(BPT) – Harley Noffsinger was a typical kid who liked to play outside and stay active. When she was 7, everything changed. She got a nose bleed, but unlike most people’s experiences, her bleeding wouldn't stop. It lasted 90 minutes.
Noffsinger's parents brought her to the emergency room at the nearest hospital, where she was diagnosed with von Willebrand Disease (VWD). Like most Americans, neither Harley, nor her parents, had ever heard of VWD, and had no family history of it. Still, VWD is the most common inherited bleeding disorder, affecting about 1 percent of the U.S. population, or more than 3 million people. According to the National Hemophilia Foundation (NHF), like hemophilia, VWD can prevent the blood from clotting normally. VWD can result in extended bleeding after injury, surgery or trauma, and, in severe cases, can be fatal if not treated effectively.
“Harley was fortunate that she was diagnosed so early because, according to the Centers for Disease Control, it takes an average of 16 years from the onset of bleeding symptoms for a woman to be diagnosed with VWD," said Dr. Robert Sidonio, Jr., a pediatric hematologist-oncologist at the Aflac Cancer and Blood Disorders Center in Atlanta, Georgia. He is a consultant to NHF.
While VWD occurs equally in women and men, women are more likely to experience its symptoms because of the increased bleeding it causes during their menstrual periods, during pregnancy and after childbirth. Menstrual bleeding that lasts more than seven days is considered heavy and heavy menstrual bleeding -- a period with excessively heavy flow -- affects one in five American women of reproductive age, or nearly 10 million women. In fact, having a bleeding disorder can be an underlying cause of heavy menstrual bleeding. Besides VWD, women can have other bleeding disorders, such as hemophilia or rare factor deficiencies.
Over time, many women simply get used to having a heavy period. They may think it’s normal because female relatives have similar experiences. However, for some women, an undiagnosed bleeding disorder may be the cause of their heavy flows and, because it’s hereditary, multiple family members may also be undiagnosed.
Now age 22, Noffsinger experiences heavy periods. Before using a menstrual cup, she would have to check every 30 minutes to change her tampon or pad. “I was worried constantly that I was bleeding through,” she said. “I see light pads and light tampons in stores and I get so jealous because I have to use these ginormous things.”
Having heavy periods is one, but not the only symptom of a bleeding disorder, according to a new public service campaign called "Better You Know," created by NHF as part of a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to raise awareness of bleeding disorders. The centerpiece of the campaign is www.BetterYouKnow.org, a website featuring a confidential, multiple-choice online questionnaire and other tools to help you determine whether you are at risk for a bleeding disorder and the next steps you can take to seek care.
According to Dr. Sidonio, you should speak to your health care provider if you've experienced one or more of the following 10 signs and symptoms of bleeding disorders:
1. Told you are "low in iron" or have been treated for anemia.
2. Experienced heavy bleeding after surgery.
3. Experienced prolonged bleeding from the gums after a dental procedure.
4. Have heavy menstrual bleeding (having to change one pad or tampon every hour).
5. Experienced heavy bleeding after childbirth or miscarriage.
6. Have frequent nosebleeds that last longer than 10 minutes.
7. Have bleeding from cuts or injuries that lasts longer than 10 minutes.
8. Bruise easily, with bruises that are raised and larger than a quarter.
9. Have blood in your stools from bleeding in your intestines or stomach, or blood in your urine from bleeding in your kidneys or bladder.
10. Have someone in your family who has one or more of these symptoms, or a family member who has been diagnosed with a bleeding disorder such as VWD or hemophilia.
If you receive a bleeding disorder diagnosis, remember it can be managed. For Noffsinger, whose story is featured on www.BetterYouKnow.org, having VWD has not prevented her from living life fully. Her future plans include having children, travel and more. Knowing her body and what to expect with bleeding has helped Noffsinger gain confidence to live fully.
“If you don’t know what’s going on and you have a period that lasts for three weeks and you’re freaking out and think you’re dying, you’re going to go to the hospital,” said Noffsinger. “But if you know you’re going to bleed for three weeks and it’s going to go away, you can relax and have a calm state of mind about it. That's why I'm doing all I can to spread the word about BetterYouKnow.org. I want everyone to know that, if you have a bleeding disorder, your life can be better if you know about it, and seek care and treatment."
* Watch more How to Understand Schizophrenia videos: http://www.howcast.com/videos/512789-How-Schizophrenia-Is-Diagnosed-Schizophrenia
Hi. I’m Jeanie Tse, and I’m here to talk to you about how schizophrenia is diagnosed. There’s no lab test or radiological X-ray test for schizophrenia. The way we diagnose is using a clinical interview and also information from other people that might know a person to know whether they have the symptoms and signs of schizophrenia.
So, there are psychological tests that sort of tell you about your general personality structure and whether you might have a risk for psychotic symptoms, but they are also not definitive ways of diagnosing schizophrenia. It’s really that interview that it comes from, as well as the person’s history. And so, the Diagnostic and Statistic Manual, which is the compendium in psychiatry that tells us all the symptoms and criteria for different disorders, talks about schizophrenia. And it recently changed over from DSM IV to DSM V in May of this year, of 2013. And the criteria are largely the same.
What’s changed is that some of the sub-types have been eliminated because they didn’t hold true in the research. And so, the symptoms of schizophrenia, basically the main symptoms fall into five different areas and you need two or more of these to qualify.
So, the first one is delusions. So, having fixed false beliefs that aren’t consistent with your culture and that other people don’t hold is one symptom area. And so, having paranoid delusions where you feel that other people are out to get you or plotting against you, that’s a paranoid delusion. Having a grandiose delusion, which is like you feel that you are more important than you really are, like you’re a world leader or you have a mission to accomplish, those are delusions. There are also nihilistic delusions, where people feel a part of them is dead or they’re all dead. Or some interesting ones that I used to remember is being the X-files delusions where the Capgras delusions, we call them, are where you feel like someone you know has been replaced by someone else. So, those are different types of delusions.
Hallucinations are where you perceive something that other people aren’t perceiving. So, hearing voices that aren’t there and sometimes you might hear commands to do things, or seeing things that aren’t there, those are hallucinations.
Disorganized thought and disorganized behavior. So, in terms of disorganized thought, sometimes people with schizophrenia cannot sort of get from point A to B when they’re talking. It kind of weaves all over the place or actually just goes from thought to thought without making sense. Disorganized behavior is generally very poor self care, but in an inability to organize activities. And so, sometimes in the worse cases, sometimes you see people who in the middle of summer are dressed in eight layers of clothing and a winter parka. And that’s a disorganization of behavior: an inability to respond to the environment and what is needed. So, those are the first four symptom categories.
The fifth is negative symptoms. And so these include anhedonia, which is a lack of interest or pleasure in things; avolition, which is a lack of motivation; flat affect, so there’s not much display of emotion, sadness or happiness; alogia, which is just not a lot of thoughts coming through in their mind. Those are some of the negative symptoms of schizophrenia.
So, we look for these symptoms and, as well, we look for them to occur over a one month period. At least a one month period. And then we look, also, at whether there is at least six months of what we call a prodromal, a deterioration of functioning, so that someone who maybe was going to school and doing quite well suddenly starts to not be able to study, is not taking care of their hygiene, is not sleeping. And that sort of decline is necessary to make the diagnosis as well.
We also have to rule out that this change in behavior and thinking is due to a substance use or is primarily due to substance use because substance use can trigger it as well. Or, that it is primarily due to a medical condition. Many things can mimic schizophrenia, like lupus, like brain tumors. So, we have to rule those things out and do medical tests to rule those things out. And then, we can make the diagnosis.
Sometimes, schizophrenia can be confused with other disorders, like bipolar disorder or depression, so we have to do a careful clinical interview to make sure that this is schizophrenia and not something else.
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