A.L.S: Amyotrophic Lateral Sclerosis

So you wake up and start doing your #socialmediacrawl while lying in bed. Then you notice a Facebook or Instagram notification about a post you have been tagged in and you realize your time has finally come. You've been nominated for the ALS Ice Bucket Challenge.

    

The ALS Ice Bucket Challenge is a viral charitable act that hit social media in August 2014. Participants are expected to dump a bucket of ice water on themselves and/or donate money towards ALS research. The acute shock of cold as the water hits your body is in theory supposed to mimic some neurological symptoms people with ALS may feel.The challenge has quickly taken social media by storm with several celebrities and politicians taking part.

What exactly is ALS and why is awareness needed? Here's the scoop: 
Amyotrophic (without muscle nourishment/growth) Lateral (nerves and muscles affecting the peripheral body parts- i.e arms, legs) Sclerosis (hardening ), commonly known as Lou Gehrig disease is a neurodegenerative disease which causes muscle degradation and paralysis. It is the most common motor neuron disease and usually presents between the ages of 40-60 years.There is a predominance with the Caucasian race however all races and ethnicities are affected, with more cases occurring in men than women.

Disease occurs when upper and lower motor neurons in the brain and spinal cord begin to dysfunction and are no longer able to send signals to muscles. Muscles are unable to move appropriately, creating atrophy (muscle wasting).

Patients often times initially present with a complaint of muscle weakness. There are three classifications of onset:

• Limb Onset- Symptoms include dropping things out of hands, increased clumsiness,tripping and awkward walking. Signs may be focused to one limb or several limbs.
•  Bulbar Onset- Changes in speech (slurring or quieter voice) and/or difficulty swallowing.
• Respiratory Onset- The muscles which assist with breathing become weak and patients present with difficulty breathing.

These varying symptoms are generalized into the Three D's

Dysarthria- difficult speaking
Dysphagia- difficulty swallowing
Dyspnea- difficulty breathing

Other common symptoms include hyperreflexia, spasticity and fasciculations (involuntary movements of muscles), and muscle cramps.  Some individuals will develop bulbar weakness (weakness of the cranial nerves affecting facial, eye, and mouth movement). 50% of people with ALS will also develop cognitive impairment (memory loss, behavioral changes). Voluntary eye movements are usually the last function to be lost and may often times be used as a way for communication.

 Most patients become wheelchair bound due to loss of function of lower extremities. They also need breathing support including respirators and other breathing mechanisms (non-invasive ventilation) due to loss of function of muscles. Esophageal movement is usually also lost and patients eventually must be fed percutaneously (directly through the stomach). 

 Death usually occurs 3-5 years after symptom onset but there are cases of people living for over 10 years. The majority of  individuals will ultimately succumb to respiratory failure or infection.
 
Management for ALS is largely supportive and includes using medications to relieve symptoms and improve quality of life. Aggressive physical, occupational, and speech therapy is also necessary. Riluzole is the only FDA approved medication that offers possible delay in progression, if only for a few months. However it does not provide physical improvement.

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Currently there is not a specific test that can diagnose ALS. Various laboratory testing and imaging must be done to exclude other causes of ALS symptoms first. Other possible causes include brain tumor, muscular injury, HIV, syphilis, and demyelinating disorders.

The process of developing ALS may be multi factorial (genetic and environmental). Many speculations regarding environmental causes include head trauma, diet, and neurotransmitter dysfunction.Several hereditary gene mutations have been identified in families with ALS in multiple members. The most frequent of these mutations has been identified as SOD1 (superoxide dismuatse) on chromosome 21. More information on this gene can be found at The National Institutes for Health Website.


Active research is still being done to find new treatments and a viable cure for ALS. This is where the Ice Bucket Challenge comes in. Monetary funds help with research, public policy and advocacy, and care resources.


More information on local resources and how you can help can be found at  ALS Association
Check out Star Wars' beloved R2D2 risking his life in the Ice Bucket Challenge

                    

Psoriasis

Psoriasis is the most common autoimmune disease in the US, affecting approximately 7.5 million Americans.   It is caused by rapid growth of the cells which make up the top layer of skin, the epidermis. This leads to a constant turnover of cells which creates thick, flaky skin. This chronic genetic condition tends to go away then reoccur (relapse/remit).
The classic look of psoriasis is a red, raised and inflamed patch of skin with silvery linings within. These patches will sometimes bleed upon scratching. Psoriasis is not contagious and is not caused by an infection.

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 Common areas of involvement include the scalp, elbows, behind the ears, gluteul cleft, and around the umbilicus (belly button). Nails can also be affected, growing abnormally and become dysfigured.

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There are numerous speculations as to what causes skin cells to grow and overturn so quickly in psoriasis, however a precise cause has yet to be found. For the most part, psoriasis can be controlled with various treatments, but certain "triggers" may cause a flare. Triggers include personal stress, changes in environment/weather, medication,obesity, and smoking.

Psoriasis can also involve the joints, called psoriatic arthritis. This usually involves multiple joint most often in the fingers and toes. There may also be finger swelling (dactylitis) and inflammation of tendons (tenosynovitis). Psoriatic skin changes usually occur prior to joint involvement, and approximately 30% of people with psoriasis will develop some type on joint involvement.



Psoriasis affects all races and men and women are equally affected. Though not completely understood,it increases an individuals risk of stroke, diabetes, heart disease, and depression.

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Many people often get confused between psoriasis and eczema.Eczema is usually concentrated in areas like behind the knees and in front of elbows. It is often times associated with allergies and asthma.  Eczema skin patches are not as raised as psoriasis plaques and do and not easily bleed when scratched. 

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Though there is no cure for psoriasis, there are treatments which can lessen its severity. These include but are not limited to

•  Biologic Agents- medicines that are given through intravenous infusion
• Topical Steroids- placed on the plaques, these will decrease the inflammation and severity of plaques
• Systemic Treatment- taken either by mouth or via injection, these are used to suppress the immune system
• Phototherapy- involves exposing the affected skin to UV light in the hopes that it will slow the rapid growth of the skin cells.

Your doctor may help you decide which treatment is most appropriate based on the severity of your condition, how many/how large your plaques are, and if you have any other medical conditions that may be affected by treatment. Skin may become resistant to treatment over time so combination therapies (multiple types at once) may have to be used.

There have been a number of alternative/homeopathic remedies that several people with psoriasis claim have helped aleve their discomfort. This includes aloe vera, fish oils, and hydrotherapy. Though there is no scientific research identifying these as plausible therapies, if they help reduce signs and symptoms they can be used with caution. Prior to starting these regimens, consult a physician to go over their pros and cons.

If you are still unsure as to whether or not you have psoriasis or another skin condition, its best to seek medical advice.

For more information on psoriasis visit The National Psoriasis Foundation