Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Travelers to other countries often face health issues
they wouldn't ordinarily experience at home. To minimize your risks of becoming
seriously ill when traveling abroad, you should find out in advance whether any
specific immunizations may be recommended for travel to the region of the world
you'll be visiting. It's also a good time to review your own immunization
history.
According to the U.S. Centers for Disease Control and Prevention (CDC), it's best to
schedule a visit to your doctor or travel medicine clinic 4-6 weeks before an
international trip. Since your body needs time to build up immunity after
receiving a vaccine and many vaccines are given in a series over time,
getting an early start on your immunizations is the best way to protect
yourself. Even if you are making a last-minute trip or plan to leave in less
than four weeks, you should still check with your doctor to see if any vaccines
or preventive medications might be recommended.
The CDC divides travel vaccinations into three categories: routine,
recommended, and required. The only vaccine classified as "required" by
International Health Regulations is the yellow fever vaccination for travel to
certain countries in sub-Saharan Africa and tropical South America.
"Routine" vaccinations are those that are normally
administered, usually during childhood, in the United States. These include immunizations against:
Hepatitis means inflammation of the liver. Many illnesses and conditions can
cause inflammation of the liver, for example, drugs, alcohol, chemicals, and
autoimmune diseases.
Many viruses, for example, the virus of mononucleosis and
the cytomegalovirus can inflame the liver. Most viruses, however, do not
primarily attack the liver; the liver is just one of several organs that the
viruses affect. When doctors speak of viral hepatitis, they usually are
referring to hepatitis caused by a few specific viruses that primarily attack
the liver. There are several hepatitis viruses; they have been named types A, B,
C, D, E, F (not confirmed), and G. As our knowledge of hepatitis viruses grows,
it is likely that this alphabetical list will become longer. The most common
hepatitis viruses are types A, B, and C.
The liver is located in the upper right hand side of the
abdomen, mostly behind
the rib cage. The liver of an adult normally weighs close to three pounds. The liver
performs the following vital functions:
The liver helps purify the blood by changing harmful chemicals into harmless
ones. The source of these chemicals can be external, such as medications or
alcohol, or internal, such as ammonia or bilirubin. Typically, these harmful
chemicals are broken down into smaller chemicals or attached to other chemicals
that then are eliminated from the body in the urine or stool.
The liver produces many important substances, especially proteins that are
necessary for good health. For example, it produces albumin, the protein
building block of the body, as well as the proteins that cause blood to clot
properly.
The liver stores many sugars, fats and vitamins until they are needed
elsewhere in the body.
The liver builds smaller chemicals into larger, more complicated chemicals
that are needed elsewhere in the body. An example of this type of function is
the manufacture of cholesterol.
When the liver is inflamed, it does not perform these functions well, which
brings about many of the symptoms, signs, and problems associated with
hepatitis.
Viral hepatitis A (HAV) accounts for about 150,000 of
the 500,000-600,000 new cases of viral hepatitis that occur each year in the
United States. The hepatitis caused by HAV is an acute illness (acute viral
hepatitis) that never becomes chronic. At one time, hepatitis A was referred
to as "infectious hepatitis" because it could be spread from person to person
like other viral infections. Infection with hepatitis A virus can be spread through the ingestion
of food or water, especially where unsanitary conditions allow water or food to
become contaminated by human waste containing hepatitis A (the fecal-oral mode of
transmission). Hepatitis A typically is spread among household members and close
contacts through the passage of oral secretions (intimate kissing) or stool
(poor hand washing). It also is common to have infection spread to customers in
restaurants and among children and workers in day care centers if hand washing
and sanitary precautions are not observed.
Hepatitis B
There are 200,000-300,000 new cases of viral hepatitis B
(HBV) infection each
year in the United States. Type B hepatitis was at one time referred to as
"serum hepatitis," because it was thought that the only way hepatitis B virus
(HBV) could spread was through blood or serum (the liquid
portion of blood) containing the virus. It is now known that hepatitis B can spread by
sexual contact, the
transfer of blood or serum through shared needles in drug abusers, accidental
needle sticks with needles contaminated with infected blood, blood transfusions,
hemodialysis, and by
infected mothers to their newborns. The infection also can be spread by
tattooing, body piercing, and sharing razors and toothbrushes (if there is
contamination with infected blood). About 6-10% of patients with hepatitis B develop
chronic HBV infection (infection lasting at least six months and often years to
decades) and can infect others as long as they remain infected. Patients with
chronic hepatitis B infection also are at risk of developing cirrhosis, liver failure
and liver cancer. It is
estimated that there are 1.2 million people in the United States and 200-300
million people world-wide who suffer with chronic hepatitis B infection.
article.
Hepatitis C
There are about 150,000 new cases of hepatitis C each
year. Type C hepatitis was previously referred to as "non-A, non-B hepatitis,"
because the causative virus had not been identified, but it was known to be
neither hepatitis A nor hepatitis B. The hepatitis C virus (HCV) usually is spread by shared needles among drug abusers,
blood transfusion, hemodialysis, and needle sticks. Approximately 90% of
transfusion-associated hepatitis is caused by hepatitis C. Transmission of the
virus by sexual contact has been reported, but is considered rare. An estimated
50-70% of patients with acute hepatitis C infection develop chronic HCV infection.
Patients with chronic hepatitis C infection can continue to infect others. Patients with
chronic hepatitis C infection are at risk for developing cirrhosis, liver failure, and
liver cancer. It is
estimated that there are about 3.5 million people with chronic hepatitis C infection in
the United States. For more, please see the Hepatitis C
article.
Types D, E, F, and G Hepatitis
There also are viral hepatitis types D, E, F (not
confirmed yet), and G. The most important of these at present is the hepatitis D
virus (HDV), also known as
the delta virus or agent. It is a small virus that requires concomitant
infection with hepatitis B to survive. HDV cannot survive on its own because it requires
a protein that the hepatitis B virus makes (the envelope protein, also called
surface antigen) to enable it to infect liver cells. The ways in which
hepatitis D is
spread are by shared needles among drug abusers, contaminated blood, and by
sexual contact, essentially the same ways as for hepatitis B.
Patients who already have chronic hepatitis B infection can acquire delta virus
infection at the same time as they acquire the hepatitis B infection or, alternatively,
on top of a chronic hepatitis B infection. Patients with chronic hepatitis due to
hepatitis B
and hepatitis D viruses develop cirrhosis (severe liver scarring) rapidly. Moreover, the
combination of delta and B virus infection is very difficult to treat.
Infectious mononucleosis is a virus infection in which there is an increase of white blood cells
that are mononuclear (with a single nucleus) "Mono" and "kissing
disease" are popular terms for this very common illness caused by the
Epstein-Barr virus (EBV).
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
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.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
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.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
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.
Hepatitis means inflammation of the liver. Hepatitis A is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
Hepatitis A and hepatitis B are the two most commnon viruses that infect the liver. Hepatitis A and Hepatitis B can be prevented and treated with immunizations (vaccinations) such as Havrix, Vaqta, Twinrix, Comvax, Pediarix, and hepatitis b immune globulin (HBIG).
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