Chronic Diseases

Chronic Diseases

Overview

If left untreated, diabetes and its complications can lead to serious, even life threatening health problems, such as heart and renal disease, blindness and others.

At Athens Medical Group we offer comprehensive diabetes treatment to help control the disease and to prevent or manage its complications.

Our Diabetes Departments are staffed with physicians that have a high level of scientific training and have invested many years in the research of diabetes’ diagnosis and treatment.

They are recognized as pioneers in their field, having constant scientific concerns and systematically monitoring new developments in diabetes and all related co-morbidities at international scientific conferences.

Studies have shown that people with diabetes do better when treated by a multidisciplinary healthcare team.

At Athens Medical Group we apply a holistic approach to the treatment of diabetes. Our team consists of certified professionals that are directly or indirectly related to the origin, development and complications of diabetes.

Our diabetologists work together on a case by case basis with vascular surgeons, infectious disease specialists, orthopedists, dermatologists, psychologists, pediatricians and other health experts, such as dietitians and specialized nurses, with a view to better care for the diabetic patient.

Your personal care team will guide you to make healthy eating and physical activity a part of your lifestyle, they will help you monitor you blood sugar levels and use your medications properly and they will encourage and support you every step of the way.

Working with our team of experts will help you achieve a number of positive results, such as:

  • Improved blood sugar levels
  • Reduced risk of complications
  • Weight loss
  • Overall positive lifestyle modification

Our doctors cover on a 24-hour basis both the needs of the patients being hospitalized and their follow-up outside the hospital.

Their concern is the proper treatment of diabetes with appropriate medication, with due care being taken to prevent and / or treat the complications of diabetes.

The hospitals of Athens Medical Group meet the higher standards for controlling blood-sugar levels of our patients while they are hospitalized. This is important because blood glucose control can be difficult in the presence of infections or if the patient is under certain medications.

Our services include:

  • Diabetes education visits
  • Special nutrition therapy visits with a registered dietitian to people with diabetes and pre-diabetes, hypertension, hyperlipidemia, as well as in need of weight loss.
  • Guidance for intensive insulin therapy
  • Insulin pump instruction
  • Inpatient diabetes education and management
  • Continuous glucose monitoring

Numerous clinical studies focusing on diabetes are performed at the clinics of Athens Medical Group, thus contributing to the development of medical research and science.

Diagnosis

The diagnosis o diabetes is made by measuring blood sugar or sugar values ​​during the glucose curve.

The diagnosis also involves the measurement of glycosylated hemoglobin (HbA1c). Large clinical studies have shown that we can minimize the chance of complications from diabetes if glycosylated hemoglobin is below 7%, provided this is achieved without hypoglycemia. The measurement of glycosylated hemoglobin should be carried out every three months.

Screening for diabetes is recommended at the age of 45 for people without symptoms, non-obese and non-risk factors should be.

People who are overweight or obese, who have an additional risk factor such as lack of exercise, who suffer from hypertension, dyslipidemia or cardiovascular disease, or are relatives of first degree of people with diagnosed diabetes, should screen themselves at an earlier stage in life.

Also, overweight / obese mothers diagnosed with pregnancy diabetes or women who have given birth to overweight babies should be regularly monitored.

People with pre-diabetes should be monitored for diabetes by specialists, at least once a year.

Genetic testing

Over the years multiple genes have been found in the human genome to be associated with diabetes mellitus indicating that the disease can be hereditary. There have been plenty of cases where hereditary diabetes had been previously misdiagnosed as type 1 and 2 diabetes.

Monogenic Diabetes, formerly known as MODY (maturity onset diabetes of the young), is recognized as the most common form of genital diabetes and is estimated to account for 2 – 5% of all cases.

Genetic testing is particularly valuable in the diagnosis of various and often rare types of monogenic diabetes, such as:

  • transient neonatal diabetes mellitus, a type of diabetes diagnosed early in neonatal life (up to 3 months), requires insulin therapy for up to 12 weeks, and then subside, without any treatment.
  • permanent neonatal diabetes mellitus is identified by the detection of mutations in the KCNJ11 gene and requires lifelong insulin therapy.
  • Wolcott Rallison syndrome is a rare syndrome that is extremely difficult to diagnose with clinical examination. Its complications include diabetes at neonatal age along with acute hepatic failure and often epileptic dysplasia.
  • Wolfram syndrome is also rare and results in the occurrence of insulin-dependent diabetes in childhood with gradual loss of vision and hearing before the age of 16. In 90% of these cases, there is a mutation in the WFS1 gene and it requires administration of insulin.
  • MIDD syndrome (maternal inherited diabetes and deafness) is a result of mitochondrial DNA damage, which is responsible for deafness and diabetes. Patients with the syndrome have low stature, hearing loss and diabetes at the age of 30-40. They require immediate insulin therapy.

In addition to the abovementioned monogenic types of Diabetes, human DNA analysis revealed areas that are associated with both an increased risk of type 1 and type 2 diabetes  ​​and areas affecting insulin secretion.

Genetic testing allows for the calculation of Genetic Risk Score, which helps doctors have a clearer clinical picture of a patient and determine whether he or she needs insulin or other types of treatment.

Athens Medical Group is at the forefront of the latest applications of genetics for therapeutic intervention. Dozens of drugs are being developed allowing doctors to interfere with regulating glucose metabolism in the body and related hormones. These drugs target may target various related co – morbidities while contributing to the treatment / or prevention of diabetes mellitus.

What We Treat

Our doctors specialize in the diagnosis and treatment of diabetes mellitus and other related conditions.

Diabetes mellitus is a chronic condition, characterized by a metabolic disorder of carbohydrates, fats and proteins. The main and common disorder in all forms of diabetes is hyperglycemia, i.e. elevated blood sugar.

It is distinguished into type I diabetes, type II diabetes, pregnancy diabetes and other rare types.

Type I diabetes mellitus is caused by the destruction of pancreatic B cells, which normally produce the hormone insulin. Thus, in this type of diabetes there is an absolute insulin deficiency and external administration of this hormone in necessary for the treatment of this disease.

Type II diabetes mellitus is caused by a combination of disorders in the discharge and action of insulin (tissue resistance to insulin).

Individuals with sugar values ​​higher than normal, but not so high to be considered diabetic are called pre-diabetic. The term indicates relatively high risk for future development of diabetes and cardiovascular disease.

Other types of diabetes treated at Athens Medical Group include:

  • Monogenic Diabetes
  • Gestational diabetes (Diabetes during pregnancy)
  • Steroid-induced Diabetes
  • Transplantation Diabetes

Chronic complications

Chronic complications of diabetes mellitus can be reduced by regulating blood sugar levels.

The target organs affected by diabetes are the eyes, the kidneys, the nervous system and the vessels of the heart, brain and peripheral arteries.

With regard to the eyes, so-called diabetic retinopathy is the damage of the small vessels of the eyes and without treatment it can even lead to blindness.

Testing by an ophthalmologist should begin early after the diagnosis of diabetes, well before the patient becomes symptomatic. It must be repeated at least once a year.

Inflammation of the kidneys is called diabetic nephropathy and is one of the most important causes of hemodialysis worldwide. We are in line with the latest diagnostic techniques that allow us to detect the onset of diabetes in the kidneys by measuring urine albumin in a random sample.  Diabetic nephropathy is asymptomatic in the early stages of the disease and therefore diabetic patients should undergo at least an annual urinalysis for albumin excretion, along with blood tests for the kidneys (urea, creatinine, electrolytes), and should be repeated every six months if the results are pathological.

Diabetic neuropathy is distinguished into:

  • peripheral neuropathy, which usually manifests itself with symptoms of the lower extremities, such as numbness, pain, burning sensation
  • neuropathy of the autonomic nervous system, in which stomach disorders (gastroparesis), urinary tract disorders (diarrhea or constipation), orthostatic (postural) hypotension, erectile dysfunction and others may occur

Infarction of the large vessels mainly affects the coronary heart vessels, carotid arteries and lower limb vessels, also known as macroangiopathy, and can manifest itself as angina or even acute myocardial infarction, stroke or intermittent claudication (pain in lower legs when walking).

Regular, annual, cardiology tests, such as electrocardiography, heart triplex, or stress test, are recommended for people with diabetes.  Also testing of the carotid arteries and leg arteries should be performed once a year.

Testing of the arteries in the lower extremities is of particular importance, if there is pain when walking. The severity of the problem is assessed depending on the distance the patient can walk before the pain occurs. If a stenosis is found, the test needs to be resumed in less than one year (depending on the severity of the stenosis). In some cases, the patient needs to undergo angiography (digital, axial or magnetic) in order to decide on possible further intervention in a vessel with stenosis.

Diabetic foot

Diabetic foot is one of the most important complications of diabetes mellitus with a serious impact on the quality of life of the patient. Regular checking of the feet (at least once every six months) allows for the early detection of a foot that is likely to have ulceration.

Such findings usually involve the occurrence of diabetic symmetrical peripheral neuropathy, which causes patients (due to the reduced perception of pain in the lower extremities) to underestimate some minor injuries to their feet. This condition, if combined with any existing arterial disease of the lower extremities, can eventually lead to limb amputation.

Obesity and Diabetes

Research has established that many people develop type 2 diabetes as a result of gaining too much weight.

In many western societies, approximately one-third of the population tends to be obese, which is defined as people with body mass index (BMI) over 30 kg/m2. Another one-third of the population are considered overweight, with a BMI of 25-29.9 kg/m2, and is at risk for developing obesity in the future.

At Athens Medical Group, we aim to provide evidenced-based, multidisciplinary and comprehensive care and treatment to overweight and obese adults.

We treat and evaluate patients with:

  • Obesity
  • Weight gain and regain after surgical treatment for obesity
  • Inability to maintain a stable, healthy weight

Athens Medical Group (AMG) is a reference center for weight-loss surgery treatments, ( Bariatric Surgery ).

Overview

At the Endocrinology Department of Athens Medical Group, we offer comprehensive treatment of all thyroid disorders, from hyperthyroidism and hypothyroidism to thyroid nodules, goiter and cancer, as well as disorders of every other endocrine or metabolic disorder.

We apply advanced diagnosis as well as the latest surgical and non-surgical procedures, offering a multidisciplinary approach on every case and our expert experienced doctors work closely with AMG’s specialists from other medical fields, such as ophthalmology, otolaryngology, radiation oncology and surgery, in order to provide holistic treatment and improve your well-being.

At AMG you are at the center of the care you receive.  Our team of thyroid specialists, including leading national experts, will review your case together with you and create a treatment plan that reflects your aims and needs.

What We Treat

The Endocrinology Department offers high level counseling to patients and preoperative assessment of their condition, as well the latest treatments applied in the best medical centers in the world.

Our doctors and nursing staff aim to provide the best possible care for a wide range of conditions involving the thyroid gland as well as every endocrine and metabolic disorder, including:

In the Endocrinology Department all required diagnostic tests are carried out in collaboration with the fully equipped diagnostic departments and laboratories of the Athens Medical Group hospitals, such as:

  • hematological, biochemical, hormonal tests
  • genetic tests
  • ultrasound
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • scintigraphy
  • image-Directed Fine Needle Aspiration Biopsy (FNA)

Also, all surgical procedures, including minimally invasive techniques, are performed to treat the full spectrum of thyroid and endocrine diseases, such as:

  • Total thyroidectomy
  • Cervical lymph node dissection,
  • Minimally invasive thyroidectomy
  • Thyroglossal duct excision
  • Minimally invasive parathyroidectomy
  • Focused parathyroidectomy
  • Total parathyroidectomy
  • Laparoscopic adrenalectomy
  • Minimally invasive adrenalectomy
  • Laparoscopic resection of pancreatic neuroendocrine tumors

Following surgery, patients receive detailed post-operative follow-up while the attending physician always receives a detailed report on the surgical procedure performed and the intraoperative findings.

Overview

Heart failure, sometimes referred to as congestive heart failure (CNS), is a condition in which the heart is unable to supply the tissues with sufficient blood to meet the needs of the organs.

The clinical syndrome of congestive heart failure (CNS) is the often ultimate endpoint of multiple heart and diseases, such as coronary artery disease, and other conditions, such as obesity, diabetes and hypertension.

Heart failure may either be acute, when the symptoms are recent, or chronic, when it evolves in the course of time.

Sometimes the conditions that lead to heart failure cannot be reversed. However, lifestyle changes, such as improving your diet, losing weight, exercising more and reducing stress, as well as expert medical treatment will help you manage your condition and live longer and better.

Athens Medical Group is a leader in the heart field offering novel diagnostic imaging approaches and treatments for heart diseases.

Our doctors work together and combine their rich clinical experience and scientific prestige, applying the latest treatments and interventional heart disease procedures to provide comprehensive treatment and care for our patients.

We provide quick and accurate test results as well as speedy and coordinated scheduling of appointments, in a matter of days and not months as it happens elsewhere.

What We Treat

Heart failure can be avoided if the cardiovascular conditions that cause it are dealt with. The latter can be successfully treated, if not easily prevented, with specialized screening and medical treatment.

There are various risk factors for the occurrence of heart failure. One factor may be enough for eventually causing heart failure and a combination of them increases the risk of its occurrence.

The main risk factors include:

  • High blood pressure, which increases the workload of the heart
  • Coronary heart disease, a disease in which coronary arteries become too narrow and are unable to supply the heart with a good amount of oxygen leading to weakening of the myocardial tissue
  • Acute ischemic strokes cause acute myocardial damage that may seriously affect the performance of the heart pump
  • Arrhythmias also cause the heart to work more and make the cardiac muscle weaker.
  • Diabetes may lead to heart failure, because it increases the risk of both coronary heart disease as well as arterial hypertension.
  • Apneic seizures during of sleep are an additional risk factor, because they cause the oxygen levels in the blood to reduce as well as in arrhythmias – factors that both weaken the heart muscle
  • Viruses, alcohol overconsumption and kidney diseases can lead to heart failure
  • Structural cardiac deficits are congenital and involve a small percentage of patients
  • Valvular Heart Disease that is neglected may lead to heart failure
  • Chronic diseases, such as diabetes, HIV and thyroid disorders may also contribute to heart failure

 

Symptoms

The main symptoms of heart failure include:

  • Dyspnea (shortness of breath)
  • Weakness, fatigue and reduced ability to exercise
  • Leg edema (swelling)
  • Tachycardia or arrhythmia
  • Decreased exercise resistance
  • Persistent coughing or wheezing with white or reddish phlegm
  • Abdominal swelling
  • Body weight increase, due to retention of fluids
  • Anorexia or nausea
  • Difficulty in concentration or reduced reflexes
  • Chest pain, in the case of a heart attack

 

Complications

There are multiple complications of chronic heart failure. It may lead to renal failure, mainly when the underlying conditions are neglected for a long period of time) due to the reduced supply of blood to the kidneys. Also, the function of the heart valves and the liver may be aggravated by the increased fluid retention. The blood flow within the cardiac pump is reduced and as a result blood clots may develop leading to cardiac arrest and / or strokes.

Timely treatment can improve to a substantial extent the symptoms and quality of life of patients.

 

Diagnosis

The diagnosis of heart failure starts with your doctor taking a detailed medical history of yours. The presence of risk factors, such as high blood pressure, coronary artery disease or diabetes in your medical history, point towards chronic heart failure.

After that, your doctor will recommend a series of clinical and paraclinical examinations, including:

  • Hematological tests, such as for natriuretic peptide (NT – proBNP), a hormone secreted by the heart which is a reliable predictor marker for heart failure
  • Chest X-ray
  • Electrocardiograph
  • Fatigue testing
  • Coronary angiogram
  • Myocardial biopsy
  • Dobutamine Stress Echocardiogram

The stress echocardiogram with dobutamine plays a prime role in cardiac function assessment. It a fast and effective test based on ultrasound technology that provides your doctor with important information about both the overall and partial function of the myocardium. As such, it is considered an objective marker assessment of the severity of the heart disease.

In selective cases, information about the causes and the severity of the heart failure may also be provided by magnetic resonance imaging (MRI) or computed tomography (CT) of the heart.

 

Classification

The results of your clinical and paraclinical examinations with help your doctors classify your case based on its severity and determine the most suitable treatment for it. There are two systems in which heart failure is classified:

The New York Heart Association (NYHA) scale is an international system of classifying patients with heart failure based on their symptoms.

In class I patients do not show any symptoms. In Class II there are no symptoms in the usual activity but patients are being challenged by fatigue in intense exercise. In class III the symptoms appear in normal activity too and in class IV, which is the most serious condition, the patient suffers from severe dyspnea (shortness of breath) at rest.

A second classification is the American College of Cardiology scale, which uses a grading of the disease from A to D depending on the risk factors of the patients, their symptoms and the dynamics of the disease. For example, Stage A patients show several aggravating factors for heart failure without disease, while the Stage D patients are in the final stage of the disease and require hospitalization.

The classification helps doctors identify the risk factors and initiate a timely and aggressive treatment, in order to predict or to slow the progression of the disease.

 

Treatment

Heart failure is a chronic disease that can significantly improve with the application of important life changes as well as with expert medical treatment of the symptoms and the underlying conditions.

While for most people heart failure is treated simply with the right medications, sometimes more interventional treatments are applied. More specifically:

 

Medication

Heart failure is usually treated with a combination of medications, such as:

  • Angiotensin-converting enzyme (ACE) inhibitors, which lower blood pressure, improve blood flow and decrease the heart’s workload. Patients that do not tolerate ACE inhibitors may opt for Angiotensin II receptor blockers.
  • Beta blockers, that slow your heart rate, reduce blood pressure and overall improve the function of the heart.
  • Diuretics cause you to urinate more frequently, thus helping prevent the collection of fluid in your body.
  • Aldosterone antagonists, such as spironolactone and eplerenone, are diuretics that treat high blood pressure and heart failure.

 

Interventional and surgical treatment

When medication is not enough for treating the underlying conditions that cause heart failure then more interventional treatment approaches are used by the doctors, including surgery:

  • Coronary bypass is recommended in the case of severely blocked arteries and in order to restore the normal blood flow through your heart.
  • Heart valve repair or replacement is carried out in the case of a faulty heart valve which is surgically repaired or replaced by a prosthetic valve. Depending on the case, the heart surgery may be open or involving cardiac catheterization and minimally invasive techniques.
  • Implantable cardioverter-defibrillators (ICDs) are used in cases of dangerous (threatening) arrhythmias. They are similar to pacemakers and are implanted under the skin of the chest.
  • Biventricular pacing or cardiac resynchronization helps patients with uncoordinated heartbeat due to problems in the electrical system of their heart. In particular patients the implantation of a biventricular (i.e. involving both lower chambers of the heart) pacemaker resynchronizes the heartbeat and prevents the worsening of heart failure.
  • Ventricular assist devices (VADs) are mechanical assistance devices that help in the pumping of blood from the ventricles (the lower chambers of the heart). They are implanted in the abdomen or the chest. Originally VADs were designed in order to serve as a bridge to heart transplantation, if the latter is not possible or delayed. Studies have shown that in most of cases VADs may improve cardiac function and substitute heart transplantation.
  • Heart transplant is the option for patients with severe heart failure that cannot benefit from any of the aforementioned treatments or medications.

At AMG our Cardiology Clinics and Special Units are staffed by physicians who are leaders in their fields using unique diagnostic, interventional equipment in order to treat with exemplary effectiveness any acute or chronic cardiac event, 24 hours a day.

 

Prevention

Essential modifications to the daily way of life can help prevent the deterioration of heart failure. Quitting smoking protects the coronary arteries and reduces arterial blood pressure and the workload of the heart. Furthermore, the regulation of body weight as well as the adoption of a diet with limited fatty acids and cholesterol reduces the likelihood of heart failure.

Alcohol consumption is restricted in cases of heart failure, since it weakens the cardiac muscle, increases the risk of arrhythmia and interferes with the medications.

In more serious cases of heart failure, patients should limit the reception of fluids and salt (to no more than 2 mg daily), in order to avoid retention of fluids in the body.

If heart failure coexists with arterial hypertension or the patient is over 50 years of age the maximum daily intake of salt is 1.5 mg.

Aerobic exercise contributes greatly to the wellbeing of myocardial tissue. Patients with heart failure need a special training program devised tailored to their needs.

Avoiding intense emotional burdens and stressors leads to a substantial reduction in the workload of the heart, hence the disease is stabilized and improves.

In cases of apneic seizures crises during sleep, patients should have a sleep study and receive the corresponding instructions from the doctors.

Overview

Hypertension is high blood pressure that does not respond to conventional treatments, such as medication. As a top healthcare provider in Greece, Athens Medical Group sets the bar for hypertension care.

We provide expertise in treating patients with hypertension and its complications through a comprehensive and multidisciplinary approach.

Our experience has shown optimal results in managing hypertension with use of a team approach, including hypertension medical specialists, such as cardiologists and nephrologists, nurses and dietitians.

You will get personal attention from a coordinated team of hypertension healthcare professionals who are experts in all forms of hypertension, including complex and difficult-to-treat cases.

Our dedicated team of healthcare professionals offers a wide array of services, including:

  • Advanced diagnosis and treatment of hypertension and its complications
  • Access to advanced therapies for hypertension and its co-morbidities
  • Assistance in creating a healthy dietary plan that meets your personal nutrition goals

More specifically, during your consultation in the Hypertension Clinics of Athens Medical Group, our specialists will:

  • Assess any secondary causes of hypertension
  • Recommend medication and modifications on your diet
  • Monitor your ambulatory blood pressure over a 24-hour period
  • Measure your central blood pressure
  • Develop a personalized treatment plan

You will have an active role in your own care, particularly in respect with medications lifestyle changes and follow-up monitoring at our clinics. Your personal care team will be by your side every step of the way, working closely with you to set your individual goals.

Our holistic approach has resulted in the overall decrease of morbidity and mortality from hypertension and associated cardiovascular disease as well as improved quality of life for our patients.

What We Treat

Arterial hypertension is a chronic condition that causes a systematic increase in systolic and diastolic blood pressure. It is one of the most important risk factors for various health threats such as stroke, myocardial infarction, heart failure, peripheral arterial disease and renal failure.

The higher the blood pressure, the higher the cardiovascular risk, especially when other risk factors (such as smoking, hyperlipidaemia, inherited history of cardiovascular disease, sugar metabolism disorders, obesity) are present. Thus, the more risk factors, the greater the risk of future cardiovascular events.

Nowadays, modern treatment of arterial hypertension is not limited to the regulation of blood pressure but is based on the assessment and modification of the overall cardiovascular risk.

In addition, recognition of cases with difficult-to-regulate hypertension, the diagnosis of secondary hypertension based on international practices and the interventional treatment of resistant hypertension are of particular importance.

According to the guidelines of the European Society of Hypertension, all patients with high blood pressure should be assessed for future cardiovascular risk using cardiovascular risk models such as the SCORE model.

The overall risk assessment of a hypertensive patient includes measuring blood pressure, recording the presence of risk factors and calculating 10-year cardiovascular risk based on SCORE.

Also, it includes assessment of potential failure of organs that are targeted by hypertension, such as the heart, kidneys, brain, and vessels.

Hypertension causes lesions caused in these organs without symptoms. Lesions such as left ventricular hypertrophy, increased albumin excretion by kidneys, increased aortic stiffness and carotid artery wall thickness, are indications that help predict the cardiovascular risk, regardless of blood pressure values ​​per se.

 

More specifically:

Electrocardiogram

One of the tests that can detect the presence of left ventricular hypertrophy is the electrocardiogram (ECG), a test that measures the electrical activity of the heartbeat. ECGs should be routine for the hypertensive patient. Studies have shown that the electrographic evidence of left ventricular hypertrophy is associated with increased cardiovascular risk. The diagnostic test of choice for the identification and quantification of hypertrophy is the triplex echocardiogram (heart triplex). Detection of hypertrophy with echocardiography is an important tool for staging the cardiovascular risk of a hypertensive patient, taking therapeutic decisions and monitoring.

 

Microalbuminuria

The persistent elevation of albumin in the urine, called microalbuminuria, is a sign of asymptomatic kidney damage by arterial hypertension and can be observed even if serum creatinine is normal. The presence of microalbuminuria has been associated with an increased risk of permanent renal damage and cardiovascular events in both diabetic and non-diabetic hypertensive patients. Specific antihypertensive drugs, such as renin-angiotensin-aldosterone-inhibitors are effective in reducing microalbuminuria.

 

Increased aortic stiffness

Hypertensive patients have increased aortic stiffness, which has been associated, besides high blood pressure, with glucose metabolism disorders. Arterial stiffness is one of the earliest detectable manifestations of adverse changes within the vessel wall and can be assessed by measuring the rate at which the pulse wave produced by each cardiac extrusion travels into the aorta. The stiffer the aorta the higher the pulse wave velocity (PWV). Aortic stiffness assessment by pulse wave measurement is done through a special device and is recommended for all hypertensive patients.

 

Carotid intima-media thickness

Carotid intima-media thickness, as well as the presence of atherosclerotic plaques, help assess the risk of vascular stroke and myocardial infarction, regardless of other risk factors. Measuring the thickness of the intima-media and detecting atherosclerotic plaques with a carotid triplex is recommended for all hypertensive patients.

 

Treatment

Hypertension is treated primarily with lifestyle changes such as dietary modifications, loss of weight, stress management and physical activity, as well with the administration of medications.

Some common types of hypertension medications include:

  • Diuretics: They remove water and sodium from the body, thus reducing the fluid in the blood vessels and causing blood pressure to go down.
  • Angiotensin-converting enzyme (ACE) inhibitors: They inhibit the formation of a hormone called angiotensin that narrows blood vessels, allowing them to open up.
  • Angiotensin II receptor blockers (ARBs): A more novel type of medication, they block the action (not the formation) of angiotensin allowing for blood vessels to widen.
  • Beta-blockers: They block the effects of the hormone epinephrine allowing the heart to beat slower and with less force, thus lowering blood pressure.
  • Calcium channel blockers: They prevent calcium from entering muscle cells in the heart and blood vessels, allowing blood vessels to relax.

If medications and lifestyle changes do not produce results, surgical reconstruction of a damaged artery may be performed.

In addition to offering advanced diagnosis, care and therapies for patients with hypertension and its complications, Athens Medical Group offers patients the opportunity to participate in innovative therapies as part of ongoing clinical research projects.

 

Renal Sympathetic Denervation

Resistant hypertension is when blood pressure remains above the target despite the concurrent use of three antihypertensive drugs at the maximum tolerated dosage including a diuretic, according to the guidelines of the European and American Society of Hypertension.

For patients with resistant hypertension, Athens Medical Group provides a new therapeutic approach, Renal Sympathetic Denervation, which is based on lowering the level of sympathetic nervous system stimulation.

Renal sympathetic denervation is a minimally invasive procedure for treating resistant hypertension. It involves the percutaneous catalysis of the renal sympathetic nerves running in the wall of the renal arteries through a specially designed catheter and the use of an appropriate source of energy.

Catalysis is performed under local anesthesia with the patient staying for one day in the hospital. Analgesics and tranquilizers are administered intravenously to reduce pain during catalysis. Catalysis is applied in the same way in both renal arteries and lasts for about 20-30 minutes.

Also, renal sympathetic denervation is associated with improving the severity of sleep apnea, glucose metabolism, decreasing left ventricular mass and arterial stiffness, as well as having a positive effect on arrhythmias (mainly atrial fibrillation) or kidney disease.

Overview

Being in pain is not easy and may have serious impact on your work, your personal and family life, your daily activities and routine, your mental and emotional well-being.

Chronic Pain is a disease and reduces the quality of life

At Athens Medical Group we have a long and rich history of offering sophisticated and multi-disciplinary therapeutic approach to pain management.

Our team is led by certified doctors dedicated to reducing and eliminating pain and providing the most advanced treatment options in a supportive, compassionate environment.

Our doctors are pioneers in the application of invasive pain management techniques, such as nerve blocks, epidural injections, Radiofrequencies, Intraspinal drug delivery systems and neurostimulation.

We work together with other medical specialties, such as Oncology, Radiology, Neurosurgery, Orthopedics, Spine Surgery and Vascular Surgery in order to provide you a holistic approach and ensure optimal improvement of your quality of life.

What We Treat

At Athens Medical Group we provide comprehensive treatment and care for all forms of pain, from the simplest to the most complex ones.

More specifically we treat:

Chronic Pain

Chronic pain is one that persists beyond the usual time required to recover from acute illness or for a wound to heal. That period of time is more than three or six months from the onset of the disease.

Chronic pain is distinguished into nociceptive (pain due to a nerve response only to painful or traumatic stimuli), neuropathic (pain due to a central or peripheral nervous system injury) or mixed (combination of both).

Chronic pain may be superficial (skin or superficial tissue damage) or deep.

Deep chronic pain is distinguished in physical pain (involving muscles, tendons, ligaments, vessels, joints) and visceral (organs).

Physical pain is deep and difficult to locate, while the visceral can be easy or difficult t identify, depending on whether it is projected in areas that are distant from the visceral area that is reported to suffer.

Chronic pain is also categorized as peripheral (resulting from peripheral nervous system injury or dysfunction) or central (resulting from damage or dysfunction of the central nervous system, i.e., the brain or the spinal cord).

Chronic pain is often accompanied by weakness, fatigue, anxiety, agitation, depression, withdrawal from daily activities, insomnia.

Most pain-causing conditions, such as musculoskeletal (rheumatoid arthritis, fibromyalgia, osteoarthritis), neurological (neuropathy, neuralgia, headache), gastrointestinal and urogenital disorders, may evolve into chronic pain.

Psychiatric disorders (depression, bipolar disorder) are associated with chronic pain syndromes and lead to magnification of pain stimuli.

As the pain is personalized and there is no specific pain-identification test, diagnosis is often difficult. Usually, doctors of various specialties need to work together and order a variety of examinations in order to determine the location of the pain in the organism and the disease that causes it.

The treatment of chronic pain is causative depending on the disease that caused the pain.

The aim of the care team is to deal with acute pain so that it does not evolve into chronic and if it is already chronic to act effectively and immediately so as prevent depression, social withdrawal or degradation of the patients’ quality of life.

At Athens Medical Group we offer a holistic therapeutic approach that includes medication, interventional techniques, psychological support, physiotherapy and alternative therapies.

Neuropathic Pain

Neuropathic Pain is the pain resulting as a direct consequence of an injury or disease that affects the somatosensory system.

The somatosensory system is the path that the stimulus (chemical, mechanical, and thermal) follows from the periphery to the center through all major parts of the vertebrate body and contributes to the uptake and awareness of information from the skin, the viscera and the musculoskeletal system as well as the perception of the body’s position in space (proprioception).

The somatosensory system includes upward nerve fibers from the peripheral sensory neuron to the spinal cord, brainstem, and cortex, as well as downward nerve fibers from the cortex, brainstem, and midbrain to the spinal cord.

It is distinguished into peripheral (peripheral sensory nerve fibers) and central (brain, spinal cord) somatosensory system.

Neuropathic pain is categorized according to its duration (acute or chronic), its location in the nervous system (peripheral or central) and its etiology (primary or secondary).

In contrast to the nociceptive pain suffered after healing or the restoration of inflammation, neuropathic pain due to pathological mechanisms is chronic and accompanied by anxiety, depression, sleep disturbances and poor quality of life.

In neuropathic pain, there is an increased activity in the peripheral and central nervous system , as well as a development of pathological painful symptoms such as hyperalgesia (increased sensitivity to painful stimulus), hyperaesthesia (increased sensitivity to mild stimulus), allodynia (perception of a non-painful stimulus as painful) hyperpathia (presence of hyperalgesia, hyperaesthesia, allodynia).

Non-painful symptoms such as dysaesthesia (uncomfortable or abnormal sensation with or without stimulus), paraesthesia (pathological feeling without stimulus) and also hypoaesthesia (reduced skin sensation) may also occur.

Patients with neuropathic pain describe it as caustic, stabbing, usually stable and difficult to endure. It can manifest itself as an electric shock, like stitching or biting, often accompanied by tingling, numbness and itching.

Diabetespostherpetic neuralgiatrigeminal neuralgiacancerneurological diseases (multiple sclerosis), chemotherapyradiotherapychronic musculoskeletal disordersand nerve entrapment syndromes are associated with neuropathic pain.

The diagnosis is based on patient history, clinical examination and specific questionnaires used worldwide as valuable diagnostic tools.

Laboratory testing consists mainly of Quantitative Sensory Testing (QST)Neurophysiological Testing – ElectroneuromyographyPain Reflex Testing, MicroneurographyFunctional Neuroimaging (Pet-scan, FMRI), and Skin Biopsy.

Neuropathic pain is treated by administering medication, such as antiepileptics (pregabalin, gabapentin), antidepressants (SSRI,SNRI,TCA), opioids (tramadol, tapentadol, and oxycodone), antiarrhythmic (mexiletine) and transdermal patches of lidocaine 5% and capsaicin.8%

Nerve blocks and neurostimulation (peripheral or central) may also be part of a treatment plan.

Postherpetic Neuralgia

Postherpetic neuralgia is a syndrome of chronic peripheral neuropathic pain and is caused by neural damage induced by herpesvirus-3 (HHV-3), also known as varicella zoster virus (VZV).

The chickenpox virus, once the patient heals, remains in the nerve ganglia and can be revived. It occurs with a vesicular erythematous rash with intense itchiness and pain.

About 50% of patients with herpes zoster over 60 years old, suffer from postherpetic neuralgia, as a complication, after the rash has stopped.

The pain may persist beyond a year with serious impact on the patient’s quality of life.

The areas of the body where it is most often appears are the thorax, the lumbar region, the neck, and the trigeminal nerve distribution region.

A risk factor for its occurrence is age

An increased incidence of postherpetic neuralgia also occurs in immunocompromised individuals (corticosteroids, immunosuppressants), cancer patients and people with diabetes mellitus.

The pain of postherpetic neuralgia is mainly found in the dermatome (an area of skin that is mainly supplied by a single spinal nerve) which corresponds to the affected ganglion.

The pain is acute, burning, stabbing and pressing. The affected area usually presents allodynia, i.e. increased sensitivity even to a non-painful stimulus (caressing, touching), increased sensitivity to a painful stimulus (hyperalgesia) and increased sensitivity to touch (hyperaesthesia).

The diagnosis of postherpetic neuralgia is based on the medical history of the patient and on the clinical examination by the treating physician.

The treatment of postherpetic neuralgia requires experience and specialization of the attending physician and includes medication and interventional techniques.

The most commonly used pharmaceutical agents to treat it are antiepileptics (pregabalin, gabapentin), mild opioids (tramadol, tapentadol), antidepressants (SNRI,SSRI,TCA).

For the treatment of post-herpetic neuralgia, transdermal patches such as (lidocaine 5%) and capsaicin 8% can be applied locally to the painful area.

Difficult cases of postherpetic neuralgia are treated with neural blocks (peripheral, central) as well as neurostimulators and totally implanted intraspinal delivery systems.

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy (DPN) occurs in up to 50% of the type I diabetes population. It is progressive and chronic, usually manifested as symmetrical peripheral polyneuropathy and, more rarely, as focal neuropathy.

The causes of DPN are multifactorial. It is caused by demyelination and axonal degeneration of the nerve fibers, either due to direct damage to the fibers due to the accumulation of glycosylated products – sorbitol, or by the microangiopathy of the vessels that supply them.

Uncontrolled diabetes mellitus, poor bowel hygiene, poor diet, smoking, alcohol, increased body weight, hypertension, hyperlipidaemia are the main risk factors for DPN.

There are many classifications about DPN, but the two most common types are acute neuropathies due to hyperglycemia and improved by the return of normal glucose levels and chronic sensory-motor neuropathy, which is the most common form of DPN.

A 10-26% of the DPN population experiences moderate to severe pain, usually located in the lower extremities and the soles, and is rarely found in the upper limbs.

The pain is caustic, intensifies in the evening and is accompanied by numbness, pins and needles in the legs. Pain can coexist with increased sensitivity (hypersensitivity) or reduced sensitivity (hypoaesthesia), with allodynia, paraesthesia, and often becomes paroxysmal during sleep.

There may also be disorders of the autonomic nervous system, i.e. sweating, vasomotor disorders, and trophic skin edema.

The diagnosis is made by excluding other causes of polyneuropathy (neurological disease, hypothyroidism, vitamin B12 deficiency, and uremia).

Neurological examination and history of diabetes mellitus facilitate diagnosis, while electromyography, nerve and skin biopsy could serve as complementary to the diagnostic test.

In order to prevent DPN, the following recommendations are given:

  • Periodic check and maintenance of blood glucose levels
  • Maintenance of glycosylated hemoglobin at tolerable levels (HbA1C of less than 7%)
  • Good limb hygiene
  • Cholesterol and blood pressure regulation
  • Proper nutrition, exercise, alcohol and smoking cessation.

The first step in treating DPN is to regulate blood glucose levels at normal levels and to correct other metabolic disorders.

The pain caused by DPN is managed with the administration of medication as well as with invasive methods.

Medication includes anti-epileptics (pregabalin, gabapentin), serotonin-noradrenaline reuptake inhibitors (duloxetine, venlafaxine), and tricyclic antidepressants (amitriptyline), antiarrhythmic agents (mexiletine), mild opioids (tramadol, oxycodone, tapentadol) 8% capsaicin patches.

If medication proves insufficient, then interventional techniques,  neurostimulation (transdermal, spinal cord) may be applied.

Lumbago – Sciatica (Lower Back Pain)

Lumbago is a general term used to describe pain in the low back, with or without reflection at the lower extremity due to pressure of a nerve or its root (sciatica).

Based on the duration of symptoms, lower back pain can be acute, lasting less than 4 weeks, subacute, with a duration of 4-12 weeks, and chronic, lasting more than 12 weeks.

Depending on the etiology, low back pain is classified as non-specific and specific.

Non-specific is the lower back pain whose cause is unclear and is usually associated with benign musculoskeletal problems (muscle or tissue stretching/sprain, spinal cord burdening).

Specific is the lower back pain that is attributed to specific pathological causes, which can be mechanical (vertebral fractures, spinal disc herniation, spondylolysis), inflammatory (rheumatoid, psoriatic, ankylosing arthritis), metabolic (osteoporosis, osteopenia), neoplasmatic (primary or secondary bone cancers) and psychosomatic.

In 20% – 37% of patients with chronic low back pain there is also neuropathic pain, i.e. pain resulting from direct damage or disease of the nervous system and manifested by numbness, burning, pins and needles, tingling, itching, allodynia and feeling of electrical shock.

There are various mechanisms responsible for neuropathic pain, such as a mechanical nerve root compression from a projected intervertebral disc herniation, localized nerve damage to the degenerate disc, and the influence of inflammatory mediators.

The diagnosis is based on the patient’s history, clinical examination and neurological assessment.

Diagnostic tools include lumbar spinal scan (CT scan) while, on suspicion of neoplasm or inflammation, it is good to perform a hematological test on the levels of C-reactive protein (CRP).

Prevention of the occurrence or recurrence of lumbago and sciatica is of utmost importance and requires exercise, good physical activity, avoiding a sedentary lifestyle, good posture, body weight adjustment, avoiding severe cough-sneezing.

Treatment of acute or subacute lumbago is mainly pharmaceutical and includes the administration of paracetamol, nonsteroidal anti-inflammatory drugsmuscle relaxantsmild opioids (tramadol, tapentadol). Physiotherapy is important for  this group of patients. Alternative therapies such as acupuncture, ozonotherapy, siatsu may be used.

It is important that the patient learns to maintain a proper posture and a lifestyle with plenty of activity, since immobility aggravates the condition.

The treatment of chronic low back pain with a neuropathic component includes the administration of all of the aforementioned medications with the addition of antiepileptics (pregabalin) and transdermal patches such as lidocaine 5% and capsaicine 8%.

Serotonin – noradrenaline reuptake inhibitors (duloxetine, venlafaxine) may also be administered.

Epidural injection of corticosteroids has very good therapeutic results in the management of low back pain.

Radiofrequencies is the treatment of choice for facet-joint syndrome.

At Athens Medical Group we have great experience with applying such invasive techniques in patients with lumbago – sciatica, helping them to avoid surgery.

Surgery is indicated when conservative treatments fail, or when the patient progressively develops functional limitations or neurological symptoms commonly associated with severe disk herniation and spinal cord compression (urinary or fecal incontinence, lower limb muscle weakness).

Fibromyalgia

Fibromyalgia is a musculoskeletal pain syndrome characterized by widespread pain with particular sensitivity in 18 specific anatomical points of the body, known as tender points.

The tender points are distributed symmetrically in the anterior and posterior surfaces of the body (neck, trapezoid-suprarachial-thoracic-medial gluteus muscle, knee-elbow joint, lumbar joint).

Fibromyalgia is a generalized disorder and with the main feature of pain intensity deteriorated by stress.

It is associated with dysfunction of the neuroendocrine and immune system, physical fatigue, cognitive disorders, sleep disorders, headache, depression, psychological disorders and is therefore no longer seen as a single disease but as a Central Sensitivity Syndrome.

Symptoms of fibromyalgia include morning stiffness, weakness, cramps, reduction of movement, while pain can be acute or stabbing, daily, paroxysmal and may coexist with allodyniahyperalgesiaand numbness.

Usually, fibromyalgia may coexist with other conditions such as irritable bowelurinary disorderscystitisrestless legs syndrometemporomandibular joint dysfunction.

Fibromyalgia is of unknown origin. Genetic, environmental, psychological factors are perceived as causes, while post-traumatic stress is likely to contribute to its occurrence. It is more common in women and is associated with neurotransmitter dysfunction, decreased serotonin levels and higher levels of the P peptide.

Fibromyalgia may be primary or secondary when a rheumatic (lupus erythematosus, rheumatoid arthritis), inflammatory or endocrine disease exists.

The diagnosis of fibromyalgia is based on the history of widespread musculoskeletal pain, lasting at least three months after an underlying pathological cause has been excluded. The presence of at least 11 out of 18 tender points is oriented towards the diagnosis of fibromyalgia but is no longer a necessary criterion.

To exclude other pathological causes of widespread musculoskeletal pain, the laboratory tests performed are red blood cell countserythrocyte sedimentation raterheumatoid control (rheumatoid factor, anti-nuclear antibodies), and thyroid hormones.

Therapy is pharmaceutical using analgesics (paracetamol, non steroidal anti-inflammatory), mild opioids (tramadol, oxycodone, and tapentadol), muscle relaxantsantidepressants (tricyclics), serotonin / serotonin- noradrenaline reuptake inhibitors, anti-epileptics (pregabalin, gabapentin).

Repeating sessions with trigger points has great results.

Mild aerobic exercise (swimming, hydrotherapy), acupuncture, reflexology, psychological support, psychotherapy, cognitive behavioral therapy, are all complementary to medication with good results.

Myofascial Pain Syndrome

Myofascial pain syndrome is a neuromuscular disease that affects the muscles and the fascia.

It is a regional chronic pain syndrome and is characterized by the presence of one or more painful trigger points.

The trigger points are distinguished according to their location into primary and secondary (satellite) and, depending on the symptoms they produce, they may be active or latent.

The primary trigger points are located centrally in the region of the neuromuscular junction (nerve entry point in the muscle), while the satellite in the adhesions of the muscle (more peripheral).

Active trigger points are very sensitive to pressure, but they also cause automatic muscle pain, while the latent ones cause pain only when palpated.

The trigger points are located along a stretched muscular bundle (palpable nodules), near the point of the neuromuscular junction. By applying pressure on the firing point, the pain of the patient is reproduced, while causing contraction of the tension muscle and reflex pain in a neighboring area.

Myofascial syndrome may affect distinct, individual muscle groups in multiple and different anatomical regions of the body, often resulting in a variety of local symptoms.

The pain is constant, acute, deep, accompanied by a reduction in the range of movement in the affected area and aggravated by stress. Pain persists or worsens and usually does not retreat automatically.

In chronic cases, it is accompanied by muscle weakness or atrophy, and often symptoms of autonomic nervous system disorder (sweating, local temperature changes, local swelling).

Myofascial syndrome is caused by overuse or strain of the affected muscle, recurrent injuries of a muscle group, poor posture or problematic motion patterns, prolonged immobility of the muscle, exposure to cold or moisture. Bone-spinal pathological conditions, such as spondyloarthropathy and degenerative osteoarthritis, may lead to the onset of the syndrome. Even hormonal disorders (dysmenorrhea, menopause) can cause the syndrome to develop.

The diagnosis of the Myofascial Pain Syndrome, after having excluded other pathological causes of musculoskeletal pain, is a clinical one. The palpation of even a single trigger point, during the clinical examination of the patient, is diagnostic.

Medications used to treat myofascial syndrome include non-steroidal anti-inflammatorymuscle relaxantsspasmolytic agents, antiepileptics (pregabalin), antidepressants (mainly serotonin-noradrenaline reuptake inhibitors), and mild opioids (tramadol).

Interventional deactivation of trigger points with local anesthetic / corticosteroid / wet needle is of primary importance.

Trigeminal Neuralgia

Trigeminal neuralgia is a syndrome of chronic neuropathic pain disorder of the face associated with trigeminal nerve. It mainly affects people aged 50-70, of which 60% are women.

The trigeminal nerve is responsible for sensitivity in the face, as well as functions such as biting and chewing. It is divided into three major branches, the ophthalmic nerve, the maxillary nerve and the mandibular nerve, which are distributed in the facial area.

Trigeminal neuralgia is a painful syndrome of unknown etiology. The most likely cause is the compression of the trigeminal nerve from a neighboring major vessel. It is usually the superior cerebellar artery, but sometimes the posterior superior and inferior cerebellar as well as the vertebral artery may be involved in the pathogenesis of the syndrome.

Compression of the trigeminal nerve causes its demyelination and release of ectopic impulses. Secondarily, trigeminal neuralgia may be the result of trigeminal demyelination due to multiple sclerosis or nerve compression by a tumor.

The pain of trigeminal neuralgia is acute, jabbing and described as electric shock or as “stabbing”. Pain is usually unilateral in the distribution of trigeminal branches, although in of 3% of patients, it is bilateral. The onset of pain as well as the recovery from it are sudden and abrupt.

In between the painful episodes, the patient is free of intense symptoms, and sometimes remains a milder, caustic pain between seizures, remains.

Seizures may last for several seconds or several minutes, and the duration of neuralgia may be days, weeks or months.

Over time and without proper treatment, painful seizures become more intense and more frequent.

Pain emanates from the cold, from untoward stimuli (light touch), as well as during speech, chewing, swallowing, washing the face, brushing the teeth, laughing.

For the diagnosis of trigeminal neuralgia, the physician performs a thorough neurological examination to see whether the painful syndrome involves the trigeminal nerve.

Magnetic resonance imaging is often necessary to exclude the possibility of multiple sclerosis or secondary trigeminal pressure from a tumor. Sometimes magnetic angiography is also useful to indicate a possible vascular pressure of the trigeminal nerve.

The treatment of trigeminal neuralgia is pharmaceutical and interventional. Administration of anticonvulsants (carbamazepine, gabapentin, pregabalin) is particularly beneficial, as electrical triggers of the trigeminal nerve are reduced. Spasmolytic agents, mild opioids or strong opioids may be used to relieve pain.

Invasive techniques are applied after the problem has been properly assessed. These treatments are proposed by the World Institute of Pain and are applied at the Athens Medical Group’s Pain Center in trigeminal neuralgia cases that do not respond effectively to medication.

The invasive treatments include botox (onabotulinumtoxinA) injections, to reduce the pain from trigeminal neuralgia, and surgical operations aiming at removing or relocating blood vessels that put pressure on the trigeminal nerve.

Disease – Damage – Injury Of The Nervous System

Damage of the nervous system is manifested by a variety of symptoms.

Patients who have a stroke with residual neurological sequelae, spinal cord injury or multiple sclerosis may experience spasticity or loose paralysisreduced or complete loss of sensation or mobilitysevere painhyperalgesiahyperaesthesiahyperpathiadysaesthesiaparaesthesiaallodynia.

The therapeutic approach includes the administration of pharmaceutical agents for the treatment of neuropathic pain such as antiepileptics (pregabalin, gabapentin), serotonin-noradrenaline reuptake inhibitors (duloxetine, venlafaxine), and serotonin reuptake inhibitorsmild opioids (tramadol, oxycodone, and tapentadol) or strong opioids (fentanyl)

Simple analgesics (acetaminophen, non-steroidal anti-inflammatory) are used in the case of parallel nociceptive musculoskeletal pain.

In cases of spasticity, the delivery of baclofen into the lumbar subarachnoid space, with the help of an implantable pump, has very good therapeutic effects. This is the technique of choice for this group of patients and in Athens Medical Center has been used since 2000.

When medication fails, invasive techniques may be of choice. According to international guidelines, the techniques that are simpler and safer for the patient should always be preferred.

Neurostimulation

Spinal cord neurostimulation has very good results and is the interventional technique of choice. In Athens Medical center our doctors have a great experience in this interventional technique.

Under the x-ray test, one or more electrodes are placed in the epidural space and periodic electrical stimuli are delivered from a microscopic generator.

Pulse intensity is adjusted to irritate the nerve endings responsible for reducing the transfer of painful stimuli from the periphery to the center.

In addition, activation of central mechanisms that inhibit pain, facilitates the achievement of analgesia by the neurostimulation technique.

As a clinical outcome, the use of neurostimulation causes paraesthesia (painless slight stinging) in the area, manifesting the painful symptomatology and significantly reducing pain intensity.

Neurostimulation is a valuable tool in the hands of our experienced doctors. A trial period (3-4 days) is needed prior the permanent implantation of the device to see if there is a positive response of the patient to the treatment.

Spinal cord neurostimulation is applied with very good results in cases of mixed (neuropathic and nociceptive pain after spinal surgery, as well as in cases of chronic neuropathic pain due to progressive disease of the nervous system (Reflex Sympathetic Dystrophy).

Overview

Respiratory Chronic Diseases Care at AMG

If you are regularly experiencing shortness of breath, while trying to complete your daily activities, it may not just be a part of aging – it could be a result of a chronic Respiratory disorder.

The term chronic Respiratory or respiratory disorder describes a range of conditions of the airways and other structures of the lungs, such as asthma and chronic obstructive Respiratory disease (COPD), the latter often found in the form of chronic bronchitis or emphysema.

Chronic Respiratory disorders are bound to have a major impact on your daily life. At Athens Medical Group, we understand your daily struggle and are always ready and available to provide the help you need in order to reduce your symptoms and manage your condition.

Our Respiratory Clinics treat patients suffering from diseases of the lungs and respiratory system with the goal of improving patients’ day-to-day function and quality of life. Our Respiratory clinical services encompass a variety of disease states including ambulatory Respiratory and sleep medicine and inpatient Respiratory medicine.

 Your personal care team

At Athens Medical Group our aim is to help you improve the quality of your life. For this purpose, we provide comprehensive and patient-centered care for Respiratory chronic disorders that goes beyond the diagnosis and treatment of the disease.

A multi-disciplinary team of experts, including pulmonologists, physical and occupational therapists, specially trained nurses, dietitians and even thoracic surgeons, will work with you to choose a treatment plan that is in line with your goals and addresses all your needs, both physical and emotional.

The immediate response and ongoing contact of our medical staff with you is a key feature of how our Respiratory clinics work.

Your personal care team will help you every step of the way, from diagnosis, to treatment and your transition to your home after a hospital stay.

We will help you manage your medications and teach you how to identify potential warning signs as well as take action before any serious complications.

We will help you quit smoking, increase your knowledge and control of your condition and provide you with dietary counseling in order for you to improve your Respiratory symptoms and build the independent living you deserve.

Diagnosis

Chronic Respiratory disorders may often be misdiagnosed and at times are not identified until the disease is advanced and its potential treatment may not be as effective. As a rule diagnosis should be considered for patients with symptoms, such as chronic cough, sputum production or difficulty to breathe and a history of exposure to risk factors, like smoking.

Your doctor will review your symptoms and your medical history. Depending on your condition, your doctor may order some tests, such as:

Lung function tests, such as spirometry, static lung volumes and carbon monoxide diffusing capacity (DLCO), in order to measure the amount of oxygen your lungs deliver to your blood.

Spirometry is the most common of these tests and involves blowing into a large tube connected to a spirometer, the apparatus that measures the volume of air inspired and expired by the lungs.

Imaging tests, such as a chest X-ray and lung CT scan. Chest X-rays detect emphysema and help rule out other lung conditions. Computerized tomography scan, or CT scan, takes smaller and more detailed pictures of the lungs. As such, the CT scan is the most sensitive and accurate test for the diagnosis of emphysema. A CT scan may capture emphysema signs that normal X-rays miss, it may detect bronchiectasis, a Respiratory disease in which the lung’s bronchial tubes are damaged and expanded, and identify potential thickening of the bronchial walls, thus helping determine the chronic bronchitis levels in the lungs. This lung CT scans will help your doctors not only diagnose accurately your condition, but also to determine if you might benefit from surgery as part of your treatment.

Allergy testing may be required in cases where there is suspicion for asthma.

An arterial blood gas analysis measures the oxygen level in your blood and if carbon dioxide is removed properly. It helps determine the severity of your Respiratory disorder and whether you might need oxygen therapy.

Laboratory tests may be ordered in order for you doctors to determine the cause of your symptoms or rule out other conditions.

A peak flow measurement is a test carried out with a small, handheld device that measures how much air you are able to push out through your lungs. It is a usual diagnostic test for asthma.

Treatment

There is no cure for chronic Respiratory disorders, but a proper management may slow the progression of the disease and relieve its symptoms, allowing you to be active and significantly improve the quality of your life.

Treatment for chronic Respiratory disorders aims to prevent further damage on the lungs and its complications, as well as easing the symptoms of the disease.

At Athens Medical Group we provide every test and therapeutic approach for the diagnosis and treatment of chronic Respiratory disorders, including the most up-to-date smoking cessation treatments.

Our doctors are widely recognized for their experience and expertise in treating chronic Respiratory disorders and have been involved in various clinical trials.

Treatment of COPD

Chronic obstructive Respiratory disease (COPD) is usually manifested in the form of chronic bronchitis and emphysema. Usually, patients with COPD have one or both of these conditions as part of their COPD diagnosis.

Most individuals with COPD have a little bit of both, but have a predominance of one or the other. Your doctor will ask questions about your family history with respiratory illnesses, your symptoms and the medicines you use, and ask questions about your lifestyle. He or she will conduct a physical exam and order some laboratory tests to diagnose and assess the severity of your COPD.

Smoking cessation

Cessation of all smoking is essential to any treatment plan for chronic Respiratory disorder. Smoking will only make your condition worse and negatively affect your ability to breathe. It is not easy to quit smoking, but our experts will help you achieve that goal.

At AMG, specialized medical practitioners will guide you in your effort by offering counseling, applying treatments, providing the necessary medication and monitoring your progress.

Medications

Several kinds of medications may be used as part of the treatment both of the symptoms and the complications of chronic obstructive Respiratory disease.

Bronchodilators

Bronchodilator drugs are important in the management of patients with COPD as they help open the airways in the lungs by relaxing muscle around those airways. Their aim is to alleviate bronchial obstruction and airflow limitation, reduce hyperinflation, and improve the emptying of the lung.

Bronchodilators usually come in an inhaler and can be short or long acting. There are different types of short or long acting bronchodilators that work in different ways.

Short acting bronchodilators have an immediate effect (within 15-20 minutes) in decreasing shortness of breath. They are usually prescribed in cases of shortness of breath or before exercise.

Long-acting bronchodilators are used to open the airways of the lungs and keep them that way.

Inhaled steroids

Inhaled corticosteroids help reduce airway inflammation and are essential in treating patients with a history of COPD exacerbations. Usually, patients breathe them in through an inhaler.

Some medications combine bronchodilators and inhaled steroids.

Oral steroids

In cases of acute exacerbation, patients with COPD may take corticosteroid medication in the form of pills in order to prevent the symptoms to get worse. Long-term use of oral steroids may have serious side effects, such as diabetes and osteoporosis.

Oxygen therapy

Oxygen therapy is prescribed in the cases of low blood oxygen levels. The latter can cause problems in your vital organs if it continues for long periods of time. Oxygen therapy contributes to bringing blood oxygen levels to normal. There are various devices for the provision of oxygen therapy, some of which are lightweight, compact and can be easily carried everywhere, such as the portable oxygen concentrators. Consult your doctors for your oxygen therapy options.

Lung Volume Reduction

Some patients with severe emphysema may benefit with a technique called lung volume reduction. Either by surgical removal of the parts of the lungs that are affected by the disease or by placing endobronchial valves and functional exclude these parts, thus giving space to the healthier lung tissue to expand and contract more efficiently.

Treatment for Asthma

At Athens Medical Group we provide comprehensive, multidisciplinary care for adults and children with asthma and related diseases, treating among else management of difficult-to-control asthma, occupational asthma, and asthma among pregnant women.

Allergists, pulmonologists and other health experts work together to provide the best possible care tailored to your needs, helping you learn how to control your symptoms and manage your condition.

Allergies are a major factor of triggering asthma attacks and effective treatment includes identifying and avoiding the allergens that trigger symptoms. That includes the use of special drugs and an emergency action plan formed by your personal care team after consulting with you. In this process you may be asked to use a peak flow meter so as to measure the airflow through your lungs.

Asthma may also be triggered by ongoing health problems, such as obesity, obstructive sleep apnea, gastroesophageal reflux, stress and depression.

At Athens Medical Group we offer comprehensive asthma and allergy evaluation to assess potential triggers and to optimize asthma therapy.

There are many treatments for asthma, and you should consult with your doctor to find the one most suitable for you.

Traditional asthma treatments include:

Rescue Medications

These are medications used in cases when there is need of immediate relief from asthma symptoms, such as a tight chest. Rescue medications quickly open the swollen airways that limit breathing.

Rescue medications include:

  • Short-acting beta agonists
  • Ipratropium
  • Corticosteroids, administered through the mouth or intravenously.

Controller Medications

These are preventive medicating aiming at long-term control of your condition minimizing the likelihood of an asthma attack. They should be taken as prescribed, usually once or twice a day.

Controller medications include:

  • Leukotriene antagonists that block leukotrienes that are produced in the lungs of some patients with asthma and allergies.
  • Inhaled corticosteroids are anti-inflammatory drugs that are generally safe for long-term use.
  • Inhaled long-acting bronchodilators include beta agonists and open the airways in the lungs. They may be combined with inhaled steroids
  • Theophylline is a medication that relaxes bronchial wall muscles and reduces inflammation, opening up the bronchial tubes.

Inhalers

Many asthma patients use inhalers as part of their treatment. As you work with your doctor to find the best treatment for your type of asthma, be sure you understand how to use your inhaler properly to provide the best control of your asthma. If you are still having problems after confirming you are using the inhaler correctly, you may want to look into additional treatments.

Biologic therapies

There are three types of immunotherapy available for asthma patients:

  • Monoclonal antibodies. They are used to treat patient with severe, persistent allergic asthma, uncontrollable with oral or injectable corticosteroids, by reducing sensitivity to allergens.
  • Allergy shots. They are very effective in relieving allergy symptoms. It is a long-term treatment that aims at building up immunity against allergens. The patient is injected the allergen, at first in small amounts and increasing over time. Ultimately, the body builds up a tolerance to the allergen.
  • Sublingual tablets. Another promising long term treatment against allergens, it involves the daily dissolution of a tablet under the tongue daily.

Bronchial thermoplasty

A treatment used in some cases of severe and difficult-to-control asthma, bronchial thermoplasty is an endoscopic and minimally invasive procedure aiming at opening the airways in the lungs using radiofrequency delivered through a bronchoscope.

Usually, bronchial thermoplasty is carried out over the span of three outpatient visits.

Overview

A stroke may occur to any person at any time in their life. Acting fast to receive a specialized treatment, is of critical importance.

At Athens Medical Group we treat a numerous stroke cases, every year, giving our patients access to life-saving treatments and a chance to a successful recovery. From advanced diagnostic tools to the most innovative treatment procedures and rehabilitation approaches, we offer comprehensive care for strokes and brain health emergencies, in general.

Your personal care team

The disruption of blood flow in your brain calls for the best possible care as soon as possible.

At Athens Medical Group, doctors, nurses and other auxiliary staff with special training and experience provide comprehensive care for patients with acute stroke.

Our medical team consists of neurologists, neurosurgeons, specialized radiologists and invasive neuro-radiologists and cardiologists. Under the guidance and coordination of the neurologists, in case of either an ischemic or a hemorrhagic stroke, the team decides immediately the appropriate treatment to be applied.

A dedicated Call Center 1012 (EMS) immediately informs the Neurologist, who initially assesses and directs the patient. The patient is transferred by a special mobile unit when this is deemed necessary. Upon arrival at the hospital, the patient is urgently addressed, avoiding delays in admission, diagnosis and treatment.

At Athens Medical Group we apply holistic care for stroke patients. You will be supported by the Intensive Care Unit and during the period of your hospital stay, by a team of interdisciplinary experts, such as Internal Medical Doctors, Neurosurgeons, Physiotherapists, Psychologists, Cardiologists, Infectious Disease Specialists etc.

The collaboration among the experts of the interdisciplinary team, in a single site, guarantees that all necessary steps for you will be taken fast and efficiently. All tests are carried out quickly and their results are available soon after, while your follow up appointments are scheduled without the delays observed elsewhere.

What We Treat

A stroke occurs by a sudden inhibition of the blood flow to the brain or by a bleeding in or around the brain. As a result, brain cells cease their activity or die.

When the nerve cells of the brain die, the function of the body parts they regulate is disrupted or stopped entirely.

Depending on which area of ​​the brain is affected, various functions of the human body may be disrupted.

About 80% of all strokes are ischemic. An ischemic stroke occurs when arterial blood supply to a part of the brain is interrupted due to a blood clot in the large or small arteries of the brain.

A hemorrhagic stroke occurs when blood vessels in or around the brain rupture or leak. As a result, the bleeding exerts too much pressure on the surrounding tissue, stopping blood circulation and depriving the brain of oxygen.

A stroke evolves rapidly and its symptoms may vary. As soon as they are manifested there is little time for the application of an effective treatment. You must act quickly if the following symptoms occur suddenly:

  • numbness or weakness in the face, hand, foot mainly on one side of the body
  • confusion – speech or perception disorder
  • disturbance of vision in one or both eyes
  • gastrointestinal disturbances, vertigo, instability or discomfort
  • severe headache

Diagnosis

Quick and accurate diagnosis is essential to treating strokes and ensuring an optimal medical result.

At Athens Medical Group stroke experts are provided with advanced technology and equipment to diagnose strokes and relevant conditions.

Your personal care team works together in order to evaluate your case based on your symptoms and decide upon the most suitable treatment for your case.

The evaluation both helps with the diagnosis of the stroke and provides critical information on the cause.

The evaluation includes:

  • Physical Examination
  • Neurological Examination
  • Blood Tests
  • Computerized tomography (CT). You may be injected a dye into your bloodstream that reveals the blood vessels in greater detail (computerized tomography angiography).
  • Magnetic resonance imaging (MRI). Again, you may be injected a dye into your bloodstream for a better view of the arteries, the veins and the blood flow (magnetic resonance angiography).
  • Heart Functional Tests
  • Electrocardiogram (ECG), to identify clots that may have traveled from the heart to the brain, causing the stroke.
  • Ultrasound of brain vessels, carotid and vertebral arteries as well as basic artery, to check for plaques and the blood flow in the carotid arteries.

 

Treatment

Our team of stroke experts, including neurologists and vascular neurosurgeons, treat a great number of patients each year performing various procedures for the treatment of stroke and other relevant conditions, opting for the latest minimally invasive approaches when possible.

The treatment for stroke needs to be urgent and depends on the type: (ischemic or hemorrhagic).

Ischemic stroke

Direct treatment of an ischemic stroke prevents damage from spreading to another area of ​​the brain where blood flow has decreased but has not been stopped.

Medication treatment

Patients with ischemic stroke who meet certain criteria are administered intravenously, a clot – dissolving drug, tissue plasminogen activator (tPA), that may improve progression when given within 4 ½ hours from the development of the first symptoms.

Blood-thinning medications and drugs that lower blood pressure and cholesterol, immediately reduce the risk of complications, optimize the recovery and prevent future stroke.

Endovascular treatments

Endovascular therapies (thrombolysis or thrombectomy) can be applied within 6 hours of the onset of symptoms, but the sooner they are performed the better.

Intra-arterial thrombolysis involves the insertion of a microcatheter to the brain through an artery in the groin. Doctors, then, inject a thrombolytic agent, such as tPA, directly into the area of the stroke.

Intra-arterial thrombectomy involves the use of a catheter to direct a mechanical device to remove the clot from the blocked vessel in the brain. It is often carried out in combination with intra-arterial thrombolysis.

Hemorrhagic stroke

Treatment for hemorrhagic stroke depends on the cause of the bleeding and the affected area.

Conservative treatment

Pharmaceutical treatment for hemorrhagic stroke usually involves controlling the patient’s blood pressure and stopping any medication that contributes to bleeding, such as warfarin and aspirin. Also, transfusions of blood with clotting factors may be carried out with the aim of stopping the bleeding.

Once the bleeding is controlled, the body starts to absorb the blood. If the area of bleeding is large, then surgery may be necessary for the removal of the blood with respect to relieving the pressure on the brain.

Surgical treatment

If the hemorrhagic stroke is caused by blood vessel abnormalities such as arteriovenous malformations (AVM) or an aneurysm, then surgery is recommended for the repair of these abnormalities.

Surgical procedures for the treatment of hemorrhagic stroke include:

  • Coiling (Endovascular Embolization). A catheter tube is inserted into a blood vessel in an arm or leg and directed to the blood vessels in the brain. Then, through the catheter, a coil or clip is placed accordingly to prevent further bleeding.
  • Surgical Clipping. It is a procedure used for the treatment of aneurysms, in which a surgeon places a tiny clamp at the base of the aneurysm to stop the blood from flowing to it.
  • Surgical AVM Removal. This procedure involves the surgical removal of AVMs that are located in an accessible area of the brain and thus prevent a potential rupture. Smaller AVMs are safer and easier to remove. If the AVM is large or deep within the brain, then it may be impossible to be removed without causing damage to the brain.

Rehabilitation & Recovery

Although some patients are restored after stroke, others continue to have problems depending on the location and size of the stroke. These problems may include:

  • memory, attention and concentration problems
  • difficulty in speaking or listening
  • difficulty to swallow
  • depression
  • loss of vision on one side of the body
  • loss of power or sense on one side of the body
  • loss of balance or walking ability

Rehabilitation helps patients regain the function they have lost after the stroke, as the brain can learn new ways of functioning, using intact cells.

Athens Medical Group is a leader in Stroke Rehabilitation and Recovery, running a comprehensive stroke rehabilitation program.

Our multidisciplinary team of experts, including neurologists, physicians, cardiologists, physical and occupational therapists, speech therapists, psychotherapists and specially trained nurses, is committed to sending you home healthy and as soon as possible.

Overview

The thyroid gland is the largest endocrine gland of the human body, a butterfly-shaped organ located in our throat, in front of the trachea. The thyroid gland is an important part of the human anatomy, tasked with the role of regulating metabolism.

The thyroid gland produces hormones, thyroxine (T4) and triiodothyronine (T3), which regulate tissue metabolism, as well as calcitonin, which regulates the levels of calcium in our blood.

The production and secretion of thyroid hormones is regulated by thyroid stimulating hormone (TSH) produced in the pituitary gland, which in turn is dependent on secretion of thyrotropin-releasing hormone (TRH) produced in the hypothalamus.

Disorders of the thyroid gland can affect many aspects of your health and lifestyle, such as your daily mood, your sleep, your weight and your overall energy.

Thyroidic Nodules

Nodules are solid, cystic or mixed growths within the parenchyma of the thyroid gland.

They are extremely common (50% of the population over 50 have at least one small or large nodule), they may be single or multiple, small or too large and may cause significant symptomatology.

They are distinguished in cold (inactive) and warm (active). They are benign in 95% of the cases, may coexist with functional disorders of the gland and their occurrence increases with age.

The risk factors for the development of thyroid nodules are age, being a female (in a ratio of 4/1 in comparison to males), hereditary history, therapeutic irradiation of the cervix for another disease primarily at an early age, as well as the effect of radiation after nuclear accidents.

 

Diagnosis

The diagnostic approach for thyroidic nodules includes:

  • Detailed personal and family history.
  • Palpation. 40% of the nodes above 15 mm and 4% of the total number of nodules are palpable.
  • Hematological – hormone tests. The basic and unique initial test needed to examine thyroid function is to measure the levels of TSH – thyroid stimulating hormone. All other hormonal parameters such as T3, FT4, calcitonin, thyroglobulin, antibodies etc. follow depending on the TSH value and the findings of ultrasound.
  • Cervical ultrasound. Suspected imaging criteria for malignancy are micro-calcifications, increased central vasculature, hypoechogenicity, etc.
  • Thyroid scintigraphy. It is carried out in some cases, where there is a clinical or laboratory image an overacting organ.
  • Elastography. It examines how hard the nodule is and points to suspect nodes with a high degree of reliability.
  • Fine needle aspiration (FNA) and subsequent cytological examination of either a nodule or a swollen cervical lymph node. FNA is the most important tool for the diagnosis of malignant diseases and should be performed for every nodule of more than 1 cm or for every nodule in general if there are suspicious imaging findings, a history of therapeutic irradiation of the cervix or a family history of thyroid malignancy.

 

Treatment

The treatment of thyroid nodules includes:

  • A simple follow-up every 6 to 12 months with the aforementioned diagnostic methods.
  • Administration of thyroxine to reduce the size of the nodules (this tactic is now highly contested by most endocrinologists, only 30% of the nodules are diminished by 25 to 30% of their size).
  • Total thyroidectomy. On the basis of history, clinical examination, hormonal testing, imaging and FNA, if there is a certain malignancy or a very strong suspicion of malignancy, or a nodule underacts, then, and only then, a surgical procedure is suggested, i.e. a total removal of the organ.

 

Total thyroidectomy

The procedure of choice performed in all modern endocrine surgery centers throughout the world for the surgical treatment thyroid gland disorders is total thyroidectomy.

Removal of the entire organ is carried out under general anesthesia, through a small cross-section of 2 to 4 cm in the lower part of the anterior cervical surface, along a natural skin fold.

In this very delicate surgical procedure the surgeon has to maintain and protect the parathyroid glands (85% of the population has 4, 10 – 12% has 5 or more and 3 – 5% less than 4), the upper laryngeal nerves and recurrent (lower) laryngeal nerves (the nerves that move the vocal cords).

For this reason, special forms of energy such as ultrasound and radio frequencies are used for even greater intraoperative safety of vulnerable neighboring organs and structures (major vessels and nerves, esophagus, larynx, trachea) while preserving the particularly sensitive nerves of vocalizing is achieved with the use of special electronic equipment.

It has been bibliographically proven that the surgery by a specialized surgeon in a center that provides modern infrastructure minimizes the possibility of any complication.

Recovery is impressive. The patient gets up within hours of waking up after surgery, gets directly fed without restrictions, does not receive any intravenous fluids or medication, feels no pain and leaves the clinic in less than 24 hours after being admitted.

The postoperative cosmetic result is excellent.

 

Cervical lymph node dissection

Besides the main surgery, surgical treatment of thyroid malignancy occasionally requires a complementary one: the radical, functional dissection of the lymph nodes of the cervix.

Cervical lymph node dissection involves the removal of lymph nodes and adipose tissue from the central or lateral sections of the cervix when there is diagnosis through histological confirmation or strong suspicion that they contain metastatic malignancy.

There are two types of lymphatic cleansing:

 

Central cervical lymph node dissection

The central cervical lymph node dissection, involves the removal of the prelaryngial, pretrachial and paratrachial lymph nodes as well as the adipose tissue that are located anatomically between the two common carotids, the hyoid bone and the sternal incision, which are essentially the lymph nodes around the thyroid.

The operation is conducted through the incision of the thyroidectomy (a small incision at the anterior surface of the lower part of the cervix) and requires special experience and specialization because of the risk of injuring fragile structures (parathyroid glands) and major nerves (laryngeal nerves) and blood vessels.

 

Functional unilateral or bilateral cervical lymph node dissection

This is an extremely delicate surgical procedure in which the lymph nodes and the adipose tissue of one or both lateral cervical regions are removed on the carotid artery, between the sternocleidomastoid and trapezoid muscles.

This procedure must be performed by specialized endocrine surgeons, because through this  anatomical region pass major blood and lymph vessels (carotid – internal jugular, major thoracic duct and others) as well as very important nerves for the function of the body, such as the brachial plexus (for the upper extremities), the phrenic nerve (it extends to the diaphragm and therefore is extremely important for the respiratory movements), the sublingual (movement of the tongue), the parasympathetic (nerve of the trapezoid and the sternocleidomastoid muscle, necessary for lifting the shoulder) and the vagus nerve (it extends to the digestive tract, the heart and the larynx).

The injuries of the above-mentioned nerves can cause major problems to patients, depending on the location and type of injury. The incision is much greater than the one performed for central cervical dissection but the cosmetic result is excellent.

The safe conduct of cervical lymph node dissection has increased dramatically in recent years owing to the use of neurotransmitters that provide information intraoperatively for the functional state of all neural structures.

Thyroid Cancer

Thyroid cancer is the most common malignancy of the endocrine system (95% of the total) and 1.5 – 3% of all malignant neoplasms of the human body.

Women are three times more likely to be affected than men, predominantly between the ages of 25 and 65.

In the last decade, thyroid cancer has had the highest annual increase in occurrence compared to all other malignancies of the various organs, probably due to environmental factors but also due to a significant improvement in its diagnosis methods.

The most recently published scientific evidence suggests that by 2030 thyroid malignancy will be the third most common malignancy among women.

The prognosis of thyroid cancer is excellent with the vast majority of patients being cured, so long as the correct protocol for treating the condition is followed.

Thyroid cancer occurs almost exclusively in the form of cold nodules (80% of all nodules are cold and non – functional).

Though thyroid nodules are very common, fortunately only 5% of them are malignant.

Risk factors include exposure to radiation (if the patient has undergone therapeutic radiation therapy – mainly in the head and neck for other oncological conditions – or exposure to radiation after nuclear accidents), family history of thyroid cancer, syndromes associated with disorders in particular genes (e.g. Multiple Endocrine Neoplasia MEN 2a and 2b – RET gene, Familial Adenomatous Polyposis and Gardner’s syndrome – APC gene, Cowden syndrome – PTEN gene, Carney syndrome type 1 – PRKAR1A gene, etc.), while the possibility of correlation of autoimmune thyroiditis with the development of thyroid cancer has also been researched.

Children with nodular or polycystic goiter, men predominantly solitary nodules, adults over 60, patients with large nodules, those with a rapidly growing thyroid nodule ​​and patients with an individual history of breast malignancy have increased risk of developing the disease.

 

Treatment

The treatment of thyroid cancer is planned the oncology council (including an endocrinologist and general surgeon specialized in endocrine gland surgery) with the sole aim of curing and minimizing the likelihood of relapse or metastasis.

Treatment is primarily surgical for all types of thyroid malignancy (excluding lymphoma) and includes the total removal of the gland (total thyroidectomy) as well as in some cases in the removal of the lymph nodes (central – unilateral or bilateral functional lymph node radical cleansing) when a disease is also present in them or there is great clinical / imaging suspicion of its presence.

After the operation, the treating endocrinologists work together – when indicated – with the Nuclear Medicine team. Usually, depending on the type of thyroid cancer, a therapeutic dose of radioactive iodine is administrated in order to destroy the possible existence of residual malignant cells and / and lymph nodes.

Radiation can be used as preoperative or complementary therapy in anaplastic carcinomas while chemotherapy is used very rarely and only for pre-or post-operative anaplasms.

Thyroid Disorders

Hyperthyroidism

Hyperthyroidism is a thyroid disorder in which the gland is overacting, i.e. it works longer than the body needs.

Hyperthyroidism affects women more often by causing acceleration of their metabolism.

Hyperthyroidism usually increases the size of the gland to the point of developing a nodular goiter, a large thyroid with many scattered nodules.

 

Symptoms of Hyperthyroidism

Hyperthyroidism is often asymptomatic for a long time or has such mild symptoms that escape even the doctors’ attention.

In its typical form of hyperthyroidism, patients manifest:

  • unnecessary loss of weight and slimming
  • tachycardia
  • intense sweating, hot flashes and intolerance to heat
  • nervousness and emotional instability
  • muscle weakness and fatigue
  • trembling
  • exophthalmos,
  • swelling of the thyroid gland (goiter)
  • premature ejaculation and erectile dysfunction (in men)

 

Causes of Hyperthyroidism

There are many causes for hyperthyroidism, such as various illnesses and medications. Graves’s disease is implicated in 70% of cases of hyperthyroidism.

A very common cause of hyperthyroidism is also the nodular toxic goiter, in which one or more nodules grow in the thyroid, resulting in the overacting of the gland.

 

Treatment of Hyperthyroidism

The treatment of hyperthyroidism depends on the cause of the disease and includes:

  • the administration of medication (propylthiouracil, methimazole, carbimazole) that suppresses the thyroid gland,
  • administration of radioactive iodine and
  • surgical removal of the gland

Surgery (total or partial thyroidectomy) is definitive and relieves the patient of hyperthyroidism and possible relapses.

 

Hypothyroidism

Hypothyroidism is a disorder in which the thyroid gland is underactive, that is, it does not produce a sufficient amount of hormones.

Hypothyroidism is more frequent in the female population and especially in women over 60 years of age.

If not treated promptly, hypothyroidism can lead to several health problems, such as obesity, joint pain, infertility and heart disease.

Some drugs can cause hypothyroidism, such as:

  • Amiodarone
  • Drugs administered for hyperthyroidism, such as propylthiouracil (PTU) and methimazole
  • Lithium

 

Symptoms of hypothyroidism

Signs and symptoms of hypothyroidism vary, depending on the severity of the disease. The most common are:

  • fatigue
  • constipation
  • dry skin
  • unexplained weight gain
  • swelling in the face
  • rough voice
  • muscle weakness
  • increased cholesterol
  • an irregular period
  • weak hair
  • depression
  • memory attenuation

 

Diagnosis of hypothyroidism

The diagnosis of hypothyroidism involves the detailed medical history of the patient, ultrasound testing as well as thyroid scintigraphy.

 

Treatment of hypothyroidism

The treatment of hypothyroidism is simple and involves the administration of thyroxine in the form of a pill.

Usually, the administration of thyroxine begins with small doses, which are gradually increased.

Thyroxine is administered for life as part of the treatment of hypothyroidism but it has no side effects when its daily dose is appropriate.

 

Hyperparathyroidism

Hyperparathyroidism is the condition due to overactive parathyroid glands resulting in excessive production and secretion of parathyroid hormone.

This hyper-secretion leads to an increase in calcium levels and a decrease in phosphorus levels in the blood, and may be symptomatic or not.

Just as a thermostat regulates the temperature of a room, so do the parathyroid glands determine the correct calcium levels by allowing or inhibiting the secretion of parathyroid hormone.

This balance usually works smoothly, i.e. if calcium is reduced, it is secreted by the parathyroid hormone, which releases calcium from the bones and increases its absorption from the small intestine. If calcium levels are high, the production of parathyroid hormone decreases with opposite effects.

There are three types of hyperparathyroidism: primary, secondary, and tertiary.

The primary type is a relatively rare disease, occurring at older ages, with women being more frequently affected by men in a ratio of 2 to 1. It is usually sporadic, but it may have family origin and be part of the Multiple Endocrine Neoplasia Syndrome 1 and MEN2A).

Secondary hyperparathyroidism is even rarer and refers to increased parathyroid production due to hyperplasia of all glands after continuous stimulation, as a result of:

  • low levels of calcium in the blood
  • chronic renal failure or
  • malabsorption problems that may lead to vitamin D deficiency

Tertiary hyperparathyroidism is extremely rare. It occurs in some patients with secondary hyperparathyroidism, who may develop hyperplastic glands over the years, i.e. glands that do not obey the normal regulation mechanism and overact regardless of the calcium value.

 

Symptoms

Most patients are asymptomatic, but some may complain of weakness, fatigue and indefinable pain.

With time, the following symptoms may develop:

  • kidney stone disease
  • abdominal pain
  • thirst
  • loss of appetite
  • nausea / vomiting
  • pancreatitis
  • osteoporosis
  • bone fractures
  • memory disorders
  • confusion and
  • muscle weakness

 

Complications

The increased amount of parathyroid hormone released in our body can lead to serious health problems such as:

  • Osteoporosis: the more the parathyroid hormone produces the more calcium the bones lose and become weak and fragile, with an increased likelihood of fractures.
  • Kidney stone disease: The body tries to eliminate excess calcium into the urine, thus increasing the risk of kidney stone disease.
  • Peptic ulcer: high levels of calcium stimulate secretion of hydrochloric acid.
  • Arterial hypertension: increased risk for arterial hypertension and heart failure possibly due to vasocontraction and kidney damage.
  • Psychological disorders: depression, behavioral change, emotional instability and others.

 

Diagnosis

The diagnosis of hyperparathyroidism includes the following tests:

  • Hematological testing for calcium and parathyroid hormone
  • X-ray of kidneys, ureters and bladder in order to check for kidney stone disease
  • bone density measurement

The detection of pathological parathyroid glands is achieved through:

  • Ultrasound
  • Scintigraphy with sestamibi (the patient receives a very small amount of a radioactive substance, which is only absorbed by the overacting parathyroid gland and helps us locate it)

 

Treatment

The treatment depends on the type and case and can be from simple monitoring to surgery. The surgical method of choice is parathyroidectomy, i.e. the removal of the parathyroid glands. In all specialized centers of endocrine glands, during parathyroidectomy an intraoperative measurement of the parathyroid hormone is performed to confirm correct excision.

For primary hyperparathyroidism surgery, is the method of choice. In secondary hyperparathyroidism treatment can be conservative by administering vitamin D and calcium, substances that mimic calcium, phosphate, hemodialysis and some surgery (removal of the three-and-a-half glands). Also, some patients after successful kidney transplantation appear to normalize the calcium values.

Tertiary hyperparathyroidism is initially treated conservatively with calcium and vitamin D. In some cases and with specific indications surgical treatment is recommended.

 

Hypoparathyroidism

Hypoparathyroidism is the condition in which a pathologically low amount of parathyroid hormone is secreted.

This results in low levels of calcium in the blood and bone, and elevated levels of phosphorus.

It is usually a chronic condition and treatment is based on long-term formulations that normalize calcium and phosphorus.

 

Cause

The causes of this condition can be genetic, an injury or parathyroid gland removal in surgical procedures, antibodies produced by the organism itself (autoimmune) as well as radiation exposure of the area or use of radioactive iodine.

 

Symptoms

Common symptoms of hypoparathyroidism include tingling, muscle cramps, convulsions, weakness, fatigue, lethargy, frequent urination, anxiety, depression and even psychosis.

Discomforts are usually mild, and rarely include more serious and urgent situations, such as difficulty in breathing.

Some of the health problems associated with hypoparathyroidism, such as hypocalcemia, dental disorders, osteoporosis, arrhythmias and loss of consciousness, are related to low calcium and are improved with the administration of calcium and vitamin D.

Other health problems, which are debilitated by the administration of calcium and vitamin D, are disorders in physical and mental development of an individual as well as cataract.

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