Archive | October 2021

QUOTE FOR THE WEEKEND:

“Post-polio syndrome (PPS) is a non-contagious condition that can affect polio survivors usually 15 to 40 years after recovery from polio.  Only a polio survivor can develop PPS, it is not contagious.

The polio vaccine has eradicated polio from the United States.  However, polio still exists in some countries and cases of PPS still arise. ”

NIH National Institute of Neurological Disorders and Stroke

Part II Those with Polio may wonder “Why after several years the disease is gone symptoms of Polio returns?”.

        PPS2  PPS  PPS3

The answer is even with a name; it is called Post-polio syndrome.

Around 40% of people who survive paralytic polio may develop additional symptoms 15–40 years after the original illness. These symptoms – called post-polio syndrome – include new progressive muscle weakness, severe fatigue and pain in the muscles and joints.

This is how it works:

What is post-polio syndrome?

Post-polio syndrome is an illness of the nervous system that can appear 15 to 50 years after you had polio. It affects your muscles and nerves, and it causes you to have weakness, fatigue, and muscle or joint pain.

Although post-polio syndrome can make some day-to-day activities more difficult, treatment can help control symptoms and help you stay active. Your symptoms may not get worse for many years. Post-polio syndrome usually progresses very slowly.

Only people who have had polio can get post-polio syndrome. But having post-polio syndrome doesn’t mean that you have polio again. Unlike polio, post-polio syndrome doesn’t spread from person to person.

What causes post-polio syndrome?

Post-polio syndrome most likely arises from the damage left over from having the polio viruse in the body still.

The polio virus harms the nerves that control muscles, and it makes the muscles weak. If you had polio, you may have gained back the use of your muscles. But the nerves that connect to the muscles could be damaged without your knowing it. The nerves may break down over time and cause you to have weak muscles again.

Researchers are studying other possible causes of post-polio syndrome. One theory is that the immune system plays a role.

What are the symptoms?

Symptoms of post-polio syndrome tend to show up very slowly. The main symptoms are:

  • New muscle weakness. This is most common in the muscles that had nerve damage from polio. You may also have weakness in muscles that you didn’t realize had been affected by polio. Overuse or underuse of the muscles can lead to weakness.
  • Fatigue. You may find that the activities you used to do without getting tired are now causing fatigue. You may often feel tired, have a heavy feeling in your muscles, or feel sleepy. At times you may have trouble thinking clearly.
  • Muscle or joint pain. Muscles affected by polio tend to be weaker than normal. To make up for this weakness, other muscles have to work harder. This puts extra wear and tear on muscles, joints, and tendons, sometimes leading to aches, cramping, and pain.

Depending on which muscles are affected, this trio of muscle weakness, fatigue, and pain can make daily activities more difficult. For example, people with shoulder or arm weakness may have trouble getting dressed. People who have weakness in their legs may have trouble walking or climbing stairs.

Post-polio syndrome is rarely life-threatening, but the symptoms can significantly interfere with an individual’s ability to function independently. Respiratory muscle weakness, for instance, can result in trouble with proper breathing, affecting daytime functions and sleep.  Weakness in swallowing muscles can result in aspiration of food and liquids into the lungs and lead to pneumonia.

Only a polio survivor can develop PPS.

The severity of weakness and disability after recovery from poliomyelitis tends to predict the relative risk of developing PPS.  Individuals who had minimal symptoms from the original illness are more likely to experience only mild PPS symptoms.  A person who was more acutely affected by the polio virus and who attained a greater recovery may experience a more severe case of PPS, with greater loss of muscle function and more severe fatigue.

The exact incidence and prevalence of PPS is unknown.  The U.S. National Health Interview Survey in 1987 contained specific questions for persons given the diagnosis of poliomyelitis with or without paralysis.  No survey since then has addressed the question.  Results published in 1994-1995 estimated there were about 1 million polio survivors in the U.S., with 443,000 reporting to have had paralytic polio.  Accurate statistics do not exist today, as a percentage of polio survivors have died and new cases have been diagnosed.  Researchers estimate that the condition affects 25 to 40 percent of polio survivors.

What causes PPS?

The cause of PPS is unknown but experts have offered several theories to explain the phenomenon—ranging from the fatigue of overworked nerve cells to possible brain damage from a viral infection to a combination of mechanisms.  The new weakness of PPS appears to be related to the degeneration of individual nerve terminals in the motor units.   A motor unit is formed by a nerve cell (or motor neuron) in the spinal cord or brain stem and the muscle fibers it activates.  The polio virus attacks specific neurons in the brain stem and spinal cord.  In an effort to compensate for the loss of these motor neurons, surviving cells sprout new nerve-end terminals and connect with other muscle fibers.  These new connections may result in recovery of movement and gradual gain in power in the affected limbs.

Years of high use of these recovered but overly extended motor units adds stress to the motor neurons, which over time lose the ability to maintain the increased work demands.  This results in the slow deterioration of the neurons, which leads to loss of muscle strength.  Restoration of nerve function may occur in some fibers a second time, but eventually nerve terminals malfunction and permanent weakness occurs.  This hypothesis explains why PPS occurs after a delay and has a slow and progressive course.

Through years of studies, scientists at the National Institute of Neurological Disorders and Stroke (NINDS) and at other institutions have shown that the weakness of PPS progresses very slowly.  It is marked by periods of relative stability, interspersed with periods of decline.

How is PPS diagnosed?

The diagnosis of PPS relies nearly entirely on clinical information.  There are no laboratory tests specific for this condition and symptoms vary greatly among individuals.  Physicians diagnose PPS after completing a comprehensive medical history and physical examination, and by excluding other disorders that could explain the symptoms.

Physicians look for the following criteria when diagnosing PPS:

  • Prior paralytic poliomyelitis with evidence of motor neuron loss.  This is confirmed by history of the acute paralytic illness, signs of residual weakness and atrophy of muscles on neuromuscular examination, and signs of motor neuron loss on electromyography (EMG).  Rarely, people had subtle paralytic polio where there was no obvious deficit.  In such cases, prior polio should be confirmed with an EMG study rather than a reported history of non-paralytic polio.
  • A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neuromuscular function.
  • Slowly progressive and persistent new muscle weakness or decreased endurance, with or without generalized fatigue, muscle atrophy, or muscle and joint pain.  Onset may at times follow trauma, surgery, or a period of inactivity, and can appear to be sudden.  Less commonly, symptoms attributed to PPS include new problems with breathing or swallowing.
  • Symptoms that persist for at least a year.
  • Exclusion of other neuromuscular, medical, and skeletal abnormalities as causes of symptoms.

PPS may be difficult to diagnose in some people because other medical conditions can complicate the evaluation.  Depression, for example, is associated with fatigue and can be misinterpreted as PPS.   A number of conditions may cause problems in persons with polio that are not due to additional loss of motor neuron function.  For example, shoulder osteoarthritis from walking with crutches, a chronic rotator cuff tear leading to pain and disuse weakness, or progressive scoliosis causing breathing insufficiency can occur years after polio but are not indicators of PPS.

Polio survivors with new symptoms resembling PPS should consider seeking treatment from a physician trained in neuromuscular disorders.  It is important to clearly establish the origin and potential causes for declining strength and to assess progression of weakness not explained by other health problems.   Magnetic resonance imaging (MRI) and computed tomography (CT) of the spinal cord, electrophysiological studies, and other tests are frequently used to investigate the course of decline in muscle strength and exclude other diseases that could be causing or contributing to the new progressive symptoms.  A muscle biopsy or a spinal fluid analysis can be used to exclude other, possibly treatable, conditions that mimic PPS.  Polio survivors may acquire other illnesses and should always have regular check-ups and preventive diagnostic tests.   However, there is no diagnostic test for PPS, nor is there one that can identify which polio survivors are at greatest risk.

Is there a treatment for PPS?

There are currently no effective pharmaceutical treatments that can stop deterioration or reverse the deficits caused by the syndrome itself.  However, a number of controlled studies have demonstrated that non-fatiguing exercises may improve muscle strength and reduce tiredness.   Most of the clinical trials in PPS have focused on finding safe therapies that could reduce symptoms and improve quality of life.

Researchers at the National Institutes of Health (NIH) have tried treating persons having PPS with high doses of the steroid prednisone and demonstrated a mild improvement in their condition, but the results were not statistically significant.  Also, the side effects from the treatment outweighed benefits, leading researchers to conclude that prednisone should not be used to treat PPS.

Preliminary studies indicate that intravenous immunoglobulin may reduce pain and increase quality of life in post-polio survivors.

A small trial to treat fatigue using lamotrigine (an anticonvulsant drug) showed modest effect but this study was limited and larger, more controlled studies with the drug were not conducted to validate the findings.

Although there are no effective treatments, there are recommended management strategies.  Patients should consider seeking medical advice from a physician experienced in treating neuromuscular disorders.  Patients should also consider judicious use of exercise, preferably under the supervision of an experienced health professional.  Physicians often advise patients on the use of mobility aids, ventilation equipment, revising activities of daily living activities to avoid rapid muscle tiring and total body exhaustion, and avoiding activities that cause pain or fatigue lasting more than 10 minutes.  Most importantly, patients should avoid the temptation to attribute all signs and symptoms to prior polio, thereby missing out on important treatments for concurrent conditions.   Always go to your physician for advisement before starting any exercise regimen to make sure your M.D. clears the activity first, for your safety!

 

 

QUOTE FOR FRIDAY:

“Most people who get infected with poliovirus (about 72 out of 100) will not have any visible symptoms.  These symptoms usually last 2 to 5 days, then go away on their own.  A smaller proportion of people (much less than one out of 100, or 1-5 out of 1000) with poliovirus infection will develop other, more serious symptoms that affect the brain and spinal cord.”

Centers for Disease Control and Prevention (CDC)

Part I Polio – What is this disease, types, risk factors, how its treated and most importantly how it’s 100% PREVENTED in the USA!

Polio I  

  

A virus is a small, infectious agent that is made up of a core of genetic material surrounded by a shell of protein. The genetic material (which is responsible for carrying forward hereditary traits from parent cells to offspring) may be either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA). Viruses are at the borderline between living and nonliving matter. When they infect a host cell, they are able to carry on many life functions, such as metabolism and reproduction. But outside a host cell, they are as inactive as a grain of sand.

Viruses cause disease by infecting a host cell and taking over its biochemical functions. In order to produce new copies of itself, a virus must use the host cell’s reproductive “machinery.” The newly made viruses then leave the host cell, sometimes killing it in the process, and proceed to infect other cells within the organism.

Viruses can infect plants, bacteria, and animals. The tobacco mosaic virus, one of the most studied of all viruses, infects tobacco plants. Animal viruses cause a variety of diseases, including AIDS (acquired immuno deficiency syndrome), hepatitis, chicken pox, smallpox, polio, measles, rabies, the common cold, and some forms of cancer.

Viruses that affect bacteria are called bacterio-phages, or simply phages (pronounced FAY-jez). Phages are of special importance due to the susceptibility of the virus transmission. The disease Polio (poliomyelitis) in time will be transmitted throughout the bloodstream and the highly viral infectious disease is now spreading in the body.

Poliomyelitis (POLIO) is a viral disease. There are three types of polio0-virus and many strains of each type. The virus enters through the mouth and multiplies in the throat and gastrointestinal tract, then moves into the bloodstream and is carried to the central nervous system where it replicates and destroys the motor neuron cells. Motor neurons control the muscles for swallowing, circulation, respiration, and the trunk, arms, and legs.

Human nerve cells have a protruding protein structure on their surface whose precise function is unknown. When polio-virus encounters the nerve cells, the protruding receptors attach to the virus particle, and infection begins. Once inside the cell, the virus hijacks the cell’s assembly process, and makes thousands of copies of itself in hours. The virus kills the cell and then spreads to infect other cells.

A virus is a small, infectious agent that is made up of a core of genetic material surrounded by a shell of protein. The genetic material (which is responsible for carrying forward hereditary traits from parent cells to offspring) may be either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA). Viruses are at the borderline between living and nonliving matter. When they infect a host cell, they are able to carry on many life functions, such as metabolism and reproduction. But outside a host cell, they are as inactive as a grain of sand.

How polio gets into the human body:

Poliomyelitis (POLIO) is a viral disease. There are three types of polio virus and many strains of each type. The virus enters through the mouth and multiplies in the throat and gastrointestinal tract, then moves into the bloodstream and is carried to the central nervous system where it replicates and destroys the motor neuron cells. Motor neurons control the muscles for swallowing, circulation, respiration, and the trunk, arms, and legs.

Human nerve cells have a protruding protein structure on their surface whose precise function is unknown. When polio virus encounters the nerve cells, the protruding receptors attach to the virus particle, and infection begins. Once inside the cell, the virus hijacks the cell’s assembly process, and makes thousands of copies of itself in hours. The virus kills the cell and then spreads to infect other cells.

Polio is spread through person-to-person contact. When a child is infected with wild polio virus, the virus enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through the faces where it can spread rapidly through a community, especially in situations of poor hygiene and sanitation. If a sufficient number of children are fully immunized against polio, the virus is unable to find susceptible children to infect, and dies out. Young children who are not yet toilet-trained are a ready source of transmission, regardless of their environment. Polio can be spread when food or drink is contaminated by feces. There is also evidence that flies can passively transfer polio virus from faces to food. Most people infected with the polio virus have no signs of illness and are never aware they have been infected. These symptom can be carried from person to person by the virus that’s in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges. For this reason, WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic – particularly in countries where very few cases occur.

Most infected people (90%) have no symptoms or very mild symptoms and usually go unrecognized. In others, initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.

TYPES OF Polio:

1.) Acute flaccid paralysis (AFP)

One in 200 infections leads to irreversible paralysis, usually in the legs. This is caused by the virus entering the blood stream and invading the central nervous system. As it multiplies, the virus destroys the nerve cells that activate muscles. The affected muscles are no longer functional and the limb becomes floppy and lifeless – a condition known AFP = Acute Flaccid Paralysis.

Know all cases of AFP among children under fifteen years old are reported and tested for polio virus within 48 hours of onset.

All cases of acute flaccid paralysis (AFP) among children under fifteen years of age are reported and tested for poliovirus within 48 hours of onset.

2.) Bulbar polio

More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in quadriplegia. In the most severe cases (bulbar polio), polio virus attacks the nerve cells of the brain stem, reducing breathing capacity and causing difficulty in swallowing and speaking. Among those paralyzed, 5% to 10% die when their breathing muscles become immobilized.

Risk factors for paralysis

No one knows why only a small percentage of infections lead to paralysis. Several key risk factors have been identified as increasing the likelihood of paralysis in a person infected with polio. These include:

  • immune deficiency
  • pregnancy
  • removal of the tonsils (tonsillectomy)
  • intramuscular injections, e.g. medications
  • strenuous exercise
  • injury.

Treatment of Polio:

There is no cure for polio, only treatment to alleviate the symptoms.  Heat and physical therapy is used to stimulate the muscles and antispasmodic drugs are given to relax the muscles. While this can improve mobility, it cannot unfortunately reverse permanent polio paralysis.

How Polio can be PREVENTED:

Polio can be prevented through immunization. Polio vaccine, given multiple times, almost always protects a child for life.

 

 

 

QUOTE FOR THURSDAY:

“Nearly 40 years ago, former President Ronald Reagan declared the last full week in October Respiratory Care Week; which raises awareness about acute and chronic respiratory illnesses and the importance of maintaining proper lung health.  From Oct. 25 to 31, The proclamation on September 15, 1983 spells out why this week is so important. “Chronic lung diseases constitute an important health problem in the United States. They afflict nearly 18 million Americans and cause nearly 70,000 deaths each year, many of which are the direct result of smoking=(COPD).”
National Today

Respiratory Care Week; Acute lower respiratory infections!

 

Acute lower respiratory infections are a leading cause of sickness and mortality both in children and adults worldwide. Unfortunately, acute lower respiratory infections are not uniformly defined and this may hamper a true appreciation of their epidemiological importance. From an epidemiological point of view, the definition of acute lower respiratory infections usually includes acute bronchitis and bronchiolitis, influenza and pneumonia.

Lower respiratory tract infection (LRTI), while often used as a synonym for pneumonia, can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue.

There are a number of symptoms that are characteristic of lower respiratory tract infections. The two most common are bronchitis and edema

Acute bronchitis can be defined as an acute illness that occurs in a patient without chronic lung disease. Symptoms include cough (productive or otherwise) and other symptoms or clinical signs that suggest lower respiratory tract infection with no alternative explanation (e.g. sinusitis or asthma).

Bronchiolitis is the most common lower respiratory tract infection and the most common cause of admission to hospital in the first 12 months of life.

Influenza affects both the upper and lower respiratory tracts.

Antibiotics are the first line treatment for pneumonia; however, they are not effective or indicated for parasitic or viral infections. Acute bronchitis typically resolves on its own with time.

“Stay away from me! I don’t want to get sick, too.” Most of us have had to utter those words to a family member, friend, or colleague who was sneezing or coughing incessantly. But how do we know how great the chances of catching someone’s cold or other illness really are? A medical review published in the New England Journal of Medicine tells us when to exercise concern over eight respiratory tract infections.

Illness

(Infectious agent)

How it gets transmitted

Places of highest risk

Percent risk of infection

Bronchiolitis

(Respiratory Syncytial Virus, RSV)

Direct contact with ill person, large-droplets from coughs or sneezes, contact with tissues, linens, or other surfaces holding the virus Homes, day-care centers In day-care centers, 100% of exposed children become ill, previous infection somewhat lowers the risk
Flu

(Influenza viruses)

Direct contact with ill person, large- and tiny-droplets from coughs or sneezes Homes, schools, bars, dormitories, areas with poor ventilation or recirculated air 20%-60% from a family member, only half of those infected will have symptoms of influenza
The common cold

(Rhinovirus)

Direct contact with ill person, large-droplets from coughs or sneezes, contact with tissues, linens, or other surfaces holding the virus Homes, dormitories 66% from a family member
Tuberculosis Tiny-droplets from coughs or sneezes Homes, bars, dormitories, nursing homes, areas with poor ventilation 25%-50% with close contact with a person with active disease, prolonged exposure is usually required
Upper respiratory illness

(Adenoviruses)

Direct contact with ill person, large- and tiny-droplets from coughs or sneezes Camps, schools, military camps 10% of those exposed may become ill, 40% among children, many infected individuals show no symptoms and infection leads to immunity from future infection
Strep throat, scarlet fever

(Group A Strep)

Direct contact with ill person, large-droplets from coughs or sneezes Homes 10% from a family member
Bacterial meningitis

(Neisseria meningitides)

Direct contact with ill person, large-droplets from coughs or sneezes Homes, schools, camps 2%-3% for a child whose sibling has active illness, 0.2%-0.4% for household contacts of the ill child, more than 95% of the time a second case of the disease does not follow a first.
Pneumococcal pneumonia

(Streptococcus pneumoniae)

Direct contact with ill person, large-droplets from coughs or sneezes Day-care centers, homeless shelters, camps, prisons, nursing homes Generally not regarded as contagious, risk of infection depends on one’s general health

You can do a number of things to help prevent infection:

  • Avoid close contact with people who are ill with infections spread through large-droplets.
  • Unless ventilation is good, avoid shared space with people who are ill with infections spread through tiny-droplets.
  • Wash your hands after greeting someone with a viral infection or after handling an object held by someone infected with Bronchiolitis or a cold.
  • Encourage children to wash their hands. Kids are more likely than adults to spread infection within a family.

 

 

QUOTE FOR WEDNESDAY:

“Children and young people with spina bifida reported improvements in their social well-being over time. Their physical and psychological health remained stable. Youth with spina bifida may adapt to their health condition.:

Centers for Disease Prevention and Control CDC

Part III Spina BIfida Awareness Month – How its diagnosed and treated!

 

How is Spina Bifida Diagnosed:

In most cases, spina bifida is diagnosed before birth (prenatal). However, some mild cases may go unnoticed until after birth (postnatal). Very mild forms of spinal bifida are found when doing tests for other conditions or may never be detected.

PRENATAL DIAGNOSED:

The most common screening methods used to look for spina bifida during pregnancy are maternal serum alpha fetoprotein (MSAFP) screening and fetal ultrasound.  A doctor can also perform an amniocentesis test.

  • Maternal serum alpha fetoprotein (MSAFP) screen.  At 16 to 18 weeks of pregnancy, a sample of the mother’s blood is taken to measure the level of a protein called alpha-fetoprotein (AFP), which is made naturally by the fetus and placenta.  During pregnancy, a small amount of AFP normally crosses the placenta and enters the mother’s bloodstream.  Abnormally high levels of AFP may indicate that the fetus has spina bifida or other neural tube defect.  This test is not specific for spina bifida and cannot definitively determine that there is a problem with the fetus.  This means that a high AFP level alone is not enough to be sure the fetus has a neural tube defect.  If a high level of AFP is detected, the doctor may request additional testing, such as an ultrasound or amniocentesis.

The second trimester MSAFP screen may be performed alone or as part of a larger, multiple-marker screen.  Multiple-marker screens can look for neural tube defects and other birth defects, including Down syndrome and other chromosomal abnormalities.  First trimester screens for chromosomal abnormalities also exist but signs of spina bifida are not evident until the second trimester when the MSAFP screening is performed.

  • Ultrasound.  A fetal ultrasound uses high-frequency sound waves to create a picture of the developing baby inside the womb.  It is highly accurate in diagnosing some birth defects during pregnancy, including spina bifida.  Fetal ultrasound can be performed during the first trimester (usually between 11-14 weeks) and the second trimester (usually at 18-22 weeks), and diagnosis is more accurate during the second trimester.
  • Amniocentesis.  In this test, a doctor removes a sample of the amniotic fluid that surrounds the fetus and tests it for protein levels that may indicate a neural tube defect and genetic disorders.

POSTNATAL DIAGNOSED:

Closed neural tube defects are often recognized at birth due to an abnormal fatty mass, tuft or clump of hair, or a small dimple or birthmark on the skin at the site of the spinal malformation.  Spina bifida occulta is usually found when x-rays are done for another reason.

In rare cases, myelomeningocele and meningocele are not diagnosed during routine prenatal tests.  The baby will be diagnosed when they are born with a bubble on their back.  Babies with myelomeningocele and closed neural tube defects may have muscle weakness in their feet, hips, and legs that result in joint deformities first noticed at birth.  Mild cases of spina bifida (occulta, closed neural tube defects) not diagnosed during prenatal testing may be detected postnatally using ultrasound or X-ray imaging to look at the spine.

Doctors may use magnetic resonance imaging (MRI) or a computed tomography (CT) scan to get a clearer view of the spinal cord and vertebrae.  To evaluate for hydrocephalus, the doctor will request a head ultrasound, CT or MRI to look for extra cerebrospinal fluid inside the brain.

HOW SPINA BIFIDA CAN BE PREVENTED, THE BEST TREATMENT TO GIVE YOUR BABY; being FOLIC ACID!

Women of childbearing age can reduce their risk of having a child with spina bifida by taking 400 micrograms (mcg) of folic acid every day pre-conception. Because it is water soluble, folic acid does not stay in the body for very long and needs to be taken every day to be effective against neural defects. Since half of all pregnancies in the United States are unplanned, folic acid must be taken whether a woman is planning a pregnancy or not. Research has shown that if all women of childbearing age took a multivitamin with the B-vitamin folic acid, the risk of neural tube defects could be reduced by up to 70%.  If you can prevent this the quality life is sure to be the best!

TREATMENTS FOR SPINA BIFIDA:

Some children with myelomeningocele and closed neural tube defects will need surgery to improve the alignment of their feet, legs, or spine.  Children with myelomeningocele usually have hydrocephalus and may require surgery to help drain fluid in the brain, such as the placement of a shunt or ETV.  Multiple surgeries may be required to replace the shunt, which may become clogged, infected, or disconnected.

Some individuals with myelomeningocele or closed neural tube defects require assistive devices for mobility such as braces, walkers, crutches, or wheelchairs.  The location of the defect on the spine often determines the type of assistive devices needed.  Children with a defect high on the spine will have little movement of the legs and will use a wheelchair for mobility.  Children with a defect lower on the spine usually have more strength in the legs.  They may be able to walk independently, or they may use crutches, leg braces, walkers, and wheelchairs depending on the activity.  Children with myelomeningocele usually have some degree of delayed mobility, so they are referred to physical therapists early on to maximize their strength and function.

Treatment for bladder and bowel dysfunction typically begins soon after birth.  Children with myelomeningocele and some closed neural tube defects have damage to the lowest spinal nerves which control typical bowel and bladder function.  Some children may be able to urinate typically, but most will need to drain their bladders with a catheter or thin tube 4-6 times a day to remain dry in between and to prevent kidney damage.  Kidneys are monitored closely so that medications or surgeries can be performed to prevent renal failure.  To prevent bowel accidents many people with myelomeningocele and closed neural type defects will use rectal medications or large volume enemas to have planned bowel movements.  Close follow-up with a spina bifida specialty clinic is recommended to develop a safe bowel and bladder program.

Treatment for progressive tethering of the spinal cord (called tethered cord syndrome) can be treated with surgery to help prevent further neurological deterioration.

 

 

 

 

 

 

 

 

 

QUOTE FOR TUESDAY:

“Complications of Spina Bifida depends on a various factors one being how soon was the Spina Bifida diagnosed and treated. Spina bifida’s impact is determined by the type of defect (there are 4 types) and in the case of myelomeningocele and closed neural tube defects the size and location of the malformation.”

NIH National Institute of Neurological Disorders and Stroke (NIH)

 

 

 

Part II Spina Bifida Awareness-The complications that can arise from Spina Bifida!

  SPINA BIFIDA

   

TETHERED SPINALCORD (shown above)

 

FETUS WITH HYDROCEPHALUS (shown above)

  HYDROCEPHALUS

Spina Bifida is one of the causes of Tethered Spinal Cord and Hydrocephalus.

Tethered Spinal Cord is a stretch-induced functional disorder associated with the fixation (tethering) effect of inelastic tissue on the caudal spinal cord, limiting its movement. This abnormal attachment is associated with progressive stretching and increased tension of the spinal cord as a child ages, potentially resulting in a variety of neurological and other symptoms.

Hydrocephalus is caused by either increased production of CSF or impaired circulation and absorption

Spina bifida is a birth defect that affects the spine. Here are the latest national statistics on spina bifida in the United States:

1.)Each year, about 1,400 babies are born with spina bifida, or 1 in every 2,758 births, according to the U.S. Centers for Disease Control and Prevention. The exact cause of spina bifida is unknown. There is no cure but most people with spina bifida lead long and productive lives.

2.)Who it effects the most: Hispanic women have the highest rate of having a child affected by spina bifida, when compared with non-Hispanic white and non-Hispanic black women. Data from 12 state-based birth defects tracking programs were used to estimate the total number of pregnancies affected by spina bifida compared to the total number of live births (also called the prevalence of spina bifida) for each racial/ethnic group:

  • Hispanic: 3.80 per 10,000 live births
  • Non-Hispanic black or African-American: 2.73 per 10,000 live births
  • Non-Hispanic white: 3.09 per 10,000 live births

The symptoms listed below are some of the ways in which tethered spinal cord syndrome may be exhibited in children:

  • Lesion on the lower back
  • Fatty tumor or deep dimple on the lower back
  • Skin discoloration on the lower back
  • Hairy patch on the lower back
  • Back pain, worsened by activity and relieved with rest
  • Leg pain, especially in the back of legs
  • Leg numbness or tingling
  • Changes in leg strength
  • Progressive or repeated muscle contractions
  • Bowel and bladder problems

Spina bifida consequences that may occur:

  • Abnormal sensation or paralysis, which mostly occurs with closed neural tube defects and myelomeningocele.  People with these conditions typically have some degree of leg and core muscle weakness and loss of feeling in the groin and feet or legs.  The sensation can be more significant on one side of the body.
  • You may see deterioration of the gait in the patient’s walking.  Typically, the lower in the spine where the condition occurs results in less weakness and loss of feeling.  The strength and feeling do not improve with age due to nerve damage.  People with these types of spina bifida may lose strength and sensation as they grow and mobility can become more difficult with age.  People with these conditions may walk independently or use some combination of leg braces, walkers, crutches, or wheelchairs.  As they age, they may require more of these supports.
  • Chiari II malformation, in which parts of the brain called the brain stem and the cerebellum (hindbrain) protrude downward into the spinal canal or neck area.  It is almost always seen on advanced imagining of the brain in people with myelomeningocele, but it rarely causes symptoms.  When it does, this condition can press on the spinal cord and cause a variety of symptoms including difficulty breathing, swallowing, and arm weakness.  Surgery is sometimes required to reduce pressure in this area.
  • Blockage of cerebrospinal fluid, causing a condition called hydrocephalus.  Hydrocephalus is the abnormal buildup of the fluid that surrounds the brain.  Most people with myelomeningocele have this condition, which is not seen in the other types of spina bifida.  This buildup can put damaging pressure on the brain.  Hydrocephalus is commonly treated by surgically implanting a shunt—a hollow tube—in the brain which allows drainage of the excess fluid into the abdomen where it is absorbed by the body.  The tube is tunneled under the skin and not very noticeable to others.  Another treatment option is an endoscopic third ventriculostomy or ETV, a procedure that creates a new path for the fluid to flow.
  • Meningitis, an infection in the meninges covering the brain.  It can sometimes be associated with shunts.  Meningitis may cause brain injury and can be life-threatening.
  • Tethered cord syndrome can occur with all forms of spina bifida, although it is very rare in individuals with spina bifida occulta.  Usually the spinal cord and nerves float freely.  A tethered cord means that there is some type of tissue attached to and pulling the cord down.  This can cause damage to the nerves and decrease feeling and strength, as well as problems with bowel and bladder control.  It is surgically treated if a person has symptoms.
  • Bowel and bladder incontinence affect most individuals with myelomeningocele and closed neural tube defects.  The nerves at the very bottom of the spine control bowel and bladder function and don’t usually work properly in people with these types of spina bifida.  Most people with myelomeningocele and some types of closed neural tube defects need a regimen or other assistance to drain their bladders periodically or to have regularly scheduled bowel movements.
  • Learning disabilities, including difficulty paying attention, understanding concepts, impaired motor skills, impaired memory, and difficulty with organization and problem solving are commonly seen in children with myelomeningocele.  People with strength lower down in their legs tend to have less difficulty than those with more leg weakness.  Evaluation for an individualized education plan is recommended for all children with myelomeningocele.
  • Other complications such as skin ulcers, low bone mineral density, impaired male fertility, obesity, and kidney failure can be seen in people with myelomeningocele and neural tube defects as they age.  Additionally, people with myelomeningocele are at risk for precocious puberty (when changes to that of an adult occur too soon), sleep apnea, and depression.

The estimated lifetime cost of care for a person with spina bifida, with caregiving costs, is $791,900.

Learn tomorrow how you can prevent Spina Bifida with much more!