“The words polio (grey) and myelon (marrow, indicating the spinal cord) are derived from the Greek. It is the effect of poliomyelitis virus on the spinal cord that leads to the classic manifestation of paralysis.”
Centers for Disease Control and Prevention
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 bacteriophages, or simply phages (pronounced FAY-jez). Phages are of special importance due to the susceptibility of the viruse 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 poliovirus 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 poliovirus 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 it is gets into the human body:
Polio is spread through person-to-person contact. When a child is infected with wild poliovirus, the virus enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through the faeces 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 faeces. There is also evidence that flies can passively transfer poliovirus from faeces to food. Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus 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.
Poliomyelitis (POLIO) is a viral disease. There are three types of poliovirus 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 poliovirus 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 poliovirus, the virus enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through the faeces 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 faeces. There is also evidence that flies can passively transfer poliovirus from faeces to food. Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus 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:
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 poliovirus 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.
More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the nerve cells of the brain stem, reducing breathing capacity and causing difficulty in swallowing and speaking. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
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:
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.
Polio can be prevented through immunization. Polio vaccine, given multiple times, almost always protects a child for life.
Post Happy Halloween!
“A healthy liver has the amazing ability to grow back, or regenerate, when it is damaged but not continuously damaged.”
The American Liver Foundation
Charcot Marie Tooth Disease=CMT is inherited. It is not contagious, nor is it caused by anything in the environment. The most common forms of CMT are passed down from one generation to the next, meaning that it is dominantly inherited.
CMTAUSA.org
Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neurological disorders, affecting approximately 1 in 2,500 people in the United States. The disease is named for the three physicians who first identified it in 1886 – Jean-Martin Charcot and Pierre Marie in Paris, France, and Howard Henry Tooth in Cambridge, England. CMT, also known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy, comprises a group of disorders that affect peripheral nerves. The peripheral nerves lie outside the brain and spinal cord and supply the muscles and sensory organs in the limbs. Disorders that affect the peripheral nerves are called peripheral neuropathies.
Causes of Charcot-Marie-Tooth disease?
A nerve cell communicates information to distant targets by sending electrical signals down a long, thin part of the cell called the axon. In order to increase the speed at which these electrical signals travel, the axon is insulated by myelin, which is produced by another type of cell called the Schwann cell. Myelin twists around the axon like a jelly-roll cake and prevents the loss of electrical signals. Without an intact axon and myelin sheath, peripheral nerve cells are unable to activate target muscles or relay sensory information from the limbs back to the brain.
CMT is caused by mutations in genes that produce proteins involved in the structure and function of either the peripheral nerve axon or the myelin sheath. Although different proteins are abnormal in different forms of CMT disease, all of the mutations affect the normal function of the peripheral nerves. Consequently, these nerves slowly degenerate and lose the ability to communicate with their distant targets. The degeneration of motor nerves results in muscle weakness and atrophy in the extremities (arms, legs, hands, or feet), and in some cases the degeneration of sensory nerves results in a reduced ability to feel heat, cold, and pain.
The gene mutations in CMT disease are usually inherited. Each of us normally possesses two copies of every gene, one inherited from each parent. Some forms of CMT are inherited in an autosomal dominant fashion, which means that only one copy of the abnormal gene is needed to cause the disease. Other forms of CMT are inherited in an autosomal recessive fashion, which means that both copies of the abnormal gene must be present to cause the disease. Still other forms of CMT are inherited in an X-linked fashion, which means that the abnormal gene is located on the X chromosome. The X and Y chromosomes determine an individual’s sex. Individuals with two X chromosomes are female and individuals with one X and one Y chromosome are male.
In rare cases the gene mutation causing CMT disease is a new mutation which occurs spontaneously in the individual’s genetic material and has not been passed down through the family. There are many forms of CMT disease, including CMT1, CMT2, CMT3, CMT4, and CMTX. CMT1, caused by abnormalities in the myelin sheath, has three main types.
CMT1A is an autosomal dominant disease that results from a duplication of the gene on chromosome 17 that carries the instructions for producing the peripheral myelin protein-22 (PMP-22). The PMP-22 protein is a critical component of the myelin sheath. Overexpression of this gene causes the structure and function of the myelin sheath to be abnormal. Patients experience weakness and atrophy of the muscles of the lower legs beginning in adolescence; later they experience hand weakness and sensory loss.
CMT1B is an autosomal dominant disease caused by mutations in the gene that carries the instructions for manufacturing the myelin protein zero (P0), which is another critical component of the myelin sheath.
CMT2 results from abnormalities in the axon of the peripheral nerve cell rather than the myelin sheath. It is less common than CMT1.
CMT3 or Dejerine-Sottas disease is a severe demyelinating neuropathy that begins in infancy. Infants have severe muscle atrophy, weakness, and sensory problems
CMT4 comprises several different subtypes of autosomal recessive demyelinating motor and sensory neuropathies. Individuals with CMT4 generally develop symptoms of leg weakness in childhood and by adolescence they may not be able to walk.
CMTX is caused by a point mutation in the connexin-32 gene on the X chromosome. Males who inherit one mutated gene from their mothers show moderate to severe symptoms of the disease beginning in late childhood or adolescence. Females who inherit one mutated gene from one parent and one normal gene from the other parent may develop mild symptoms in adolescence or later or may not develop symptoms of the disease at all.
How is Charcot-Marie-Tooth disease diagnosed?
Diagnosis of CMT begins with a standard medical history, family history, and neurological examination. Individuals will be asked about the nature and duration of their symptoms and whether other family members have the disease. During the neurological examination a physician will look for evidence of muscle weakness in the individual’s arms, legs, hands, and feet, decreased muscle bulk, reduced tendon reflexes, and sensory loss. Doctors look for evidence of foot deformities, such as high arches, hammertoes, inverted heel, or flat feet. Other orthopedic problems, such as mild scoliosis or hip dysplasia, may also be present. A specific sign that may be found in people with CMT1 is nerve enlargement that may be felt or even seen through the skin. These enlarged nerves, called hypertrophic nerves, are caused by abnormally thickened myelin sheaths.
If CMT is suspected, the physician may order electrodiagnostic tests. This testing consists of two parts: nerve conduction studies and electromyography (EMG). During nerve conduction studies, electrodes are placed on the skin over a peripheral motor or sensory nerve. These electrodes produce a small electric shock that may cause mild discomfort. This electrical impulse stimulates sensory and motor nerves and provides quantifiable information that the doctor can use to arrive at a diagnosis. EMG involves inserting a needle electrode through the skin to measure the bioelectrical activity of muscles. Specific abnormalities in the readings signify axon degeneration. EMG may be useful in further characterizing the distribution and severity of peripheral nerve involvement.
Genetic testing is available for some types of CMT and results are usually enough to confirm a diagnosis. In addition, genetic counseling is available to assist individuals in understanding their condition and plan for the future.
If all the diagnostic work-up in inconclusive or genetic testing comes back negative, a neurologist may perform a nerve biopsy to confirm the diagnosis. A nerve biopsy involves removing a small piece of peripheral nerve through an incision in the skin. This is most often done by removing a piece of the nerve that runs down the calf of the leg. The nerve is then examined under a microscope.
The treatment of CMT:
There is no cure for CMT, but physical therapy, occupational therapy, braces and other orthopedic devices, and even orthopedic surgery can help individuals cope with the disabling symptoms of the disease. In addition, pain-killing drugs can be prescribed for individuals who have severe pain.
Physical and occupational therapy, the preferred treatment for CMT, involves muscle strength training, muscle and ligament stretching, stamina training, and moderate aerobic exercise. Most therapists recommend a specialized treatment program designed with the approval of the person’s physician to fit individual abilities and needs. Therapists also suggest entering into a treatment program early; muscle strengthening may delay or reduce muscle atrophy, so strength training is most useful if it begins before nerve degeneration and muscle weakness progress to the point of disability.
Stretching may prevent or reduce joint deformities that result from uneven muscle pull on bones. Exercises to help build stamina or increase endurance will help prevent the fatigue that results from performing everyday activities that require strength and mobility. Moderate aerobic activity can help to maintain cardiovascular fitness and overall health. Most therapists recommend low-impact or no-impact exercises, such as biking or swimming, rather than activities such as walking or jogging, which may put stress on fragile muscles and joints.
Many CMT patients require ankle braces and other orthopedic devices to maintain everyday mobility and prevent injury. Ankle braces can help prevent ankle sprains by providing support and stability during activities such as walking or climbing stairs. High-top shoes or boots can also provide support for weak ankles. Thumb splints can help with hand weakness and loss of fine motor skills. Assistive devices should be used before disability sets in because the devices may prevent muscle strain and reduce muscle weakening. Some individuals with CMT may decide to have orthopedic surgery to reverse foot and joint deformities.
The National Institute of Neurology Disorders and Stroke supports research on CMT and other peripheral neuropathies in an effort to learn how to better treat, prevent, and even cure these disorders.
“Spina bifida is one of the most common birth defects today and may be called by a number of other clinical names, such as spina bifida cystica and myelodysplasia, both of which are synonyms of ‘spina bifida’.”
Columbia Presbyterian Hospital – Orthopaedic Surgery
“It’s Halloween time and the flu season is here! Keeping hands clean by washing them with soap and water is one of the best ways to prevent the spread of germs. Everyone 6 months and older should get a flu vaccine each year for the best protection against influenza throughout flu season.”
CDC (center for disease control & prevention)
Go to striveforgoodhealth.com on Safety tips regarding halloween for kids.
“A full 70 percent of people say chocolate is their favorite Halloween treat, followed by candy corn (13 percent), chewy candy (6 percent) and gummy candy (5 percent).”
National Confection National Confectioners Association’s (NCA)
Sciatica is pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatica nerve. The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. It goes down through the buttock, then its branches extend down the back of the leg to the ankle and foot. When something presses on the sciatica nerve, like a herniated disc, it presses on that nerve which causes the pain from the buttock that can radiate all the way down to the foot. The intensity of the pressure on the nerve and where its pressed decides if it goes to the foot or less. Other causes of sciatica nerve damage:
The most common cause -a bulging or ruptured disc in the spine pressing against the nerve roots that lead to the sciatic nerve.
-Sciatica Nerve Damage can be a symptom of other conditions that affect
*Narrowing of the spinal canal due to spinal stenosis. This spinal canal narrowing pinches on the sciatica nerve.
*Bone spurs-they are growths that are small forming along joints caused by arthritis.
*Simply injury (like a car accident or fall) causing nerve root compression=again the same result-pinching the sciatica nerve.
*Pregnancy-not as common as a cause as the others listed.
*Rarely but also tumors could cause the problem also.
What are the symptoms?
Symptoms of sciatica include pain that begins in your back or buttock and moves down your leg and may move into your foot.
*Weakness, tingling, or numbness in the leg may also occur.
*At times a inconsistent stabbing feeling or pricking feeling in the ankle or foot
*Sitting, standing for a long time, and movements that cause the spine to flex (such asexercises using the knee to chest) which may make symptoms worse.
*Walking, lying down, and movements that extend the spine (such as press-ups) may relieve symptoms.
How is sciatica diagnosed?
Sciatica is diagnosed with a medical history and physical exam. Sometimes x-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of the sciatica.
What are the Complications?
Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you experience:
-Loss of feeling in the affected leg -Weakness in the affected leg
-Loss of bowel or bladder function
How is it treated?
In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and exercises to relieve pain. You can help relieve pain by:
*Avoiding sitting (unless it is more comfortable than standing).
*Alternating lying down with short walks. Increase your walking distance as you are able to, without pain.
* Takingacetaminophen (tylenol) or Motrin (Ibuporfen) or Advil or Aleve (Naproxen). All are nonsteroidal anti-inflammatory drugs which decrease the swelling of the inflammation around the area or injury to the back which will decrease the pain. More inflammation=more pinching on the nerve.
*Using a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help you.
*Additional treatment for sciatica depends on what is causing the nerve irritation. If your symptoms do not improve, your doctor may suggest physical therapy, injections of medicines such as steroids, stronger medicines such as muscle relaxants or opiates.
*Physical Therapy or chiropracter therapy or some form of therapy for 6 to 8 weeks.
* If the therapy is uneffective than the last resort in most cases is surgery that ranges from:
– laser surgery
– scrapping of the vertebrae pinching the nerve with leaving the rest of the vertebrae spacing the spinal cord in place or removing the vertebrae pinching the nerve and replacing it with cement (not cement we use for sidewalks that we know of). It’s natural to want to return to your regular activities as soon as possible after surgery, but a lot depends on the type of operation you get.
In two common methods, vertebroplasty and kyphoplasty, your surgeon makes a small cut in your back, which lets you recover faster. If you get spinal fusion surgery, the cut is larger, and it will take a longer time to heal.
-small endoscopic surgery that is microsurgery removing pieces of the vertebraepinching which has a test called a discogram (injecting a dye right into the injured disc and than a ultrasound of the area is done to show the surgeon the exact route he has to follow to cure the problem. The surgeon numbs the area that he will repair with the pt wide awake; he makes a incision about 2/10 of an inch, using the cat scan as a guide for his eyes inserting a scope inserting a grabber that goes in the scope removing disc fragments that are pressing on the nerves causing the pain. It takes about 30 minutes for this procedure with only a small bandage covering the incision followed with the patient leaving the hosp–ital in less than a few hours
*Other self-care treatments that may be helpful include:
-Cold packs. Initially, you may get relief from a cold pack placed on the painful area for up 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
-Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
-Stretching. Stretching exercises for your low back can help you feel better and may help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch and try to hold the stretch at least 30 seconds.
-Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve) are sometimes helpful for sciatica.
References:
National Cancer Society
Web MD
Mayo Clinic
Dr. Bruce Hensel M.D. (chief medical editor channel 4)/Dr. David Ditsworth Surgeon – does back scoping -Robert Forrest Physical Therapy in Santa Monica, California.In this article