Medical Aspects of MS, Back Injury and Hepatitis C

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Medical Aspects of MS, Back Injury and Hepatitis C

• Matthew E. Markve
• Region VIII RCEP

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Learning Objectives

• Learning Objective 1 A higher understanding of
  the physiological implications of the three main
  topic, including discussion of mechanism of
  injury, structure and function, and physical,
  psychological and behavioral effects where
  applicable.
• Learning Objective 2 Discussion of a number of
  vocational issues involving ideas for job
  development skills and contemporary research
  (practical implications of research)
• Learning Objective 3 Participants will join in
  the instruction. Your input is a valuable
  resource, rather than viewing the training
  relationship in the traditional
  instructor/student roles, adult learning models
  prefer the term leader rather than instructor. We
  are all instructors here and your combined years
  of experience will be viewed as a valuable
  resource.

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Myelin

• The soft, white, partially fatty material which
  makes up the sheath surrounding a nerve axon. It
  insulates the axons and enables signals to be
  conducted along them at a faster rate. In people
  with multiple sclerosis, the myelin becomes
  damaged or destroyed, and the impulse
  transmission is impaired.
• -brainexplorer.org

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Multiple Sclerosis

• Myelin around the neurons are destroyed
• Affects young adults between 20 and 40
• 2x as common among females over males
• 60 cases per 100,000
• Cause is unknown

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Multiple Sclerosis

• Progressive Disease of the Central Nervous
  System
  
• Mechanism of Injury Unknown
• Speculation that it is a virus
• Allergic reaction
• Toxin
• Vitamin D

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Clinical Subtypes

• Relapse-remitting
• Secondary Progressive
• Primary Progressive
• Progressive relapsing
• Subtypes are not constant, an individual may
  change status at any time
  
• -US National MS Society

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Remylination

• The body cannot completely rebuild a destroyed
  myelin sheath
  
• The brain does, however, recruit stem cells which
  migrate from unknown regions of the brain
  
• These new cells differentiate and partially
  rebuild sheath
  
• Not as effective as original sheath
• Repeated attacks less effective remylination
• http//en.wikipedia.org/wiki/Multiple_sclerosis

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Effects

• Portion of brain or spinal cord involved
  determines the symptoms experienced
  
• Websites of progressive history
• Initial symptoms vague
• Parethesia
• Extremity weakness
• Visual disturbances

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Course of the Condition and Symptoms

• Symptoms vary from case to case
• Exacerbations followed by remissions
• Progressive disease (progression varies)
• 5-15 years from onset to continuous disability

• Cognitive problems
• Dizziness
• Fatigue
• Spasticity/ Gait problems
• Weakness
• Pain
• Numbness
• Bladder/Bowel dys

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Symptoms

• Paralysis
• Dysphagia (difficulty swallowing)
• Incontinence/retention
• Impotence/genital numbness
• Cognitive changes
• Depression
• Falvo, Medical and Psychosocial Aspects of
  Chronic Illness and Disability
  

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Psychosocial Issues

• Diagnostic relief
• Lifestyle changes
• Long-term Planning
• Misunderstood fatigue
• Bladder problems
• Alcohol
• http//www.lifewithms.com/
• -Falvo 1999

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MS Treatment Rehabilitation

• Drug Tx during exacerbations- corticosteroids
• Physical therapy
• Cognitive therapy
• Speech therapy
• Vocational rehabilitation

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Vocational Impact/Job Development

• Participation
• Based on variability/severity
• Stress
• Fatigue factor
• Temperature/Environmental factors
• Increased susceptibility to complications

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Recent Research in MS

• Hopeful period following completion of the Human
  Genome Project
  
• Numerous Articles into Treatment Effectiveness
• Research continues into cause

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Back Injury

• Variety of causes
• Number of symptoms
• Psychogenic pain
• Importance of establishing cause

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www.yourneighborhooddoctor.com/back-anatomy.html
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Types of Back Pain

• Mild
• Moderate
• Severe
• Static Pain
• Non-moving spine
• Kinetic Pain
• During movement
• Lordosis caused by inadequate posture (swayback
  position)

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Types of Back Pain

• Low Back Pain
• Spondylolysis
• Spondylolisthesis
• Genetics
• Overuse
• -Orthoinfo.aaos.org

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Spondylolysis/Spondylolisthesis-American Academy
of Orthopaedic Surgeons
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Sciatica

• Syndrome of pain that radiates from the lower
  back into the hip and down the leg
  
• Typical onset 30-50 years old
• Numbness
• Tingling
• Muscle weakness
• Can accompany a number of disorders of the lower
  back
  
• Herniated disk most common
• Falvo/AAOOS

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Herniated or Ruptured Disk

• Rupture of the soft inner area of the disk
  between the vertebrae
  
• Caused by sprain or strain of the back, or
  disease
  
• Back pain
• Back spasms
• Loss of sensation/weakness
• Bowel/blader issues

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Scoliosis

• Impacts 2 percent of people
• Risk 20 higher in families
• Usually develops in childhood but may occur in
  adults
  
• Severe back pain
• Deformity
• Difficulty in breathing

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Treatment

• Acute
• Impair function from days to weeks
• Difficulty standing erect
• Preventative measures
• Caveat Drugs
• Chronic
• Persists for six months or more
• Long term therapy
• Profound consequences

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Hepatitis

• Categorized according to the cause (A/B/C)
• Hepatitis C (HCV) First discovered in 1989
• Contracted primarily through the transfusion of
  contaminated blood or blood products or from
  infected needles

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Hepatitis and Substance-Related Disorders

• Hepatitis is a common complication of drug abuse
• People who abuse substances are at a higher risk
  of hepatitis overall
  
• A poor hygiene habits and environmental
  conditions
  
• B Nonsterile or contaminated injections
• C Infected blood

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Impact of Hepatitis C

• Chronic Hepatitis
• Inflammation continues longer than 3 to 6 months
• Cirrhosis
• Viral Hepatitis
• Hepatoxins
• Anorexia, nausea, vomiting
• Fluid retention
• Hematemesis (Vomiting of blood)
• Hemorrhage, coma, death

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Hepatitis Mechanisms of Injury II

• In addition to the main two mechanisms of injury,
  Hepatitis C may also be transmitted through
  
• Acupuncture
• Tattooing
• Sharing razors
• Less than 5
• High risk sexual activity, maternal-fetal
  transmission
  
• -Hepatitis C Information Center

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Statistics on Hepatitis C

• 30,000-41,000 new infections in US annually
• Down from 242,000 Annually during the 1980s
• 8,000-10,000 deaths annually
• 1.8 of US population
• 3.9 million people infected
• 2.7 million have chronic infection
• -CDC

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http//hepatitis-central.com/hcv/image3lg.jpg
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Clinical Info

• Evolution of Hep C Therapy over last decade

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Side Effects of Treatment

• IFN
• Flu symptoms greater than 60
• Chronic fatigue, depression
• Symptoms intensify with increased duration of
  treatment
  
• Insomnia, rash, anorexia, neutropenia (decrease
  in white blood cells), thrombocytopenia (decrease
  in blood platelets), thyroid dysfunction
  
• Contraindicated with ongoing recent alcohol use
  or progressed liver disease
  
• -Hepatitis C Information Center

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Side Effects of Treatment

• Ribavirin
• Anemia
• Teratogenic effects possible
• Coughing
• Rash
• Insomnia
• Anorexia
• 20 can not tolerate this therapy

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HIV and HCV

• 30-50 of people with HIV also have HCV
• IV Drug Users in this category increase
  coinfection rate to 90

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Miscellaneous

• There are different types of HCV (1-6)
• Type 1 is the most difficult to treat and people
  with type 1 have the worst prognosis
  
• 75 of US infections are Type 1
• Types 1, 2 and 3 are predominately found in the
  US
  

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Hepatitis C

• Chronic vs. Acute Hepatitis C
• At risk for
• Chronic liver disease
• Cancer of the liver
• Early symptoms
• Anorexia
• Jaundice
• Itching of the skin

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Interferon
http//www.hepnet.com/hepc.html
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Vocational Impact

• Participation