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.
People can dream, but their road to success can be derailed in the most unusual ways, perhaps none as strange as that which affected Ryan Clark of the Pittsburgh Steelers. When his team plays in Denver, the Mile High City, so named because it sits at an altitude of 5,280 feet, Clark is sidelined. This is because of an incident in 2007 in which Clark ended up critically ill requiring emergency surgery because of his genetics; he suffers from sickle trait, a condition that affects the shape and function of red blood cells. So when his teammates compete in the Mile High City, Clark is relegated to the sidelines.
Red blood cells are manufactured in the bone marrow. Their unique biconcave shape (think of squeezing a marshmallow between your fingers) increases their storage capacity for hemoglobin molecules that carry oxygen. They also make the cells pliable and soft so they can squeeze through the tiniest blood vessels in the body. In sickle disease, the red blood cells form an abnormal crescent shape that is rigid, causing the red blood cells to be damaged. The cells aren't malleable enough to get through tight spaces, and this can increase the risk of forming blood clots in the small capillaries of different organs causing the potential for organ damage...
Sickle cell anemia (sickle cell disease) is a disorder of the blood caused by an inherited
abnormal hemoglobin (an oxygen-carrying protein within the red blood
cells). The abnormal hemoglobin causes distorted (sickled) red blood
cells. The sickled red blood cells are fragile and prone to rupture.
When the number of red blood cells decreases from rupture
(hemolysis), anemia is the result. This condition is referred to as
sickle cell anemia. The irregular sickled cells can also block blood
vessels causing tissue and organ damage and pain.
Sickle cell anemia is one of the most common inherited blood
anemias. The disease primarily affects Africans and
African Americans. It is estimated that in the United States, some 50,000
African Americans are afflicted with the most severe form of sickle cell anemia.
Overall, current estimates are that one in 1,875 U.S. African American is
affected with sickle cell anemia.
Sickle cell anemia is inherited as an autosomal (meaning that the
gene is not linked to a sex chromosome) recessive condition whereas
sickle cell trait is inherited as an autosomal dominant trait. This
means that the gene can be passed on from a parent carrying it to
male and female children. In order for sickle cell anemia to occur, a
sickle cell gene must be inherited from both the mother and the
father, so that the child has two sickle cell genes.
The inheritance of just one sickle gene is called sickle cell trait
or the "carrier" state. Sickle cell trait does not cause sickle cell
anemia. Persons with sickle cell trait usually do not have many
symptoms of disease and have normal hospitalization rates and life
expectancies. Sickle cell trait is present in some two million
blacks in the United States (8% of the U.S. black population at
birth). When two carriers of sickle cell trait mate, their offspring
have a one in four chance of having sickle cell anemia. (In some
parts of Africa, one in five persons is a carrier for sickle cell
trait.)
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Osteomyelitis is an infection of the bone. Potential causes include injections around the bone, fractures that puncture the skin, recent surgeries, and bacterial infections that travel from other areas of the body, spreading through the blood to the bone. Symptoms include pain, fever, chills, stiffness, and nausea. Treatment involves antibiotics and pain medications. Surgery is sometimes necessary.
A brain hemorrhage is a type of stroke caused when an artery bursts in the brain, causing localized bleeding in the surrounding tissue. Causes of brain hemorrhage include aneurysm, liver disease, brain tumor, head trauma, high blood pressure, and blood vessel abnormalities. Symptoms include sudden severe headache, nausea, vomiting, loss of balance, tingling, numbness, vision changes, loss of consciousness, and loss of fine motor skills. Treatment depends upon the cause, location, and size of the brain hemorrhage.
Diabetes insipidus is a condition in which the patient has frequent urination. Symptoms of diabetes insipidus include irritable, listless, fever, vomiting, or diarrhea due to the loss of large volumes of urine. There are three types of diabetes insipidus, central, nephrogenic, dipsogenic, and gestational. Treatment depends upon the type of diabetes insipidus.
Alpha thalassemia is a disorder in which the alpha globin protein is underproduced. There are two pairs of genes that carry the code for the alpha chains of hemoglobin. When one gene is impaired, that person is in a carrier state and suffers no medical problems. When four genes are impaired, the production of fetal and adult hemoglobin is prevented, resulting in hydrops fetalis and leading to death before birth.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Septic arthritis, or infectious arthritis, is infection of one or more joints by bacteria, viruses, or fungi. Symptoms and signs of septic arthritis include fever, joint pain, chills, swelling, redness, warmth, and stiffness. Treatment involves antibiotics and the drainage of the infected joint.
Aseptic necrosis (avascular necrosis or osteonecrosis) is a condition that develops when blood supply diminishes to an area of bone and causes bone death. Though aseptic necrosis may be painless, pain is often associated when the degenerating bone is used. If caught early, aseptic necrosis may be treated by grafting new bone into the degenerating area. In later stages, joint replacement surgery may be required.
Your health care provider may refer you to a genetic professional. Universities and medical centers also often have affiliated genetic professionals, or can provide referrals to a genetic professional or genetics clinic. Genetic counseling provides patients and family members the tools to make the right choice in regard to test for a disease or condition.
Place the pump, which can be pumped by hand or run on batteries, over the penis.
Pump the air out of the cylinder so that a vacuum is created. The vacuum draws blood into the shaft of the penis and causes it to swell and become erect.
Once the penis is erect, with the help of lubricant, slide the retaining band down onto the lower end of the penis.
Remove the pump after releasing the vacuum.
Intercourse can be attempted with the constriction band in place to help
maintain the erection. The band can be left on safely for up to 30 minutes to
allow for successful intercourse.
Be sure that devices brought without a prescription contains a "quick release" feature, as there have been reports of penile injuries due to devices that did not release its vacuum on-demand or released it too slowly.
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