Anorectal Abscess

The last phase of the digestive process is the collection of and passing from the body of solid wastes. These wastes (what's left of what we eat after the water and nutrients have been taken by our bodies) collect in the rectum and then are expelled through the anus.

The inside of the anus is lined with glands and four to six crypts or pockets. Sometimes one of these pockets gets filled with stool. This can cause the gland to become infected and develop an abscess.

Symptoms

Signs of an anorectal abscess include:

• Fever
• A vague feeling of being unwell or uncomfortable
• Swelling and discomfort around or near the anus
• Redness around the area
• Drainage of pus or fluid from the area

Causes and Risk Factors

This type of abscess is usually happens when the glands in the area of the anus or rectum become infected. When an infection occurs in a gland, it can create a cavity that fills with pus. The cavity swells and causes constant pain and discomfort. The skin may look red and swollen and drain pus.

Diagnosis

A doctor will take the patient's medical history and do a physical examination. Diagnosis will be based on the symptoms and the presence of pain or tenderness, swelling, redness and possible drainage of pus from the area.

The presence of a fever or an elevated white blood cell count as measured by a blood test can confirm the presence of an infection in the body.

Treatment

Antibiotics alone are rarely enough to treat this type of infection. Usually surgical drainage is required.

In about half the cases where an abscess has drained, a fistula (an opening between the inside of an anal pocket or gland where the infection started and the outside of the body where it drained) can develop. A fistula will not heal without treatment that involves removing the pocket where the infection started.

Resources at Cedars-Sinai

Atrial Fibrillation

Atrial fibrillation occurs when electrical impulses in the upper chambers of the heart (atria) begin in multiple sites in a chaotic pattern and are sent rapidly to the heart's lower chambers, causing them to contract irregularly and quickly. The fibrillation or irregular heartbeat can occur for a few minutes, weeks or can continue for a lifetime. Episodes of atrial fibrillation that are brief or intermittent are termed "paroxysmal" while episodes that last longer requiring treatment are referred to as "persistent."

During atrial fibrillation, the atria do not pump blood as effectively as they normally should. In some cases, blood in the atria, which is not being pumped out effectively, can stagnate and clot. If these clots break up or break off, they may pass into the left ventricle, travel through the blood stream and block a smaller artery. If this happens in the brain, it can cause a stroke. Therefore, diagnosis, careful monitoring and treatment are all important aspects of managing atrial fibrillation.

Symptoms of Atrial Fibrillation

Symptoms of atrial fibrillation depend on how rapidly the heart is beating. If it remains below 120 beats a minute, there may be no symptoms other than the irregular or increased pulse. If the rate is higher, there may be heart palpitations or discomfort felt in the chest.

Other symptoms may include:

• A feeling of weakness
• Dizziness or faintness
• Shortness of breath
• Chest pain, especially in adults who are older than 65
• Rarely, blood pressure may fall and cause shock. This usually only occurs in individuals who also have severe heart disease.

Causes and Risk Factors of Atrial Fibrillation

Atrial fibrillation can be caused by heart diseases, such as coronary heart disease, high blood pressure, congestive heart failure or abnormalities of the heart valves. They can also be caused by another conditions, such as alcohol abuse, an overactive thyroid gland (hyperthyroidism), or a birth defect affecting the heart. Rheumatic fever (which often leads to damage to heart valves) and high blood pressure cause the atria to enlarge, making atrial fibrillation more likely. The risk of atrial fibrillation and atrial flutter also increase with age.

Abdominal Pain - Unexplained

Pain and other abdominal symptoms can signal any number of problems. These range from indigestion to cancer.

Symptoms

Some of the more serious conditions associated with abdominal pain include:

• Acute pancreatitis may cause general, constant and worsening pain in the upper abdomen. Sometimes the pain moves to the upper back. Other possible symptoms are weakness, shortness of breath and nausea.
  
• Appendicitis starts as general abdominal pain that settles into the lower right side.
  
• Biliary colic can cause a steady ache in the upper right abdomen. Sometimes the pain spreads to the upper back. Patients may also experience nausea and vomiting.
  
• Crohn's disease can present symptoms similar to appendicitis. These include pain in the lower right side and bloody diarrhea.
• Diverticulitis can cause moderate pain in the lower left side of the abdomen that grows worse over time.
  
• Gallstones may produce severe, cramping pain in the lower right part of the abdomen. Pain may spread to the back.
• Gastroesophageal reflux disease (GERD) causes a burning sensation or discomfort after eating. This occurs especially when the patient is lying down or bending over. GERD may also produce pain in the chest that awakens the patient at night. Other symptoms can be very similar to those of a heart attack.
  
• Hepatitis may cause pain in the upper right abdomen, nausea and vomiting.
  
• Pancreatic cancer may produce the same symptoms as pancreatitis.
  

Treatment

New technologies, such as video cameras that can be swallowed, are now available. These cameras can help diagnose gastrointestinal problems, including unexplained abdominal pain, bleeding with an unknown cause or anemia.

The tiny video camera is swallowed and then eliminated in about 24 hours. The camera sends data to receivers placed on the patient's body. A recorder worn on the patient's belt collects the data. Using special software, the doctor can process the data and produce a video with information from the digestive tract. The camera itself is disposable. Patients can continue normal daily activities while the camera is working.

Resources at Cedars-Sinai

• Samuel Oschin Comprehensive Cancer Institute
• GI Motility Program
• Inflammatory Bowel Disease Center
• Pancreatic and Biliary Diseases Program
• Pediatric Inflammatory Bowel Disease Center

Why Haven't I Ever Heard of Biotoxins, Neurotoxins or Biotoxin Illness Before?

You probably have heard of it, only it was called something else like Chronic Fatigue Syndrome (CFIDS), Fibromyalgia, Chronic Lyme Disease (CLD), Mold Illness, or ADHD (see "Other Names for Biotoxin Illnesses" below). The discoveries and the science behind how biotoxins and neurotoxins are involved in these illnesses and disorders is fairly new. The goal of this site is to provide information to both patients and physicians, to increase awareness regarding causes of Biotoxin Illness and highlight new clinical treatment discoveries. In the few months our new site has been up, we have reached many people, mainly in the United States and Europe. Many MD's are adopting Dr. Shoemaker's protocols and we are working on providing formal training for those individuals. Biotoxin Illness is still controversial and we are working to publish new peer-reviewed papers that can start to change the way doctors currently think. In the meantime, patients must continue to advocate for their rights and pursue the treatments that they feel are best for them. Ritchie Shoemaker, MD presented some fairly recent Chronic Fatigue research and treatment findings at The International Association for Chronic Fatigue Syndrome conference held in Fort Lauderdale, Florida in January of 2007. We have also just completed a soon to be published ground-breaking study on the health effects of mold exposure. Many progressive doctors around the country endorse the use of our on-line BIRS© test and the cholestyramine-based treatment protocol pioneered by Ritchie Shoemaker, MD. Remember though, that medical advances are ultimately driven through peer-reviewed publication in medical journals. These studies are expensive and time consuming and our recent peer-reviewed publications will help advance these discoveries into mainstream medicine. Many more doctors are becoming aware of biotoxins and the role they play in chronic illness.

That said, many leading experts in mold illness and exposure, chronic fatigue syndrome (CFIDS), fibromyalgia and Acute or Chronic Lyme Disease (CLD) are familiar with, and use our screening test and cholestyramine protocol. For example, Dr. Jacob Teitelbaum, Chief Medical Officer of the Fibro and Fatigue Center Clinics, has included a chapter on Dr. Ritchie Shoemaker's biotoxin discoveries and how they relate to CFIDS and Fibroymylgia in the updated revision of his book titled From Fatigued to Fantastic!, which was published in 2007. Additionally, Dr. Shoemaker testified about the human health effects of mold exposure for the US Congress in January of 2006.

Biotoxins play a large role in Chronic Lyme Disease (CLD) and our research in this area is recognized by many preeminent Lyme Literate MD's (LLMD's). A recent presentation summarizing the role of biotoxins in Lyme Disease was given by ILADS member Eric Gordon, MD and is available by clicking here . Another example is found in the monograph Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illnesses , published in 2005 by Joseph Burrascano, MD, (click here for the webcast of Dr. Burrascano speaking about Neurotoxins/Biotoxins in Lyme Disease. He acknowledges that:

"Two groups have reported evidence that Borrelia, like several other bacteria, produce neurotoxins. These compounds reportedly can cause many of the symptoms of encephalopathy, cause an ongoing inflammatory reaction manifested as some of the virus-like symptoms common in late Lyme, and also potentially interfere with hormone action by blocking hormone receptors. At this time, there is no assay available to detect whether this compound is present, nor can the amount of toxin be quantified. Indirect measures are currently employed, such as measures of cytokine activation and hormone resistance. A visual contrast sensitivity test (VCS test) reportedly is quite useful in documenting CNS effects of the neurotoxin, and to follow effects of treatment. This test is available at some centers and on the internet.

It has been said that the longer one is ill with Lyme, the more neurotoxin is present in the body. It probably is stored in fatty tissues, and once present, persists for a very long time. This may be because of enterohepatic circulation, where the toxin is excreted via the bile into the intestinal tract, but then is reabsorbed from the intestinal tract back into the blood stream. This forms the basis for treatment."

Dangers of Iron Supplements

© Leo Galland M.D., F.A.C.N.

Iron is unique among essential minerals, because there is no mechanism for its excretion once absorbed into the body. Whatever iron is absorbed must either be used or stored and excessive storage of iron in the body promotes the generation of free radicals. Excess dietary iron has been implicated by some scientists as a cause of cancer and heart disease. It also increases the risk of bacterial infection. Except for the lactic acid bacteria like Lactobacilli, all microbes require iron for growth. Many of them produce special binding proteins to secure iron from their environments. Humans also produce iron-binding proteins which have as their role the capture of free iron so that microbes can't use it. An excess of iron overcomes this protective mechanism and in-creases susceptibility to bacterial infection. The amount of iron needed for optimal health reflects a delicate balance between deficiency and excess. The best known effect of iron deficiency is anemia, which is the name given to a state in which the number of red blood cells is lower than normal. Anemia is not the same as iron deficiency, however. There are many different causes of anemia, which include folic acid deficiency, vitamin B12 deficiency, disorders of the bone marrow and conditions which increase the rate at which red blood cells are broken down in the spleen. Iron deficiency, when mild, may not produce anemia but may still cause fatigue, im-mune de-fects or fungal infections of skin. There are probably twenty million people in the U.S. who are iron deficient and half of them are not anemic. Wom-en with chronic fatigue and mild iron deficiency who are not anemic improve their energy after taking low doses of iron. Twenty milligrams per day is all that's needed, no more. Low-dose iron supplements can cure people with recurrent boils on the skin, but only if those people have mild iron deficiency. Presumably, correcting iron deficiency improves metabolism and immunity. It is unfortunate that most commercial iron pills contain sixty to three hundred milligrams of iron, far more than are needed or than can even be absorbed from a single pill. High dose iron supplements, taken orally or by injection, increase susceptibility to bacterial infec-tion. Studies in southeast Asia and in Africa demonstrate that even low-dose iron can be harmful. When Indonesian school children who are not iron deficient take iron pills, they fail to grow normally. When iron supplements are given to Somali nomads or Masai tribes-man, their rate of infection increases, even though their iron deficiency is corrected. The high frequency of negative responses to iron supplements in Africa and Asia may reflect the interaction between iron and zinc. Iron in food or pills interferes with zinc absorption and supplemental iron can aggravate zinc deficiency. The recommended daily allowance for zinc (RDA) is based on the assumption that forty per cent of the zinc that is swallowed is absorbed into the body. Actually, zinc absorption is only seventeen to thirty-five per cent and depends upon what is eaten along with zinc. Starch and fiber interfere with zinc absorption, as do calcium and iron. Lack of stomach acid, which may be caused by infection or acid-lowering drugs, also interferes with zinc absorption. Zinc deficiency is common in Africa and Asia, where people consume large quantities of milk, which is high in calcium and low in zinc, and of starches and fibres which inter-fere with zinc absorption. Zinc deficiency profoundly depresses immunity and administering iron to a zinc-deficient person is extremely risky. Not only does iron stimulate bacterial growth, but, by aggravat-ing zinc deficiency, it weakens the immune system of the person being supplemented. No one should ever take iron supplements unless iron deficiency is present, with the possible exception of pregnant women. The best test for iron deficiency is a blood test called the serum ferritin level. Ferritin is a protein that carries iron, and low ferritin levels are a common sign of iron deficiency. Like all laboratory tests, the interpretation of ferritin levels is subject to interpretation. Because the body has a limited capaci-ty for iron absorption, it does not make any sense to administer more than twenty milligrams of elemental iron at a time. Iron should not be taken as part of a multivitamin or multimineral preparation. Iron interferes with the absorption of the essen-tial minerals zinc, manganese and molybdenum; it destroys vitamin E; its own absorption is blocked by calcium and magnesium. Iron is best absorbed after a meal, with a small quantity of vitamin C (between one hundred and five hundred milligrams).

Archived columns by Leo Galland M.D., F.A.C.N.