Summary of End-of-Life Diseases

Summary of End-of-Life Diseases

Posted on: November 19, 2013

Excerpts below concerning end-stage diseases are taken from The Final Journey--Complete Hospice Care for the Terminally ill Vaishnavas (Torchlight Publishing)

 by Sangita Devi Dasi (Susan Pattinson, RN, CHPN) and other website sources. 

In Chapter 4 of The Final Journey, many diseases are discussed which, at their end-stage, are considered terminal and hospice-appropriate illnesses.  The following information is not meant to be all-inclusive. It is, however, meant to prompt further inquiry by the reader, if desired. (PLEASE NOTE: SINCE THE PUBLICATION OF THIS PAGE WE ARE ATTEMPTING TO ADD MORE PAGES AND DETAILS TO OUR “END-OF-LIFE DISEASES” SECTION OF OUR WEBSITE TO PROVIDE OUR READERS WITH MORE INFORMATION.) However, if you require even more assistance, kindly send your questions to “Contact Us” and we will have one of our many medical professionals on our Vaishnavas CARE Team  respond to your inquiry. Thank you. 

Sincerely,

Sangita Devi Dasi

(Susan Pattinson, RN, Hospice Educator)

President, Co-Founder

Vaishnavas CARE

Acquired Immune Deficiency Syndrome (AIDS)

Acquired Immune Deficiency Syndrome (AIDS) is a syndrome of opportunistic infectins that occur as the result of uncontrolled spread of the human immunodeficiency virus (HIV). When the virus is uncontrolled, these opportunistic diseases can invade every system of the body and eventually cause death. The Center for Disease Control and Prevention (CDC) first described the virus in 1981. HIV is spread by intimate sexual contact, contaminated needles or blood products, or from mother to child. Blood products are now routinely screened to prevent transmission of the virus through blood transfusions.

When contracted, HIV attaches itself to cells in the body, specifically the CD4 receptors of T-cells. T-cells are lymphocytes (white blood cells) that fight infection. HIV can infect other cells with CD4 receptors, as well. Once attached, the virus then enters the cells, infiltrates the ribonucleic acid (RNA), transfers its own deoxyribonucleic acid (DNA) to the cells, and prevents the cells from performing their normal function. With the transfer of its own DNA, the virus can then replicate. Diagnosis of HIV is determined by a simple blood test that detects antibodies that the body naturally develops to fight the virus. Antibodies to HIV can usually be detected approximately two to six weeks after exposure to the virus. Early symptoms may include a mild fever, muscular pain, joint pain, weight loss, and rash. Even when an HIV-infected person has no symptoms, he can still infect others and should be under the care of a physician.

Highly active antiretroviral agents (HAART), medications introduced in 1996 to fight HIV, have greatly reduced the number of opportunistic infections contracted by HIV-infected patients. Each type of drug works on a different part of the replication cycle of the virus. When taken in combination, they have proven to suppress viral replication for long periods of time. In a 1996 issue of the New England Journal of Medicine, it states, “The goal of antiretroviral therapy should be to reduce levels of circulating virus as much as possible, for as long as possible.” For those who have access to these medications and are able to follow a strict daily regime, the HIV infection has now become more of a chronic long-term disease.

It’s important to note, however, that these medications are not a cure for HIV or AIDS, and those undergoing this medication regime may still develop infections. They also have not been shown to eliminate the risk of passing HIV to others through sexual contact or blood contamination. Those who are undiagnosed, untreated, not properly treated, or those for whom antiretroviral therapy has failed are still at risk for developing many of the opportunistic infections long associated with AIDS. The development of these opportunistic infections, as well as the number of T4 cells in the body, signals the difference between being HIV-infected and having AIDS. Those patients who do not comply with their medication regime, those who do not have access to HAART, and those in third-world countries are at additional risk for developing AIDS.

Because one’s immune system is lowered with the presence of HIV infection, there are many opportunistic illnesses that can compromise the health of a person infected with HIV. Details about these infections can be found in The Final Journey.

Some infections include:

✦ Pneumocystis carinii pneumonia (PCP)

✦ Toxoplasmosis

✦ Mycobacterium Avium-Intracellular (MAI) Infection

✦ Herpes Simplex Virus

✦ Cytomegalovirus (CMV) Infection

✦ Candida Albicans Infection

✦ Progressive Multifocal Leukoencephalopathy (PML)

    Alzheimer’s Disease

Dementia causes problems with thinking, memory, and reasoning. It happens when the parts of the brain used for learning, memory, decision making, and language are damaged or diseased.

Also called major neurocognitive disorder, it’s not a disease itself. Instead, it’s a group of symptoms caused by other conditions.

Alzheimer’s disease is the most common cause of dementia. Between 60% to 80% of people with dementia have Alzheimer’s. But there are as many as 50 other causes of dementia.

The symptoms of dementia may improve with treatment. But many of the diseases that cause dementia aren’t curable.

Some causes of Dementia include: 

Degenerative neurological diseases. These include Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and some types of multiple sclerosis. These diseases get worse over time.Vascular disorders. These are disorders that affect the blood circulation in your brain. Traumatic brain injuries caused by car accidents, falls, concussions, etc. Infections of the central nervous system. These include meningitis, HIV, and Creutzfeldt-Jakob disease. Long-time alcohol or drug use Certain types of hydrocephalus, a buildup of fluid in the brain

In general, many people do not think of Alzheimer’s disease as a terminal illness, but in its final stages it is considered a hospice-appropriate disease. It is the most common cause of dementia (a progressive condition causing, among other things, intellectual impairment, memory loss, apathy, and speech disturbances), contributing to about 50% of all cases. Because it is progressive, prognosis is poor. Duration of the disease generally lasts from three to 20 years, with an average of approximately seven years from diagnosis to death. It is rarely seen in patients before 45 years of age.

Early signs of Alzheimer’s Disease may include the following:

1. Memory loss

This is the most common symptom. Do you easily forget information you just learned? Do you lose track of important dates, names, and events? Do you forget big things even happened? Do you ask for the same information over and over?

2. Trouble planning and problem solving

Do you have trouble making plans and sticking to them? Is it hard to concentrate on detailed tasks, especially if they involve numbers?

3. Daily tasks are a challenge

Even familiar things can become hard. Do you have trouble driving to a location you go to often? Can you complete an ordinary task at home or at work?

4. Times and places are confusing

Do you feel disoriented at times? Can you fully grasp something that’s not happening right now?  Do you get lost easily? Do you forget where you are? Do you remember how you got there?

5. Changes in vision

Is it harder to read the words on the page? Do you have trouble judging distance? Can you tell colors apart? This is important because it can affect your driving.

6. Words and conversations are frustrating

Vocabulary becomes hard. Can you find the right word you’re looking for? Or do you call things by the wrong name? Do you keep repeating yourself?

7. You lose things

Everyone misplaces things from time to time, but can you retrace your steps to find them again? Do you put things in unusual places, like your watch in the refrigerator? Do you accuse people of taking things?

8. Lapse in judgment

Have you made poor decisions lately? Do you make mistakes with money, like giving it away when you normally wouldn’t? Are you showering as often? Do you take less care of yourself? Do you dress for the wrong weather?

9. Social withdrawal Do you lack motivation? Do you find yourself sleeping more than usual?

10. Mood changes

Do you get upset more easily? Do you feel depressed, scared, or anxious? Are you suspicious of people?

Alzheimer’s disease causes irreversible damage to brain cells, causing early symptoms of short-term memory loss, forgetfulness, inability to concentrate, difficulty learning new information, and often, deterioration in personal hygiene. In its later stages, Alzheimer’s disease may cause deterioration of long-term memory and communication, including spoken and written language; repetitive actions; urinary and fecal incontinence; and personality changes, including extreme agitation that can lead to violent episodes. In its final stage, patients with Alzheimer’s disease often stop eating and drinking, leading to dehydration and starvation. They are also at high risk for infections, a major cause of death. Because of decreased mobility, many patients are at risk for decubitus ulcers (sometimes referred to as bed sores or pressure sores). Usually occurring over bony areas of the body, decubitus ulcers can begin with superficial skin maceration or become deep enough to expose muscle and even bone. Meticulous skin care as well as frequent repositioning of a patient with Alzheimer’s disease (at least every two hours around the clock) is essential to help avoid such ulcers.

Medications are available that can slow its progression in some patients who are in the early stages of the disease. However, the illness still remains irreversible.

Amyotrophic Lateral Sclerosis (ALS) 

Amyotrophic Lateral Sclerosis (ALS) was first written about in the late 1800’s, but became known as Lou Gehrig’s disease in 1939 when the famous New York Yankee showed great courage after being diagnosed with the illness. ALS is a neurological disease caused by the degeneration of upper and lower motor

neurons in a part of the brain called the medulla oblongata and the spinal cord. It leads to progressive muscular weakness and the inability to speak and, eventually, to swallow. The disease progresses rapidly in some patients and slowly in others. It often begins in the limbs with muscle weakness but can start with speech and swallowing difficulties. (You may  observe unusual drooling in the patient which would warrant a complete medical exam to determine the cause.) The incidence of onset is usually between the ages of 50 and 70. It is rare under the age of 30. ALS leads to quadriplegia (paralysis of all limbs) and to a loss of speech, swallowing, and eventually, the ability to breathe.

Patients with ALS usually remain mentally alert through their illness, since it does not affect intellect. Similarly, ALS does not affect eyesight, hearing, or bladder and bowel control. It can sometimes affect emotions, causing a patient to laugh or cry at inappropriate times. When the patient can no longer speak or move his limbs, communication becomes difficult. Boredom and loneliness are common. Communication devices such as a word board or picture board can be helpful. A caregiver points to a word or picture while the patient blinks his eyes to confirm. This system can be tedious, but effective.

Initial symptoms may include slurred speech, uncontrolled drooling, hand weakness, muscle twitching, poor balance when standing or walking causing frequent falls, and shortness of breath on exertion. Diagnosis is made after a physical examination, study of clinical symptoms, and exclusion of other possible causes for the symptoms. More invasive testing to confirm a diagnosis of ALS may include electromyography, blood tests, nerve conduction studies, muscle biopsy, and examination of cerebrospinal fluid.

Cancer

There are an estimated 200 different types of cancer. All forms of cancer involve the uncontrolled growth of abnormal cells derived from normal tissue. Even when discovered in its early stages, these cells may or may not spread. When they do spread, it is called metastasis. Unfortunately, many cancers remain silent, with few or no symptoms at first, so by the time they are discovered they may have already metastasized to other parts of the body. Benign tumors are not cancer. They can usually be removed and, in most cases, do not return. The cells in benign tumors do not spread and, therefore, are not life-threatening. On the other hand, malignant tumor cells are cancerous and can break away from the original tumor.

Normally, cells in the body grow, divide, and eventually die in a systematic order. As we reach adulthood,

this process slows and most cells divide only to restore worn-out cells or to repair injuries. Cancer cells continue to grow and divide, however, and when gathered together, form tumors that invade normal tissue. When cells break away from the original tumor, they can travel through the bloodstream or the lymphatic system. They are then free to compress and invade other parts of the body, including major organs. Even when a particular type of cancer has spread, it is still referred to by its original or primary site of growth. For example, if a patient has breast cancer that metastasizes to the lungs, it is still called breast cancer, or metastatic breast cancer.

“Staging” refers to the extent and prognosis of the tumor. There are many staging systems of cancer. A common system is the tumor, node, and metastasis system (TNM) that adds numbers to each of these categories, depending on the distribution of the cancer cells.

Some important warning signs of cancer to be aware of are:

✦ Unusual bleeding or discharge, either internally or externally

✦ Any lump or thickening

✦ A sore that does not heal

✦ A significant change of bowel or bladder habits

✦ A persistent cough or hoarseness

✦ Difficulty swallowing

✦ The appearance of a new wart or mole, or a change in size and shape of an existing wart or mole

✦ Unexplained weight loss

Any of these signs should immediately be brought to the attention of a physician.

Cerebrovascular Disease (CVA)  

Cerebrovascular disease (CVA ) is also referred to as a stroke. A stroke most commonly occurs when a blood clot blocks an artery carrying blood to the brain, or when one of these blood vessels breaks. In either case, blood flow to a portion of the brain is interrupted; therefore oxygen to that part of the brain ceases as well.

Within minutes or a few hours after a stroke begins, the brain cells in the immediate area die. This

area of dead brain cells is called an infarct. The dead cells then release a chemical that creates a type of chain reaction that kills cells in surrounding areas of the brain, where blood flow is compromised but not completely blocked. This chain reaction occurs quickly. Therefore, it is believed that the first six hours after stroke symptoms occur is crucial for medical intervention. Once the stroke begins, every second counts in order to increase one’s chances of recovery. Some risk factors include: diabetes mellitus, hypertension (high blood pressure), arteriosclerosis (a thickening and hardening of the artery walls), gout, increased triglyceride levels, family history of CVA, decreased exercise, use of oral contraceptives, and cigarette smoking.

A patient will develop loss of certain abilities depending on which part of the brain is affected by the stroke, as well as the size of the area of dead cells. Loss of function may involve movement, speech, and memory. A small stroke may leave only weakness in an arm and leg, for example, whereas a larger stroke may leave one paralyzed and unable to speak. If a stroke occurs on the left side of the brain, the right side of the body is affected. If it occurs on the right side of the brain, symptoms occur on the left side of the body. CVA is the third most common cause of death in the United States, attacking mostly older adults. It can, however, occur at any age. Diagnostic tests include computed tomography (CT) scan of the brain, a lumbar puncture (spinal puncture), an electroencephalogram (EEG), and an angiogram.

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is an airway obstruction that can result

from many conditions such as emphysema, chronic bronchitis, cystic fibrosis, or asthma. Often a patient may suffer from more than one of these illnesses before COPD develops. It is a chronic condition that tends to worsen with time. Cigarette smokers are at high risk for developing COPD. Often, those who worked in a dusty environment develop COPD later in life as well as those who have been previously exposed to radiation treatment in the lungs. Chronic lung infections and allergies may also contribute to the disease.

Symptoms can include a chronic cough, shortness of breath on minimal exertion, an anxious feeling, audible wheezing, tachypnea (rapid respirations), and tachycardia (rapid heartbeat). Diagnostic tests for COPD include a chest x-ray, pulmonary function tests, blood tests, and an EKG. In end-stage COPD, patients generally require constant oxygen therapy and may have extreme difficulty breathing even when in a sitting position.  COPD is categorized into stages of Stage 1: Mild, Stage 2: Moderate, Stage 3: Severe and Stage 4: Very Severe. Understandably, patients with advanced chronic obstructive pulmonary disease usually exhibit a tremendous amount of anxiety due to severe breathlessness.

Congestive Heart Failure

Congestive heart failure (CHF) is a disease in which the heart becomes inefficient and cannot pump enough blood to meet the demands of the body’s organs. As blood flows too slowly from the heart due to

diminished cardiac output, the blood returning to the heart backs up and causes congestion in the tissues. As a result, edema (swelling) can occur, usually in the patient’s legs and feet. Fluid can also form in the lungs, which can cause breathing difficulty. (Pulmonary edema is an acute, life-threatening condition.) Congestive heart failure can cause the kidneys to inadequately rid the body of sodium and water, a condition that also contributes to edema. CHF often occurs on the left side of the heart but can also develop in the right side. Sometimes, left- and right-sided heart failure can occur simultaneously.

Symptoms of CHF differ according to which side of the heart is affected. For example, left-sided heart failure may cause dyspnea (difficulty breathing), tachycardia (rapid heartbeat), edema, weight gain, fatigue, and muscle weakness. Right-sided heart failure may cause edema, distended neck veins, and hepatomegaly (an enlarged liver).

There are many causes of congestive heart failure. Some common causes include coronary artery disease (the narrowing of arteries that supply blood to the heart), myocardial infarction (a previous heart attack that leaves scar tissue to interfere with the heart muscle), hypertension (high blood pressure), previous rheumatic fever, congenital heart disease (heart defects present at birth), and infections of the heart valves or muscle, such as endocarditis or myocarditis. Diagnostic tests to determine if someone has congestive heart failure may include a chest x-ray, an EKG, cardiac catheterization, and an echocardiogram. Prognosis of the disease depends on the cause and its response to treatment.

Diabetes Mellitus  

Diabetes mellitus is a chronic disease caused by inadequate production of insulin or the inability to utilize the insulin produced. Both men and women are equally affected. The incidence rises with age.

Type I Diabetes refers to a condition in which a person secretes little or no insulin. This is also called insulin-dependent diabetes mellitus (IDDM). In the past, it was referred to as juvenile diabetes. IDDM usually occurs before age 30, although it can occur at any age.

In Type II Diabetes, or non-insulin dependent diabetes (NIDDM), a patient develops insulin resistance or insufficiency. It is sometimes called adult-onset diabetes and usually occurs in patients after age 40. It is most frequently treated with diet and exercise, although oral hypoglycemia medications may be required. Type II diabetes is more common than Type I. Diabetes causes disturbances in the metabolism of carbohydrates, protein, and fat. It is a chronic, incurable disease, but symptoms can often be controlled with proper therapy, such as diet and exercise. However, insulin injections may become required.

Patients with diabetes mellitus are at risk for two very serious metabolic complications caused by hyperglycemia (increased blood sugar levels) called diabetic ketoacidosis (DKA) and hyperosmolar nonketotic syndrome (HNKS). These are acute, life-threatening conditions that can lead to dehydration, shock, coma, and death, and they therefore require immediate medical attention. Diabetic patients are also at risk for developing chronic illnesses such as cardiovascular disease, peripheral vascular disease (often leading to amputation of lower limbs), severe hypertension (increased blood pressure), retinopathy (a disorder of the retina that can lead to blindness), nephropathy (a disease of the kidneys), and peripheral neuropathy (a disease of the nerves usually causing pain and numbness in the hands and feet).

Signs and symptoms of diabetes mellitus may include weakness or fatigue, polyuria (increased urination), polydypsia (excessive thirst), dry mucous membranes, weight loss in IDDM, and polyphagia (eating excessive amounts of food) in IDDM. Diagnostic tests include various blood and urine tests.

Occasionally, hospice patients with cancer of the pancreas may develop diabetes secondary to their cancer. In any hospice patient with diabetes, care is taken to avoid hyperglycemia (increased levels of blood sugar) or hypoglycemia (decreased levels of blood sugar). Symptoms of hypoglycemia include headaches, confusion, dizziness, sweating, irritability, or tremors. If not treated, hypoglycemia can lead to seizures and coma. Signs and symptoms of hyperglycemia may include excessive thirst, frequent urination, fatigue, weakness, abdominal pain, nausea, vomiting, fruity breath, drowsiness, flushed skin, and general discomfort. If a diabetic patient was taking insulin medications prior to his hospice admission, it is generally continued even if the patient stops eating because the liver continues to produce glucose. Once the patient becomes unresponsive (unconscious), insulin is usually stopped in hospice care.

Hepatitis 

Hepatitis is a disease causing inflammation of the liver. There are many types of hepatitis viruses, some with higher risk of complications than others. Hepatitis may be acute, meaning it has a sudden onset with severe symptoms, but runs a short course. Hepatitis may also be chronic, meaning it is of long duration and/or slow progression.

Patients with chronic hepatitis are at risk for lasting liver disease. This can be of a serious nature, because the liver has many functions, including:

✦ Storing iron, vitamins, and minerals

✦ Producing bile to help in digestion

✦ Acting as a filter to convert poisonous chemicals to substances that can either be used by the body or excreted from the body

✦ Converting food into stored energy

✦ Producing new proteins

✦ Producing clotting factors so blood can clot

Types of Viral Hepatitis

Hepatitis A, formerly known as infectious hepatitis, is highly contagious. It is transmitted by the fecal to oral route. It can result from ingesting contaminated milk, food, or water. The hepatitis A virus enters the digestive tract and begins reproducing. It then spreads to the liver and multiplies in the liver cells. The incubation period (the amount of time between infection and the development of symptoms) is usually two to four weeks. Symptoms may include fatigue, abdominal pain, decreased appetite, nausea, diarrhea, and jaundice in which the skin and the whites of the eyes become yellowish. A complication that can occur with hepatitis A is a relapse after apparent recovery. If desired, a vaccine is available for long-term prevention of hepatitis A virus infection for those two years of age and older.

Hepatitis B virus is transmitted through exchange of contaminated blood, intimate sexual contact, contact with contaminated bodily secretions and feces, and from mother to child. The hepatitis B virus can cause lifelong infections, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. The average incubation period for hepatitis B is two to three months. Initial symptoms may resemble the flu: fatigue, abdominal discomfort, fever, decreased appetite, nausea, and diarrhea. Other symptoms include dark urine, pale stools, and jaundice (yellowish eyes and skin). Invasive diagnostic testing includes a blood test and sometimes a needle biopsy of the liver to test for the virus and liver damage. In general, hepatitis B is treated over a period of four months with a medication called interferon that is given by injection. In advanced stages where liver function ceases, a liver transplant may be needed. A three-step vaccine is available for all age groups to prevent the virus. Healthcare workers are at increased risk of being infected by hepatitis B due to the presence of infectious materials in their work place. In some countries, including the United States, the three-step vaccine is mandatory for all employees working in healthcare facilities.

Hepatitis C (HCV) is transmitted through contaminated blood and bodily fluids, from mother to child, as well as intravenous drug use (presently the most common type of transmission). It is now known that hepatitis C is rarely transmitted sexually and studies show that sexual transmissions account for less than 5% of cases. However, it is still possible to transfer the Hepatitis C virus through sexual activity, especially when one of the partners has HIV or another sexually transmitted disease. Even with such a small percentage of cases known, extreme caution is still strongly advised. High-risk groups include intravenous drug users, kidney dialysis patients, healthcare professionals, persons with multiple sex partners, recipients of blood transfusions before July 1992, and infants born to infected mothers. It is believed that the risk of neonatal transfer of the hepatitis C virus increases if the mother is infected with HIV. The incubation period for hepatitis C is usually six to nine weeks. The infected person may feel a sudden onset of flu-like symptoms that seem to linger. Others may gradually develop symptoms over a long period of time. Symptoms may include fatigue, low-grade fever, headache, sore throat, decreased appetite, nausea, vomiting, aching joints, dark urine, light stools, and pain in the right side over the area of the liver. In some cases, jaundice may appear. Hepatitis C is a progressive disease that, if left untreated, can cause death due to liver failure or hepatocellular carcinoma (liver cancer).

HCV-related chronic liver disease may take up to 20 or more years to develop. It is now known that hepatitis B and HIV may be present in patients with HCV. Therefore, testing for each of these diseases is indicated. Screening for HCV is not routine. However, patients in high-risk categories should consider screening.

These include the following:

✦ Those with a history of I.V. drug abuse

✦  Those with chronic hemodialysis

✦ Those with a history of a blood transfusion before June 1992

✦ Living in the same house as someone with HCV

✦ Sexual partners of someone with HCV who is in a nonmonogamous relationship

✦ History of sharing intranasal devices for drugs such as cocaine

✦ Those with a history of liver disease

✦ Healthcare providers who received a needle-stick injury from a person with HCV

Screening for contact with blood or body fluids from someone known to have the hepatitis C virus starts immediately after exposure. Testing is repeated in 4-6 months if the first test is negative. The HCV RNA test can be administered as early as 4-6 weeks.

Latest Cures for Hepatitis C:

In 2015, ombitasvir, paritaprevir and ritonavir (Technivie) was approved for use in combination with ribavirin for treatment of genotype 4 hepatitis C infections. It is the first treatment option for genotype 4 infections that does not require interferon. It can achieve 100% cure rates. That same year, daclatasvir (Daklinza) was approved to treat genotype 3 infections. This is given with sofosbuvir (Sovaldi) with cure rates up to 98%.

That same year, daclatasvir (Daklinza) was approved to treat genotype 3 infections. This is given with sofosbuvir (Sovaldi) with cure rates up to 98%.

In 2016, approval was given for elbasvir and grazoprevir (Zepatier) to be used with or without ribavirin for treating genotype 1and 4. The single tablet drug joins Harvoni and Viekira Pak as being treatments for genotype 1 treatments that do not require interferon. Its cure rates in genotype are 94-97% while for genotype 4 it could reach 100% cure rates. (www.webmd.com)

The new drugs are not inexpensive. A full course of treatment can cost tens of thousands of dollars. Check with your insurance company. Also, ask your doctor if you can take advantage of drug company programs that give financial assistance.

Hepatitis D, also called delta hepatitis, is caused by a very small virus that cannot replicate on its own. Instead, it requires the presence of the hepatitis B virus. Hepatitis D can become chronic and is found only in patients with hepatitis B. It can cause a patient with a mild case of hepatitis B to develop a severe, chronic hepatitis and cirrhosis of the liver. It is estimated that hepatitis D is responsible for about 50% of fulminant hepatitis cases, which is a rare form of hepatitis that causes massive damage to the liver and eventually can lead to coma and death, possibly within two weeks. As the disease progresses, the patient may experience cerebral edema (swelling in the brain), brainstem compression, gastrointestinal bleeding, respiratory failure, cardiac failure, and kidney failure.

Hepatitis E is a virus transmitted through the fecal to oral route similar to hepatitis A. As in hepatitis A, it first enters the gastrointestinal tract, begins reproducing, and then spreads to the liver where it multiplies in the liver cells.

Hepatitis G is a virus transmitted through contaminated blood products. As in hepatitis B, C, and D, it enters the bloodstream, travels to the liver, and begins to reproduce. When the body’s natural defenses attack the infected cells, the liver becomes inflamed.

Multiple Sclerosis 

Multiple sclerosis (MS) is a debilitating disease affecting the brain and spinal cord. It is a major cause of disability in young adults, usually striking between the ages of 20 and 40. It is more common in women than in men.

There are five main types of MS, ranging from relatively mild symptoms that do not worsen and do not cause permanent disability to progressive deterioration without periods of remission. In a small number of MS patients, the disease progresses rapidly, sometimes causing complete disability and death within a few months of onset.

MS causes inflammation in portions of the nervous system that results in the destruction of the myelin sheaths that cover the nerve fibers. Areas of sclerosis or scarring remain that inhibit nerve signals. This can lead to visual impairment, muscle weakness, numbness, decreased coordination, paralysis, tremors, urinary and bowel incontinence, mood swings, and difficulty with speech. In advanced stages, patients can exhibit forgetfulness and confusion, sometimes referred to as “MS dementia.”

As of this writing, the exact cause of MS is unknown, but a great deal of research has led to some possibilities—including a slow-acting viral infection and an auto-immune response of the nervous system, meaning the immune cells in one’s body destroy the cells that produce myelin sheaths, or the nerve fiber covering. Diagnostic tests may include an electroencephalogram (EEG), a lumbar puncture, psychological testing, and a CT scan.

(www.webmd.com) If you have multiple sclerosis (MS), there are many medical treatments you can use to treat your disease, like medications or physical therapy. But many people look for other ways to feel better, such as acupuncture, yoga, relaxation, herbal remedies, and massage. They’re called alternative and complementary therapies.

These therapies won’t cure your disease. But there’s evidence that some of them are helpful when you use them along with your regular treatment. For others, the science isn’t as clear. When you’re deciding if you want to try something new, it’s important to know what might help you and what could be harmful. Always talk with your doctor before you start any new therapy. Together you can decide what is best for you.

Complementary Therapies Recommended for Multiple Sclerosis:

(Please Note: The following Complementary Therapies are not recommended as a cure for Multiple Sclerosis. They are merely suggested as therapies to be added along with your medications and/or treatments prescribed by your healthcare practitioner as a means for decreased stress,  relaxation, etc. Please discuss all complementary therapies (ie. exercise, massage, acupuncture, evening primrose oil, etc.) with your physician before starting.) 

Positive Attitude. A positive outlook cannot cure your condition, but it can ease your stress and help you feel better.

Exercise. Some types, such as tai chi and yoga, can lower stress, help you relax, and increase your energy, balance, and flexibility. As with any fitness program, check with your doctor before you start.

Diet. It’s important for people with MS to eat the right amounts of nutritious foods such as fresh fruits and vegetables.

Massage. Many people with MS get regular massage therapy to help them relax and reduce stress and depression. There is no evidence that massage changes the course of the disease. It’s usually safe for people with MS to have a massage, but you should tell your therapist if you have osteoporosis. Talk to your doctor first before getting any massage therapy.

Acupuncture . Some people report that acupuncture, a practice that places needles at specific points in the body, relieves symptoms like pain, muscle spasms, or bladder control problems. Once again, discuss this with your physician before adding acupuncture to your regimen. 

Evening primrose oil (linoleic acid). You can find linoleic acid in sunflower seeds and safflower oil. There is some evidence that taking it as a supplement may slightly improve MS symptoms.

Parkinson’s Disease 

Parkinson’s disease is a slow-progressing neurological disease. On average, deterioration progresses over a period of about ten years. Men are affected more often than women. Onset usually occurs in middle age or older, but may also occur at a younger age. It is believed that the cause of this illness is a deficiency in dopamine which prevents brain cells from performing their normal function within the central nervous system. Death usually occurs from aspiration pneumonia or another type of infection.

In general, symptoms progress to muscle rigidity; cramping in the neck, trunk, and legs; tremors; difficulty walking, with frequent falls; a high-pitched monotone voice; flat affect (lack of facial expression); body bent forward; difficulty swallowing; and eyes fixed upward.

Much research is being done to discover a cure for Parkinson’s disease, but at present none exists. Treatment involves replacement medication for decreased dopamine levels. Often this decreases the severity of symptoms. Physical therapy is also used to help maintain normal muscle tone. In some cases, patients may opt for neurosurgery, but this is usually more of an option when the patient is comparatively young and otherwise healthy. Surgery is not a cure and is performed for palliative reasons to help relieve symptoms. A great deal of spiritual and emotional support is needed for patients with this cruel and debilitating illness.

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