Signs and Symptoms of a stroke happening:

Symptoms of stroke include trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm, or leg.

People may experience the following:                                                                      

Muscular: difficulty walking, paralysis with weak muscles, problems with coordination, stiff muscles, overactive reflexes, or paralysis of one side of the body

Visual: blurred vision, double vision, sudden visual loss, or temporary loss of vision in one eye

Whole body: balance disorder, fatigue, or lightheadedness

Speech: difficulty speaking, slurred speech, or speech loss

Sensory: pins and needles or reduced sensation of touch

Facial: muscle weakness or numbness

Limbs: numbness or weakness

Also common: difficulty swallowing, headache, inability to understand, mental confusion, numbness, or rapid involuntary eye movement

What is done for a stroke regarding diagnostic tooling:

 To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you’re having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including:

CT scan of brain tissue damaged by stroke

Cerebral angiogram A cerebral angiogram showing a carotid aneurysm due to a stroke.

Physical examination. Your doctor will ask you or a family member what symptoms you’ve been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present.

Your doctor will want to know what medications you take and whether you have experienced any head injuries. You’ll be asked about your personal and family history of heart disease, transient ischemic attack or stroke.

Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.

Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Managing your blood’s clotting time and levels of sugar and other key chemicals will be part of your stroke care.

Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).  The goal is if the CT scan determined the stroke to be a ischemic stroke start rtpa a drug IV if the symptoms of the stroke started in the past 3 hrs if not treat it another way OR if the stroke is determined to be hemorrhagic than its the OR.  Will go into treatment in more detail in Part III tomorrow.

Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).

Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.

Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.

Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.

You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into the tube that connects the back of your mouth to your stomach (esophagus). Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots.

In reality going to an ER room if the pt comes suspected of a stroke and has symptoms or not than nationally in America the hospitals are to do the following:

-A neuro assessment should be done in 10 minutes  by the doctor.

-A CT SCAN ordered and pt sent off for the CT SCAN test and done within 25 minutes.

-The CT SCAN read and interpreted by the radiologist / neuro doctor within 45 minutes.                        At this point it tells the MD if the pt has a blockage or a hemmorage in the brain that caused the stroke. Remember a ischemic stroke and hemmoragic stroke are treated differently.

We’ll get into treatment tomorrow in Part III Treatment of a stroke.

“93,000 + Americans will be diagnosed with a primary brain tumor diagnosis in 2025 (An estimated 24,80o new primary malignant brain tumors (brain cancer) will be diagnosed in 2025 in this amount.); 35.7 percent is the five-year survival rate for patients with malignant brain tumors and 18, 330 Americans will die from a malignant brain tumor in 2025.  73% of all brain tumors are benign and approximately 27% are malignant.”

National Brain Tumor Society (NBTS) – Brain Tumor Awareness Month

May is Brain Cancer and Brain Tumor Awareness Month (BTAM), a time to raise awareness about brain tumors and educate the community.

Doctors will diagnose cancers of the brain or central nervous system in about 25,400 people in the United States in 2024, according to the National Cancer Institute. All brain and spine tumors, collectively called central nervous system (CNS) tumors cover over 130 different CNS tumor types. These cancers make up a portion of the more than 94,000 brain tumors alone (including benign tumors) that will occur in this country in 2024.

It can be hard for people with CNS tumors to find accurate information, specialized support, and expert care. You can help by spreading awareness and sharing educational materials like through blogs live striveforgoodhealth.com and other sites in the internet.

There are many types of brain and spinal cord tumors. The tumors result from the abnormal growth of cells and may be either benign or malignant. Benign brain and spinal cord tumors grow and press on nearby areas of the brain. Normally, they rarely spread into other tissues; the brain tumors that are diagnosed malignant rapidly spread only in brain tissue and remember when your a fetus the brain develops that the spinal cord grows out of made of brain tissue so spreading can go in those 2 areas.  A brain tumor malignant can form in the brain or other parts of the central nervous system (CNS), being the spine or cranial nerves. So remember, Malignant tumors in the brain and spinal cord only grow quickly spreading only into the brain and (CNS) spinal cord tissue.  The positive note is the tumor stays in those areas but unfortunately it spreads rapidly for most brain tumors.  Survival in a brain tumor especially malignant is a survival rate of 5 years or less but there are those cases that have lasted longer but on average its 5 years or less and this would include a benign tumor not operable but it is suppose to grow slower than a malignant tumor.  Malignant brain tumors need to be treated as soon as possible to prolong life.

Tumor grading:

Tumor grade has long been a way to define the aggressiveness of a tumor, particularly for malignant brain tumors such as glioma but also for non-malignant (benign) brain tumors including meningioma.

Traditionally, tumors have been classified as grade 1 to 4 based on histology (cells as viewed under a microscope) and molecular markers. Grade 1 tumors occur primarily in children and represent a type separate from grade 2-4 (seen primarily in adults). Grade 2 tumors are considered low grade, but some can be aggressive. Grade 3 and 4 tumors are defined as high grade.

What are molecular markers?

Not all brain tumors are the same. Some tumors have differences in the genetic or molecular makeup of the cells. These differences are called molecular markers, or biomarkers. Molecular markers are becoming increasingly important for brain tumor diagnosis and treatment. For example, some molecular markers help determine how aggressive a tumor may be. Others determine how responsive a tumor will be to treatment.

Some common molecular markers include the following:

• IDH1 and IDH2
• MGMT
• 1p/19q co-deletion
• BRAF
• EGFR
• TP53
• ATRX
• TERT
• PTEN
• NTRK
• FGFR

In 2016, the World Health Organization (WHO) included two molecular markers into the CNS tumor classification system that improved accuracy of glioma diagnosis. In 2021 WHO again updated CNS tumor classification, incorporating new knowledge gained from additional molecular markers and new diagnostic techniques. Tumors are now listed as “CNS grade 1-4” with presence or absence of IDH mutation, a key factor in glioma classification.

Basis Review of Brain & the CNS with how it functions:

The brain and spinal cord together form the central nervous system (CNS), like we said in knowing this the brain is a complex organ made up of nerves and connective tissue. Nerves in the brain and spinal cord transmit messages throughout the body. The CNS directs and regulates all of the body’s functions. The brain tumor can definitely mess up a lot of these functions depending on where the tumor is located since the brain is broken up in lobes to do different functions that is what causes the wide signs and symptoms of dysfunctions that occur in time with a brain tumor especially that is metastatic.

The CNS is the core of our existence. It controls:

> Personality: thoughts, memory, intelligence, speech, understanding and emotions

> Senses: vision, hearing, taste, smell and touch

> Basic body functions: breathing, heartbeat and blood pressure

> How we function in our environment: movement, balance and coordination

The brain is made up of multiple parts, and each part of the brain is responsible for different body functions. Therefore, brain tumor symptoms, and potential treatment options, depend a great deal on where the tumor is located.

Learning about the normal workings of the brain and spine will help you understand the symptoms of brain tumors, how they are diagnosed and how they are treated.

Major parts of the brain: There are three major parts of the brain:

1. Cerebrum: uses information from senses to tell our body how to respond. It controls reading, thinking, learning, movement, speech, vision, personality and emotions.

2. Cerebellum: controls balance for standing, walking and other motion.

3. Brain stem: connects the brain with the spinal cord and controls basic body functions such as breathing, sleeping, body temperature and blood pressure.

Lobes of the brain

Different lobes of the brain control different functions. The frontal lobe of the brain helps you think and reason. The temporal lobe contains the neural pathways for hearing and vision, as well as behavior and emotions. Having a tumor, or treatment, in one of these lobes could affect the lobe’s specific functions. Additionally, since the brain has areas that connect, it is possible for a brain tumor to impact a function of the brain where the tumor is not specifically located.

Other common brain tumor locations include the meninges (a layer of tissue that covers the brain and spinal cord), skull base (the bottom of the skull), spinal cord, pituitary tumor, and cranial nerves.

Brain tumor statistics:

Brain tumors are reported in people of all ages, races, ethnicities, and genders. Over 1.3 million Americans are living with a primary or secondary/metastatic brain tumor today.  Primary tumors originate in the brain, and the most common types are meningiomas, pituitary tumors, and gliomas. Metastatic, or secondary brain tumors arise from outside the brain in another organ such as the breast or lung and spread to other areas of the brain. These are the most common brain tumors.

Unless otherwise specified, the follow statistics come from the Central Brain Tumor Registry of the United States Annual Report:

• Approximately 90,000 people are diagnosed with a primary brain tumor every year.   
• Brain and other CNS tumors are the fifth most common cancer. 
• Over 1 million people are living with a diagnosis of a primary brain tumor. 
• There are more than 100 different types of primary brain and CNS tumors. 
• Nearly one-third (27.9 percent) of brain and central nervous system (CNS) tumors are malignant. 
• Brain and CNS tumors are the most common cancer diagnosed in children aged 0-14. 
• More than 28,000 children in the United States are currently diagnosed with a brain tumor. 
• Approximately 3,400 children (aged 0-14) are diagnosed with a primary brain tumor each year. 
• Approximately 12,800 adolescents and young adults (aged 15-39) are diagnosed with a primary brain tumor each year. 
• The incidence rate for brain and CNS tumors is highest among those aged 85 years and older. 
• Each year, approximately 17,200 people die from a malignant brain tumor. Survival after diagnosis with a primary brain tumor varies significantly by age, race, geographical location, tumor type, tumor location, and molecular markers. 

Risk Factors for Brain Tumors:

Genetic and hereditary risk factors

Inherited traits are carried in genes. Each individual has two copies of each gene, one from each parent. Genes often contain small changes. Sometimes these changes do not cause any problems, but sometimes these changes are more serious and can interfere with the way the gene is supposed to work.

There are a few rare, inherited genetic syndromes that are associated with brain tumors., including Neurofibromatosis 1 (NF1 gene), Neurofibromatosis 2 (NF2 gene), Turcot syndrome (APC gene), Gorlin syndrome (PTCH gene), Tuberous Sclerosis (TSC1 and TSC2 genes) and Li-Fraumeni syndrome (TP53 gene).

Although 5-10% of persons with brain tumors have a family history of a brain tumor, the vast majority of CNS tumors appear not to be a part of inherited genetic syndromes.  A number of studies have identified genetic variants that may be associated with an increased risk of certain brain tumors including glioma and meningioma.  Study results from 2017 show that while there are some hereditary similarities in glioma tumors between family members, there is not a statistically significant difference between families having tumors with similar hereditary features as compared to families with tumors having different hereditary features. Also, in families with more than one glioma, the tumors tend to have the same molecular markers. This study continues to collect and analyze data.

Environmental risk factors:

Other than family history, the most consistently identified risk factor associated with brain tumor development is therapeutic or high-dose ionizing radiation.  With regard to medical diagnostic radiation exposure, small increases in brain tumor risks have been reported.  Although certain brain scans and radiation therapy used to treat brain tumors use ionizing radiation, the risk of developing a new brain tumor due to these causes is very low. Occupational exposures among medical radiation workers have been associated with approximately twice the risk of brain cancer mortality, though data on the level of radiation exposure were not available.

With respect to the impact of non-ionizing radiation from cell phones, the association between this exposure and brain cancer has been the subject of much research. Radio frequency fields were classified by the World Health Organization’s International Agency for Research on Cancer in 2011 as a possible carcinogen following the observation of increased glioma risk among heavy cell phone users: the topic remains under study at present.

Industrial chemicals have long been suspected as a cause of glioma due to their ability to cross the blood–brain barrier.  The blood-brain barrier that the human brain has protects the brain from toxins and pathogens. Despite numerous chemical, environmental, and occupational exposures having been explored in epidemiological studies of glioma, results have been inconsistent for most factors. Although not precisely defined, an association between exogenous hormones (e.g., oral contraceptives, hormone replacement therapies) and meningioma risk is often reported and thus patients might discuss this topic with their health care providers.

“What can you do to prevent stroke? Age makes us more susceptible to having a stroke, as does having a mother, father, or other close relative who has had a stroke.

You can’t reverse the years or change your family history, but there are many other stroke risk factors that you can control—provided that you’re aware of them. Knowledge is power. If you know that a particular risk factor is sabotaging your health and predisposing you to a higher risk of stroke, you can take steps to alleviate the effects of that risk.  To prevent a stroke in your control is the following:

1-Control you B/P in therapeutic range.  An ideal goal is maintaining a blood pressure of less than 120/80. But there may be good reasons why you and your doctor will not want your readings to be this low. For some, a less aggressive goal (such as no higher than 140/90) may be more appropriate.

2-Obesity, as well as the complications linked to it (including high blood pressure and diabetes), raises your odds of having a stroke. If you’re overweight, losing as little as 10 pounds can have a real impact on your stroke risk.  While an ideal body mass index (BMI) is 25 or less, that may not be realistic for you. Work with your doctor to create a personal weight loss strategy.

3-Exercise contributes to losing weight and lowering blood pressure, but it also stands on its own as an independent stroke reducer.

Your goal: Exercise at a moderate intensity at least five days a week.

How to achieve it:

• Take a walk around your neighborhood every morning after breakfast.
• Start a fitness club with friends.
• When you exercise, reach the level at which you’re breathing hard, but you can still talk.
• Take the stairs instead of an elevator when you can.
• If you don’t have 30 consecutive minutes to exercise, break it up into 10- to 15-minute sessions a few times each day.

Harvard Health Publishing / Harvard Medical School (7 things you can do to prevent a stroke – Harvard Health)

Statistics to know about strokes:

Stroke was the third leading cause of death in the United States. Presently the CDC says under its statistics that Stroke is the fifth leading cause of death for Americans, but the risk of having a stroke varies with many factors.  Remember strokes have declined since 2003 based on CDC risk factors now compared to risk factors CDC listed in 2014.

More than 140,000 people die each year from stroke in the United States, that’s 1 out of every 20 deaths now.

Stroke costs the United States an estimated $34 billion each year.  This total includes the cost of health care services, medicines to treat stroke, and missed days of work.

Stroke is the leading cause of serious, long-term disability in the United States. Each year, approximately 795,000 people suffer a stroke.

About 600,000 of these are first attacks, and 185,000 are recurrent attacks. Nearly three-quarters of all strokes occur in people over the age of 65.  Stroke reduces mobility in more than half of stroke survivors age 65 and over.

The risk of having a stroke more than doubles each decade after the age of 55.

Strokes can & do occur at ANY age. Nearly one fourth of strokes occur in people under the age of 65.  Stroke risk increases with age, but strokes can—and do—occur at any age.

In 2009, 34% of people hospitalized for stroke were less than 65 years old.

Stroke death rates are higher for African-Americans than for whites, even at younger ages.

On average, someone in the United States has a stroke every 40 seconds.

Stroke accounted for about one of every 17 deaths in the United States in 2006. Stroke mortality for 2005 was 137,000.

From 1995–2005, the stroke death rate fell ~30 percent and the actual number of stroke deaths declined ~14 percent.  It still has declined from 2005 by CDC statistics which is good.

While stroke death rates have declined for decades among all race/ethnicities, Hispanics have seen an increase in death rates since 2013.

What is a Stroke?

A Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.  A stroke occurs when a blood vessel which carry oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so this in the end causes brain cells to die.

There is a stroke noted as a mini stroke which is a transient (temporary) ischemic attack= TIA, which we went over last Friday.  If you want to review it go right ahead, its listed under 5/08/2020 article.  A TIA is different than  strokes.  First some call it a mini stroke but remember the symptoms of a TIA are similar to stroke symptoms listed below for actual strokes; the difference for the patient is that they are completely reversible.  Take angina for example, in this case the pt has the heart affected but the symptoms are completely reversible, just a different organ.  The organs (the heart for angina and the brain for TIA) are simply having the symptoms of an infarction of the organ that is involved but both are due to lack of 0xygen, called ischemia.

Getting back to actual strokes lets review types of strokes.

There are 2 types of strokes:

Ischemic Stroke which are strokes that occur through an obstruction of blood flow by a clot called a thrombus.

Hemorrhagic stroke by a blood vessel rupturing and preventing blood flow to the brain.

In the case of a stroke its a infarction to the brain due to lack of oxygen to the organ we call the brain, only the symptoms are not reversible but they can decrease in the intensity of the damage the caused in time with treatment (PT and OT) in time.  For some the symptoms are almost completely gone, again it depends on the intensity of the stroke to the brain, how bad was it with the symptoms it caused.

What are the risk factors for a stroke?

Non modiafiable risks meaning you can’t change them are:

–Age:  Stroke occurs in all age groups.  Studies show the risk of stroke doubles for each decade between the ages of 55 and 85.  But strokes also can occur in childhood or adolescence.  Although stroke is often considered a disease of aging, the risk of stroke in childhood is actually highest during the perinatal period, which encompasses the last few months of fetal life and the first few weeks after birth.

-Gender:  Men have a higher risk for stroke, but more women die from stroke.  Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival.

-Race:  People from certain ethnic groups have a higher risk of stroke.  For African Americans, stroke is more common and more deadly—even in young and middle-aged adults—than for any ethnic or other racial group in the United States.  Studies show that the age-adjusted incidence of stroke is about twice as high in African Americans and Hispanic Americans as in Caucasians.  An important risk factor for African-Americans is sickle cell disease, which can cause a narrowing of arteries and disrupt blood flow. The incidence of the various stroke subtypes also varies considerably in different ethnic groups.

–Family history of stroke:  Stroke seems to run in some families.  Several factors may contribute to familial stroke.  Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes.  The influence of a common lifestyle among family members also could contribute to familial stroke.

Modiafiable Risk Factors meaning you CAN change them:

–High Blood Pressure (hypertension)

RX: DIET & EXERCISE & MEDS that a MD would decide.

–High Cholesterol

RX: DIET and if necessary MEDS that a MD would decide.

–Diabetes Mellitus

RX: DIET & EXERCISE & MEDS that a MD would decide.

–Cigarette Smoking

RX: QUIT

–Carotid Artery Disease

RX: DIET & EXERCISE & MEDS  even possible SURGERY that a MD would decide.

–Atrial Fibrillation

RX: DIET & EXERCISE & MEDS even possible SURGERY that a MD would decide.

–Unhealthy Diet   RX: DIET

–Physical Inactivity and Obesity

RX: DIET & EXERCISE & possibly even MEDS that a MD would decide.

Go to your DOCTOR before doing any program and let your MD tell you what type of a program would be best for you especially if you are diagnosed with disease (EX. Diabetes, Cardiac, etc…).

“Urothelial carcinoma accounts for the vast majority of bladder cancer cases in the United States, about 90%. It is sometimes called transitional cell carcinoma (TCC) because the urothelial cells from which it develops are also known as transitional cells. This is because they may expand when the bladder is full and contract when it is empty.

These urothelial (transitional) cells line the bladder and, as more cancer cells grow, they may form a cancerous tumor.

The exact cause of bladder cancer is not known, but researchers have identified some factors that may increase a person’s lifetime risk for developing this cancer.

These risk factors may be linked to DNA changes in the body, causing mutations in the parts of cells that control growth. These mutations change how bladder cells behave, allowing them to grow abnormally, which may cause cancer cells to form.

Gene changes that occur during a person’s life sometimes happen randomly, without a known cause. Other times, exposure to chemicals that cause cancer, such as tobacco smoke, may be what prompts cells in the bladder to mutate. About 50% of people diagnosed with bladder cancer have a history of smoking.”

City of Hope (What is Bladder Cancer & Its Causes | City of Hope)

“Finding cancer early, when it’s small and hasn’t spread, often allows for more treatment options. Some early cancers may have signs and symptoms that can be noticed, but that’s not always the case.

After a cancer diagnosis, staging provides important information about the extent (amount) of cancer in the body and the likely response to treatment.

Bladder cancer signs and symptoms may include:

• Blood in urine (hematuria), which may cause urine to appear bright red or cola colored, though sometimes the urine appears normal and blood is detected on a lab test
• Frequent urination
• Painful urination
• Back pain
• Feeling tired or weak (advanced)
• Swelling in the feet (advanced)
• Bone pain (advanced)”

American Cancer Society  (Bladder Cancer Signs and Symptoms | American Cancer Society)

“Bladder cancer is a common type of cancer that begins in the cells of the bladder. The bladder is a hollow muscular organ in your lower abdomen that stores urine.

Bladder cancer most often begins in the cells (urothelial cells) that line the inside of your bladder. Urothelial cells are also found in your kidneys and the tubes (ureters) that connect the kidneys to the bladder. Urothelial cancer can happen in the kidneys and ureters, too, but it’s much more common in the bladder.

Most bladder cancers are diagnosed at an early stage, when the cancer is highly treatable. But even early-stage bladder cancers can come back after successful treatment. For this reason, people with bladder cancer typically need follow-up tests for years after treatment to look for bladder cancer that recurs.”

MAYO Clinic (Bladder cancer – Symptoms and causes – Mayo Clinic)

“According to a 2023 report, the prevalence of ALS in the United States is about 9.1 cases per 100,000 people.

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

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

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

PT and OT:

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

Speech Therapy:

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

Respiratory Therapy:

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

Psychotherapy:

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

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

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

Medications:

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

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

Radicava™ (edaravone)

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

Rilutek (riluzole, now generic)

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

Tiglutik (thickened riluzole)

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

Nuedexta®

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