Archive | October 2021


“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


“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)


“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.


(Infectious agent)

How it gets transmitted

Places of highest risk

Percent risk of infection


(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

(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


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


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.




“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.


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.


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.


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!


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.











“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 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!




October is Spina Bifida Awareness Month and October 25 is the international holiday for World Spina Bifida and Hydrocephalus Day!  Each year, about 1,427 babies are born with spina bifida, or 1 in every 2,758 births. Statistics say:  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 estimated lifetime cost of care for a person with spina bifida, with caregiving costs, is $791,900. Children and young people with spina bifida reported lower health-related quality of life than youth with other chronic health conditions.”.

Centers for Disease Control and Prevention (CDC)


Part I Spina Bifida Monthly Awareness

spina3  4 


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.

Spina bifida occurs during the third and fourth weeks of pregnancy when a portion of the fetal spinal cord fails to properly close. As a result, the child is born with a part of the spinal cord exposed on the back.

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.

Spina bifida is a birth defect that mainly affects the spine. Normally in the first month of pregnancy, a special set of cells forms the “neural tube.” The top of the tube becomes the brain and the remainder becomes the spinal cord and structures around it.  In spina bifida, the neural tube doesn’t close all the way and some of the bones of the spine don’t close in the back.

Often, abnormalities of the brain (such as hydrocephalus, described below) accompany abnormalities of the spine because the neural tube closes first in the middle and then closure proceeds both upward and downward—meaning that if something happens that prevents normal formation of the spine, it may also prevent normal formation of the part of the brain that is forming (closing) at the same time.

The term neural tube defect describes a group of conditions, including spina bifida, that occur when the neural tube does not close all the way.

Although doctors and researchers don’t know for sure why spina bifida occurs, they have identified a few risk factors:

  • Race. Spina bifida is more common among whites and Hispanics.
  • Sex. Girls are affected more often.
  • Family history of neural tube defects. Couples who’ve had one child with a neural tube defect have a slightly higher chance of having another baby with the same defect. That risk increases if two previous children have been affected by the condition.
  • In addition, a woman who was born with a neural tube defect, or who has a close relative with one, has a greater chance of giving birth to a child with spina bifida. However, most babies with spina bifida are born to parents with no known family history of the condition.
  • Folate deficiency. Folate (vitamin B-9) is important to the healthy development of a baby. Folate is the natural form of vitamin B-9. The synthetic form, found in supplements and fortified foods, is called folic acid. A folate deficiency increases the risk of spina bifida and other neural tube defects.
  • Some medications. Anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, perhaps because they interfere with the body’s ability to use folate and folic acid.
  • Diabetes. Women with diabetes who don’t control their blood sugar well have a higher risk of having a baby with spina bifida.
  • Obesity. Pre-pregnancy obesity is associated with an increased risk of neural tube birth defects, including spina bifida.
  • Increased body temperature. Some evidence suggests that increased body temperature (hyperthermia) in the early weeks of pregnancy may increase the risk of spina bifida. Elevating your core body temperature, due to fever or the use of saunas or hot tubs, has been associated with increased risk of spina bifida.
  • If you have known risk factors for spina bifida, talk with your doctor to determine if you need a larger dose or prescription dose of folic acid, even before a pregnancy begins.

There are 4 different types of Spina Bifida:

occulta, closed neural tube defects, meningocele, and myelomeningocele.

1-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.

2-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, & has no visible signs.  Spinal Cord & nerves are usually fine.

Visible indications of spina bifida occulta (SBO) can sometimes be seen on the newborn’s skin above the spinal defect, including:

  • An abnormal tuft of hair
  • A collection of fat
  • A small dimple or birthmark.  Meningocele A meningocele causes part of the spinal cord to come through the spine like a sac that is pushed out. Nerve fluid is in the sac, and there is usually no nerve damage. Individuals with this condition may have minor disabilities.
  • Many people who have spina bifida occulta don’t even know it, unless the condition is discovered during an X-ray or other imaging test done for unrelated reasons. People find out they have it after having an X-ray of their back. It is considered an incidental finding because the X-Ray is normally done for other reasons. However, in a small group of people with SBO, pain and neurological symptoms may occur. Tethered cord can be an insidious complication that requires investigation by a neurosurgeon.

3-Meningomyelocele is a type of spina bifida. Spina bifida is a birth defect in which the spinal canal and the backbone don’t close before the baby is born. This type of birth defect is also called a neural tube defect.  Meningocele occurs when the bones do not close around the spinal cord and the meninges are pushed out through the opening, causing a fluid-filled sac to form. The meninges are three layers of membranes covering the spinal cord, consisting of dura mater, arachnoid mater and pia mater. In most cases, the spinal cord and the nerves themselves are normal or not severely affected. The sac is often covered by skin and may require surgery. This is the rarest type of spina bifida. 

4-Myelomeningocele (Meningomyelocele), also called Spina Bifida Cystica.  Myelomeningocele is the most severe form of spina bifida, occurring nearly once for every 1,000 live births.

Number 4 – 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 HYDROCEPHALUS. 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.  A portion of the spinal cord or nerves is exposed in a sac through an opening in the spine that may or may not be covered by the meninges. The opening can be closed by surgeons while the baby is in utero or shortly after the baby is born. Myelomeningocele is often called a snowflake condition because no two people with the condition are the same. Typically, the lower in the spine the opening occurs relates to less symptoms in the person. People with myelomeningocele require close follow-up with physicians throughout their childhood and lifespan to maximize their function and prevent complications such as kidney failure.

Neurological impairment is common, there is brain structure changes including:

  • Muscle weakness of the legs, sometimes involving paralysis
  • Bowel and bladder problems
  • Seizures, especially if the child requires a shunt
  • Orthopedic problems — such as deformed feet, uneven hips and a curved spine (scoliosis)Treatment for spina bifida depends on the severity of the condition.

    In general, Spina Bifida Treatment:

  1. Most people with spina bifida occulta require no treatment at all.
  2. Children with meningocele typically require surgical removal of the cyst and survive with little, if any, disability.
  3. Children with myelomeningocele, however take the longest road with treatment.  It require complex and often lifelong treatment and assistance. Almost all of them survive with appropriate treatment starting soon after birth. Their quality of life depends at least partially on the speed, efficiency, and comprehensiveness with which that treatment is provided.  A child born with myelomeningocele requires specialty care.  If the hospital the baby is in does not have newborn neuro surgery than the following is done:
  1. The child should be transferred immediately to a center where newborn surgery can be performed.
  2. Treatment with antibiotics is started as soon as the myelomeningocele is recognized; this prevents infection of the spinal cord, which can be fatal.

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.

Remember the most common complications are tethered spinal cord and hydrocephalus, which can have very severe consequences.  This is discussed in the next couple of topics!

Updated 10/19/2021