Low-Lying Placenta

Topic Overview

During pregnancy, the placenta is normally attached to the upper wall of the uterus. A placenta that develops low in the uterus without overlapping the cervical opening is referred to as a low-lying placenta. A low-lying placenta is not a high-risk condition and often resolves as the pregnancy progresses.
If you have a low-lying placenta early in pregnancy, there is a good chance that as the lower uterus enlarges, the placenta's relative position will shift away from the cervix. But when the placenta does overlap the cervix, it is called placenta previa, which can bleed heavily during labor. Fortunately, about 90% of placenta previa cases diagnosed before the 20th week no longer overlap the cervix by the end of the pregnancy.¹

Low-Dose Aspirin Therapy

Topic Overview

Why take low-dose aspirin?

Good old aspirin, the common pain reliever that has been in our medicine cabinets for almost a century, also has a talent for prevention.
For people who have had a heart attack: Aspirin can help prevent a second heart attack.
For people who have had a stroke: Aspirin can help prevent a second stroke or a transient ischemic attack (TIA), which is often a warning sign of an impending stroke.
For people who have never had a heart attack or stroke: Aspirin may reduce your chance of having a heart attack or a stroke if you have certain risk factors, such as diabetes, high blood pressure, high cholesterol, or smoking. If you have a higher risk for a heart attack or stroke, aspirin will have even more benefit for you.

Who should take low-dose aspirin?

If you have had a heart attack or stroke, your doctor has probably already prescribed low-dose aspirin for you.
If you have never had a heart attack or stroke, talk to your doctor before you start taking aspirin every day.
Doctors use different guidelines to decide who should take daily aspirin. But no matter which guideline your doctor follows, he or she will look at your health and at your risk for a heart attack or stroke. Then you and your doctor will balance the benefits and the risks of taking a daily aspirin to see if a daily aspirin is right for you. For help on the decision to take low-dose aspirin, see:

Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

If you have a higher risk for a heart attack or stroke, aspirin will have even more benefit for you. If the benefit of aspirin is more than the risk of side effects, you may want to take daily aspirin.
Daily aspirin isn't advised for people who have a low risk of heart attack or stroke.
Your doctor can help you know your risk of having a heart attack or stroke and the risk of bleeding from aspirin. If you know your blood pressure and cholesterol numbers, you can use this Interactive Tool: Are You at Risk for a Heart Attack? to find out your risk.
Low-dose aspirin may be used:

• After a heart attack, to prevent another one.
• By people who have coronary artery disease.
• By people with stable angina.
• By people with unstable angina.
• After bypass surgery or angioplasty.
• By people who have had a stroke or transient ischemic attack (TIA).
• After surgery to prevent a stroke (carotid endarterectomy).
• By healthy men over age 45 when the benefits of aspirin to prevent a heart attack are greater than the risk of stomach bleeding from taking daily aspirin.
• By healthy women over age 55 when the benefits of aspirin to prevent a stroke are greater than the risk of stomach bleeding from taking daily aspirin.

If you have atrial fibrillation and have a low risk of stroke, you might take aspirin to help lower your risk of stroke. Aspirin may be a good choice if you are young and have no other heart or health problems or if you can't take an anticoagulant (also called a blood thinner) safely.

Who should not take low-dose aspirin?

Some people shouldn't take aspirin. These include people who:

• Have a stomach ulcer.
• Have recently had a stroke caused by bleeding in the brain.
• Are allergic to aspirin.
• Have high blood pressure that isn't under control.
• Have asthma that is made worse by aspirin.

Daily aspirin isn't advised for people who have a low risk of heart attack or stroke.
If you think you are having a stroke, do not take aspirin because not all strokes are caused by clots. Aspirin could make some strokes worse.
Gout can become worse or hard to treat for some people who take low-dose aspirin.
If you can't take aspirin, your doctor may have you take clopidogrel (Plavix) to help prevent a heart attack or a stroke.
If you take an anticoagulant, such as warfarin (Coumadin), talk with your doctor before taking aspirin, because taking both medicines can cause bleeding problems.

What should I avoid when taking low-dose aspirin therapy?

Drinking 3 or more alcoholic drinks every day while taking daily aspirin increases your risk for liver damage and stomach bleeding. If your doctor recommends aspirin, limit or stop alcohol usage.
Aspirin should not be taken with many prescription and over-the-counter drugs, vitamins, herbal remedies, and supplements. So before you start aspirin therapy, talk to your doctor about all the drugs and other remedies you take.
Because aspirin reduces your blood's ability to clot, your doctor may want you to stop taking aspirin at least 5 days before any surgery or dental procedure that may cause bleeding. Do not suddenly stop taking aspirin without talking to your doctor first. Talking to your doctor first is especially important if you have had a stent placed in a coronary artery.
Tell your doctor if you notice that you bruise easily, have bloody or black stools, or have prolonged bleeding from cuts or scrapes.
Although nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, relieve pain and inflammation much like aspirin does, they do not affect blood clotting in the same way that aspirin does. Do not substitute NSAIDs for aspirin, because they will not decrease your risk of another heart attack.
If you need both aspirin and a pain reliever every day, talk to your doctor about what pain reliever you should take. If you take uncoated aspirin and ibuprofen at the same time, the aspirin may not work as well to prevent a heart attack. You may be able to use acetaminophen instead of ibuprofen to treat your pain. But if ibuprofen is your only option, avoid taking it during the 8 hours before and the 30 minutes after your aspirin dose. For example, you can take ibuprofen 30 minutes after your aspirin dose. If you take ibuprofen once in a while, it does not seem to cause problems.
Experts do not know if NSAIDs other than ibuprofen interfere with uncoated aspirin. Also, experts do not know if people who take a daily coated aspirin should be concerned about ibuprofen or other NSAIDs interacting with the aspirin. Talk to your doctor if you take these medicines every day.

How do you take low-dose aspirin?

Your doctor will recommend a dose of aspirin and how often to take it. Most people take aspirin every day to help prevent a heart attack or a stroke, but others might take aspirin every other day.
Low-dose aspirin (81 mg) is the most common dose used to prevent a heart attack or a stroke. But the dose for daily aspirin can range from 81 mg to 325 mg. One low-dose aspirin contains 81 mg. One adult-strength aspirin contains about 325 mg.
Low-dose aspirin seems to be as effective in preventing heart attacks and strokes as higher doses.
Take aspirin with food if it bothers your stomach.
For low-dose aspirin therapy, do not take medicines that combine aspirin with other ingredients such as caffeine and sodium.

How does aspirin work to prevent a heart attack or stroke?

Aspirin protects you from having a clot-related stroke in the same way it protects you from having a heart attack.
Aspirin slows the blood's clotting action by reducing the clumping of platelets. Platelets are cells that clump together and help to form blood clots. Aspirin keeps platelets from clumping together, thus helping to prevent or reduce blood clots.
During a heart attack, blood clots form in an already-narrowed artery and block the flow of oxygen-rich blood to the heart muscle (or to part of the brain, in the case of stroke). When taken during a heart attack, aspirin slows clotting and decreases the size of the forming blood clot. Taken daily, aspirin's anti-clotting action helps prevent a first or second heart attack.

Triglycerides (Triglyceride Test)

Triglycerides Overview

Triglycerides are one of the types of fats (lipids) transported in the bloodstream. Most of the body's fat is also stored in the tissues as triglycerides. Triglyceride blood levels are commonly measured along with other lipid levels, such as cholesterol.
Triglycerides are also present in foods like vegetable oils and animal fats. The triglycerides in our blood are a mixture of triglycerides obtained from dietary sources and triglycerides produced by the body as sources of energy.
Elevated triglyceride levels can be caused by a variety of disease processes. Elevated triglyceride levels are considered to be a risk factor for developing hardening of the arteries (atherosclerosis) because many of the triglyceride-containing lipoproteins that transport fat in the bloodstream also transport cholesterol, a known contributor to atherosclerosis. Often, elevated triglyceride levels are present along with elevated cholesterol levels. This condition is referred to as a mixed hyperlipidemia.

Low Testosterone (Low-T)

Low testosterone (low-T) facts

• Low testosterone is a term used by physicians to describe below normal levels of the hormone testosterone in individuals.
• Symptoms of low testosterone include erectile dysfunction in men as the most common symptom; there are many other symptoms that can occur in both men and women (for example, low sex drive, bone and muscle tissue loss, depression) while infants and children may not develop normal male sex organs or may not go through normal puberty.
• Causes of low-T are numerous; some are classified into primary, secondary or tertiary causes while others are due to underlying diseases or conditions and/or lifestyle factors.
• Medical care should be sought for symptoms of low-t; especially in infants and children.
• Low-T is presumptively diagnosed by clinical signs and symptoms; definitive diagnosis is usually done in adult males by a blood test that determines testosterone levels.
• Treatment in males is done by prescribing testosterone shots or testosterone that can be adsorbed topically through the skin or gums.
• The complications of low-T are many and include erectile dysfunction, depression, bone density loss, muscle loss, and many others.
• The outlook for patients with low-T may range from good to poor, depending on a individual's sex, age, and response to treatment.
• Low-T cannot be prevented in some individuals usually because of genetic or underlying diseases; however, in other individuals, low-T can be prevented or delayed by lifestyle changes and choices.

What is low testosterone (low-T)?

Low testosterone is a term used by doctors to describe an abnormal level of the hormone testosterone. When appropriately measured, low testosterone is considered to be below 300 ng/dl in male patients, although some doctors suggest the normal range is 270 – 1070 ng/dl. Other terms for low-T include hypogonadism (primary, secondary and tertiary, depending on the cause of low-T) and testosterone deficiency (TD).
Testosterone is a steroid hormone made in the testes of males and the ovaries of females and is largely responsible for formation and maintenance of male sex characteristics, including both the larger bone and muscle development seen in males. The testosterone levels in humans are regulated by hormones released from the brain; in males the hypothalamus and pituitary glands in the brain increase testosterone during puberty and male characteristics develop (for example, penile enlargement, facial hair, interest in sex).
Although the large majority of low testosterone problems centers on adult males, low-T is not confined to male adults. However, the definition and characterization of low-T in women, children, and infants are less clear than for adult men. Although low-T will be briefly be described in relation to women, children, and infants, either a pediatric endocrinologist or an endocrinologist would be the best source for information on these specialized conditions.
Testosterone production is part of the body's endocrine system.

Illustration of the Endocrine System

Hyponatremia (Low Sodium)

Hyponatremia (Low Sodium) Overview

Sodium and water levels in the body are tightly regulated to keep it functioning normally. Sodium concentration is higher in the bloodstream than inside cells. Regulatory mechanisms help control and maintain sodium levels. The hormones aldosterone (made in the adrenal gland) and anti-diuretic hormone (ADH) or vasopressin (made in the pituitary) adjust the way the kidneys deal with water and sodium to maintain the appropriate total amount of sodium and water in the body.
Water in the body is closely linked to the location of sodium in the body. If the concentration of sodium is too high in the bloodstream, water will leak from cells into the blood stream to try to dilute and lower the sodium concentration. Conversely, if sodium levels in the bloodstream are too low, water will leave the blood and enter cells, causing them to swell.
Hyponatremia is the term used to describe low sodium levels in the bloodstream (hypo=low + natr=sodium + emia=blood). Acute hyponatremia describes the situation in which sodium levels drop quickly, while chronic hyponatremia describes situations with a gradual fall in the sodium concentrations over days or weeks. Chronic hyponatremia is often well tolerated since the body has a chance to adapt.
Neurologic changes are the most concerning consequence of hyponatremia. Cerebral edema (excess fluid in the brain, leading to swelling) may occur with severe or acute hyponatremia. Water enters the brain cells causing them to swell. Because the brain is enclosed in a bony skull that cannot expand, the brain is compressed since there is no room for swelling to occur. As a result, brain function may be compromised significantly.

Anemia

Anemia Overview

Anemia describes the condition in which the number of red blood cells in the blood is low. For this reason, doctors sometimes describe someone with anemia as having a low blood count. A person who has anemia is called anemic.
Blood is comprised of two parts; a liquid part called the plasma and a cellular part. The cellular part contains several different cell types. One of the most important and the most numerous cell types are red blood cells. The other cell types are the white blood cells and platelets. Only red blood cells are discussed in this article. The purpose of the red blood cell is to deliver oxygen from the lungs to other parts of the body.
Red blood cells are produced through a series of complex and specific steps. They are made in the bone marrow (inner part of some bones that make most of the cells in the blood), and when all the proper steps in their maturation are complete, they are released into the blood stream. The hemoglobin molecule is the functional unit of the red blood cells and is a complex protein structure that is inside the red blood cells. Contrary to most cells in the human body, red blood cells do not have a nucleus (metabolic center of a cell).
Even though the red blood cells (or RBCs) are made within the bone marrow, many other factors are involved in their production. For example, iron is a very important component of the hemoglobin molecule; erythropoietin, a molecule secreted by the kidneys, promotes the formation of red blood cells in the bone marrow.
The following are some key points summarizing anemia and red blood cells:

• Having the correct number of red blood cells and prevention of anemia requires cooperation among the kidneys, the bone marrow, and nutrients within the body. If the kidneys or bone marrow are not functioning, or the body is poorly nourished, then normal red blood cell count and function may be difficult to maintain.
• Anemia is actually a sign of a disease process rather than bring a disease itself. It is usually classified as either chronic or acute. Chronic anemia occurs over a long period of time. Acute anemia occurs quickly. Determining whether anemia has been present for a long time or whether it is something new, assists doctors in finding the cause. This also helps predict how severe the symptoms of anemia may be. In chronic anemia, symptoms typically begin slowly and progress gradually; whereas in acute anemia symptoms can be abrupt and more distressing.
• Red blood cells live about 100 days, so the body is constantly trying to replace them. In adults, red blood cell production occurs in the bone marrow. Doctors try to determine if a low red blood cell count is caused by increased blood loss of red blood cells or from decreased production of them in the bone marrow. Knowing whether the number of white blood cells and/or platelets has changed also helps determine the cause of anemia.
• In the United States, 2% to 10% of people have anemia. Other countries have even higher rates of anemia. Young women are twice as likely to have anemia than young men because of regular menstrual bleeding. Anemia occurs in both young people and in old people, but anemia in older people is more likely to cause symptoms because they typically have additional medical problems.
• In general, there are three major types of anemia, classified according to the size of the red blood cells:
1. If the red blood cells are smaller than normal, this is called microcytic anemia. The major causes of this type are iron deficiency (low level iron) anemia and thalassemia (inherited disorders of hemoglobin).
2. If the red blood cells size are normal in size (but low in number), this is called normocytic anemia, such as anemia that accompanies chronic disease or anemia related to kidney disease.
3. If red blood cells are larger than normal, then it is called macrocytic anemia. Major causes of this type are pernicious anemia and anemia related to alcoholism.

Low Potassium (Hypokalemia)

Low Potassium (Hypokalemia) Overview

Low potassium levels (hypokalemia), can cause weakness as cellular processes are impaired.
Potassium is a mineral (electrolyte) in the body. Almost 98% of potassium is found inside the cells. Small changes in the level of potassium that is present outside the cells can have severe effects on the heart, nerves, and muscles.
Potassium is important to maintain several bodily functions:

• Muscles need potassium to contract.
  
  
• The heart muscle needs potassium to beat properly and regulate blood pressure.

The kidney is the main organ that controls the balance of potassium by removing excess potassium into the urine.
When potassium levels are low (hypokalemia), you can become weak as cellular processes are impaired.

• The normal potassium level is 3.5-5.0 mEq/L (mEq/L stand for milliequivalents per liter of blood and this is a measure used to evaluate the level). Low potassium is defined as a potassium level below 3.5 mEq/L.

• Almost one out of five people hospitalized in the United States has a low potassium level.
  
• People with eating disorders such as anorexia nervosa and bulimia, patients with AIDS, alcoholics, and those who have had bariatric surgery have a higher incidence of hypokalemia than others.