(continuation of MS Awareness)

Less common symptoms:

*Speech problems-this including slurring (dysarthria) and loss of volume (dysphonia) occur in approximately 25-40% of people with MS, particularly later in the disease course and during periods of extreme fatigue. Stuttering is occasionally reported as well.

*Swallowing problems — referred to as dysphagia — result from damage to the nerves controlling the many small muscles in the mouth and throat.

*Tremor, or uncontrollable shaking, can occur in various parts of the body because of damaged areas along the complex nerve pathways that are responsible for coordination of movements.

*Seizures — which are the result of abnormal electrical discharges in an injured or scarred area of the brain — have been estimated to occur in 2-5% people with MS, compared to the estimated 3% of the general population.

*Breathing Problems-Respiration problems occur in people whose chest muscles have been severely weakened by damage to the nerves that control those muscles.

*Itching-Pruritis (itching) is one of the family of abnormal sensations — such as “pins and needles” and burning, stabbing or tearing pains — which may be experienced by people with MS.

*Headaches-Although headache is not a common symptom of MS, some reports suggest that people with MS have an increased incidence of certain types of headache.

 *Hearing Loss-About 6% of people who have MS complain of impaired hearing. In very rare cases, hearing loss has been reported as the first symptom of the disease.

Secondary and tertiary symptoms

While the primary symptoms described on this page (more and less common) are the direct result of damage to the myelin and nerve fibers in the central nervous system (CNS), the secondary symptoms are the complications that can arise as a result of these primary symptoms. For example:

• Bladder dysfunction can cause repeated urinary tract infections.
• Inactivity can result in loss of muscle tone and disuse weakness (not related to demyelination), poor postural alignment and trunk control, decreased bone density (and resulting increased risk of fracture), and shallow, inefficient breathing
• Immobility can lead to pressure sores.

While secondary symptoms can be treated, the optimal goal is to avoid them by treating the primary symptoms.

Tertiary symptoms are the “trickle down” effects of the disease on your life. These symptoms include social, vocational and psychological complications. For example, if you are no longer able to drive or walk, you may not be able to hold down your usual job. The stress and strain of dealing with MS often alters social networks and sometimes fractures relationships. Problems with bladder control, tremor or swallowing may cause people to withdraw from social interactions and become isolated.

Depression is very common in people with MS. Depression may be both a primary and a tertiary symptom as it can be caused by the disease process itself and/or triggered by the challenges discussed above.

Treatments for Multiple Sclerosis:

Multiple sclerosis is a neurologic disease that affects women more often than men. Onset is most commonly in the 20s or 30s.

MS is an autoimmune disease in which there is initially focal inflammation and then permanent damage to nerves of the central nervous system. The damage is really removal of the insulating material surrounding nerves. The tissue that insulates nerves is called myelin, and the damage is referred to as demyelination.

As a nerve that controls sensation or movement of a part of the body loses some of its myelin covering, the nerve may become dysfunctional. This can manifest itself as loss of that nerves function which can be sensation, vision, movement or coordination of movement. Affected sensory nerves can also cause pain.

There have been tremendous advances in our ability to diagnose and assess MS with the development of magnetic resonance imaging. Unfortunately, our understanding of the cause of this disease remains limited, as does our ability to treat it. There is some limited success in stopping or decreasing the severity of an MS attack. We would also like to stimulate a regrowth of the damaged myelin over the nerve. Unfortunately, this is not possible at this time.

There are several types of MS. Some patients have disease that will have an acute exacerbation followed by a prolonged quiet period, which can last years or decades. This form of disease is referred to as relapsed remitting MS, or RRMS. Others have a disease that gets progressively worse over time. There are two types of progressive disease. In primary progressive MS, or PPMS, symptoms steadily worsen over time from the very beginning. Secondary progressive MS, known as SPMS, begins as relapsed remitting disease and becomes progressive over time.

For an acute exacerbation of multiple sclerosis that can result in neurologic symptoms and increased disability or impairments in vision, strength or coordination, the preferred initial treatment is usually a type of steroid called a glucocorticoid. Patients who do not have a good response to steroidal therapy are often treated with plasma exchange. Plasma exchange is an extreme therapy that removes antibodies to myelin from the blood.

Patients with RRMS are often treated with immune-modulating drugs such as interferon or glatiramer acetate. Glatiramer is an exciting drug. It is a series of small proteins that are similar to myelin protein. It is thought to prompt the immune system to avoid attacking myelin.

Available treatments of primary and secondary progressive MS are of limited efficacy and have significant side effects. An additional fact to consider is that most trials have not lasted longer than two or three years and give only hints about long-term results of treatment.

In brief, no clinical trial has shown convincing evidence of benefit in the treatment of primary progressive MS. All suggested treatments for PPMS are empiric. Several drugs that are more commonly used in the treatment of malignancy, cladribine and mitozantrone, appear to have some activity.

In contrast, there is definite modest benefit in some treatments for secondary progressive MS. These treatments include various regimens of steroid therapy and the use of some drugs that modulate the immune system. Many of these drugs are more commonly used in treatment of cancer and rheumatoid arthritis such as cyclophosphamide, methotrexate and interferon.

MS should be treated by a neurologist with experience in managing it.

“Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).”

Multiple Sclerosis Foundation

“Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.”

MAYO CLINIC

There are numerous causes of kidney failure, and treatment of the underlying disease may be the first step in correcting the kidney abnormality. Some causes of kidney failure are treatable and the kidney function may return to normal. Unfortunately, kidney failure may be progressive in other situations and may be irreversible.

1. Urination Changes

The kidneys are responsible for handling urine, so it makes sense that urine will start to change if the kidneys are failing. Some examples of urination changes include: • Urine comes out bubbly or foamy • Urine may have traces of blood • You may have the overwhelming urge to urinate during the night, waking up • Urination occurs more often and appears pale • Urination occurs less often and appears dark • You may have difficulty attempting to urinate

2. Fatigue

The kidneys are responsible for producing a specific hormone called erythropoietin (EPO). This hormone is responsible for instructing the body to produce red blood cells, which are meant to carry oxygen throughout the body. If the kidneys start to fail, they will make less EPO, which means fewer hormones are directing the body to produce the necessary amount of red blood cells. At the end of this cycle, you’re left feeling very tired and weakened throughout the day. Experiencing fatigue even when you seem to get enough sleep at night is one symptom that the kidneys are not producing enough hormones for your body.

3. Swelling

Because of the way the kidneys interact with the body and handle the process of urination, they also are largely responsible for removing the extra fluid within your body. Kidneys that are starting to fail won’t get rid of that fluid as well as they should be. As a result, it stays inside the body — and while it’s in the body, it has to go somewhere; the fluid starts filling in pocketed areas. You may experience swelling in one or both ankles, the legs, the face, hands, as well as feet. While the swelling can be mild, it can also swell to difficult stages; for instance, it might be hard to wear a regular shoe. This is edema.

4. Nausea

Healthy kidneys also take on the role of the body’s garbage men; that is, they’re responsible for getting rid of waste in the body. In the event of kidney problems or failure, waste won’t exit the body as efficiently as before, causing a buildup of excess waste in the bloodstream. This is known as uremia, and it can cause feelings of nausea or make you need to vomit. It should go without saying that your body doesn’t like being filled with waste, and it attempts to purge the waste by way of vomiting.

5. Bad Taste in Mouth

When kidneys begin to fail and cause uremia, or a buildup of waste in the body, the body may react by producing the taste of metal in your mouth or causing bad breath. Overall, you might taste a rather poor flavor in your mouth that causes you not to taste food in the same way as you did before. In particular, this may make you less interested in eating meats. In addition, you might start to notice some weight loss as a result of not eating. This could be due to the taste issue or you may simply not feel hungry enough to eat much.

6. Rashes

Developing uremia as a result of kidney disease doesn’t stop with metallic taste or the need to vomit. The waste buildup in the bloodstream manifests further by causing patches of rashes on the skin and causing itchiness. In some cases, patches of skin can break out in what appears to be acne as well. These itchy rashes can be difficult to relieve; in more progressed instances, the itch can feel like it goes right down to the bone, making it difficult to feel relief by way of scratching.

7. Chills

As explained in a previous slide, the kidneys produce the hormone EPO to signal the body’s production of red blood cells. Failing this, there are fewer blood cells, which is anemia. Anemia comes with its own set of symptoms, the most prominent but overlooked being chills. If you feel cold, even inside of a warm room, you could be experiencing anemia.

8. Leg Pain

One of the more characteristic symptoms of chronic kidney disease include feeling discomfort in the back or in the legs. In some cases, the feelings of discomfort could be painful. It is also possible to experience pain as far as the upper back. Problems that can cause pain include: • Kidney stones and infections, which cause severe spasms of pain • Bladder infections, which can produce a burning sensation during urination • Polcystic kidney disease, which produces painful cysts on the kidneys and liver.

9. Out of Breath

If you have been experiencing shortness of breath lately, it could be connected to the kidneys in two different ways. The first possible connection is a result of the extra fluid buildup; sometimes, this extra fluid builds up in the lungs, making it more difficult to breathe. Otherwise, the shortness of breath can be a result of anemia; in this case, there are an insufficient number of red blood cells available to carry oxygen throughout the body. This leaves the brain and body starved and short of breath. If you experience shortness of breath, sit down for a moment and calmly attempt deep breaths. The experience is naturally frightening, but panicking can only lead to more difficulty breathing.

10. Dizziness

Anemia as a result of kidney disease has one more grasp on the body: It can make you dizzy and cause you to have trouble concentrating on things. When this happens, your brain is becoming starved of the oxygen it needs to be at full power. When your brain isn’t getting enough oxygen, it manifests beyond dizziness and concentration problems; you can also experience memory problems and other issues with cognitive functions. This symptom often goes hand in hand with fatigue due to the taxing effects on the brain.

“Kidney donors don’t have to be close relatives of recipients, but they do need to have the right blood type. And kidneys from living donors tend to last many years longer than kidneys from deceased donors.”

Virginia Postrel (born January 14, 1960 is an American political and a cultural writer). …

“We can make a commitment to promote vegetables and fruits and whole grains on every part of every menu. We can make portion sizes smaller and emphasize quality over quantity. And we can help create a culture – imagine this – where our kids ask for healthy options instead of resisting them.”

Michelle Obama

Scoliosis is a problem with the spine where the spine is curved instead of straight, with the upper back being rounded and the lower back having a “swayback,” or inner curved problem, reports WebMD. 

According to the Scoliosis Research Society, 85 percent of all scoliosis causes are idiopathic, meaning the cause is unknown. The remaining causes of scoliosis include birth defects, such as vertebrae that form abnormally before birth, and certain disorders such as cerebral palsy, Marfan’s syndrome, muscular dystrophy and Down syndrome. Infections and spinal fractures can also cause scoliosis.curvature of the spine during surgical correction of this condition. Screws and rods are placed in order to stabilize and straighten the spine.

What You Should Know About Adult Scoliosis

Scoliosis is defined as a curve of the spine of 10 degrees. Adult scoliosis is broadly defined as a curve in your spine of 10 degrees or greater in a person 18 years of age or older. Adult scoliosis is separated into 2 common categories:

• Adult Idiopathic Scoliosis patients have had scoliosis since childhood or as a teenager and have grown into adulthood.  We do not yet know the cause of idiopathic scoliosis, but there is a lot of genetic work going on in an attempt to answer this question.

• Adult “De Novo” or Degenerative Scoliosis develops in adulthood. Degenerative scoliosis develops as a result of disc degeneration. As the disc degenerates, it loses height. If one side of the disc degenerates more rapidly than the other, the disc begins to tilt. As it tilts, more pressure is placed on one side of your spine and gravity tends to cause the spine to bend and curve. The more discs that degenerate, the more the spine begins to curve.Types of idiopathic scoliosis are categorized by both age at which the curve is detected and by the type and location of the curve.
• When grouped by age, scoliosis usually is categorized into three age groups:
• Scoliosis is more common in girls than in boys, and the diagnosis is usually made after a child reaches 10 years of age. A doctor performs a physical examination and may take X-rays to definitively diagnose the disease. An X-ray tells if there is any growth left in the growth plates of the femur or humerus, and scoliosis can become worse if the patient has more growing to do, states MedicineNet. Serial X-rays are performed to track the changes of the spinal curve, which helps determine the best course of treatment.

• Infantile scoliosis: from birth to 3 years old
• Juvenile scoliosis: from 3 to 9 years old
• Adolescent scoliosis: from 10 to 18 years oldTerms Used to Describe Spinal CurvatureTerms that describe the direction of the curve:
• Scoliosis curves are often described based on the direction and location of the curve. Physicians have several detailed systems to classify specific curves, but here are some common terms used to describe scoliosis:
• This last category of scoliosis, adolescent scoliosis, occurs in children age 10 to 18 years old, and comprises approximately 80% of all cases of idiopathic scoliosis. This age range is when rapid growth typically occurs, which is why the detection of a curve at this stage should be monitored closely for progression as the child’s skeleton develops.

• Dextroscoliosis describes a spinal curve to the right (“dextro” = right). Usually occurring in the thoracic spine, this is the most common type of curve. It can occur on its own (forming a “C” shape) or with another curve bending the opposite way in the lower spine (forming an “S”).Symptoms of scoliosis include an uneven waist, uneven shoulders, disjointed hip and a protruding shoulder blade, according to Mayo Clinic. The spine also curves or twists in acute cases, and the disease can cause one side of the ribs to protrude more than the other. Severe cases also induce labored breathing and back pain.Scoliosis can be recognized and diagnosed with a clinical exam, but xrays are necessary to fully evaluate the magnitude and type of scoliosis present. For a proper scoliosis evaluation, full length, whole spine xrays need to be performed. An MRI may also be recommended if there are symptoms of leg pain that may be associated with stenosis or if there is concern about possible spinal cord compression or abnormalities.
• Treatment
• Diagnosis
• Severe scoliosis can lead to heart and lung problems if not treated, as the ribs press against the chest, making breathing more difficult, states Mayo Clinic. Adults who had scoliosis as a child may experience more back pain throughout their lives as compared to people without scoliosis.

The treatment of adult scoliosis is very individualized and based on the specific symptoms and age of the patient. Many patients have scoliosis and have very minor symptoms and live with it without treatment. Patients with predominant symptoms of back pain would typically be treated with physical therapy. Patients with back pain and leg pain may receive some benefit from injection treatment to help relieve the leg pain.  If lumbar stenosis (narrowing of the spinal canal) is present and is unresponsive to non-surgical treatment, then a decompression( removal of bone and ligaments pressing on the nerves) may be recommended. If the scoliosis is greater than 30 degrees, a fusion procedure will most likely be recommended along with the decompression. The fusion is recommended to prevent the curve from progressing when the spine is destabilized by the bone removal that is necessary to  decompress the nerves. Fusions are usually accompanied with metal rod and screw placement into the spine to help correct and stabilize the scoliosis and help the bone heal or fuse together. The length of the fusion, or the number of spine levels included, depends on the type of scoliosis and the area of the spine involved. The goal of adult scoliosis surgery is to first remove pressure on the nerves, and second to keep the scoliosis from progressing further.

Severe scoliosis or left untreated can look like this:

“Scoliosis is a problem with the spine where the spine is curved instead of straight, with the upper back being rounded and the lower back having a “swayback,” or inner curved problem, reports WebMD.”