Multiple Sclerosis symptoms vary from person to person but there are common symptoms with MS.  Those could be the following:

*Fatigue-Occurs in about 80% of people, can significantly interfere with ability to function at home and work, and may be the most prominent symptom in a person who otherwise has minimal activity limitations.

*Difficulties with your walking gait-Related to several factors including weakness, spasticity, loss of balance, sensory deficit and fatigue, and can be helped by physical therapy, assistive therapy and medications.

*Numbness or Tingling-Numbness of the face, body, or extremities (arms and legs) is often the first symptom experienced by those eventually diagnosed as having MS.

*Spasticity-Refers to feelings of stiffness and a wide range of involuntary muscle spasms; can occur in any limb, but it is much more common in the legs.

*Weakness-Weakness in MS, which results from deconditioning of unused muscles or damage to nerves that stimulate muscles, can be managed with rehabilitation strategies.

*Visual Problems-The first symptom of MS for many people. Onset of blurred vision, poor contrast or color vision, and pain on eye movement can be frightening — and should be evaluated promptly.

*Dizziness or Vertigo-People with MS may feel off balance or lightheaded,  and for some even much less often have the sensation that they or their surroundings are spinning (vertigo).

*Bladder Problems-Bladder dysfunction, which occurs in at least 80% of people with MS, usually can be managed quite successfully through dietary and fluid management, medications, and catheterization.

*Sexual Problems-Very common in the general population including people with MS. Sexual responses can be affected by damage in the central nervous system, as well by symptoms such as fatigue and spasticity, and by psychological factors.

*Bowel Function-Constipation is a particular concern among people with MS, as is loss of control of the bowels. Bowel issues can typically be managed through diet, adequate fluid intake, physical activity and medication.

*Pain-Pain syndromes are common in MS. In one study, 55% of people with MS had “clinically significant pain” at some time, and almost half had chronic pain.

*Cognitive changes-Refers to a range of high-level brain functions affected in 50% of people with MS, including the ability to learn and remember information, organize and problem-solve, focus attention and accurately perceive the environment.

*Emotional changes-Can be a reaction to the stresses of living with MS as well as the result of neurologic and immune changes. Bouts of depression, mood swings, irritability, and episodes of uncontrollable laughing and crying pose significant challenges for people with MS and their families.

*Depression-Studies have suggested that clinical depression — the severest form of depression — is among the most common symptoms of MS. It is more common among people with MS than it is in the general population or in persons with many other chronic, disabling conditions

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.

Tune in tomorrow for Part III about the treatments of MS!

“Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS).  The CNS is made up of the brain, spinal cord and optic nerves.

Within the CNS, the immune system causes inflammation that damages myelin — the fatty substance that surrounds and insulates the nerve fibers — as well as the nerve fibers themselves, and the specialized cells that make myelin.”

National Multiple Sclerosis Society

“Brain Injury Awareness Challenges come across Significant Deficits in Memory provide the most significant barrier to developing Intellectual Awareness/Self-Knowledge.

In Emergency Awareness Episodes these are times of difficulty recognizing a problem while it is actually happening; trouble monitoring the connection between actions and environment and deficits at this level are the MOST FRUSTRATING to caregivers and clinicians.”.

Neuro Institute Continuing Education for Rehabilitation Professionals (https://www.neurorestorative.com)

An acquired brain injury (ABI) is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Essentially, this type of brain injury is one that has occurred after birth. The injury results in a change to the brain’s neuronal activity, which affects the physical integrity, metabolic activity, or functional ability of nerve cells in the brain.

There are two types of acquired brain injury: traumatic and non-traumatic.

A traumatic brain injury (TBI) is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Traumatic impact injuries can be defined as closed (or non-penetrating) or open (penetrating).

Often referred to as an acquired brain injury, a non-traumatic brain injury causes damage to the brain by internal factors, such as a lack of oxygen, exposure to toxins, pressure from a tumor, etc.

A Brain Injury is damage to the brain that results in a loss of function such as mobility or feeling.

Traumatic Brain Injuries can result from a closed head injury or a penetrating head injury.

Closed Injury:  A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull.

Penetrating Injury: A penetrating injury occurs when an object pierces the skull and enters brain tissue. As the first line of defense, the skull is particularly vulnerable to injury. Skull fractures occur when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized injury to brain tissue. Skull fractures can cause cerebral contusion.

Brain trauma occurs when a person has an injury to the brain, and can be mild or severe. When a person sustains trauma to the brain, he or she may lose motor functions along with cognitive and physical abilities. Physicians use the Glasgow Coma Scale to determine the extent of brain trauma. This is a neurological scale that measures the level of a person’s consciousness. The Rancho Los Amigos Scale is used to monitor the recovery of the brain.

There are several different types of brain injuries. A mild injury may cause temporary symptoms while a severe injury could require years of rehabilitation. The two most common types of brain trauma are:

1. Traumatic Brain Injuries 

2. Acquired Brain Injuries.

1-Traumatic brain injury occurs from external force on the head or neck. These injuries can occur from blows to the head or aggressive twisting of the neck. Some ways this could happen include falls, motor vehicle accidents, sports, and vigorous shaking. In infants, Shaken Baby Syndrome is a type of traumatic brain injury.

2-An acquired brain injury means simply you got this injury after you were born and it was caused by a condition or illness after birth. This type of injury can result from several different causes like strokes, toxic poisoning or brain tumors. Degenerative diseases and lack of oxygen may also cause this type of brain trauma. Here are some examples of acquired brain injuries:

-Bleeding in the brain which can lead to brain injury.   Blood Vessels in the brain can rupture resulting in an intra-cerebral hemorrhagic (one of the causes of a stroke, its what we called Hemorrhagic Stroke). Symptoms may include headaches, loss of vision, weakness to one side of the body and eye pain to even garbled speech.

Other Causes of Brian Injury:

-Anoxia is another insult to the brain that can cause injury. Anoxia is a condition in which there is an absence of oxygen supply to an organ’s tissues, even if there is adequate blood flow to the tissue.  Common causes of anoxia are near drowning, choking, suffocation, strangulation, heart attacks, lung damage, or very low blood pressure.  They all decrease oxygen intake to the red blood cells that feed the organs nutrients (being oxygen) to our body.  Anoxia is starvation to our body tissues.  

-Hypoxia:

Hypoxia refers to a decrease in oxygen supply rather than a complete absence of oxygen, and ischemia is inadequate blood supply, as is seen in cases in which the brain swells that causes compressing on the brain vessels near where the swelling is. In any of these cases, without adequate oxygen, a biochemical cascade called the ischemic cascade is unleashed, and the cells of the brain can die within several minutes. This type of injury is often seen in near-drowning victims, in heart attack patients, or in people who suffer significant blood loss from other injuries that decrease blood flow to the brain.

-Toxemia:

This occurs due to poisoning from chemical or biological factors that can damage the brain. Toxemia can be caused by drugs, chemicals, gases or even toxic foods.

-Viruses and bacteria. An infection of the brain can be very damaging like:

*Meningitis is a inflammation of the lining around the brain or spinal cord, usually due to infection; Neck stiffness, headache, fever, and confusion are common symptoms.

*Encephalitis (en-sef-uh-LIE-tis) is inflammation of the brain. Viral infections are the most common cause of the condition. Encephalitis can cause flu-like symptoms, such as a fever or severe headache. It can also cause confused thinking, seizures, or problems with senses or movement.

*HIV can lead to brain injury. HIV, can affect the brain in different ways. HIV-meningoencephalitis is infection of the brain and the lining of the brain by the HIV virus. It occurs shortly after the person is first infected with HIV and may cause headache, neck stiffness, drowsiness, confusion and/or seizures. HIV-encephalopathy (HIV-associated dementia) is the result of damage to the brain by longstanding HIV infection.  It is a form of dementia and occurs in advanced HIV infection. Mild Neurocognitive Disorder is problems with thinking and memory in HIV, however is not as severe as HIV-encephalopathy. Unlike HIV-encephalopathy it can occur early in HIV infection and is not a feature of Aquired Immune Deficiency Syndrome – AIDS.

*Lastly, Herpes. There are two types of herpes simplex virus (HSV). Either type can cause encephalitis. HSV type 1 (HSV-1) is usually responsible for cold sores or fever blisters around your mouth, and HSV type 2 (HSV-2) commonly causes genital herpes. Encephalitis caused by HSV-1 is rare, but it has the potential to cause significant brain damage or death.

*Other herpes viruses. Other herpes viruses that may cause encephalitis include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.*Viral infections due to blood sucking insects like mosquitoes and ticks to animals with rabies a rapid progression to encephalitis once symptoms begin. Rabies is a rare cause of encephalitis in the U.S.

When a person is diagnosed with a brain trauma, doctors will decide if rehabilitation is needed.

Rehabilitation programs may vary depending on the type of brain injury and estimated recovery time. Treatment usually consists of physical therapy and daily activities. In extreme cases, patients may need to learn how to read and write again.

Therapy for brain trauma typically takes place on an outpatient basis or through an assisted living facility. Therapy may last several weeks, months or even years, and sometimes the patient is not able to make a full recovery.

It may not always be obvious when a person has sustained a brain injury. The patient may have hit his or her head and not have symptoms until a few hours later. Some signs of a possible brain injury are headaches, confusion and loss of memory. If brain trauma is not treated, it could cause permanent damage or death.

Brain injuries can affect the patient and the patient’s family, with emotional and financial hardship. When problems arise with treatment or financial issues, a brain injury lawyer or specialist may need to intervene.

REVISED 2/25/2021 By Elizabeth Lynch RN BSN Cardiac/Stroke Certified (RN 34.5 Years)

“Check your health insurance to see if it includes international travel coverage, the CDC recommends. Also, consider travel health insurance and medical evacuation insurance. The CDC estimates that — without insurance, a medical evacuation can $100,000 or more.”

Consider traveling in the U.S.!

CDC Centers of Disease and Control Prevention

The corona virus spreads continues to grow around the globe, there are steps you can take to protect yourself and your family.

“I told my children that while I didn’t think that they were at risk right now, we, as a family, need to be preparing for significant disruption of our lives,” says Dr. Nancy Messonnier of the Centers for Disease Control and Prevention.

The CDC plans to expand testing across the U.S. as a preventative measure.

Currently, if you live in the U.S. the risk of getting the virus remains very low, but public health officials say there will likely be outbreaks in the United States. So this is a good time to review your emergency game plan.

Here’s what you need to know to make good decisions to plan, prepare and even prevent the spread of the disease.

1. This virus is contagious, but it’s not as deadly as other outbreaks

In China, more than three quarters of the cases have been classified as mild. Symptoms include low-grade fever and a cough. Some people also experience fatigue, headaches and, less frequently, diarrhea.

Overall, the death rate in China is estimated at 2 percent, and the average age of death among those with COVID-19 is in the 70’s. People with underlying medical problems, and particularly smokers, seem to be at higher risk.

Compared to prior outbreaks of novel viruses, this coronavirus appears less deadly than other human coronaviruses that have spread in recent years. For instance, the death rate was about 34% for MERS, and about 10% for SARS.

The flu causes more than 12,000 deaths a year in the U.S. An annual vaccine is the most effective way to prevent flu, but there are other strategies to prevent it. So far, there’s no vaccine against the new coronavirus, but some of the same strategies to prevent flu can also protect against coronavirus.

2. To fend off coronavirus, follow flu prevention tips

The top tip: Wash your hands. Why? Viruses can spread from person to person via respiratory droplets. When an infected person coughs or sneezes, close contacts can be infected. In addition, the virus can end up on door knobs, elevator buttons and other surfaces. If you touch those surfaces then touch your eyes, nose or mouth, you can become infected.

This is why it’s important to wash rigorously. Here’s the CDC’s guidance.

“Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.”

“Americans are friendly. We not only shake hands, we also hug. These are ways we can transmit the virus,” Katz says. She recommends an elbow bump.

Here’s 5 more things to remember, per the CDC:

• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose, and mouth.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

3. Don’t panic — start to prepare

This is not the time to panic, but it is a time to prepare – good old fashioned preparedness planning for your family,” says Rebecca Katz, who directs the Center for Global Health Science and Security.

Think about the threat of a possible outbreak in your community the way you’d think about a big snowstorm or a hurricane. If it never hits, great. But if it does, you’ll be glad you prepared.

Don’t hoard, but do stock your cupboards with some extra food and cleaning supplies. Each time you grocery shop, buy a few extra items. Shelf stable foods such as beans and rice are good options. Also, utilize your freezer to preserve foods, everything from meats and vegetables to cooked grains and bread. Think about having enough on hand to last a few weeks.

• Check the medicine cabinet to ensure you have basic medications such as aspirin or ibuprofen.
• Think about a back up plan if schools were to close during an outbreak.
• If you take a daily prescription medication, have as much of a supply on hand as possible.
• Ask your employer about a work-from-home option.

“If there’s widespread virus in your community, you may not want to go to the [store]. You may want to distance yourself from others,” Katz says.

4. The uncertainty of masks to prevent illness

Overall, there’s not conclusive evidence that wearing a face mask can help prevent people from being infected by the virus. And public health officials give mixed messages about usefulness for the general public. As we’ve reported, masks may not fit the face tightly, so you’re still able to breath in infected droplets. And, experts worry that masks can give a false sense of security.

Health care providers are trained to use masks properly, and there’s evidence that they’re effective in clinical settings. For people at home, the CDC recommends using masks in certain situations. For instance, if you’re caring for an infected person at home, the proper use of masks can protect the caregiver.

5. Be smart about travel

The CDC updates its travel advisory information frequently. The federal government uses a 4 level scale to rank risk. Level 1 = lowest risk, Level 4, highest.

For Italy, where there’s been sustained spread of the novel coronavirus, there’s now a Level 2 Alert. The CDC advises that older adults and those with chronic medical conditions should consider postponing nonessential travel. “Travelers should avoid contact with sick people and clean their hands often by washing with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer with 60%–95% alcohol.”

Check your health insurance to see if it includes international travel coverage, the CDC recommends. Also, consider travel health insurance and medical evacuation insurance.

The CDC estimates that — without insurance, a medical evacuation can $100,000 or more.

If you’ve planned a cruise or overseas travel consider the possibility of travel disruptions in the event of an outbreak. “Think about the consequences of being caught on ship or over a border when decisions are being made,” that could limit or disrupt your travel without much warning says Christopher Mores of George Washington University. If you were quarantined, what would your back-up plan be for your work and family responsibilities back home? This is definitely something to consider.

“Affected Geographic Areas with Widespread or Sustained Community Transmission (Remember Widespread or Sustained and the U.S. is not a widespread yet).

Last updated February 26, 2020

• China
• Iran
• Italy
• Japan
• South Korea”
  

 World Health Organization

“Think of your bones as a “bank” where you “deposit” and “withdraw” bone tissue. During your childhood and teenage years, new bone is added (or deposited) to the skeleton faster than old bone is removed (or withdrawn). As a result, your bones become larger, heavier, and denser.

For most people, bone formation continues at a faster pace than removal until sometime after age 20. After age 30, bone withdrawals can begin to go faster than deposits. If your bone deposits don’t keep up with withdrawals, you can get osteoporosis.”

National Institute of Arthritis, Musculoskeletal and Skin Diseases.

“Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.”

MAYO CLINIC