ALS – The Principal Objective of the Ice Bucket Challenge

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Behind the current entertaining challenge, which encourages the masses to dump ice cold water over their heads, is the devastating illness ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig’s Disease, after the famous baseball player who was afflicted with and ultimately succumbed to the disorder. It’s a progressive condition that begins with muscle weakness and rapidly evolves into a major disabling disorder. In addition to this, it carries a high mortality rate with an average survival of 3-5 years after initial diagnosis. In the U.S., 7,000 new cases are diagnosed every year and, unfortunately, scientists have yet to decipher the cause of the sickness. The Ice Bucket Challenge has provided a fun way of bringing attention to and creating awareness for ALS, but we shouldn’t forget that the serious disease for which the campaign was created is in considerable need of financial support; a necessary step for the continuation of essential research.
ALS is a degenerative disease of the nervous system responsible for the active decomposition and death of motor neurons (nerve cells that carry the signal from the spinal cord to the muscles, resulting in the manifestation of movement). When these cells collapse, the signaling process becomes aberrant and the muscles are unable to receive proper instruction on how to accomplish movement. Scientists have suggested that abnormalities in the mitochondria and DNA might play a role in ALS and, to date, the only confirmed risk factors are genetic predisposition and advanced age. The classic clinical presentation of patients with ALS includes: lack of coordination, loss of balance, development of a slow pace, weakness of the arms and legs, difficulty with speech and swallowing, poor cognition, and weakness of the diaphragm muscle which results in respiratory failure [the most common cause of death]. The diagnosis of ALS is mostly clinical and is based on a set of objective exam criteria. Additional testing may include electro-diagnostic studies (e.g. nerve conduction study) which can measure the capacity of a nerve to transmit signals. The treatment of ALS is mostly assistive, as there is no cure for this disease and therapy is geared toward improving the patient’s symptoms. This is generally accomplished by a specialized medical team that can provide physical, occupational, and respiratory therapy.
Lou Gehrig, ironically nicknamed the “Iron Horse” due to his durability and remarkable consecutive games streak, had a dramatic deterioration in speed and coordination in the year 1939. It was that year, at the all-too-young age of 36, when he was diagnosed with ALS. His wife was told that the cause of ALS was unknown and that despite the fact that it was a painless and non-contagious disease, it was a cruel condition characterized by the destruction of the motor nervous system. Maddeningly, not much has changed in 75 years as we have yet to find a finite cause or a cure. The Ice Bucket Challenge marketing campaign, however, has revived an interest in Lou Gehrig’s Disease. Research cannot be conducted without appropriate financial backing, therefore, whether you want to dump ice on yourself or not, you must remember that monetary contributions are the most effective way for the average person to make a difference in overcoming this aggressive and debilitating disease.

Suicide – When Mental Illness Trumps the Spirit

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We have all been struck by the tragic loss of Robin Williams, an esteemed actor who lost his life by way of suicide. In the aftermath, the public has been engrossed in the following question: how is it that such a successful individual could end up taking his own life? Unfortunately, for those of us familiar with the mentally ill, this is not a surprising or infrequent scenario, given that psychiatric illness has the ability to override a patient’s overall resolve. Suicide is a desperate measure by those burdened with severe mental illness and, contrary to popular commentary, it is not a selfish act. There are 50,000 suicide attempts in the U.S. every year and although it may seem an impenetrable event, it isn’t. If we teach the public to recognize the common risk factors that lead to suicide, they might be able to further identify an individual at risk and spur them to seek medical attention. More importantly, we must remove the stigma attached to mental illness and start taking responsibility for those around us, as this is the only effective approach that will result in the reduction of deaths by suicide.
Researchers have found a number of critical risk factors that predispose patients to suicide and, not surprisingly, psychiatric disease is at the top of the list. More than 90% of patients who have attempted suicide suffer from a psychiatric disorder; and the higher the severity of illness, the higher the risk. The most commonly encountered diseases include depression, bipolar disorder, schizophrenia, PTSD, alcoholism, and any other substance abuse disorder. Other significant determinants include being of male gender, being unmarried, suffering from a chronic illness, and having a history of childhood abuse. Of note, patients approaching the anniversary of a lost loved one or those who have had prior suicide attempts are also at great risk. Interestingly, data shows that the most critical protective factor for the prevention of suicide is having abundant social support and family connectedness. A psychiatrist will evaluate a patient at risk and if there is significant concern, the doctor will admit the patient to a psychiatric facility for further therapy.
The public may sometimes feel weary about asking someone if they are feeling suicidal because they are afraid that talking about the subject matter might lead an individual to commit the act. Studies have shown that this question has the opposite effect and patients are more likely to pursue aid when asked about their feelings. Kevin Hines, a patient who actually survived his suicide attempt, states that while sobbing for 40 minutes while standing on the Golden Gate Bridge, a tourist came by and asked him to take a picture. She never asked him why he was crying and he soon realized that nobody really cared; he took the picture and later proceeded to jump off the bridge. The moral of the story is that family, friends, and even strangers matter. Take the time to connect and listen to those around you, as you might detect something that nobody else will. This has been proven to be the most crucial intervention that can make the difference between living and dying.

Gonorrhea – Fun Acquisition; Frightening Side-Effects

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While attempting to urinate, a 21 year-old male notices that he is expelling a white discharge instead of urine; he quickly googles his symptoms and finds out that he might have the sexually transmitted disease: gonorrhea. There are approximately 800,000 new cases of gonorrhea in the U.S. every year, a conservative estimate as there many others who contract this condition who remain undetected. It is one of the most common sexually transmitted diseases, predominantly affecting those in the 15-24 year-old category. Unbeknownst to many, gonorrhea is not isolated to the genital region and it has the capacity to reach a multitude of organs within the human body. The real endangerment is that despite the fact that classic symptomatic gonorrhea presents with a thick white discharge, there are numerous patients who never manifest symptoms, posing an infectious disease threat as they continue to spread disease without ever knowing that they were carriers to begin with. Therefore, it is critical for the public to familiarize themselves with gonorrhea, its respective transfer, and complications; in this way, patients can undergo prompt diagnosis and treatment if affected, and receive proper instruction on disease prevention.
Gonorrhea is an infection caused by the Neisseria Gonorrhoeae bacteria, a microorganism that has the ability to easily attach to any mucosa (moist tissue that lines certain parts of the inside of the body); and once it adheres to the human cells, it can subsequently invade the specified organ. Gonorrhea is notorious for its infection of the genital organs in both genders but it is also able to infect other regions such as the pharynx (throat) and rectum. The transmission of bacteria occurs via sexual intercourse [including oral and anal intercourse], given that through these areas bacteria gain rapid access to the mucosal tissue. The classic manifestation of symptomatic gonorrhea consists of purulent discharge from the vaginal region or penis, burning with urination, testicular pain, and abdominal pain. Furthermore, although infection of the pharynx only causes a sore throat, disease in the rectum presents with pain and irritating discharge. In rare cases, gonorrhea has the ability to invade the bloodstream and cause serious infections in organs such as the brain. Fortunately, the diagnosis can be made by obtaining a culture of the vaginal or penile area or through a urine test. Gonorrhea is easily treated with antibiotics and when these are taken appropriately, they completely eradicate the infection.
Patients who are at high risk for gonorrheal infections include: HIV infected patients, individuals with new or multiple sexual partners, sexually active homosexual men, and those with a history of other sexually transmitted diseases. In these cases, routine screening should be conducted irrespective of the presence or absence of symptoms. Even if gonorrhea is isolated to the genital organs, if left untreated, it has the ability to cause serious and devastating complications. For instance, females with untreated disease can develop scarring of their pelvic organs, infertility, and Fitz-Hugh Curtis syndrome (a condition whereby pelvic disease may cause scarring of the liver). As with any other disease, prevention is the ideal scenario, therefore, using prophylactics, practicing mutual monogamy, or abstinence, will save you and others from an unpleasant experience.

Ebola – Fear It…If You Have a Reason To

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In 1995, Hollywood released the movie Outbreak, a film about a fictional Ebola-like virus that was responsible for numerous deaths in the country of Zaire. One of the most frightening details within the film’s plot was the notion that the virus was extremely contagious. Well, sorry to say that this Hollywood depiction is not as far from the truth as one would hope; it’s actually based on real data regarding the Ebola virus. Ebola’s current outbreak in West Africa is the largest the world has ever seen and, as has been reported vociferously, among those infected are two Americans who had been working in Liberia [both are being brought to the U.S. for specialized medical treatment]. The two Americans have been safely placed in isolation and consequently, disease dissemination is no longer a concern. However, the uncertainty remains for those who continue to travel internationally; therefore, avoiding countries where Ebola is endemic is fiercely recommended. Ebola is a virus that belongs to the filoviridae family (filamentous-structured virus) – a class of viruses discovered when a group of vaccine workers in Germany became ill after working with infected monkeys brought from Uganda. Ebola can either be transmitted from an infected primate to a human or from person-to-person through the direct contact of bodily fluids (such as blood, vomitus, urine, feces, and even sweat). When Ebola enters the human body, it targets the macrophages (white blood cells that combat foreign material) and begins to replicate within these cells. Subsequently, the macrophage cell ruptures and the virus is released into the rest of the body, resulting in a severe inflammatory response that precipitates hemorrhage and circulatory collapse. The time of acquisition of the virus to manifestation of disease is 5-7 days and the virus is only transmissible during the period of symptomatic physical illness. The typical clinical symptoms of Ebola are similar to those of any other viral illness, including: fevers, chills, headache, back pain, abdominal pain, vomiting, and diarrhea. The diagnosis is made with a combination of the patient’s clinical history and a specialized antibody test. There is no cure for Ebola and vaccines have yet to be developed. Therefore, the treatment is symptomatic, but it may include blood transfusions and experimental drugs. Even though Ebola is one of the most dangerous microorganisms to human kind (conferring a 90% death rate), its death toll continues to be statistically low when compared to diseases such as AIDS and malaria. The two Americans with Ebola will be situated in a highly specialized hospital unit and, therefore, it’s highly unlikely that the virus will spread to the general public. Moreover, even in the improbable scenario whereby the virus might be transmitted to another individual within the U.S., it would not be expected to cause the same degree of harm as it has in Africa, given that our infection control practices would avert such an epidemic. Accordingly, the U.S. public should not be overwhelmed with concern about Ebola. The only people who should be on high alert are those who have recently traveled to Africa. If those travelers develop symptoms of a fevered illness, they will immediately require an evaluation for Ebola.

Probiotics – Proactive or Profligate?

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Consumers are always on the lookout for new products that will allow them to enjoy a healthier lifespan, and the market has responded to this demand by providing an abundance of ‘innovations’ that promise to do just that.  One such invention is probiotics, an artificial term applied to a line of healthy bacteria that pledges an improvement in human health.  The 32 billion dollar probiotics industry offers their product in a variety of forms; some are available in yogurt formulations and others are simply found in a tablet form.  To date, these products are labeled as supplements and not medications because they do not require FDA approval, meaning they have not undergone the rigorous scrutiny which would normally advise the public of the precise contents within each product.  As a result, physicians cannot make any formal recommendations as to which probiotics, if any, are effective.   Notwithstanding the lack of regulatory oversight, the real question at hand remains: do probiotics work?

The moniker “probiotics” represents bacterial microorganisms that have beneficial effects for the human host.  However, in order to comprehend this symbiotic relationship, one must understand the biological interaction in the intestinal tract.  There are trillions of types of microorganisms in the gastrointestinal tract, which have a variety of functions that include: the fermentation of unused energy, prevention of harmful bacterial growth, regulation of the biological processes in the gut, production of vitamins and hormones, and the maintenance of proper immunity.  Years ago, scientists conducted tests to analyze the effects of deliberately manipulating the microorganisms in the gastrointestinal system, and these investigative efforts led to the development of a variety of targeted medical treatments for disorders involving the immune system and gastrointestinal tract.  They also discovered that there are many different types of what we now refer to as probiotics; the most commonly recognized commercial forms include VSL#3, Culturelle, Danactive, and Florastor.  Studies have shown that probiotics can improve our health by limiting the entry of harmful bacteria along with strengthening our immune system by suppressing the action of destructive inflammatory cells.  In addition, probiotics have also been found to deliver analgesic effects.  Not surprisingly, most of the published research involves diseases of the intestinal tract (e.g. ulcerative colitis and Crohn’s) and for the affected population, probiotics have been found to decrease disease exacerbations.

Each probiotic supplement has a unique arrangement of microorganisms and, as a result, they each embody individual properties and effects.  Therefore, particular characteristics need to be reviewed before deciding on a specific probiotic supplement.  If probiotics are recommended for a medical disease, they should be taken under the direction and supervision of a physician.  Exciting new research promises to deliver more concrete data on the effects of probiotics but the current reality is that the scientific evidence on the subject matter remains scarce.  Furthermore, despite the fact that probiotics are generally safe, larger clinical trials need to be conducted before any efficacy claims can be made.  And so, if you are on a quest to improve your health and wellness, investing in a well-rounded diet and exercise program will ensure a cost-effective approach and won’t have you spending repeated monetary sums on supplements that may or may not work for you.

Alcohol Dependency – The Need, The Want is Everywhere but Nary a Drop to Drink!

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Consumption of alcoholic beverages is considered a customary social practice in many countries including our own, with 66% percent of Americans admitting to occasional alcohol use.  Yet, trying to decipher why so many of those occasional drinkers become alcohol dependent is a more complicated equation.  Currently, a mind-boggling 1 in 12 adults in the U.S. suffer from alcohol addiction, a number that does not come as a surprise considering that alcohol is the most commonly used addictive drug.  To make matters worse, patients who attempt to quit alcohol use fail in the majority of cases due to the unbearable and life-threatening withdrawal effects.  Alcohol is no different than any other addictive drug (legal or illegal) and, as a result, everyone is subject to its dependent properties and withdrawal symptoms.  Therefore, for those who want to end the addictive cycle, the first – and most important – step is to recognize that they have become dependent and subsequently to acknowledge the need for professional medical assistance.

Alcohol is a substance that affects the GABA (gamma-aminobutyric acid) receptors in the brain, which are known for their inhibitory effects in the central nervous system.  The typical GABA effects include: sedation, amnesia, hypnosis, relaxation, and euphoria.  Patients who drink alcohol regularly will manifest the aforementioned effects but when they abruptly quit, the central nervous system goes into a hyperactive mode in which there is a reversal of the normal GABA effects.  The alcohol withdrawal symptoms can be noted as early as 6 hours from alcohol cessation.  The classic minor withdrawal signs include: insomnia, shivers, anxiety, anorexia, headache, profuse sweating, and palpitations.  Alternatively, in moderate to severe withdrawal, patients develop seizures and delirium tremens, a condition whereby patients develop hallucinations, disorientation, fever, and agitation.  Patients with delirium tremens, the most extreme form of withdrawal, manifest symptoms within 48 to 96 hours from the last drink and can continue in this state for about one week.  The treatment for withdrawal symptoms includes medications in the benzodiazepine class (e.g. lorazepam), which are drugs that exert their activity on the GABA receptor.  These medications ameliorate the symptoms and return the body to a balanced state.  Patients will also need replenishment of their electrolytes and significant hydration.

Studies have shown that even just one week of excessive drinking can lead to withdrawal, which could culminate in alcohol dependency.  Furthermore, if patients enter into an extreme withdrawal state, their risk of death significantly increases.  A variety of risk factors for alcohol abuse have been delineated; patients who should be extra cautious are those with a family history of alcohol abuse and those with psychiatric disorders because they tend to have a predisposition for dependency.  Once a patient recognizes that they have alcohol dependency, they must seek medical treatment through their primary care physician or the emergency room.  Not everyone needs to be in a hospital setting, and outpatient therapy is a valid and effective option with a 90% success rate.  Getting professional help is the only realistic way to keep patients healthy and sober because without medical treatment, most patients end up grabbing another bottle of booze just to remain physically collected.

Vertigo – A Virtual Volatile Whirl of the Mind

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Spinning around as fast as possible until one feels too dizzy to stand up straight is one of the most amusing activities commonly practiced by children; and they engage in this merriment because the spinning action creates a false sensation of movement known as vertigo.  But for the 69 million adult Americans who suffer from this disorder, experiencing the sudden onset of unprovoked vertigo is not as much fun.  Patients with vertigo have a hard time carrying out simple tasks given that they feel as if they are constantly traveling on a ship being tossed about in the open ocean.  Despite the fact that vertigo can be an extremely uncomfortable scenario, it is generally due to a benign cause such as disequilibrium in the ear canal [although in older patients, vertigo might signify an ominous sign related to cerebrovascular disease].  The good news is that for the majority of cases of vertigo, simple and effective treatment is available.

Vertigo can be perceived as self-motion versus motion of the actual environment, and in order to understand vertigo one must first comprehend how balance is coordinated in the human body.  The two systems involved are the vestibular system (structures in the ear that sense angular and linear motion) and the brain.  The vestibular system on the right and left sides exist in perfect harmony; however, when the head turns one way or the other the brain reads the inner nerve signals and is able to interpret that to mean the body is leaning in a specific direction.  Yet, when there are abnormalities within the vestibular system itself (making it unbalanced at its baseline state) and patients proceed to physically move their head, the brain receives too many signals resulting in vertigo.  In addition to the spinning sensation, patients with vertigo also experience significant nausea and vomiting.  The most common causes for vertigo include stones (calcification of fluid, like gall or kidney stones) in the ear canals, inflammation of the canal due to viruses and bacteria, excess fluid in the ear canal, medication toxicity, or a tumor.  In older patients with known risk factors for cardiovascular disease, vertigo could be caused by a brainstem (area of the brain where balance processing occurs) stroke.  The diagnosis of vertigo is mostly clinical, with the exception of tumors and strokes which require an imaging modality such as an MRI.  The treatment encompasses medications (e.g. meclizine) which suppress the vestibular symptoms.  In addition to this, certain physical maneuvers can be conducted to ameliorate the symptoms.

For patients who develop new onset vertigo, a visit to a primary care doctor might do the trick.  In a preponderance of cases, vertigo is a short-lived condition that can be readily treated with medications.  On the other hand, if patients have refractory symptoms they might need to undergo vestibular rehabilitation (physical therapy).  Lastly, for the patients who suffer from intermittent benign vertigo, all that is needed is to stop by the nearest pharmacy and purchase the available over-the-counter medications.  Whatever the case, taking action at the first sign of symptoms will promote quick relief and ensure that things don’t spin out of control.

Tetanus – Your Shot Not to Get Locked-Up!

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Is your tetanus shot up to date?  If this question rings a bell it’s because this is one of the most frequently asked questions in the emergency room, which is generally brought up in the instance of a patient who has an open wound or animal bite.  Even though patients are familiar with the term “tetanus,” they don’t really understand what tetanus is or why a tetanus shot matters (likely because tetanus is extremely rare in the U.S.).  Nevertheless, it is still important for the public to learn about the disease process and its respective control through vaccination. Tetanus is a severe nervous system disorder which commonly occurs in patients who never completed their vaccination sets or who did not keep up with the vaccines later in life.  Moreover, due to the fact that we cannot get rid of tetanus in the environment, vaccination remains the only treatment that confers full protection.

Tetanus is a neurological disorder caused by a toxin which is produced by the clostridium tetani bacteria.  These micro-organisms are normally found in the soil and in the guts of numerous mammals.  When the bacteria encounter damaged tissue (e.g. devitalized tissue from infections or open wounds from lacerations) they undergo a biological reaction and produce the tetanus toxin.  The toxin ascends into the spinal cord and within 8 days patients demonstrate the clinical effects of the toxin.  The most common physical presentation includes a stiff neck, trismus (i.e. lockjaw), risus sardonicus (severe painful spasm of the facial muscles appearing like a grin), abdominal rigidity, painful swallowing, and airway obstruction.  Additionally, patients will also develop restlessness, rapid heart rate, profuse sweating, elevated blood pressure, and cardiac arrhythmias.  The diagnosis is based on clinical history and a physical examination.  Once a patient contracts tetanus, they must undergo extensive treatment, which includes: debridement of the wounds; antibiotic therapy [although this is minimally effective once the disease is present]; and immunoglobulins (a.k.a. antibodies) to neutralize the toxin.  Furthermore, patients will also need to receive the full vaccination series because, as opposed to other disease processes, having tetanus once does not protect you from future infections.

Tetanus is a serious disorder with potentially devastating effects.  As a result, even after patients receive the full vaccination series as a child, they should make sure their vaccinations remain updated through adulthood.  The Centers for Disease Control and Prevention (CDC) recommend a routine tetanus booster every ten years and active immunization with antibodies should be given to those with high risk wounds such as burns and contaminated lacerations.  Aside from this, there are certain high risk populations that continue to be susceptible to tetanus and these include intravenous drug users, immigrants, patients who live in rural areas, and the elderly.  Unfortunately, immunization to tetanus in the U.S. continues to decline and even though we are lucky enough to still have a low disease occurrence, this might not always be the case.  If adults don’t keep up with their vaccinations, the prevalence of disease will rise.  A simple visit to your primary care doctor and a quick shot on your arm is all that’s necessary to keep your head straight and your neck clean!

Achilles Tendon Rupture – The Athlete’s Achilles’ Heel

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Here’s the scenario: while playing softball with his friends, a 40 year-old male recreational athlete running to home base suddenly develops a severe pain on the back of his calf and subsequently falls to the ground in agony – this is the classic case of an Achilles tendon rupture: an extremely painful condition whereby the Achilles tendon snaps.  Even though this particular example pertains to a recreational athlete, this condition is also often witnessed in competitive athletes as well as in anyone who might suffer from tendon degeneration.  An Achilles tendon rupture is a serious injury that entails a prolonged recovery course; however, the overall treatment for this condition is excellent.  Most patients experience a full recovery and can eventually resume all types of exercise activities.  Of course, not having to experience this condition is what everyone wants so taking the time to learn and practice preventative measures might save you a trip to the operating room.

The Achilles tendon (so called because of the Greek warrior Achilles’ vulnerability in this very spot) is the largest tendon in the body and connects the heel to the soleus and gastrocnemius muscles (both in the calf region).  Due to its anatomical location, this tendon has a limited blood supply, resulting in the formation of a vulnerable area which is prone to injury.  Movements that involve running, jumping, overuse, and sudden acceleration or deceleration predispose patients to tendon injury.  The most commonly witnessed scenario generally involves a patient who abruptly changes their physical activity (e.g. rarely exercising to an intense workout or an athlete boosting a fitness activity).  Patients with this condition report that when the Achilles ruptures they feel as if someone else had physically kicked them on the back of the ankle; they also describe a pop-like sound.  The diagnosis can be made on physical examination but most patients undergo an MRI for confirmation.  Once the rupture is diagnosed, patients will have their leg splinted and will undergo evaluation by an orthopedic surgeon.  Patients then have two therapeutic options: conservative management, where they get a cast and intense rehabilitation; or surgical treatment.  Although there are risks and benefits associated with either option, what has been consistently reported is that patients who undergo surgery have a smaller risk of re-rupturing the tendon.

Some of the risk factors associated with tendon rupture include:  age, which is a significant determinant because as age increases, blood flow decreases, resulting in an inflamed and weakened tendon; medications, such as the fluoroquinolone class of antibiotics (commonly used to treat pneumonia and urinary infections); and the use of oral steroids.  Additionally, several poor training techniques such as flawed running mechanics and improper footwear can also lead to damage.  As a result, anyone who engages in physical activity (with the exception of elite athletes, who follow specialized training regimens) should engage in the following: dynamic warm-up, post-running stretching, running on soft surfaces, limiting mileage to 40 miles per week, usage of proper foot wear, and strength training of the calf muscles.  Implementing these simple changes into your routine workout will protect your tendons and ensure that you never have to hear the ‘pop’!