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.

“ALS is a progressive disease in which a person’s brain loses connection with the muscles, slowly taking away their ability to walk, talk, eat, and eventually breathe. There is no cure for ALS, but there is hope.”

ALS Association (May is ALS Awareness Month | The ALS Association)

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

“7 Disorders are part of or closely related to Autism. Each disorder has symptoms commonly seen with autism, as well as its own specific symptoms.  These disorders are:

“The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about a recently confirmed outbreak of Ebola disease in Uganda caused by the Sudan virus (species Orthoebolavirus sudanense) and to summarize CDC’s recommendations for U.S. public health departments and clinicians about case identification, testing, and biosafety considerations in clinical laboratories.

Currently, no suspected, probable, or confirmed Ebola cases related to this outbreak have been reported in the United States, or outside of Uganda. However, as a precaution and because there are other viral hemorrhagic fever (VHF) outbreaks in East Africa, CDC is sharing best practices for public health departments, public health and clinical laboratories, and healthcare workers in the United States to raise awareness about this outbreak.

On February 5, 2025, CDC issued a Travel Health Notice Level 2: Practice Enhanced Precautions for people traveling to Uganda. Currently, CDC has not issued any interim recommendations to health departments for post-arrival risk assessment and management of travelers, including U.S.-based healthcare workers, arriving from Uganda. CDC recommends that travelers monitor themselves for symptoms of Sudan virus disease (SVD) while in the outbreak area and for 21 days after leaving. Travelers should also self-isolate and contact local health authorities or a clinician if they develop symptoms (early “dry” symptoms may include fever, aches, pains, and fatigue and later “wet” symptoms may include diarrhea, vomiting, and unexplained bleeding).”

Centers for Disease Control and Prevention – CDC (Ebola Outbreak Caused by Sudan virus in Uganda | HAN | CDC)

10Years Ago

Lets see the facts Ebola:

 First signs / symptoms range from

• Fever (greater than 38.6°C or 101.5°F)
• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhage (bleeding or bruising)

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

Reference on symptoms of Eboli: (http://www.cdc.gov/vhf/ebola/symptoms/index.html).

Healthcare workers who may be exposed to people with Ebola should follow these steps:

• Wear protective clothing, including masks, gloves, gowns, and eye protection.
• Practice proper infection control and sterilization measures. For more information, see “Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting”.
• Isolate patients with Ebola from other patients.
• Avoid direct contact with the bodies of people who have died from Ebola.
• Notify health officials if you have had direct contact with the blood or body fluids, such as but not limited to, feces, saliva, urine, vomit, and semen of a person who is sick with Ebola. The virus can enter the body through broken skin or unprotected mucous membranes in, for example, the eyes, nose, or mouth.

Looking at some of the history is as follows:

In 1995, an outbreak of Ebola hemorrhagic fever (Ebola HF) affected more than 300 people in and around the city of Kikwit, Democratic Republic of the Congo (formerly, Zaire); approximately 80% of the patients died. More than one-fourth of all the patients were health care workers. After the outbreak, the DRC Ministry of Health, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) developed practical recommendations for carrying out viral hemorrhagic fever (VHF) isolation precautions in rural health facilities in Africa. These recommendations have been consolidated in a manual for the local health community but something needs to be put into play in getting this epidemic under control if not history noted for repeating itself would be a shame in see results like the following:

The Black Death, 1918 Spanish Flu, HIV/AIDS (As of 2011 at least 60 million people had been infected by AIDS and 25 million had died. while in 2008 an estimated 1.2 million Americans had HIV, Sub-Saharan Africa alone was home to 22.9 million cases, with one in five adults infected. About 35.3 million people were believed to have HIV in 2012.), The Plague of Justinian (ultimately killed 25 million people dead), The Antonine Plague, Cholera, reference to this information is at http://www.rwjf.org/en/blogs/new-public-health/2013/12/the_five_deadliesto.html to go further into details about them.

Other epidemics are Polio, Typhus (camp fever), Malaria, Small Pox, Yellow Fever, The Flu in 1918 before the vaccine. The flu only survived for a year, this strain of virus was responsible for the deaths of 50 to 100 million people, as it was able to quickly spread from country to country as troops and soldiers returned home from WWI from all around the globe. Symptoms were common to those in today’s influenza virus. Also the death for many was the complication of the flu in causing fluid build up in the lungs causing the death (from probably putting the pt into the complication septicemia or or those with or without congestive heart failure going into a exacerbation without having effectively removing the fluids by getting better and ending result drowning in their own lungs).

This is not a pretty picture in having to repeat in history for some Epidemic to occur in our time; which could be Ebola.

Although there is still a great deal to learn about Ebola HF, two observations from the Kikwit outbreak strongly indicate that future outbreaks of this magnitude could be prevented:

• The first case occurred in January 1995, but went unrecognized as Ebola HF by health-care workers. This one case started a chain of transmission of the virus that finally was recognized in April of that year, when many more cases appeared. The outbreak peaked in May. Thus, between January and April, there was a window of opportunity that could have allowed early detection and proper management of patients; the early response might have prevented widespread transmission of the virus.
• After an international investigation team arrived in May 1995 and worked with Kikwit medical community to introduce VHF isolation precautions as well as standard precautions, no further nosocomial transmission of the virus was documented, indicating that although Ebola HF is highly infectious, the use of these measures is effective in preventing the spread of disease. Questionable by many since we have it in our country starting an epidemic and it is already an active one in Africa now.
• The observations sent a strong message to the public health and medical communities in Africa and internationally: combining early suspicion of VHF and isolation precautions can help to prevent another serious outbreak of Ebola HF or other VHF in the future. The only question remaining was how these goals could be achieved in a region where resources are scarce and the health care infrastructure is either underdeveloped or deteriorating. This manual, prepared collaboratively by CDC and WHO, attempts to address the issues of early provisional diagnosis and response within a limited infrastructure. It is designed for the following uses:  For prevention through preparedness–to help African health facilities make advance preparations for responding with appropriate precautions when a VHF case is suspect.
• For planning and conducting in-service training to strengthen standard precautions and VHF isolation precautions. With follow up by superiors of the facility, from floor managers to nursing education depts.
• As a rapid reference when a VHF case appears at a health facility where no previous VHF preparations have been made give the following by CDC:     The recommendations in the manual make use of common, low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Step-by-step instructions for implementing the recommendations are presented along with instructional aids for easy reference in health centers. For further information on this go to http://www.cdc.gov/vhf/abroad/vhf-manual.html.

• God willing this becomes no epidemic in our country with our government taking better and stronger actions in prevention of diseases spreading in this country. In carrying out stricter rules and regulations which should have been laid down awhile ago regarding people living here or just visiting that travel to and from different countries. This is should have taken place already just by looking at our history of epidemics that have occurred from spread diseases that came some other than United States.

“Ebola is a serious, life-threatening type of viral hemorrhagic fever — a viral infection that damages your blood vessels. Ebola symptoms start off like the flu (influenza). But they can progress to:

• Severe bleeding (hemorrhage)
• Neurological disorders (conditions that affect your brain and nerves)
• Severe vomiting

2o14 An epidemic of Ebola virus disease was occurring in Western Africa on a scale not seen before, particularly in the countries of Guinea, Liberia, and Sierra Leone. The continued spread is facilitated by insufficient medical facilities, poor sanitation, travel, and unsafe burial practices. Several patients diagnosed with Ebola virus disease in Africa have been evacuated to the United States for treatment, and several other patients have been diagnosed in the United States. It is important for laboratories to be aware of available tests, especially those granted emergency use authorization, as hospitals prepare protocols for the diagnosis and management of high-risk patients.”

Cleveland Clinic (Ebola Virus: Causes, Symptoms, Treatment & Prevention)

How bad is it elsewhere? In West Africa, pretty bad. Lack of resources and a slow global response has let the virus run wild. Over at Nature, they used WHO data to illustrate just how terrifying it’s getting. For an on-the-ground perspective, see what Karin Huster, a healthcare worker who just got back from treating Ebola in Liberia’s clinics, told R29. We’re also beginning to feel the first economic effects of the crisis.

What is the CDC doing to stop the spread of Ebola? Well, the first thing to remember is that the U.S. is not in the middle of the same kind of outbreak those in Guinea, Sierra Leone, and Liberia have been dealing with for months now. Ebola has not spread to the general American population, and those who have contracted the virus here have been in close contact with someone who was already severely infected. Complicating matters, the nurses who cared for Duncan report that they were forced to do so without proper training or equipment. And, Vinson says that she called the CDC before getting on her flight with a low-grade fever, but was told her temperature did not surpass the dangerous threshold (100.4 degrees Fahrenheit). However, the CDC has learned from its slow response to Dallas and has vowed to dispatch an Ebola response team to any hospital in the country with a confirmed case of the

How contagious is Ebola? Compared to other diseases you are more likely to get (such as enterovirus D68, the measles, and the flu), Ebola is not very contagious. It has a long incubation period (21 days) during which an infected person may begin to show symptoms. But, as far as we know, that person is not contagious until he or she is symptomatic. Ebola can only be spread by: direct contact with the bodily fluids of someone who is contagious (e.g., blood, urine, vomit); objects that have been contaminated with those fluids; or infected mammals, such as bats.

What are the symptoms of Ebola? Fever, headache, muscle pain, severe vomiting, and bloody diarrhea, among other unpleasant things. These symptoms hit hard and and they hit fast. They also get worse the longer you’re infected. So, if you feel kind of icky but are still dragging yourself to work, you’re probably Ebola-free BUT GO TO THE M.D.

Can we treat it? Not in every case. We have several experimental options, such as ZMapp, that have worked for some human cases or in animals. But, American scientists are still working on a cure that can save as many people as possible — and get approved by the FDA, too. Chinese and Russian scientists are on the case too, reportedly working on a cure and vaccine, respectively. But, Ebola is not necessarily a death sentence. About half of the people who have contracted it worldwide have lived to tell the tale. The CDC says whether or not you survive depends on your immune system and the quality of care you’re getting. And, when a person recovers from the virus, he or she will have antibodies that will protect against Ebola infection for at least 10 years.

Can we protect against it? Yes — with proper hand hygiene, basic public health tactics, a vaccine on the way, and a ramped-up CDC response.

Finally, I reinforce that unless you have had direct contact with the bodily fluids of someone with Ebola when that person was contagious (or if you’ve eaten some bushmeat recently), then your risk for Ebola are low and you don’t need to worry about getting it. Really, even Fox News says so. Instead, you should probably just get yourself a flu shot with how much higher you are at risk of getting the flu as opposed to the disease Ebola but our country should take strict action in preventing a disease epidemic in travelers coming back or from Africa to the US or any other country that has this disease in their country, safety for the people in America.

How is Ebola so deadly:

Lets look here on how it works: Symptoms start in two days to three weeks after contracting the virus, with a fever, sore throat, muscle pain, and headaches. Typically, vomiting, diarrhea, and rash follow, along with decreased function of the liver and kidneys. Looking at a car the engine of the human body is the heart, the liver Are we absolutely sure it’s not airborne? Pretty much.

Some of these fears can be traced to a 2012 paper in which researchers found that one strain of Ebola in pigs could be transmitted to macaque monkeys housed in separate cages. But, this effect has only been shown in animals. Although some scientists have suggested that the virus may have mutated into a more contagious (i.e. airborne) form, this has not been confirmed and remains extremely unlikely. Plenty of other scientists have proclaimed their disagreement.

Symptoms start two days to three weeks after contracting the virus, with a fever, sore throat, muscle pain, and headaches. Typically, vomiting, diarrhea, and rash follow, along with decreased function of the liver and kidneys. Which means in English your organs, the kidney and the liver go in decreased function and not resolved will go into failure and with the these 2 organs doing that it effects the rest of your organs. Just like a car if your oil or transmission or both aren’t functioning properly it will affect your engine (and the heart is our engine to the human body where your oil and transmission are like the kidneys and liver for example as a metaphor). Ending line one system affected with multiple systems failing with no treatment death occurs whether a car or human body.

No, the virus that causes Ebola is not transmitted through the air. Unlike a cold or the flu, the Ebola virus is not spread by tiny droplets that remain in the air after an infected person coughs or sneezes.

Ebola is spread between humans when an uninfected person has direct contact with body fluids of a person who is sick with the disease or has died. People become contagious when they develop symptoms.”

MAYO CLINIC (Ebola transmission: Can Ebola spread through the air? – Mayo Clinic)