More than 65 million Americans overall have asthma and allergies. Some people may have one or both of these conditions.  About 25 million Americans have asthma (20 million adults and 5 million children)  About 32 million Americans have food allergies (26 million adults and 6 million children).  About 24 million Americans have rhinitis (hay fever), or nasal allergies (19.2 million adults and 5.2 million children)  There is no cure for asthma or allergies.

Rates of asthma are highest among African Americans and Puerto Ricans, young boys, and people living below the poverty line. Each year, asthma leads to more than 1.6 million emergency department visits and 170,000 hospital stays. For many, the change in seasons—with more allergens in the environment—can increase wheezing, chest tightness, shortness of breath, coughing, or severe asthma attacks.

Asthma is a chronic (long-term) condition that affects the airways in the lungs. The airways are tubes that carry air in and out of your lungs. If you have asthma, the airways can become inflamed and narrowed at times. This makes it harder for air to flow out of your airways when you breathe out.  Many of those affected with Covid 19 with asthma have a harder time with dealing with it compared to those with no asthma due to the condition affecting breathing to begin with.

Normally, the body’s immune system helps fight infections. But it may also respond to other things you breathe in, such as pollen or mold.  These are things that trigger symptoms of asthma to come on.   In some people, the immune system reacts strongly by creating inflation.  Ending result is the airways narrow causing it more difficult to breath. Over time, the airway walls can become thicker again making oxygen and carbon dioxide exchange not be as effective as someone without asthma.

“There is no treatment to reverse damage to motor neurons or cure ALS at this time. However, some treatments may slow progression of the disease, improve quality of life, and extend survival. New treatments have become available in the past several years, and researchers continue to explore diverse avenues to slow or stop progression of ALS.

Supportive health care is best provided by integrated, multi-disciplinary teams of professionals.  Doctors may use the medications approved by the U.S. Food and Drug Administration (FDA) to support a treatment plan for ALS.”

National Institute of Neurological Disorders and Stroke – NIH (https://www.ninds.nih.gov/health-information/disorders/amyotrophic-lateral-sclerosis-als)

Over the past decade, understanding of the multiple destructive pathways that lead to neuronal death in amyotrophic lateral sclerosis (ALS) has greatly improved.  There is still no cure for ALS unfortunately with all the technology medicine has but there are therapies.

Home Care at some point in middle to beginning of late stage.

This would include a Home Health Assistant followed under a Visiting Nurse/RN with an Attending Doctor for follow up on the pt care=A whole team of medical care including as soon as needed:

PT and OT:

Physical therapy (PT) is the use of exercises and treatments to improve physical movement and overall mobility. Occupational therapy (OT) is similar but is focused on developing or maintaining the physical skills needed to perform everyday tasks. For example, a physical therapist might prescribe stretching exercises to limit discomfort and preserve range of motion or use pool therapy to help you walk and improve joint function. An occupational therapist may help you find new ways to brush your teeth or recommend equipment that can make your activities of daily living easier to perform.

Speech Therapy:

For people living with ALS with bulbar symptoms, ALS leads to speech problems when it attacks bulbar neurons. These are the nerve cells responsible for bringing messages from the lower parts of the brain (bulbar region) to the muscles that move the lips, tongue, soft palate (back of roof of mouth), jaw, and vocal folds (voice box). As nerves are lost to the disease, the muscles they control become weak and tight. This causes dysarthria-difficulty speaking).  A speech-language pathologist can help with both speaking and swallowing difficulties. This may include finding devices to help you communicate as your speech becomes harder for others to understand.

Respiratory Therapy:

A respiratory therapist can teach you new techniques for breathing and coughing, helping you keep your airway and lungs clear and healthy. When mechanical ventilators are needed, they can help you evaluate the options and choose the best ventilator for your needs.  An ALS diagnosis is shocking and frightening, but as with any disease, knowledge is power. Being aware of symptoms and how you can prepare for – and manage – them is key to quality of life and often, for peace of mind. The impact of ALS on breathing is one of the most daunting aspects of the disease and one for which you and your family can and should prepare for early in the ALS journey.

Psychotherapy:

Feeling sad or scared after being diagnosed with ALS is completely natural.

In time the patient with ALS has there life completed turned upside down when they need assistance with there activitities of daily living from independent in their ADLs.  It’s not unusual to feel depressed or anxious after getting diagnosed with ALS. If you have difficulty coping with the mental and emotional side of ALS, a counselor or psychiatrist can help.

Potential symptoms of depression include:  Prolonged feelings of sadness, hopelessness, worthlessness, anxiety, or guilt.   Irritability or angry outbursts over small matters. Changes in sleeping patterns, including insomnia or sleeping too much.  Changes in appetite.

Medications:

There are a number of medications that can help treat the various symptoms of ALS and new drugs are being developed all the time. Talk with your doctor or therapist to find out what is currently available and whether any such medications might be right for you.

There are currently four drugs approved by the U.S. Food and Drug Administration to treat ALS (Radicava, Rilutek, Tiglutik, and Nuedexta). Studies all over the world, many funded by The ALS Association, are ongoing to develop more treatments and a cure for ALS.

Radicava™ (edaravone)

The FDA approved Radicava™ in 2017, less than a year after Mitsubishi Tanabe Pharma America submitted a new drug application, making it the first new treatment specifically for ALS in 22 years.

Rilutek (riluzole, now generic)

This was the first FDA-approved drug available to treat ALS — in 1995. It inhibits glutamate release and prolongs life approximately three months. Riluzole is the generic name of Rilutek.

Tiglutik (thickened riluzole)

The first and only thickened liquid form of riluzole, Tiglutik was approved by the FDA in September 2018. This formulation contrasts with the oral pill form of riluzole that has been on the market for ALS for more than 20 years. It is designed to avoid potential problems of crushing tablets.

Nuedexta®

Indicated for the treatment of pseudobulbar affect (PBA), which is characterized by frequent, involuntary, and often sudden episodes of crying and/or laughing that are exaggerated and/or don’t match how you feel. PBA occurs secondary to a variety of otherwise unrelated neurologic conditions. Nuedexta® (dextromethorphan HBr and quinidine sulfate) was FDA-approved in 2011.

“ALS is a disease that typically involves a gradual onset. The initial symptoms of ALS can be quite varied. One person may have trouble grasping a pen or lifting a coffee cup, while another may experience a change in vocal pitch when speaking.

The progression rate of ALS can be quite variable, as well. Although the mean survival time with ALS is two to five years after diagnosed with ALS, some people go longer for live five years, 10 years or even longer.  It varies from individual to individual after diagnosed with ALS.”

ALS Association (https://www.als.org/understanding-als/symptoms-diagnosis)

Once ALS starts, it almost always progresses, eventually taking away the ability to walk, dress, write, speak, swallow, and breathe, and shortening the life span. The onset of ALS often involves muscle weakness or stiffness as early symptoms. Progression of weakness, wasting, and paralysis of the muscles of the limbs and trunk, as well as those that control vital functions such as speech, swallowing, and breathing, generally follows.

How fast and in what order this occurs is very different from person to person. While the average survival time is three years, about 20 percent of people with ALS live five years, 10 percent will survive 10 years and 5 percent will live 20 years or longer.

End stages of ALS often include trouble swallowing and speaking. Weak and paralyzed vocal cords make speaking difficult and eventually impossible. Trouble swallowing occurs gradually in some patients, but can occur suddenly in others.

Stages of ALS

ALS is a relentlessly progressive disorder. The rate of progression between individuals is variable and the history generally reflects gradual and progressive worsening over time until death occurs.

Early stages:

Muscles

• Muscles may be weak and soft, or they may be stiff, tight, and spastic. Muscle cramping and twitching (fasciculation) occurs, as does loss of muscle bulk (atrophy).
• Symptoms may be limited to a single body region or mild symptoms may affect more than one region.

Physical effects

• The person may experience fatigue, poor balance, slurred words, a weak grip, tripping when walking, or other minor symptoms.
• Sometimes this stage occurs before a diagnosis is made.

Middle stages:

Muscles

• Symptoms become more widespread.
• Some muscles are paralyzed, while others are weakened or unaffected. Fasciculations may continue.

Physical effects

• Unused muscles may cause contractures, in which the joints become rigid, painful, and sometimes deformed.
• If a fall occurs, the person may not be able to stand back up alone.
• Driving is relinquished.
• Weakness in swallowing muscles may cause choking and greater difficulty eating and managing saliva.
• Weakness in breathing muscles can cause respiratory insufficiency, especially when lying down.
• Some people experience bouts of uncontrolled and inappropriate laughing or crying (pseudobulbar affect). Despite how it seems, the person usually doesn’t feel particularly sad or happy.

Late stages:

Muscles

• Most voluntary muscles are paralyzed.
• The muscles that help move air in and out of the lungs are severely compromised.

Physical effects

• Mobility is extremely limited, and help is needed in caring for most personal needs.
• Poor respiration may cause fatigue, fuzzy thinking, headaches, and susceptibility to pneumonia. (Respiratory insufficiency is a leading cause of death in ALS.)
• Speech, or eating and drinking by mouth, may not be possible
• Assistance needed if not needed in the previous stage yet; in the home care you would need:
  
  • Power wheelchair, hospital bed, mechanical lift, and switches that enable any moving body part to operate computers, environmental control units, and communication devices.
  • Assisted ventilation, either noninvasive or invasive (tracheostomy).
  • Feeding tube.
  • Possibly urinary catheters aren’t required but can make toileting easier.
  • The type of home assistance you need:

  1.) Caregivers should:

  • Find and train caregiving help.
  • Oversee 24-hour care operations.
  • Find ways to help the person with ALS stay socially and mentally active.
  • Get into a routine that supports themselves as well as the person with ALS.
  • Know that although this stage is all-consuming, surprisingly many caregivers report great stability and satisfaction in their daily lives at this later stage of the disease.

       2.) Visiting RN (Nurse) who basically follows up on the care and decline or no change in pt    with letting the attending M.D. in charge be kept informed on pt’s status who makes any change with orders on the pt’s care.  It’s a whole team effect to make sure the pt gets the best care!

• Progression is not always a straight line in an individual, either. It is not uncommon to have periods lasting weeks to months where there is very little or no loss of function. There are even very rare examples in which there is significant improvement and recovery of lost function. These ALS “arrests” and “reversals” are, unfortunately, usually transient. Less than 1 percent of people with ALS will have significant improvement in function lasting 12 months or longer

End stage

• The vast majority of deaths in ALS are the result of respiratory failure, a process that progresses slowly over months. Medications can relieve discomfort, anxiety, and fear caused by respiratory insufficiency.
• Far less-common causes of death in ALS include malnutrition as a result of swallowing problems, pulmonary embolism (a blockage in one of the arteries of the lungs), abnormalities in the heart’s electrical pacing system called cardiac arrhythmias, and pneumonia as the result of aspiration (when food or fluid gets into the lungs).
• Hospice care (in a facility or in the home) focuses on providing comfort and maintaining quality of life by supporting the physical, emotional, and spiritual needs of the individual with ALS and their family members. Families should contact hospice early on to see what in-home services are available even before the most advanced stage.
• At MDA clinics, physicians work closely with palliative care teams to coordinate treatment with in-home hospice care providers, assisted living facilities, or inpatient hospice settings. Such cooperation helps ensure the person with ALS has the most peaceful and painless experience possible.

“The more you learn about ALS, the better prepared you’ll be. Remember, in addition to doing your own research, speaking regularly with your healthcare provider(s) will help you make the most informed decisions moving forward. Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease, is a disease that affects parts of the nervous system that control voluntary muscle movements (the muscles that people move at will, like those of the arms and legs). ALS is referred to as a progressive disease, meaning the symptoms continue to get worse over time. People with ALS gradually lose strength in their muscles and become weaker, which can limit movement and the ability to live an independent life.

As ALS progresses, it will eventually affect muscles that control breathing, as well as chewing and swallowing food.”

ALS Pathways (https://www.alspathways.com/als-overview)

Amyotrophic lateral sclerosis concept illustration

ALS amyotrophic lateral sclerosis is a rare neurological disease affecting nerve cells that control voluntary muscle movement.  Amyotrophic Lateral Sclerosis or ALS, more commonly known as Lou Gehrig’s disease, is a terminal and progressive motor neuron disease. ALS specifically targets and kills the motor neurons responsible for controlling the vast majority of skeletal muscles in the human body, which eventually leads to respiratory failure and death.

Individuals with ALS experience a degeneration of their motor neurons, which causes the muscles to stop receiving the signals needed to function. After a certain time, the brain completely loses its ability to control voluntary movements, hence, people with ALS are unable to walk, move, or even breathe properly.

ALS belongs to, and is perhaps the most common example of, a group of neurological disorders known as Motor Neuron Diseases.  These diseases affect the body by causing the death of millions of neurons found in the motor cortex of the brain as well as the spinal cord. These nerve cells are directly responsible for the regulation and control of skeletal muscle function.

How ALS is diagnosed:

Considering the damage ALS can do, it became essential to spread the message regarding the disease so that people could treat it at an early stage. Though there is no cure for ALS but early detection can help in improving the quality of life of those with the disease. 

The signs and symptoms of this diagnosis:

1-Fatigue

A positive diagnosis of ALS is based primarily on a patient’s symptomatology.  Unfortunately there is no test that can currently provide a more conclusive assessment.

There are many diseases whose symptoms resemble those observed in patients with ALS. Therefore, diseases such as cervical osteoarthritis, cervical hernias that compress the spinal cord, heavy metal poisoning, and some infectious diseases such as Lyme disease or syphilis, can delay a correct diagnosis of ALS immediately.

As such, when ALS is suspected, it is common practice to rule out other diseases through a variety of tests including but not limited to lumbar punctures, MRIs, and electromyographic studies. In some cases, it might be necessary to perform a biopsy of muscle tissue in order to assuage any remaining doubts.

Often, the earliest symptoms of ALS are ignored or outright dismissed. Therefore, better understand this disease’s signs and symptoms.

2-Loss of strength

Pt’s with ALS eventually lose the ability to control all voluntary movement. During the progression of the disease, which typically lasts for several years, patients will experience a cumulative loss of muscle strength.

In most cases, the first muscles affected by the disease are those of the arms and legs which results in patients experiencing awkwardness when walking or moving about, an increased propensity for stumbling or tripping, and difficulty performing everyday tasks especially fine motor tasks like texting on the phone, typing, and even tying shoe or sneaker laces.

3-Muscle Atrophy

This is when the muscle actually deteriorates and muscle is lost.  Leading to muscle dystrophy,in the specific case of ALS, it occurs due to a dramatic reduction in the connection between nerves and muscle fibers caused by the death of motor neurons.  It often culminates to paresthesia to partial or total paralysis.

4-Fasciculations

Fasciculations are slight and involuntary muscular contractions that occur underneath the skin, but that do not produce any observable limb movement. Fasciculations are visible to the naked eye and are sometimes described as looking like small worms are moving within the muscle. These contractions occur because of spontaneous nerve discharges that fire within clumps of skeletal muscle fibers.  They can occur due to damage present in the lower motor neurons. They could be considered an early warning sign of the possible onset of ALS.

5-Cramps

Muscle cramps are highly common in patients who have ALS, and their incidence increases as the disease progresses. These sustained involuntary contractions of the muscles are typically accompanied by palpable contractures, can last anywhere from 30 to 45 seconds, and tend to be extremely painful.  Spasticity could develop and may not allow certain movements as a consequence of cramps;  in which antagonistic muscle groups participate.

Other Symptoms include:

• Tripping and falling
• Hand weakness or clumsiness
• Slurred speech or trouble swallowing
• twitching in your arms, shoulders and tongue
• Inappropriate crying, laughing or yawning
• Cognitive and behavioral changes

“There are two main types of high blood pressure.

1.) Primary hypertension, also called essential hypertension:
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure is called primary hypertension or essential hypertension. It tends to develop gradually over many years. Plaque buildup in the arteries, called atherosclerosis, increases the risk of high blood pressure.

2.) Secondary hypertension
This type of high blood pressure is caused by an underlying condition. It tends to appear suddenly and cause higher blood pressure than does primary hypertension. Conditions and medicines that can lead to secondary hypertension include:

-Adrenal gland tumors
-Blood vessel problems present at birth, also called congenital heart defects
-Cough and cold medicines, some pain relievers, birth control pills, and other prescription drugs
-Illegal drugs, such as cocaine and amphetamines
-Kidney disease
-Obstructive sleep apnea
-Thyroid problems

Sometimes just getting a health checkup causes blood pressure to increase. This is called white coat hypertension.”

MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410)

The times and the era we live in are those of uncertainty. The state of flux caused by economic upheavals and pandemic-related restrictions have added to our health woes, with the crazy chaosis going on with our government to not protesting but RIOTING being allowed on college campuses like now aiding to having hypertension in your life that you didn’t have before. People have been facing stress on all fronts. Job losses, health issues starting, family issues or even losses, etc.  Our government is not thinking of family (the US citizens but illegals?  Really!)   Stress can cause short-term spikes in blood pressure. It is your body doing FIGHT OR FLIGHT and your rotten diet living on fast food places or going 3 times a week as finally starting to impact you at a later age or now with the stress induced on it. 

Being under stress can cause your blood pressure to spike briefly. But researchers aren’t sure whether stress can cause blood pressure to rise long-term.

Experts do know that exercising 3 to 5 times a week for 30 minutes can lower stress. For people with high blood pressure, doing activities that help manage stress and improve health can help lower blood pressure.

We do know furthermore the following facts in how reactions to stress can affect the blood pressure:

The body releases a surge of hormones when under stress. These hormones cause the heart to beat faster and the blood vessels to narrow. These actions increase blood pressure for a time.

There’s no proof that stress by itself causes long-term high blood pressure. But reacting to stress in unhealthy ways can raise blood pressure and increase the risk of heart attack and stroke.

Behaviors linked to higher blood pressure.  What we do know already is how diet can impact B/P due to bad diet behaviors in your choice in what to eat commonly which is the following:

• Drinking too much alcohol or caffeine.
• Eating unhealthy foods=Processed, restaurants/fast foods, bakery items, food delivery, pizzeria, deli meats.
• Eating too much.  Too much salt in your diet or caffeine or unhealthy foods.
• Not moving enough.

Heart disease also might be linked to certain health conditions related to stress, such as:

• Anxiety.
• Depression.
• Being cut off from friends and family.

Diabetes alot of times goes with heart disease, renal disease and others.  The best thing too do eat healthy, stay in your body mass index (therapeutic weight), some exercise everyday 30 mins or more & routine M.D. check ups.

There’s no proof that these conditions are directly linked to high blood pressure but it can impact it. Remember again when we are under stress we go through flight and flight (meaning we either deal with it or we don’t at all). But the hormones the body makes when under emotional stress might damage arteries. The artery damage might lead to heart disease. And symptoms of depression and anxiety might cause some people to forget to take medicines to control high blood pressure or other heart conditions.

Stress can cause a steep rise in blood pressure. But when stress goes away, blood pressure returns to what it was before the stress. However, short spikes in blood pressure can cause heart attacks or strokes and may also damage blood vessels, the heart and the kidneys over time. The damage is like the damage from long-term high blood pressure.

SO THE BIG QUESTION IS CAN ANYTHING BE DONE IN CONTROLLING STRESS? THE ANSWER IS YES!!!

Here are some ways to manage stress:

One way is simply adjust your schedule. If you have too much to do, look at your calendar and to-do lists. Ask others to do some things. Schedule less time for activities that aren’t important to you. Say no to things you don’t want to do.

Harvard Health Publishing/Harvard Medical School states the following in helping to reduce stress:

1. Get enough sleep. Inadequate or poor-quality sleep can negatively affect your mood, mental alertness, energy level, and physical health.
2. Learn relaxation techniques. Meditation, progressive muscle relaxation, guided imagery, deep breathing exercises, and yoga are powerful relaxation techniques and stress-busters.
3. Strengthen your social network. Connect with others by taking a class, joining an organization, or participating in a support group.
4. Hone your time-management skills. The more efficiently you can juggle work and family demands, the lower your stress level.
5. Try to resolve stressful situations if you can. Don’t let stressful situations fester. Hold family problem-solving sessions and use negotiation skills at home and at work.
6. Nurture yourself. Treat yourself to a massage. Truly savor an experience: for example, eat slowly and really focus on the taste and sensations of each bite. Take a walk or a nap, or listen to your favorite music.
7. Ask for help. Don’t be afraid to ask for help from your spouse, friends, and neighbors. If stress and anxiety persist, talk to your doctor.

Along with these ways to reduce stress, add in a healthy lifestyle — maintaining a healthy weight, not smoking, regular exercise, and a diet that includes fruits, vegetables, whole grains, lean protein, and healthful fats — and high blood pressure could be a thing of the past.

American Heart Association states the following in how to go about stress to lower it that decreases your B/P:

“1. You can’t control all the outside events in your life.

However, you can change how you handle them emotionally and psychologically. Try to learn to accept things you can’t change. You don’t have to solve all of life’s problems.

2. Think about problems under your control and make a plan to solve them.

You could talk to your boss about difficulties at work, talk with your neighbor if his dog bothers you or get help when you have too much to do.

3. Know your stress triggers.

Think ahead about what may upset you. Some things you can avoid. For example, spend less time with people who bother you or avoid driving in rush-hour traffic.

4. Reduce stress by taking care of your mood

Relaxing is important!  Even if you are busy, take 15 to 20 minutes a day to sit quietly, breathe deeply and think of a peaceful picture.

5. Spend time developing supportive and nurturing relationships.

We all need supportive and encouraging relationships. Invest yourself in developing relationships that build character and foster growth.

6. Give yourself the gift of a healthy lifestyle.

Engage in physical activity regularly. Do what you enjoy; walk, swim, ride a bike or jog to get your muscles going. Letting go of the tension in your body will help you feel better.

Limit alcohol, don’t overeat and don’t smoke.

Relaxing for short periods during your workday, at night and on weekends may help lower your blood pressure. Another great stress-buster is to get regular physical activity.

7. Reduce stress by practicing gratitude and joy

Change how you respond to difficult situations, focusing on the positive, not the negative. Expressing gratitude to others can also boost your level of feeling good about life and reduce stressful thoughts.

8. Know what brings you pleasure and find ways to enjoy the experience.

Perhaps you enjoy volunteer opportunities or cooking your favorite foods. By taking time not only to participate in these activities but to intentionally enjoy them, you can build a satisfying life rather than hurry through your “relaxing activities” at a stressful pace.

Reducing B/P by reducing bad foods in our diet the would cause vessel vasoconstriction or blockages in our vessels causing HTN, with reducing stress in out lives, practicing activities healthy in our lives like getting a 1/2 to 1 full hour of exercise a day, meditating a few times a week, loosing weight to therapeutic level will all help reduce your B/P or HTN.  It is all up to you in what moves you do to change your live to better your health and live a productive, happy and relaxing at frequency in your life!  Don’t be ill that stops you from doing things you enjoy and be healthy!

Revised 5/07/24

“Statistics on Hypertension by CDC:

• Having hypertension puts you at risk for heart disease and stroke, which are leading causes of death in the United States.²
• In 2021, hypertension was a primary or contributing cause of 691,095 deaths in the United States.²
• Nearly half of adults have hypertension (48.1%, 119.9 million), defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg or are taking medication for hypertension.³
• About 1 in 4 adults with hypertension have their hypertension under control (22.5%, 27.0 million).³
• About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mmHg or higher. This includes 37 million U.S. adults. ³
• About 34 million adults who are recommended to take medication may need it to be prescribed and to start taking it. Almost two out of three of this group (19 million) have a blood pressure of 140/90 mmHg or higher.^3″

Centers for Disease Control and Prevention (https://www.cdc.gov/bloodpressure/facts.htm)