Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Paget's disease is diagnosed based on the X-ray appearance. Paget's disease
might also be detected with other imaging tests, such as a bone scan, MRI scan,
and CT scan. Alkaline phosphatase,
an enzyme that comes from bone, is
frequently elevated in the blood of people with Paget's disease as a result of
the abnormal bone turnover of actively remodeling bone. This blood test is also
referred to as the serum alkaline phosphatase (SAP) and is used to monitor the results of treatment of Paget's disease.
The bone scan is particularly helpful in determining the extent of the involvement of Paget's disease as it provides an image of the entire skeleton. Bone that is affected by Paget's disease can easily be identified with bone scanning images.
What is the treatment for Paget's disease?
The treatment of Paget's disease is directed toward controlling the disease
activity and managing its complications. When Paget's disease causes no symptoms
and blood testing shows that the level of serum alkaline phosphatase is normal
or minimally elevated, no treatment may be necessary. Bone pain can require
anti-inflammatory drugs (NSAIDs) or pain-relieving medications. Bone deformity
can require supports such as heel lifts or specialized footwear. Surgical
operations may be necessary for damaged joints, fractures, severely deformed bones,
or when nerves are being pinched by enlarged bone. Prior to undergoing an
operation on bone affected by Paget's disease, it is helpful to be treated with
medications, such as bisphosphonates or calcitonin (Miacalcin), as this tends to diminish
the risk of surgical complications, including bleeding.
The medical treatment of the bone of Paget's disease involves either
medications called bisphosphonates or injectable calcitonin. These drugs are also used to treat certain patients with osteoporosis.
Bisphosphonates are the mainstay of treatment. There are a number of these
available that are taken by mouth, including alendronate (Fosamax), risedronate
(Actonel), etidronate (Didronel), and tiludronate (Skelid), and that are
administered intravenously, including pamidronate (Aredia) and
zoledronate (Reclast).
In general, oral bisphosphonates are taken first thing in the morning on an
empty stomach with 8 ounces of water. They can cause irritation of the stomach
and esophagus. Intravenous bisphosphonates can cause temporary muscle and joint
pain but are not associated with irritation of the stomach or esophagus.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Cauda equina syndrome is a medical emergency condition that is caused by the uncommon compression of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include lower back pain, tingling and/or numbness in the buttocks and lower extremities, bowel or bladder incontinence, and weakness in the legs. Causes of cauda equina syndrome include herniated discs, hematomas, or infection. Treatment is generally prompt surgery.
Blindness is the state of being sightless. Causes of blindness include macular degeneration, stroke, cataract, glaucoma, infection and trauma. Symptoms and signs may include eye pain, eye discharge, or the cornea or pupil turning white. Treatment of blindness depends upon the cause of the blindness.
Hearing loss (deafness) may be present at birth or it may manifest later in life. Deafness may be genetic or due to damage from noise. Treatment of deafness depends upon its cause.
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