“A healthy liver has the amazing ability to grow back, or regenerate, when it is damaged but not continuously damaged.”
The American Liver Foundation
“A healthy liver has the amazing ability to grow back, or regenerate, when it is damaged but not continuously damaged.”
The American Liver Foundation
Charcot Marie Tooth Disease=CMT is inherited. It is not contagious, nor is it caused by anything in the environment. The most common forms of CMT are passed down from one generation to the next, meaning that it is dominantly inherited.
Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neurological disorders, affecting approximately 1 in 2,500 people in the United States. The disease is named for the three physicians who first identified it in 1886 – Jean-Martin Charcot and Pierre Marie in Paris, France, and Howard Henry Tooth in Cambridge, England. CMT, also known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy, comprises a group of disorders that affect peripheral nerves. The peripheral nerves lie outside the brain and spinal cord and supply the muscles and sensory organs in the limbs. Disorders that affect the peripheral nerves are called peripheral neuropathies.
Causes of Charcot-Marie-Tooth disease?
A nerve cell communicates information to distant targets by sending electrical signals down a long, thin part of the cell called the axon. In order to increase the speed at which these electrical signals travel, the axon is insulated by myelin, which is produced by another type of cell called the Schwann cell. Myelin twists around the axon like a jelly-roll cake and prevents the loss of electrical signals. Without an intact axon and myelin sheath, peripheral nerve cells are unable to activate target muscles or relay sensory information from the limbs back to the brain.
CMT is caused by mutations in genes that produce proteins involved in the structure and function of either the peripheral nerve axon or the myelin sheath. Although different proteins are abnormal in different forms of CMT disease, all of the mutations affect the normal function of the peripheral nerves. Consequently, these nerves slowly degenerate and lose the ability to communicate with their distant targets. The degeneration of motor nerves results in muscle weakness and atrophy in the extremities (arms, legs, hands, or feet), and in some cases the degeneration of sensory nerves results in a reduced ability to feel heat, cold, and pain.
The gene mutations in CMT disease are usually inherited. Each of us normally possesses two copies of every gene, one inherited from each parent. Some forms of CMT are inherited in an autosomal dominant fashion, which means that only one copy of the abnormal gene is needed to cause the disease. Other forms of CMT are inherited in an autosomal recessive fashion, which means that both copies of the abnormal gene must be present to cause the disease. Still other forms of CMT are inherited in an X-linked fashion, which means that the abnormal gene is located on the X chromosome. The X and Y chromosomes determine an individual’s sex. Individuals with two X chromosomes are female and individuals with one X and one Y chromosome are male.
In rare cases the gene mutation causing CMT disease is a new mutation which occurs spontaneously in the individual’s genetic material and has not been passed down through the family. There are many forms of CMT disease, including CMT1, CMT2, CMT3, CMT4, and CMTX. CMT1, caused by abnormalities in the myelin sheath, has three main types.
CMT1A is an autosomal dominant disease that results from a duplication of the gene on chromosome 17 that carries the instructions for producing the peripheral myelin protein-22 (PMP-22). The PMP-22 protein is a critical component of the myelin sheath. Overexpression of this gene causes the structure and function of the myelin sheath to be abnormal. Patients experience weakness and atrophy of the muscles of the lower legs beginning in adolescence; later they experience hand weakness and sensory loss.
CMT1B is an autosomal dominant disease caused by mutations in the gene that carries the instructions for manufacturing the myelin protein zero (P0), which is another critical component of the myelin sheath.
CMT2 results from abnormalities in the axon of the peripheral nerve cell rather than the myelin sheath. It is less common than CMT1.
CMT3 or Dejerine-Sottas disease is a severe demyelinating neuropathy that begins in infancy. Infants have severe muscle atrophy, weakness, and sensory problems
CMT4 comprises several different subtypes of autosomal recessive demyelinating motor and sensory neuropathies. Individuals with CMT4 generally develop symptoms of leg weakness in childhood and by adolescence they may not be able to walk.
CMTX is caused by a point mutation in the connexin-32 gene on the X chromosome. Males who inherit one mutated gene from their mothers show moderate to severe symptoms of the disease beginning in late childhood or adolescence. Females who inherit one mutated gene from one parent and one normal gene from the other parent may develop mild symptoms in adolescence or later or may not develop symptoms of the disease at all.
How is Charcot-Marie-Tooth disease diagnosed?
Diagnosis of CMT begins with a standard medical history, family history, and neurological examination. Individuals will be asked about the nature and duration of their symptoms and whether other family members have the disease. During the neurological examination a physician will look for evidence of muscle weakness in the individual’s arms, legs, hands, and feet, decreased muscle bulk, reduced tendon reflexes, and sensory loss. Doctors look for evidence of foot deformities, such as high arches, hammertoes, inverted heel, or flat feet. Other orthopedic problems, such as mild scoliosis or hip dysplasia, may also be present. A specific sign that may be found in people with CMT1 is nerve enlargement that may be felt or even seen through the skin. These enlarged nerves, called hypertrophic nerves, are caused by abnormally thickened myelin sheaths.
If CMT is suspected, the physician may order electrodiagnostic tests. This testing consists of two parts: nerve conduction studies and electromyography (EMG). During nerve conduction studies, electrodes are placed on the skin over a peripheral motor or sensory nerve. These electrodes produce a small electric shock that may cause mild discomfort. This electrical impulse stimulates sensory and motor nerves and provides quantifiable information that the doctor can use to arrive at a diagnosis. EMG involves inserting a needle electrode through the skin to measure the bioelectrical activity of muscles. Specific abnormalities in the readings signify axon degeneration. EMG may be useful in further characterizing the distribution and severity of peripheral nerve involvement.
Genetic testing is available for some types of CMT and results are usually enough to confirm a diagnosis. In addition, genetic counseling is available to assist individuals in understanding their condition and plan for the future.
If all the diagnostic work-up in inconclusive or genetic testing comes back negative, a neurologist may perform a nerve biopsy to confirm the diagnosis. A nerve biopsy involves removing a small piece of peripheral nerve through an incision in the skin. This is most often done by removing a piece of the nerve that runs down the calf of the leg. The nerve is then examined under a microscope.
The treatment of CMT:
There is no cure for CMT, but physical therapy, occupational therapy, braces and other orthopedic devices, and even orthopedic surgery can help individuals cope with the disabling symptoms of the disease. In addition, pain-killing drugs can be prescribed for individuals who have severe pain.
Physical and occupational therapy, the preferred treatment for CMT, involves muscle strength training, muscle and ligament stretching, stamina training, and moderate aerobic exercise. Most therapists recommend a specialized treatment program designed with the approval of the person’s physician to fit individual abilities and needs. Therapists also suggest entering into a treatment program early; muscle strengthening may delay or reduce muscle atrophy, so strength training is most useful if it begins before nerve degeneration and muscle weakness progress to the point of disability.
Stretching may prevent or reduce joint deformities that result from uneven muscle pull on bones. Exercises to help build stamina or increase endurance will help prevent the fatigue that results from performing everyday activities that require strength and mobility. Moderate aerobic activity can help to maintain cardiovascular fitness and overall health. Most therapists recommend low-impact or no-impact exercises, such as biking or swimming, rather than activities such as walking or jogging, which may put stress on fragile muscles and joints.
Many CMT patients require ankle braces and other orthopedic devices to maintain everyday mobility and prevent injury. Ankle braces can help prevent ankle sprains by providing support and stability during activities such as walking or climbing stairs. High-top shoes or boots can also provide support for weak ankles. Thumb splints can help with hand weakness and loss of fine motor skills. Assistive devices should be used before disability sets in because the devices may prevent muscle strain and reduce muscle weakening. Some individuals with CMT may decide to have orthopedic surgery to reverse foot and joint deformities.
The National Institute of Neurology Disorders and Stroke supports research on CMT and other peripheral neuropathies in an effort to learn how to better treat, prevent, and even cure these disorders.
“Spina bifida is one of the most common birth defects today and may be called by a number of other clinical names, such as spina bifida cystica and myelodysplasia, both of which are synonyms of ‘spina bifida’.”
Columbia Presbyterian Hospital – Orthopaedic Surgery
Spina Bifida is the most common permanently disabling birth defect in the United States.
Spina Bifida literally means “split spine.”
Spina Bifida happens when a baby is in the womb and the spinal column does not close all of the way. Every day, about 8 babies born in the United States have Spina Bifida or a similar birth defect of the brain and spine.
No one knows for sure the exact cause of spina bifida but have their ideas. Scientists believe that genetic and environmental factors act together to cause the condition.
Although doctors and researchers don’t know for sure why spina bifida occurs, they have identified a few risk factors:
There are different types of Spina Bifida:
Occult Spinal Dysraphism (OSD) Infants with this have a dimple in their lower back. Because most babies with dimples do not have OSD, a doctor has to check using special tools and tests to be sure. Other signs are red marks, hyperpigmented patches on the back, tufts of hair or small lumps. In OSD, the spinal cord may not grow the right way and can cause serious problems as a child grows up. Infants who might have OSD should be seen by a doctor, who will recommend tests.
Spina Bifida Occulta It is often called “hidden Spina Bifida” because about 15 % of healthy people have it and do not know it. Spina Bifida Occulta usually does not cause harm, and has no visible signs. The spinal cord and nerves are usually fine. Visible indications of spina bifida occulta can sometimes be seen on the newborn’s skin above the spinal defect, including:
Myelomeningocele (Meningomyelocele), also called Spina Bifida Cystica This is the most severe form of Spina Bifida. It happens when parts of the spinal cord and nerves come through the open part of the spine. It causes nerve damage and other disabilities. 70 to 90% of children with this condition also have too much fluid on their brains. This happens because fluid that protects the brain and spinal cord is unable to drain like it should. The fluid builds up, causing pressure and swelling. Without treatment, a person’s head grows too big, and may have brain damage. Children who do not have Spina Bifida can also have this problem, so parents need to check with a doctor. Usually, however, tissues and nerves are exposed, making the baby prone to life-threatening infections.
Neurological impairment is common, including:
The operation involves closing the opening in the spinal cord and covering the cord with muscles and skin taken from either side of the back. The most common complications are tethered spinal cord and hydrocephalus, which can have very severe consequences.
“It’s Halloween time and the flu season is here! Keeping hands clean by washing them with soap and water is one of the best ways to prevent the spread of germs. Everyone 6 months and older should get a flu vaccine each year for the best protection against influenza throughout flu season.”
CDC (center for disease control & prevention)
Go to striveforgoodhealth.com on Safety tips regarding halloween for kids.
Treats: Warn children not to eat any treats before an adult has carefully examined them for evidence of tampering.
Flame Resistant Costumes: When purchasing a costume, masks, beards, and wigs, look for the label Flame Resistant. Although this label does not mean these items won’t catch fire, it does indicate the items will resist burning and should extinguish quickly once removed from the ignition source. To minimize the risk of contact with candles or other sources of ignition, avoid costumes made with flimsy materials and outfits with big, baggy sleeves or billowing skirts.
Costume Designs: Purchase or make costumes that are light and bright enough to be clearly visible to motorists.
For greater visibility during dusk and darkness, decorate or trim costumes with reflective tape that will glow in the beam of a car’s headlights.
Bags or sacks should also be light colored or decorated with reflective tape. Reflective tape is usually available in hardware, bicycle, and sporting goods stores.
To easily see and be seen, children should also carry flashlights.
Costumes should be short enough to prevent children from tripping and falling.
Children should wear well-fitting, sturdy shoes . Mother’ s high heels are not a good idea for safe walking.
Hats and scarfs should be tied securely to prevent them from slipping over children’s eyes.
Apply a natural mask of cosmetics rather than have a child wear a loose-fitting mask that might restrict breathing or obscure vision. If a mask is used, however, make sure it fits securely and has eyeholes large enough to allow full vision. Swords, knives, and similar costume accessories should be of soft and flexible material.
Pedestrian Safety: Young children should always be accompanied by an adult or an older, responsible child. All children should WALK, not run from house to house and use the sidewalk if available, rather than walk in the street.
Children should be cautioned against running out from between parked cars, or across lawns and yards where ornaments, furniture, or clotheslines present dangers.
Choosing Safe Houses: Children should go only to homes where the residents are known and have outside lights on as a sign of welcome.
Children should not enter homes or apartments unless they are accompanied by an adult.
People expecting trick-or-treaters should remove anything that could be an obstacle from lawns, steps and porches.
Candlelit jack-o’-lanterns should be kept away from landings and doorsteps where costumes could brush against the flame. Indoor jack-o’-lanterns should be kept away from curtains, decorations, and other furnishings that could be ignited.
Even though it’s not an official holiday, Halloween is much beloved by children and adults alike. What could be more fun than trick-or-treating, apple bobbing, or costume parties?
To make sure treats are safe for children, follow these simple steps:
Snacking: Children shouldn’t snack on treats from their goody bags while they’re out trick-or-treating. Give them a light meal or snack before they head out – don’t send them out on an empty stomach. Urge them to wait until they get home and let you inspect their loot before they eat any of it.
Safe treats: Tell children not to accept – and especially not to eat – anything that isn’t commercially wrapped. Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.
Food Allergies: If your child has a food allergy, check the label to ensure the allergen isn’t present. Do not allow the child to eat any home-baked goods he or she may have received.
Choking hazards: If you have very young children, be sure to remove any choking hazards such as gum, peanuts, hard candies, or small toys.
Bobbing for apples is an all-time favorite Halloween game. Here are a couple of ways to say “boo” to bacteria that can cause foodborne illness. Reduce the number of bacteria that might be present on apples and other raw fruits and vegetables by thoroughly rinsing them under cool running water. As an added precaution, use a produce brush to remove surface dirt.
Try this new spin on apple bobbing from FightBAC.org: Cut out lots of apples from red construction paper. On each apple, write activities for kids, such as “do 5 jumping jacks.” Place a paper clip on each apple and put them in a large basket. Tie a magnet to a string. Let the children take turns “bobbing” with their magnet and doing the activity written on their apple. Give children a fresh apple for participating.
If your idea of Halloween fun is a party at home, don’t forget these tips:
Bacteria will creep up on you if you let foods sit out too long. Don’t leave perishable goodies out of the fridge for more than two hours (1 hour in temperatures above 90°F).
“A full 70 percent of people say chocolate is their favorite Halloween treat, followed by candy corn (13 percent), chewy candy (6 percent) and gummy candy (5 percent).”
National Confection National Confectioners Association’s (NCA)
TRICK or TREAT
The trick to enjoying your favorite Halloween treats? Moderation, according to the results of the National Confectioners Association’s (NCA) new national survey. As the holiday approaches, nearly 80 percent of parents report that they have a plan in place to help their children make smart decisions when it comes to the enjoyment of treats. More than three-quarters of Americans will hand out candy to trick-or-treaters this year and many others will participate in community-sponsored Halloween events, display a seasonal candy bowl or attend a Halloween party. NCA projects that retail sales of Halloween candy in 2015 will be $2.6 billion, a boost to the U.S. economy that helps support 55,000 manufacturing jobs and hundreds of thousands of jobs in related industries.
“People understand that candy is a treat, and this year’s survey tells us that they are celebrating Halloween in more ways than ever and practicing moderation,” said Alison Bodor, executive vice president of the National Confectioners Association. “Parents, including me, are embracing Halloween celebrations and traditions, but we’re also using the holiday as an opportunity to teach our children how to enjoy candy as a fun part of a balanced lifestyle.”
Bodor added that the U.S. confectionery industry supports 465,000 American jobs. “From our industry’s own manufacturers to the jobs we help support on the farms where our ingredients are grown and in the stores where our products are sold, candy makers are supporting good-paying jobs in this country. Confectioners are vital to the economic success of their communities – at Halloween and year round.”
According to NCA’s seasonal survey, more than 90 percent of parents discuss or plan to discuss balance and moderation with their children relative to their candy consumption, and while most report having these conversations year-round, many use the holiday as a starting point.
Those who stay home to hand out candy also recognize the importance of balance and moderation. More than 60 percent of respondents prefer to hand candy to trick-or-treaters, rather than having the ghosts and goblins help themselves, and nearly 60 percent of those surveyed believe that up to two pieces is just the right amount per household.
Halloween Is Meant For Sharing Halloween continues to be the top candy-giving holiday with 86 percent of people gifting or sharing chocolate or other candy. Seven in 10 people believe that holidays like Halloween are meant for enjoying candy, and that it is important to do so in moderation. Parents support the notion that sharing is a critical piece of the Halloween celebration – a full 80 percent report that they enjoy some of their children’s Halloween bounty by either sneaking it when the kids aren’t looking (23 percent) or by instituting a house rule that it must be shared (57 percent).
Candy Is Always A Treat NCA’s survey revealed that 81 percent of Americans support the notion that candy is a treat and 75 percent agree that it is okay to enjoy seasonal chocolate or candy. Almost 20 percent of consumers say they are more likely to buy seasonal candy in smaller portion sizes than they were five years ago.
Everyone Has A Favorite Americans love chocolate year-round, and Halloween is no exception. A full 70 percent of people say chocolate is their favorite Halloween treat, followed by candy corn (13 percent), chewy candy (6 percent) and gummy candy (5 percent). Despite chocolate’s popularity, most Americans (63 percent) say they stock their trick-or-treat candy bowls with a mix of chocolate and non-chocolate, so that they can be sure to have something everyone will like. When it comes to selecting candies in shapes like spiders, eyeballs and brains to inspire seasonal celebrations, parents are 24 percent more likely than non-parents to pick creepy candy over other Halloween themes.
Keeping An Eye On The Candy Stash Nearly four in five parents (79 percent) encourage moderation by keeping tabs on their children’s candy consumption following Halloween, but they take different approaches. Some limit their children to a certain number of pieces per day (35 percent), a total number of pieces overall (14 percent), or a general amount of calories (9 percent) and then take the rest away. Twenty-one percent opt to take responsibility for the candy and dole it out as appropriate. NCA supported research at Pennsylvania State University to help parents learn practices that promote balance and moderation with treats in their homes. As part of that research, a scientific literature review published recently in the Journal of Pediatric Obesity concluded that simply restricting or forbidding children from having snack foods or other treats, like candy, is not an effective approach to helping them learn how to consume these foods in moderation.
WAYS TO HANDLE HALLOWEEN IN MODERATION:
Something Good to Eat
A growing number of parents are bucking the candy-giving tradition altogether. The 2000 American Express Retail Index estimated that 18% of adults distributed non-candy treats. In some of these homes, children may have special dietary needs. Other parents are alarmed by reports about the increasing rate of child obesity, and some parents just hope to lessen the day’s sugar intake.
A recent study even showed that kids welcome such alternatives. Researchers offered trick-or-treaters in five Connecticut neighborhoods two bowls to choose from: one with lollipops or fruit candy and one with inexpensive Halloween-themed trinkets. About half the kids skipped the sweet stuff and took a toy instead. So consider making the switch at your house.
From the grocery:
From the party-supply store (purchased in bulk, these items should cost about 20 cents each):
More cool options:
Acts of Sweetness
Halloween is a great time to teach children about sharing. This is a day when kids are inspired to be like Spider-Man or other heroic do-gooders. Encourage their charitable attitude by turning trick-or-treating into a save-the-world mission. In addition to candy, have your child ask for donations for a non-profit organization or school program.
The most common cause -a bulging or ruptured disc in the spine pressing against the nerve roots that lead to the sciatic nerve.
-Sciatica Nerve Damage can be a symptom of other conditions that affect
*Narrowing of the spinal canal due to spinal stenosis. This spinal canal narrowing pinches on the sciatica nerve.
*Bone spurs-they are growths that are small forming along joints caused by arthritis.
*Simply injury (like a car accident or fall) causing nerve root compression=again the same result-pinching the sciatica nerve.
*Pregnancy-not as common as a cause as the others listed.
*Rarely but also tumors could cause the problem also.
What are the symptoms?
Symptoms of sciatica include pain that begins in your back or buttock and moves down your leg and may move into your foot.
*Weakness, tingling, or numbness in the leg may also occur.
*At times a inconsistent stabbing feeling or pricking feeling in the ankle or foot
*Sitting, standing for a long time, and movements that cause the spine to flex (such asexercises using the knee to chest) which may make symptoms worse.
*Walking, lying down, and movements that extend the spine (such as press-ups) may relieve symptoms.
How is sciatica diagnosed?
Sciatica is diagnosed with a medical history and physical exam. Sometimes x-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of the sciatica.
What are the Complications?
Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you experience:
-Loss of feeling in the affected leg -Weakness in the affected leg
-Loss of bowel or bladder function
How is it treated?
In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and exercises to relieve pain. You can help relieve pain by:
*Avoiding sitting (unless it is more comfortable than standing).
*Alternating lying down with short walks. Increase your walking distance as you are able to, without pain.
* Takingacetaminophen (tylenol) or Motrin (Ibuporfen) or Advil or Aleve (Naproxen). All are nonsteroidal anti-inflammatory drugs which decrease the swelling of the inflammation around the area or injury to the back which will decrease the pain. More inflammation=more pinching on the nerve.
*Using a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help you.
*Additional treatment for sciatica depends on what is causing the nerve irritation. If your symptoms do not improve, your doctor may suggest physical therapy, injections of medicines such as steroids, stronger medicines such as muscle relaxants or opiates.
*Physical Therapy or chiropracter therapy or some form of therapy for 6 to 8 weeks.
* If the therapy is uneffective than the last resort in most cases is surgery that ranges from:
– laser surgery
– scrapping of the vertebrae pinching the nerve with leaving the rest of the vertebrae spacing the spinal cord in place or removing the vertebrae pinching the nerve and replacing it with cement (not cement we use for sidewalks that we know of). It’s natural to want to return to your regular activities as soon as possible after surgery, but a lot depends on the type of operation you get.
In two common methods, vertebroplasty and kyphoplasty, your surgeon makes a small cut in your back, which lets you recover faster. If you get spinal fusion surgery, the cut is larger, and it will take a longer time to heal.
-small endoscopic surgery that is microsurgery removing pieces of the vertebraepinching which has a test called a discogram (injecting a dye right into the injured disc and than a ultrasound of the area is done to show the surgeon the exact route he has to follow to cure the problem. The surgeon numbs the area that he will repair with the pt wide awake; he makes a incision about 2/10 of an inch, using the cat scan as a guide for his eyes inserting a scope inserting a grabber that goes in the scope removing disc fragments that are pressing on the nerves causing the pain. It takes about 30 minutes for this procedure with only a small bandage covering the incision followed with the patient leaving the hosp–ital in less than a few hours
*Other self-care treatments that may be helpful include:
-Cold packs. Initially, you may get relief from a cold pack placed on the painful area for up 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
-Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
-Stretching. Stretching exercises for your low back can help you feel better and may help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch and try to hold the stretch at least 30 seconds.
-Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve) are sometimes helpful for sciatica.
National Cancer Society
Dr. Bruce Hensel M.D. (chief medical editor channel 4)/Dr. David Ditsworth Surgeon – does back scoping -Robert Forrest Physical Therapy in Santa Monica, California.In this article