What is ALS?
ALS is a rapidly progressive, fatal neuromuscular disease. It attacks the motor neurons responsible for transmitting electrical impulses from the brain to the voluntary muscles throughout the body. When these muscles fail to receive messages, they eventually lose strength, atrophy and die. There is no known treatment.
Anyone can get ALS. More than 3,000 Canadians currently endure the disease with two to three dying every day as a result.
Why is it Known as Lou Gehrig’s Disease?
Lou Gehrig, a famous baseball player in the U.S. during the 1930’s, became afflicted with ALS. He was known as baseball’s “Ironman”. Strength, agility, excellent health – Lou Gehrig had everything it took to become a baseball legend. But Lou Gehrig had something else. At the peak of his career, he was diagnosed as having Amyotrophic Lateral Sclerosis (ALS). He died at the age of 38.
What Causes ALS?
The cause is not yet known, although several theories are now being researched. At present, neither a cure for ALS nor a means of prevention is known. In 1993, scientists announced in a paper published in the British journal “Nature” that they had isolated the gene associated with about 20% of the cases of the inherited form of the disease. While only 10% of ALS patients have this genetic predisposition, there is no evidence of a clinical difference between the familial and the sporadic forms of the illness.
Does ALS Cause Pain?
The onset is insidious and without pain. As the disease progresses, muscle cramping can occur. In its final stages, the wasting of the body may cause severe pain. Extreme mental anguish is often caused by a lively, unimpaired mind trapped in a totally immobilized body.
What Parts of the Body Does ALS Affect?
ALS does not affect the mind because it attacks only motor neurons. The person with ALS remains mentally sharp and in full possession of the senses of sight, hearing, taste, smell and touch.
Are There Different Types of ALS?
- Sporadic (which is the most common form of ALS)
- Familial (a small number of cases suggest genetic inheritance of ALS)
- Guamanian (a high number of cases of ALS occur in Guam and the Trust Territories of the Pacific.)
What are the Early Symptoms of ALS?
ALS usually becomes apparent either in the throat or upper chest area or in the arms and legs. Some people begin to trip and fall; some lose the use of their hands and arms; some find it hard to swallow and some slur their speech.
Can You “Catch” ALS?
ALS cannot be “caught”. It is not contagious. In 90% of ALS cases, it strikes people with no family history of the disease. Ten percent of the cases are classified as familial or inherited ALS. It may occur at any age, the likelihood increasing as people grow older. However, many are struck down in the prime of life. ALS occurs equally in men and women.
How Do People with ALS Cope with the Disease?
People with ALS generally are remarkably cheerful and resilient. Nevertheless, ALS has a devastating effect on patients and their families. It consumes their financial and emotional resources while they attempt to deal with the advancing disability and the prospect of death.
Clinical Progression of ALS
Many patients are debilitated before they have contracted ALS, because the disease frequently takes its toll before being positively diagnosed. Patients are initially prompted to seek medical attention because of a persistent muscle twitch, muscle fatigue or even muscle wasting. This usually starts in the hands or lower legs, and is usually accompanied by cramps. In some cases, patients experience difficulty in swallowing and/or a change in their voice.
As the disease progresses, patients lose the ability to dress and feed themselves, sit up, walk or even speak. The bodily functions that remain intact until or near death are the control of excretory functions (i.e. urination, defecation), sexual function, eye movement, and intellect.
Generally, patients survive three to five years after diagnosis. Death usually occurs due to respiratory failure.
Is There Any Treatment for ALS?
There is no treatment for ALS. However, as the body deteriorates, there is treatment for the symptoms, such as spasms and saliva control. Also, supportive strategies are available to prolong and improve the quality of life.
SOURCE: This information was obtained through the ALS Society of Canada.
Arthritis literally means “inflammation of a joint”. Since there are any number of factors that can cause inflammation of a joint, there are many types of arthritis.
Some examples of arthritis include Ankylosing Spondylitis, Fibromyalgia, Osteoarthritis, Sjogren’s Syndrome, Rheumatoid Arthritis and Gout. Each of these may affect the patient differently and may have significantly different complications. It is, therefore, very important to know the exact type or form of arthritis that you may be treating.
Rheumatoid Arthritis (RA) is a chronic, systemic, inflammatory disease that chiefly affects the synovial membranes of multiple joints in the body. As a consequence of the disease being systemic, there are many extra-articular features of the disease as well.
In most cases of RA, the patient has remissions and exacerbations of the symptoms. This means that there are periods of time when it “feels good” and times when it “feels worse”. There will likely be times when RA “feels cured”. It is important to understand that there are very few people that have complete remission of the disease. It is essential that the RA patient does not stop the treatment program established by knowledgeable health care practitioners. Rarely does the disease “go away”, although at times the symptoms might temporarily remit.
The disease is considered an autoimmune disease that is acquired and in which genetic factors appear to play a role.
The prevalence of the disease is 1-2% of the general population and is found world-wide. Females with RA outnumber males by a 3:1 margin. The onset of the disease in adults is usually between the ages of 40-60 years, although it can occur at any age. The cause of RA is presently unknown.
Effects of the Disease
Rheumatoid Arthritis can attack any synovial joint in the body. Excepting the distal interphalangeal joints, it has the greatest affinity for the small joints of the hand, wrist, and foot. In many cases, the joint involvement in the limbs becomes relatively symmetrical. Further, the cervical spine, usually the superior aspect, becomes affected and patients must be watched carefully for disruption of the atlantoaxial joint. In advanced cases of the disease, subluxation at the atlantoaxial joint can occur.
Early in the course of the disease, several changes on joint structures occur. Joint effusion and inflammation of the synovium occur, producing a soft tissue swelling that is easily detected during evaluation of the patient. Additionally, changes (osteoporosis) in the ends of the bones forming the joint may be present early in the disease process.
The attack on a joint by the disease usually begins with the synovium. Early in the disease, edema begins to be seen in cells in the synovium and multiplication of synovial lining cells occurs. As the disease progresses, the synovium may grow considerably larger, eventually forming tissue called pannus. Pannus can be considered the most destructive element affecting joints in the patient with rheumatoid arthritis. Pannus can attack articular cartilage and destroy it. Further, pannus can destroy the soft subchondral bone once the protective articular cartilage is gone. The synovial fluid secreted by the synovium is thought to serve two main purposes, lubrication of the joint and provision of nutrients to the avascular articular cartilage. In this disease process, interaction between antibodies and antigens occurs, causing alterations in the composition of the synovial fluid. Ultimately, digestants are formed in the fluid, which attack the surrounding tissue. Once the composition of this fluid is altered, it is less able to perform the normal functions noted above, and more likely to become destructive.
The changes in the synovium and synovial fluid briefly described above are responsible for a large amount of joint and soft tissue destruction. The destruction of bone eventually leads to laxity in tendons and ligaments. Under the strain of daily activities and other forces, these alterations in bone and joint structure result in the deformities frequently seen with rheumatoid arthritis. Considerable destruction of the joint can occur with pannus invading the subchondral bone.
Bone destruction occurs at areas where the hyaline cartilage and the synovial lining do not adequately cover the bone. If the disease progresses to a more advanced stage, the articular cartilage may lose its structure and density, resulting in an inability to withstand the normal forces placed on the joint. In these advanced cases, muscle activity causes the involved ends of the bones to be compressed together causing further bone destruction. Further, the disease can irreversibly change the structure and function of a joint to the degree that other degenerative changes may occur, especially in the weight-bearing joints of the body. Joint destruction can progress to the degree that joint motion is significantly limited and joints can become markedly unstable.
Prevention of Disability and Preservation of Function
Another major element in the treatment of patients with Rheumatoid Arthritis is to prevent disability and preserve bodily function. One way to achieve this goal is to develop an exercise routine, based on specific needs, that preserves motion, strength, functional activities and lifestyle.
Positioning is also valuable in preserving motion and enhancing function. Patients should be encouraged to frequently change body position at work, home and during leisure activities.
Preservation of muscle strength and endurance is also very important in individuals with RA. Muscle atrophy can quickly occur because of disuse, splinting or the inflammatory process. Loss of muscle bulk is correlated with loss of functional ability. Thus, the health care practitioner must develop an exercise program that maintains or increases the strength of the patient with RA.
Maintenance of Lifestyle
The significance of a systemic disease like Rheumatoid Arthritis (RA) is that it is pervasive, leaving no part of the patient’s life untouched. Perhaps the best way for the health care practitioner to understand what it is like to live with a systemic disease is to imagine every activity that takes place during a “normal” day and how those activities might be affected by a disease like RA.
Examples of possible situations and questions that may need to be answered are:
- The first hurdle to overcome for many of these patients is fighting the morning stiffness that frequently accompanies RA in order to get out of bed. Will the patient need assistance getting out of bed and if so, what modification may be necessary?
- Depending on the degree of joint involvement, patients may have considerable difficulty performing self care activities like brushing teeth, combing hair, putting on shoes, and buttoning or zipping garments. What devices or strategies may help the patient successfully complete these activities?
- Preparing meals can offer challenges like opening boxes and cans, and attempting to pour from heavy objects like coffee pots or full containers of milk or orange juice. What strategies can the patient use to minimize the stresses placed on the wrist, hand, and finger joints when preparing meals or participating in other activities?
- Are there steps that need to be negotiated either within the house or to move in or out of the house? Will modifications need to be made?
- Does the patient need to drive? If so, what recommendation do you need to make regarding choice of vehicle?
- Is the patient employed? Are there reasonable accommodations that need to be made to keep the patient a productive employee?
- Is there family support for the patient? Are external services necessary for the patient?
The point is that health care practitioners need to carefully evaluate every element of the patient’s day, including work and social events in order to develop the strategies, assistive devices and new skills necessary for the patient to function with the illness. A major goal of health care practitioners should be to assist patients with planning and living the lifestyle of their choice.
Source: This information was made available through the Arthritis Society.
Aging is a natural process that is the future of all living creatures. The number of people over 65 increases annually. Since aging is an inevitable fact, it must be discussed in the sense of the coherent problems. Medical care has provided longer life but is no guarantee of a trouble-free physical or mental existence.
To a varying extent, the following conditions of aging appear and often progress in later years:
- Muscles fatigue easily and there is less endurance
- With decreased body movement, joints can become stiff
- There is a tendency toward hardening of the arteries
- Muscle reaction to stimuli slows and concentration becomes more difficult
- Many of the senses may experience partial or complete loss
- Body resistance declines, increasing susceptibility to infection
- Decreased circulation and absorption of calcium from the bones may result in osteoporosis, shown by skeletal shrinkage and an increased tendency to bone fractures (more prevalent in women).
- Incontinence concerns
Although aging is neither a disease nor an accident, it requires consideration and understanding to satisfy the needs of the geriatric client, who may require assistive devices.
Concerns Associated with Aging
Many seniors endure a variety of aches and pains. Chronic pain can have a serious impact on physical and emotional well-being. Common sources of chronic pain include migraine headaches and arthritis. The most common forms of arthritis in the aging population are Osteoarthritis, Fibromyalgia and Rheumatoid Arthritis.
Falls and In-Home Injuries
Falls are very common among the elderly and can be caused by intrinsic and extrinsic factors. Intrinsic factors are related causes which are external to the person such as the physical environment. Some examples associated with falls are: unkept sidewalks, poor or wet walking surfaces, stairs, inadequate lighting, obstructions on pathways, lack of handrails, scatter rugs, low beds and seats, and improper footwear.
Depression is a mental state of depressed mood characterized by feelings of sadness, despair and discouragement. Depression has a wide range of severity. The causes of depression can vary but are often the result of the loss of a loved one, chronic pain, poor health and/or a chemical imbalance in the brain. In most cases, treatment is available and is often a combination of medication and behavioral counseling/therapy. Medication compliance is an issue for many individuals with mental illness.
The fear of crime is a serious problem for seniors. Important security measures for seniors may include:
- Installing new locks
- Changing activities or avoiding certain places
- Installing alarm systems
Source:This information was obtained through the National Advisory Council on Aging.
Cystic Fibrosis (CF) is an incurable inherited disorder, mainly affecting the lungs and digestive system. In the lungs, where the effects of the disease are most devastating, CF causes increasingly severe respiratory problems. In the digestive tract, CF often results in extreme difficulty in digesting adequate nutrients from food.
Most persons with cystic fibrosis eventually die of lung disease.
It is estimated that one in every 2500 children born in Canada has CF. At the present time, approximately 3000 children, adolescents and adults with cystic fibrosis attend specialized CF clinics.
What Causes Cystic Fibrosis?
Cystic Fibrosis is a genetic disease occurring when a child inherits two copies of the defective gene, one from each parent. Approximately one in every 25 Canadians is a carrier of the gene which causes CF. Since they have only one copy of the gene, these individuals do not have cystic fibrosis themselves, and can never get the disease. In most cases, they are not even aware that they are carriers, since they do not have CF or any of the symptoms.
Signs and Symptoms of Cystic Fibrosis
- Chromic cough producing a thick mucus
- Excessive appetite, combined with weight loss
- Bowel disturbances • Salty deposits on the skin
- Repeated or prolonged bouts of pneumonia
Treatment of Cystic Fybrosis
- Percussion and postural drainage, to help loosen the mucus which clogs the lungs
- Pancreatic enzymes, taken with all meals to aid digestion
- Nutritional supplements and vitamins to promote good nutritional status
- Inhalation of aerosol medications to alleviate congestion and ward off or combat lung infection
How Does Cystic Fibrosis Affect Everyday Life?
For persons with CF, life includes a daily routine of therapy and periodic visits to a CF clinic. Otherwise, most individuals with cystic fibrosis lead normal lives for many years, in terms of education, physical activity and social relationships. Eventually, however, lung disease begins to place limits on daily life.
Can Cystic Fibrosis Be Cured?
Cystic Fibrosis is an incurable disease. Comprehensive treatment programs have dramatically extended the life expectancy of persons with CF. Many affected individuals are living into their 20’s and 30’s and even beyond. However, mainly because of lung disease, children and adults who have CF face foreshortened lives.
Source:This information was made available though The Canadian Cystic Fibrosis Foundation.
Diabetes is a chronic disease that impairs the body’s ability to use food properly. Normally, glucose, a form of sugar produced when starches and sugar are digested, is burned as fuel to supply the body with energy. This process, turning food into energy, is called metabolism.
In order to metabolize glucose properly, the body requires another substance: insulin. Insulin is a hormone produced by the pancreas. Its job is to regulate the body’s use of glucose. Insulin is essential to the metabolic process. Trying to burn glucose without insulin is like trying to set fire to a pile of logs without a match. It can’t be done. People with Diabetes either don’t produce enough insulin to properly metabolize glucose or the insulin they have works inefficiently. Without insulin to turn glucose into energy, the glucose piles up in the bloodstream and spills into the urine, showing as “sugar in the urine”. High levels of sugar in the blood and urine are the hallmarks of untreated diabetes.
While there is currently no cure for diabetes, it can be controlled. The main goal of diabetes treatment is to control blood sugar levels and keep them in the normal range. The specific kind of treatment used to control blood sugars depends on the specific type of diabetes a person has.
Types of Diabetes
Type I Diabetes (insulin dependent or juvenile)
In this form of Diabetes, a person’s pancreas produces little or no insulin. Although the causes for this are not entirely known, scientists believe that the body’s own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. As insulin is necessary for life, people with Type I Diabetes must take one or more injections of insulin every day in order to metabolize their food. Before the discovery of insulin in 1921, people would fall into a diabetic coma and die, usually within a few weeks of onset.
This form of Diabetes used to be known as “juvenile diabetes” because it usually appears in children or young adults.
Type II Diabetes (non-insulin dependent or adult-onset)
In this form of diabetes, the pancreas still produces insulin, but for some reason, the body is not able to use it effectively. So, in spite of the presence of adequate amounts of insulin, blood glucose levels are not normal. Fortunately, Type II Diabetes can be treated in a variety of ways including weight loss, proper diet, reduced sugar intake and exercise. More severe cases may be treated with oral drugs or insulin injections.
Type II, which is also known as “adult-onset diabetes” occurs most often in people over 40.
Symptoms of Diabetes
One or more of these symptoms on a recurring basis, indicate a need to consult a doctor.
Type II -These symptoms usually occur gradually:
- Any of the symptoms for Type I
- Recurring or hard-to-heal-skin, gum or urinary tract infections
- Tingling or numbness in hands or feet
- Itching skin and genitals
Who is at Risk for Diabetes?
Nearly 1 in every 20 North Americans had diabetes. Out of about 6 million diagnosed with diabetes, 1 million are Type I and 5 million are Type II. Another 5 million are Type II and have not yet been diagnosed.
High-risk categories include the following:
- People with diabetic relatives; an inherited genetic tendency seems to prevail.
- People who are overweight: excess weight increases susceptibility.
- People over 40: Type II Diabetes is prevalent after 40
Treatment of Diabetes
Treatment of diabetes aims to do what a normal body does naturally, ie. maintain a proper balance of insulin and glucose.
- Complications from diabetes include blindness, kidney failure, nerve damage, gangrene, amputation of feet and toes, heart disease and stroke.
- Diabetes is the leading cause of new adult blindness among 20 –74 hears of age.
- About 60 to 70% of people with diabetes have mild to severe nerve damage.
- People with diabetes are 2 to 4 times more likely to have heart and vascular disease than people without diabetes.
- Gangrene, due to diabetic complications, is the leading cause for amputation of the lower extremities.
- One third of all dialysis patients have diabetes-caused kidney failure and the death rate from kidney disease is 500 times higher in young adults with diabetes.
- The death rate among infants born to mothers with diabetes is 203 times as high as for women without diabetes.
- With its complications, Diabetes is the leading cause of death by disease in North America. Diabetes is a chromic, complicated and destructive disease.
Diabetes and the Workplace
- Diabetes and its complications costs the Canadian economy more than $3 billion each year in health care, absenteeism and lost productivity.
- People with diabetes have an absenteeism rate 2 to 3 times higher than the general population.
- Approximately 72% of those with juvenile diabetes are in the workplace.
- Approximately 58% of those with mature onset diabetes are in the workplace.
Hope for the Future
There is increasing hope that diabetes and its problems can be cured. Significant progress has been made. Funding has been involved in all of these areas:
- Transplanting insulin-producing cells and pancreases into human subjects
- Understanding how the body’s own immune system destroys insulin-producing cells
- Identifying the genes involved in diabetes to define who is at risk
- Establishing how viruses may work as a “trigger” mechanism on diabetes
- Improving laser techniques to treat eye problems
- Developing insulin pumps and other experimental insulin-delivery systems
- Developing new ways to monitor blood glucose
- Developing drugs that may reduce diabetic complications
Source: This information was made available through the Canadian Diabetes Association.