss of ability to recognize danger
Using the wrong word, mispronouncing words, speaking in confusing sentences
Withdrawing from social contact
Having hallucinations, arguments, striking out, and violent behavior
Having delusions, depression, agitation
Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and driving

People with severe AD can no longer:

Understand language
Recognize family members
Perform basic activities of daily living, such as eating, dressing, and bathing

Other symptoms that may occur with AD:


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Osteoporosis is the thinning of bone tissue and loss of bone density over time.

Causes, incidence, and risk factors

Osteoporosis is the most common type of bone disease.

Researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine).
Osteoporosis occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both.
Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.
As you age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury.
Usually, the loss occurs gradually over years. Many times, a person will have a fracture before becoming aware that the disease is present. By the time a fracture occurs, the disease is in its advanced stages and damage is severe.

The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women over age 50 and men over age 70 have a higher risk for osteoporosis.

Other causes include:

Being confined to a bed
Chronic rheumatoid arthritis, chronic kidney disease, eating disorders
Taking corticosteroid medications (prednisone, methylprednisolone) every day for more than 3 months, or taking some antiseizure drugs

White women, especially those with a family history of osteoporosis, have a greater than average risk of developing osteoporosis. Other risk factors include:

Absence of menstrual periods (amenorrhea) for long periods of time
Drinking a large amount of alcohol
Family history of osteoporosis
History of hormone treatment for prostate cancer or breast cancer
Low body weight
Too little calcium in the diet


There are no symptoms in the early stages of the disease. Symptoms occurring late in the disease include:

Bone pain or tenderness
Fractures with little or no trauma
Loss of height (as much as 6 inches) over time
Low back pain due to fractures of the spinal bones
Neck pain due to fractures of the spinal bones
Stooped posture or kyphosis, also called a "dowager's hump"

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