How does multiple sclerosis impact mental health. What are the common symptoms of anxiety in MS patients. Which treatment options are most effective for managing MS-related anxiety. How can lifestyle changes help reduce anxiety symptoms in people with MS. What role do support systems play in anxiety management for MS patients. How can mindfulness techniques benefit those with MS-related anxiety. When should someone with MS seek professional help for anxiety.

Understanding the Link Between Multiple Sclerosis and Anxiety

Multiple sclerosis (MS) is a chronic, unpredictable condition that affects the central nervous system. While its physical symptoms are well-known, the psychological impact of MS is often overlooked. Anxiety is a common comorbidity in MS patients, significantly affecting their quality of life.

Why is anxiety so prevalent in MS patients? There are several contributing factors:

• Unpredictability of symptoms and disease progression
• Fear of disability and loss of independence
• Changes in brain chemistry due to MS-related nerve damage
• Side effects of MS medications, particularly corticosteroids
• Stress related to lifestyle changes and managing a chronic illness

Understanding these factors is crucial for developing effective anxiety management strategies for MS patients.

Recognizing Anxiety Symptoms in MS Patients

Identifying anxiety in MS patients can be challenging, as some symptoms overlap with those of MS itself. However, certain signs can indicate the presence of anxiety:

• Excessive worry about MS symptoms or progression
• Restlessness or feeling on edge
• Difficulty concentrating
• Sleep disturbances
• Irritability
• Muscle tension
• Panic attacks

Is anxiety always visible in MS patients? Not necessarily. Some individuals may experience internal anxiety without obvious external signs. This is why open communication with healthcare providers is essential.

The Impact of Anxiety on MS Management

Anxiety can significantly affect how individuals cope with and manage their MS. It may lead to:

1. Increased perception of MS symptoms
2. Reluctance to engage in physical activities or social interactions
3. Poor adherence to treatment plans
4. Difficulty making decisions about care
5. Reduced overall quality of life

Addressing anxiety is not just about improving mental health; it’s an integral part of comprehensive MS care.

Effective Treatment Options for MS-Related Anxiety

Managing anxiety in MS patients often requires a multifaceted approach. Here are some effective treatment options:

Psychotherapy

Cognitive-behavioral therapy (CBT) has shown particular efficacy in treating anxiety in MS patients. It helps individuals identify and change negative thought patterns and behaviors associated with anxiety.

Medication

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can be effective in managing anxiety symptoms. However, medication should always be prescribed and monitored by a healthcare professional familiar with MS.

Mindfulness and Relaxation Techniques

Practices such as meditation, deep breathing exercises, and progressive muscle relaxation can help reduce anxiety and promote overall well-being.

Support Groups

Connecting with others who have similar experiences can provide valuable emotional support and practical coping strategies.

Lifestyle Modifications to Reduce Anxiety in MS

In addition to medical treatments, certain lifestyle changes can significantly impact anxiety levels in MS patients:

• Regular exercise: Physical activity can improve mood and reduce stress. Consult with a healthcare provider to develop a safe exercise plan.
• Healthy diet: A balanced diet can contribute to overall well-being and may help manage MS symptoms.
• Adequate sleep: Establishing good sleep hygiene can improve both physical and mental health.
• Stress management: Learning and practicing stress-reduction techniques can help manage anxiety triggers.
• Limiting caffeine and alcohol: Both substances can exacerbate anxiety symptoms.

How effective are these lifestyle changes? While individual results may vary, many MS patients report significant improvements in their anxiety levels after implementing these modifications.

The Role of Support Systems in Managing MS-Related Anxiety

A strong support system can play a crucial role in helping MS patients manage anxiety. This support can come from various sources:

• Family and friends
• Healthcare providers
• MS support groups
• Mental health professionals
• Online communities

Effective support systems provide emotional comfort, practical assistance, and a sense of connection. They can help individuals feel less isolated and more empowered in managing their MS and associated anxiety.

Mindfulness Techniques for MS-Related Anxiety

Mindfulness practices have gained recognition for their effectiveness in managing anxiety, particularly in chronic conditions like MS. These techniques can help individuals:

• Stay present-focused rather than worrying about the future
• Develop greater body awareness
• Reduce stress and promote relaxation
• Improve emotional regulation

Popular mindfulness techniques for MS patients include:

1. Mindfulness meditation
2. Body scan exercises
3. Mindful movement practices like yoga or tai chi
4. Mindful breathing exercises

Can mindfulness replace traditional anxiety treatments? While mindfulness can be a powerful tool, it’s often most effective when used in conjunction with other treatments as part of a comprehensive anxiety management plan.

When to Seek Professional Help for MS-Related Anxiety

While some level of anxiety is normal when living with MS, there are times when professional help is necessary. Signs that it’s time to seek help include:

• Persistent anxiety that interferes with daily life
• Anxiety symptoms that worsen over time
• Development of panic attacks
• Anxiety that leads to avoidance of necessary medical care
• Thoughts of self-harm or suicide

Early intervention can prevent anxiety from becoming severe and improve overall quality of life for MS patients.

Innovative Approaches to Anxiety Management in MS

As research in MS care progresses, new approaches to anxiety management are emerging:

Virtual Reality Therapy

VR technology is being explored as a tool for exposure therapy and relaxation training for MS patients with anxiety.

Biofeedback

This technique helps individuals gain awareness and control over physiological processes related to anxiety.

Neurofeedback

This form of biofeedback focuses specifically on brain activity, helping patients learn to regulate brain waves associated with anxiety.

Teletherapy

Remote counseling services have become increasingly available, providing convenient access to mental health support for MS patients with mobility challenges.

While these approaches show promise, more research is needed to fully understand their long-term effectiveness in managing MS-related anxiety.

The Importance of Holistic Care in MS Anxiety Management

Effective management of anxiety in MS requires a holistic approach that addresses both physical and psychological aspects of the condition. This integrated care model may include:

• Collaboration between neurologists, mental health professionals, and primary care physicians
• Regular mental health screenings as part of routine MS care
• Patient education on the relationship between MS and anxiety
• Incorporation of stress management techniques into overall MS treatment plans
• Addressing lifestyle factors that may contribute to anxiety

By treating the whole person, rather than just the physical symptoms of MS, healthcare providers can significantly improve outcomes and quality of life for patients dealing with anxiety.

Empowering MS Patients in Anxiety Management

While professional support is crucial, empowering MS patients to take an active role in managing their anxiety is equally important. This can involve:

• Educating patients about anxiety and its relationship to MS
• Teaching self-monitoring techniques to recognize anxiety symptoms early
• Providing resources for self-help strategies
• Encouraging the development of personalized coping strategies
• Promoting self-advocacy in healthcare settings

How can MS patients become more proactive in managing their anxiety? By learning to recognize their own anxiety triggers and symptoms, patients can take timely action to prevent anxiety from escalating. This might involve using relaxation techniques, reaching out for support, or adjusting their environment to reduce stress.

The Future of Anxiety Management in MS Care

As our understanding of MS and its psychological impacts grows, the future of anxiety management in MS care looks promising. Emerging areas of focus include:

• Personalized medicine approaches that tailor anxiety treatments to individual patient profiles
• Integration of digital health technologies for real-time anxiety monitoring and intervention
• Development of MS-specific anxiety management programs
• Increased emphasis on preventive mental health strategies in MS care
• Exploration of the potential benefits of complementary therapies like acupuncture or art therapy

These advancements hold the potential to significantly improve the quality of life for MS patients struggling with anxiety.

Navigating the Challenges of MS-Related Anxiety

Living with MS-related anxiety presents unique challenges, but it’s important to remember that effective management is possible. Key strategies include:

• Building a strong support network
• Maintaining open communication with healthcare providers
• Practicing self-compassion and patience
• Staying informed about MS and anxiety management techniques
• Celebrating small victories in anxiety management

By adopting a proactive and holistic approach to anxiety management, MS patients can significantly improve their mental health and overall quality of life.

Conclusion

Anxiety is a common and challenging aspect of living with multiple sclerosis, but it doesn’t have to define the MS experience. Through a combination of professional treatment, lifestyle modifications, and self-management strategies, individuals with MS can effectively manage their anxiety and lead fulfilling lives. As research continues to advance our understanding of MS-related anxiety, new and more effective treatment options are likely to emerge, offering hope for even better outcomes in the future.

Managing anxiety in MS: What works?

Ever since I was diagnosed with MS, it seems like I’m constantly worried about something. What can I do?

Answer From B Mark Keegan, M.D.

Day-to-day living with a chronic, unpredictable condition such as multiple sclerosis (MS) can understandably take a psychological toll. People with MS have an increased risk of anxiety for many reasons.

You may not know how you’ll feel from morning to afternoon or one day to the next. Often, you never know when or if a flare-up will occur or how severely you may be affected.

Other factors in MS also can affect you emotionally, such as damage to your brain’s nerve cells or side effects from medications, such as corticosteroids.

The good news is that, unlike some other aspects of MS, anxiety is treatable. And with proper treatment, you can significantly improve your quality of life.

If you feel your anxiety is something above and beyond the regular worries of everyday life, take steps to address it.

• Reach out. Communication is key in treating emotional problems in MS. Tell your family, friends and doctor about your feelings. Informing your doctor will help you be diagnosed and receive treatment, if necessary. Family and friends are better able to help you if they know what you’re going through.
• Seek treatment. Professional counseling and support groups can be very helpful in dealing with the anxiety and distress that may accompany MS. The National Multiple Sclerosis Society or your doctor can put you in touch with helpful resources.
• Find ways to relax. Many people find that relaxation or mind-body exercises — such as deep breathing, meditation, progressive muscle relaxation, yoga or tai chi — can significantly reduce anxiety and bring on feelings of calm.

• CBD safety
• Managing depression in MS

Sept. 19, 2019

Show references

1. Minden SL, et al. Evidence-based guideline: Assessment and management of psychiatric disorders in individuals with MS: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82:174.
2. Emotional changes. National Multiple Sclerosis Society. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Emotional-Changes. Accessed Dec. 11, 2017.
3. Olek MJ, et al. Symptom management of multiple sclerosis in adults. https://www.uptodate.com/contents/search. Accessed Dec. 12, 2017.
4. Gromisch ES, et al. Assessment and treatment of psychiatric distress, sexual dysfunction, sleep disturbances, and pain in multiple sclerosis. International Journal of MS Care. 2016;18:291.
5. Seven things to know about complementary health approaches for anxiety. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/tips/anxiety. Accessed Dec. 15, 2017.

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Managing depression in MS – Mayo Clinic

First, know you’re not alone. Depression is very common among people with multiple sclerosis (MS). Between the physical loss of function and lifestyle changes, it’s easy to understand how MS could cause depression.

Some evidence also suggests that MS itself may cause changes in the body that make you more vulnerable to depression. Whether your depression is a reaction to or caused by MS, there are effective treatments.

Know the symptoms

Recognizing depression is not always easy. Some of the physical and mental symptoms, such as fatigue and cognitive problems, are common to MS as well. It’s also important to distinguish between a fleeting case of “the blues” and true depression.

Some common signs and symptoms of depression include:

• Feeling sad or irritable most of the day
• Loss of interest or pleasure in activities
• Significant weight loss or gain or a decrease or increase in appetite
• Sleeping too much or being unable to sleep
• Persistent fatigue or loss of energy
• Feeling worthless or guilty with no apparent cause
• Inability to concentrate or make decisions
• Recurrent thoughts of death or suicide

You may have all or only a few of these signs and symptoms. The hallmark of depression is that your symptoms persist, usually lasting at least two weeks.

Get help

If you’re depressed, don’t wait to reach out for help. Talk with your doctor or neurologist first to determine your next step. He or she can help you with treatment or refer you to someone who can help.

Treatments for depression may include:

• Medication. Many types of antidepressants are available for depression. These types of drugs generally take a few weeks to reach their full effect. Your doctor will work with you to find the right dosage and best medication for your symptoms.
• Talk therapy. This type of treatment ranges from individual sessions with a licensed therapist to support groups. One type, cognitive behavioral therapy, has proved to be very effective in treating depression for people with MS. Many doctors combine drug therapy with some type of counseling.

Studies show that exercise can also significantly improve mood and quality of life for people with MS.

• Managing anxiety in MS: What works?
• Stress management for MS

Aug. 24, 2019

Show references

1. Olek MJ, et al. Symptom management of multiple sclerosis in adults. https://www.uptodate.com/contents/search. Accessed Nov. 27, 2017.
2. Depression. National Multiple Sclerosis Society. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Depression. Accessed Nov. 27, 2017.
3. Newsome SD, et al. A framework of care in multiple sclerosis, part 2: Symptomatic care and beyond. International Journal of MS Care. 2017;19:42.

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Late-Onset Multiple Sclerosis

What Is Late-Onset Multiple Sclerosis?

When you have multiple sclerosis, your immune system attacks nerve cells and fibers in your brain. When this happens, your brain can’t send electrical messages to your body as well as it should. That changes the way your body moves and operates. Most people start to get MS symptoms between 20 and 40 years old. But sometimes, you won’t have any MS symptoms until you’re 50 or older. When this happens, doctors call it later-onset multiple sclerosis (LOMS).

Symptoms of Late-Onset MS

Symptoms of late-onset multiple sclerosis are often mistaken for signs of normal aging. They typically include:

• Fatigue
• Muscle weakness
• Changes in your vision
• Decline in cognitive ability (memory trouble, having a hard time focusing)

Late-onset MS causes a lot of changes in your motor skills too. You might notice:

• Bladder and bowel problems
• Tremors
• Stiffness
• Balance and coordination problems
• Trouble walking

Diagnosis of Late-Onset MS

There isn’t a single lab test doctors use to diagnosis multiple sclerosis. Instead, they use several tests to check out your nervous system and brain. Some of the tests your doctor might use to diagnose late-onset multiple sclerosis include:

• MRI of the brain and spinal cord. The magnetic resonance imaging test can show any plaque or scars on your brain, which is a key indicator of MS.
• Cerebrospinal fluid (CSF) evaluation. To do this test, your doctor will take a sample of the fluid that surrounds and protects your spine and brain. They’ll examine the amount of chemicals in the fluid for abnormalities or problems with your immune system.
• Sensory evoked potential studies. Your doctor might test how your brain responds to sight, sound, and electrical stimuli to measure how electrical impulses travel in your brain and spinal cord.

But as you age, it can be harder to diagnose MS, so your doctor may study your neurological history as well to help confirm late-onset MS.

Progression of Late-Onset MS

Multiple sclerosis is a difficult condition to predict. Sometimes, the condition progresses slowly, but at other times, it moves quickly. Late-onset MS shows similar nervous system changes as early onset MS. But when you develop the condition later in life, it may progress faster.

Older adults with MS have a greater risk of the primary progressive form of the condition as well. This means that your body will likely gradually decline over time even though you may not have a lot of MS flare-ups.

Treatment of Late-Onset MS

There is no cure for any type of multiple sclerosis, but there are many ways for you to manage the condition. Some common treatments for late-onset multiple sclerosis include:

• Medication. There are many types of medications to treat relapsing forms of MS. But there are no FDA-approved medications to treat primary progressive multiple sclerosis. The good news is your doctor can give you treatments that help manage your symptoms.
• Managing relapses. Corticosteroids, or steroid hormones, adrenocorticotropic hormone (ACTH) in a gel, or a plasma exchange can help manage MS flare-ups.
• Rehabilitation. Physical, occupational, and cognitive rehabilitation can help you manage the way MS changes your body. These programs can give you better mobility, limit fatigue, and improve your memory. If you have trouble speaking or swallowing, speech language pathology can help.

Talk to your doctor if you’ve been diagnosed with late-onset multiple sclerosis. There are many ways they can help you manage symptoms and improve your quality of life.

Early Signs of Multiple Sclerosis

Multiple sclerosis is the ultimate chameleon.

This chronic, inflammatory autoimmune disease affects the central nervous system, resulting in damaged nerves and scar tissue formation, so it can resemble a multitude of other illnesses. This also makes it incredibly hard to detect. And the fact that no two people with MS experience the same symptoms only adds to its unpredictability.

Here’s what makes it so tricky: Your brain and spinal cord are full of nerves that send electrical signals rapidly to all areas of your body, which allow you to walk, talk, see, swallow and much more. These nerves are coated in a sheath called myelin that helps transmit the signals.

With MS, the myelin gets destroyed because your immune system mistakenly tells your body to attack it, causing scarring — or sclerosis — and signal interruption. As a result, those with MS experience a variety of different symptoms depending on which signals get interrupted.

“Because MS can develop anywhere within the central nervous system and encompasses the optic nerves, the brain and the spine, a lot of different types of critical attacks can occur, so that leads to diagnostic complexity,” says Thomas Shoemaker, MD, a neurologist and MS expert at the Rush Multiple Sclerosis Center.

Although there’s currently no cure for MS, there are a number of promising treatments. Being aware of the early symptoms can help you get a diagnosis and start treatment earlier, which can help you better manage the disease. We asked Shoemaker to explain which initial signs to look for, as well as the risk factors associated with the disease.

Here’s where MS (typically) starts

Although a number of MS symptoms can appear early on, two stand out as occurring more often than others:

• Optic neuritis, or inflammation of the optic nerve, is usually the most common, Shoemaker says. You may experience eye pain, blurred vision and headache. It often occurs on one side and can eventually lead to partial or total vision loss.
• Spinal cord inflammation, or what’s called partial transverse myelitis, is the second most common symptom Shoemaker typically sees. “You may experience numbness, tingling, weakness in the arms and legs, bladder dysfunction and/or difficulty walking,” he explains.

Other early signs of MS include the following:

• Bowel problems range from constipation due to reduced physical activity causing a reduction of food moving through the intestinal tract to diarrhea and incontinence related to neurological dysfunction.
• Depression
• Difficulty thinking
• Fatigue
• Pain, which may be acute or chronic, caused by the nerves that carry sensation “short circuiting.” Types of pain can include band-like pain around the chest, or MS hug, caused by spastic nerves along with other types of painful sensations in the neck, arms, legs and feet. 
• Sexual problems. These may include changes in sexual function such as arousal and orgasm since arousal starts in the central nervous system and nerve pathways become damaged. MS may also create psychological factors such as mood changes and lower self-esteem that can affect sexual desire as well.

Detecting MS earlier and starting MS therapies earlier tend to improve the chances of having a good long-term outcome.

MS can also look like this

Another potential harbinger of MS is clinically isolated syndrome, or CIS, but this condition is complicated.

“CIS is kind of within the spectrum of MS. In fact, sometimes CIS is just the initial presentation of MS. And people with CIS often will go on to develop multiple sclerosis, but not always,” Shoemaker explains.

CIS is basically the first brush with MS, where neurological symptoms occur that often last 24 hours. The episode may result in one symptom or multiple, depending on scarring that occurs in one place or several places. The most common CIS symptoms include the following:

• Optic neuritis
• Numbness
• Slurred speech
• Tingling
• Weakness in legs

If you’re experiencing these symptoms, it’s important to see a doctor as soon as possible. If testing doesn’t reveal a high risk for MS, CIS could signal another serious condition that needs prompt attention, including the following:

• Autoimmune conditions that cause blood vessel inflammation
• Exposure to toxic materials
• Serious vitamin B12 deficiency
• Viral infection

Proper testing shows the bigger picture

Even if you have symptoms associated with MS, you may not have MS. You’ll need to confirm the diagnosis. 

“No single MS test exists, so the diagnosis can be delayed, incorrect or even missed altogether,” Shoemaker says. “An MS diagnosis really requires the synthesis of lots of different types of information by experts who know what to look for and how to put the pieces together.”

That’s why he recommends seeing a neurologist, who can ensure that the appropriate testing is done to get a complete and accurate picture.

This usually includes having an MRI of the brain and spine, which can reveal changes in the central nervous system that indicate MS.

“You need to have an experienced radiologist or experienced clinician, or both, to interpret the MRIs,” Shoemaker explains. “And the images can’t be viewed in isolation. They need to be put in the context of the clinical picture of the patient in front of you. So while the MRI may be somewhat able to predict MS, if the clinical history or the clinical exam is not really supportive of that, then it’s kind of inappropriate to make a diagnosis.”

Lesions are, however, a strong predictor of the disease. According to a 2014 report in Neurology, the risk for developing MS is generally 60 to 80 percent when lesions show up in an MRI. If none are found on the scan, then the risk lowers to 20 percent.

In addition to an MRI, additional procedures may also be required to help confirm a diagnosis, such as a spinal tap, also called a lumbar puncture, to test cerebrospinal fluid. When MS is present, the fluid often has a higher concentration of a certain type of immune proteins.

Shoemaker adds that in certain instances, more in-depth vision testing is needed.

“There’s a procedure called an optical coherence tomography, which can sometimes demonstrate prior optic nerve injury, and similarly, there’s a test called visual evoked potential, and that can also help dilate the optic nerve to see if there’s prior injury as well, which may indicate MS.”

Your doctor may also order blood tests if similar conditions to MS are also being considered.

Time and timing differentiate two types of MS

There are two main types of MS:

• Relapsing-remitting MS is exactly what it sounds like: New neurological symptoms develop caused by inflammatory attacks on myelin, called a relapse, followed by periods of recovery where the symptoms may improve, remain but not worsen, or go away. This period is called remission.

Relapsing-remitting MS is the most common form of the disease. According to the National Multiple Sclerosis Society, approximately 85 percent of people with MS are first diagnosed with relapsing-remitting MS. Most diagnosed with this type of MS are generally in their 20s and 30s.

• Primary-progressive MS occurs when there’s no improvement in symptoms from the onset of disease. “There may be subtle improvements, but overall, the trajectory is continued worsening over a period of at least a year,” Shoemaker explains.

This form of MS can be more difficult to diagnose since people with the primary-progressive type tend to have less brain scarring, more spinal cord scarring and less inflammation than those with relapsing-remitting MS. They also have more difficulty with mobility and everyday activities, and onset usually occurs in the 40s or 50s.

Whereas 80 to 85 percent of cases of MS are relapsing, primary progressive MS is about 15 percent of the cases at diagnosis, and a 50-50 split between men and women.

Know the risk factors

MS affects more than 2.3 million people globally. Though MS is not contagious or even directly inherited, some factors may increase the risk for this disease, including the following:

• Age. Most people diagnosed with MS, are between the ages of 20 and 50 years old, although MS can develop at any age.
• Ethnic background. Those of Northern European descent are at the greatest risk of developing MS, while Native Americans and those from African or Asian descent have the lowest risk.
• Gender. Although both men and women are affected by MS, women are at increased risk. In fact, according to the National Multiple Sclerosis Society, four times as many women have relapsing MS as men. “It tends to be a disease of women of reproductive age, so those from ages 18 to 50 receive the bulk of new diagnoses, with a median age of diagnosis being around 30 to 32,” Shoemaker says. 
• Genetics. Although MS is not inherited, the genetic risk for the disease may be, reports the National Multiple Sclerosis Society. The risk of developing MS is about 1 in 750 to 1,000 people in the general population. It increases, however, when a first-degree relative, such as parents, siblings and children, have the disease. And the risk is greater, nearly one in four, for identical twins.
• Geography. Areas farther away from the equator have more cases of MS. With less sun exposure, research indicates that people tend to have lower levels of vitamin D, which supports the immune function and protects against diseases like MS.

Shoemaker also cites other specific factors, either alone or in combination that may contribute to the disease, which include the following:

• Certain gene variations
• Exposure to the Epstein-Barr virus
• Low vitamin D or sun exposure
• Obesity during adolescence

Earlier diagnosis means better outcomes

Knowing what signs and symptoms to look for early has tremendous benefits.

“From some of the longer duration studies, detecting MS earlier and starting MS therapies earlier tend to improve the chances of having a good long-term outcome. Patients started on MS therapies earlier in their disease tend to have a lower likelihood of reaching certain disability milestones, like needing a cane or walker,” Shoemaker says. 

Although receiving an official MS diagnosis can be overwhelming, Shoemaker ensures that his patients understand how treatment can help. With nearly 15 Food and Drug Administration-approved therapies available, and new ones constantly being developed that are increasingly effective, management of MS continues to improve.

“We are at a point where we’re happy with how good we are at controlling the inflammatory aspect of the disease,” Shoemaker says. “Now we’re working on trying to improve patients’ overall quality of life so they can lead healthy, productive lives — as if they don’t even have MS.”

Undiagnosed multiple sclerosis is more common than you think – Your Health Today

Seven years.

That’s how long actress Selma Blair struggled with undiagnosed flare-ups of multiple sclerosis. She thought it was a pinched nerve—and, even for her, a Hollywood actress whom you might expect to get the best of the best health care, it was a challenge to get doctors to take her symptoms seriously.

“I fall sometimes,” she said. “I drop things. My memory is foggy. And my left side is asking for directions from a broken GPS…it’s a drag, literally.”

But when she finally had an MRI and a neurologist identified about 20 MS lesions on her brain, she said, “I cried with some relief. Like, ‘Oh, good, I’ll be able to do something.’”

Not Uncommon

Blair’s experience isn’t that unusual, say Dr. Suzanne Smith and assistant director Rebecca Rahn, both of the Augusta MS Center at Augusta University Health.

“MS is diagnosed most commonly in the ages between 20 and 50. It can occur in children and teens, and those older than 50,” said Smith. “But it can go unrecognized for years.”

Added Rahn, “The incidence of MS in the United States according to the Multiple Sclerosis Society is over 1 million people. It’s a lot higher than previously suspected.”

Blair’s crippling fatigue and cognitive problems are typical symptoms. (Others can include pain, loss of sensation or numbness, paralysis, bowel/bladder problems, vision problems or blindness, even sexual dysfunction.) But that’s another reason MS can be so hard to diagnose—because the usual symptoms tend to be harder for those on the outside to see. “It’s very common for friends and family to say, ‘But you look so good,’” said Rahn. “The MS community identifies with that because outside, you may appear fine, but you’re dealing with all of this fatigue and cognitive trouble.”

No one knows why or how someone develops MS. Something—and no one has been able to determine what exactly—triggers the immune system to attack the brain and spinal cord, stripping the protective cover of myelin from the nerve cells and fibers and causing lesions.

Those lesions trip up the signals going from the brain and spinal cord to the rest of the body, causing MS symptoms.

But experts do know this: Diagnosing MS early can make a huge difference.

The Difference With MS

For most of us, the image we have of MS is that person in a wheelchair.

That may have been accurate 10 years ago, but not today. Neurologists and other specialists have been working hard to diagnose MS earlier and start patients on treatment sooner. Unlike other neurological diseases like Alzheimer’s disease, “We can slow MS,” said Smith. “Our goal is to stop disease progression, and we have highly effective therapies now that are very beneficial.”

According to Rahn, just in the past month, two new therapies were approved for MS. “MS is one of those disease states where we’ve had the most positive clinical trials,” she said. “Over the past 10 years, we’ve gone from two classes of drugs to now 18. Today the treatment options are so much better and also more varied so you can find the right drug for each individual patient.”

Treatments can’t reverse the lesions, but if the disease is diagnosed after the first flare-up, treatments can help prevent further disability. “The most common form of MS is relapsing MS,” Smith explained. “Patients develop symptoms, and over time, symptoms may go away. They may have complete resolution [no symptoms] or some degree of symptoms. But if flare-ups continue, patients can accumulate disability over time.”

Patients today can try a variety of disease-modifying therapies, from self-injectable home therapies, oral medications or infusions that can be done in a doctor’s office, a local infusion site or sometimes at home.

That’s part of a very personalized approach, which takes into account a person’s lifestyle and stage in life. “If you’re wanting to get pregnant in six months, that’s different from someone who has a lot of other diseases like heart disease or diabetes,” said Rahn.

Which is why it’s very important for patients to get care from a specialist at an MS center, who knows all the options available and how to target drug therapies to fit with all the different aspects of a person’s lifestyle and overall health. MS centers also offer physical, speech and occupational therapists who are trained in MS; neuro-psychologists and urogynecologists; even counselors who specialize in diet and exercise.

MS Today

With the options available today, people around you whom you know and love may have MS—and you might not even know it.

“When we talk to patients and families about the clinical course of MS, they are amazed to find out that patients run marathons, have children, live completely normal lives,” said Smith.

Still, there can be a grieving process. “Diagnosed patients, as well as their family, do have to get past the life they thought they were going to have, but at the same time, they often can still achieve that,” said Rahn. “And I think what patients would want people to recognize is that they are not their MS. It doesn’t change who they are as an individual. They can still live their best life and accomplish so many things apart from having a chronic illness.”

To find a primary care physician or schedule an appointment at Augusta University Health, visit augustahealth.org or call 706-721-2273 (CARE).

Who Gets Multiple Sclerosis | MSAA

MS Prevalence and the Need for a National Registry

Most people with MS experience their first symptoms and are diagnosed between the ages of 15 and 50, although individuals of any age may be diagnosed with MS. More women are diagnosed with MS than men, and the area where someone lives, as well as race and ethnic background, also helps to determine his or her risk of developing the disease.

Nearly one million individuals are living with MS in the United States. This new prevalence figure was published in 2019 and is more than double the previous estimate of 400,000 affected people in the United States. Researchers arrived at the higher figure by using a sophisticated algorithm (a step-by-step problem-solving process) to analyze the data found in claims from private, public, and military healthcare systems covering more than 125 million people. Correcting lower, inaccurate estimates of how many people are affected by MS is critical as the government, payers, and healthcare systems determine how to allocate resources – including research funds and patient-care staff – to address various conditions and diseases.

MS organizations have been advocating for several years to create a national MS registry in the United States, but this has yet to become a reality. In the meantime, the North American Research Committee on Multiple Sclerosis (NARCOMS) has an MS registry with an active database of more than 35,000 individuals with MS. The benefits of a national registry include the ability to learn about the rate of disease diagnosis, progression, and disability, as well as the success of treatments and the availability of services – to better meet the needs of the MS community. If you are interested in learning more or becoming a part of this registry, please visit narcoms.org.

Prevalence Factors According to Gender, Location, and Race

The distribution of this disease is not totally random. On average, with relapsing forms of MS, women are three times more likely than men to develop this disorder. With the primary-progressive form, genders are more equally divided.

Geographically, people who live farther from the equator (in more temperate climates) have a higher risk of developing MS than people living in hotter areas near the equator, or in very cold areas near the north or south poles. Individuals living beyond the 40-degree mark north or south of the equator are far more likely to develop MS, and this is especially true for people in North America, Europe, and southern Australia.

MS is very rare in Inuit populations (sometimes referred to as Eskimos) living in the far north. Asia continues to have a lower incidence of MS. More prevalent among those of northern European or Scandinavian ancestry, Caucasians have a higher incidence than those of African heritage to develop MS.

In addition to the fact that a lower percentage of African-Americans are diagnosed with MS than White-Americans, other differences have been observed. According to recent studies, on average, African-Americans are slightly older at diagnosis, although these statistics can sometimes conflict. Analysis of NARCOMS data shows that a larger proportion of African-Americans have never seen a neurologist who specializes in MS.

African-Americans tend to have more symptoms at the time of diagnosis, which are usually limited to the optic nerves and spinal cord, and this is termed “opticospinal MS.” This means that African-Americans may experience more problems with vision and mobility, versus other common MS symptoms. The disease course tends to be more progressive and responds less to disease-modifying therapies.

One study, however, challenges the existing theories on the prevalence of MS according to race and ethnic background. Appearing in the May 7, 2013 issue of Neurology, the results of this study contradict theories that African-Americans are less prone to MS as compared to Caucasians. The study looked at data from the Kaiser Permanente Southern California health plan (with more than 3.5 million members) from January 1, 2008 to December 31, 2010.

During the timeframe mentioned, 496 individuals were diagnosed with MS. Approximately 70 percent of those diagnosed were women, most of whom were diagnosed with relapsing-remitting MS (RRMS). According to the published results, compared to Caucasians, African-Americans had a 47-percent increased risk of MS, while Hispanics had a 50-percent reduced risk and Asians had an 80-percent reduced risk. The risk of MS was highest for African-American women, whereas the risk of MS for African-American men was lower and about the same as the risk for Caucasian men.

The authors of this study suggest that limitations in earlier studies may have provided inaccurate figures as to the proportion of individuals diagnosed with MS within the different ethnic populations, along with other factors such as misdiagnosis and inadequate medical care. The authors present several possible theories for the results of this study, but in general, explain that their findings “indicate that MS risk is determined by complex interactions among race/ethnicity, sex, environmental factors, and likely genotype.” More studies are needed to confirm the risk of MS among different ethnic populations.

With the help of NARCOMS data, research reveals that Latinos are usually diagnosed at a younger age than both African-American as well as White-American individuals. They tend to have fewer mobility and bladder/bowel problems compared to White-Americans, but may experience more depression. Additionally, research has indicated that fewer Latinos receive access to services to address mental health needs. The same is true for much-needed rehabilitation from specialists in MS, where fewer Latinos are able to access adequate services.

Other Risk Factors

While MS is not contagious or hereditary, MS susceptibility is increased if a family member has MS. The average risk of developing MS in the United States is roughly 3.5 in 1,000, or less than half of one percent. For first-degree relatives (such as a child or sibling), the risk increases to three or four percent. This is not true for adopted children or half siblings (who do not share the same parent who has MS), whose risk is the same as unrelated individuals.

In situations where one identical twin has been diagnosed with MS, the other twin has a 31-percent risk of developing the disease. (If MS was strictly hereditary, when one identical twin has MS, the other identical twin would have a 100-percent risk of getting MS.) The risk for twins who are not identical is five percent – similar to that of other siblings.

Another factor linked to MS is cigarette smoking. Women who smoke are 1.6 times more likely to develop MS than women who are non-smokers. Individuals with MS who smoke also appear to be at a much greater risk of experiencing a more rapid progression of their disease.

Vitamin D as well as exposure to sunlight (both discussed under Possible Causes of MS), appear to reduce the risk of developing MS. The Nurses’ Health Studies (I & II) found that women who were taking 400 IU or more of vitamin D daily had a lower risk of developing MS. Also, populations exposed to greater amounts of sunshine or ultraviolet radiation had lower rates of MS.

Parasites are another possible risk factor in the development of MS. Research has found that parasites can modulate the immune system and dampen its responses. People who have parasites are less likely to be diagnosed with MS, and as conditions in different countries become cleaner – with fewer parasites – the number of individuals being diagnosed is increasing in these parts of the world.

MS Progression

The different patterns of multiple sclerosis affect each person differently. Perhaps you are wondering what MS is going to look like for you, or how the disease is going to progress. Progression is a term that means the accumulation of disability, even when relapses or flare-ups are not present or part of the disease course. Your healthcare provider might use the Expanded Disability Status Scale (EDSS) to measure progression of disability.

Much evidence now suggests that for most patients, progression is slow, and most people with MS do not become severely disabled. Twenty years after diagnosis, about two-thirds of people with MS are likely to still be walking, although some individuals may need assistance with walking. This includes assistive devices to help with mobility, as well as items such as scooters to help conserve energy.

Predicting how fast MS will progress for individual people is difficult, but certain signs and symptoms can provide some clues (a prognosis) about the rate of disease progression. To follow is the clinical and radiologic information that your doctor might consider to predict long-term outcomes, according to studies that have suggested a link between these factors and faster progression. Please note, however, that with the introduction of disease-modifying therapies, as well as new study findings about other risk factors such as smoking, the course of one’s MS may be altered.

• Age: being older than 40 at the time of a first attack
• Male gender
• More than two attacks in the first two years after disease onset
• A score of more than 1.5 on the Expanded Disability Status Scale (EDSS) after the second attack
• Motor symptoms (affecting mobility), or symptoms that affect mental functioning, or symptoms affecting urinary control, at the onset of the disease
• Frequency of relapses (the more relapses you have initially, perhaps the greater the progression of the disease)
• Initial symptoms affecting many parts of the body
• A high number of MRI lesions or lesions in the brainstem at the time of diagnosis
• New or gadolinium-enhancing lesions seen on MRI (these suggest new inflammatory activity)

Other factors may also modify the disease course. These include:

• Racial factors: African Americans who develop MS have a later age of disease onset than Caucasians and are more likely to develop problems with mobility than Caucasians with MS
• Relapsing MS is thought to have a better prognosis than progressive forms of the disease
• Some studies have noted that women with MS who become pregnant have fewer relapses late in pregnancy and an increase in relapses during the three-month postpartum period

Previous: The MS Process and Symptoms | Next: Types of MS

Early signs of MS | Multiple Sclerosis Society UK

What are usually the first signs and symptoms of MS?

There’s no typical pattern of MS symptoms that applies to everyone – people can have different symptoms at different times.

One of the more obvious first signs of MS is a problem with vision, known as optic neuritis. This is often because it’s a more concrete symptom as opposed to vaguer neurological symptoms like numbness and tingling. You shouldn’t assume these symptoms are a sign of MS though – not everyone who experiences them will get an MS diagnosis.

If you’ve searched for symptoms online or you know someone with MS, it may be at the front of your mind. But many symptoms of MS can also be symptoms of other conditions.

What are some of the common symptoms of MS?

Some of the most common symptoms of multiple sclerosis are listed below. There are lots of symptoms that MS can cause, but not everyone will experience all of them.

Fatigue

Fatigue in MS is not just an ordinary tiredness, like you might get at the end of a hard day’s work. People describe it as an overwhelming sense of tiredness with no obvious cause.

Read more about fatigue

Numbness and tingling

A common type of discomfort in MS is unpleasant, unusual sensations that appear to be in your skin, like numbness and tingling. They’re caused by damage to nerves.

Read more about pain and unpleasant sensations

Loss of balance and dizziness

Problems with balance and feeling dizzy are common in MS, and can affect your walking.

Read more about balance and dizziness

Stiffness or spasms

Muscle stiffness and spasms are common MS symptoms, and are often described as ‘spasticity’.

Read more about stiffness and spasms

Tremor

A tremor is a trembling or shaking movement. It can be mild or more pronounced, causing a drink to spill when a cup is full, for example, or affecting handwriting.

Read more about tremor

Pain

Pain in MS can take many different and unusual forms. It can be caused by direct nerve damage. Or it can come from your symptoms and strains they place on your body.

Read more about pain

Bladder problems

There are two main types of bladder problems in MS: problems with storage and problems with emptying.

Read more about bladder problems

Bowel trouble

MS can cause bowel problems like constipation and incontinence.

Read more about bowel problems

Vision problems

The most common problems with vision in MS are optic neuritis and eye movement problems. Optic neuritis is often an early symptom of multiple sclerosis, although you might have problems with your eyes at any time.

Read more about vision

Memory and thinking

Problems with memory and thinking – also called ‘cognitive problems’ – can affect people with MS, but most people will be affected mildly.

Read more about memory and thinking

What age does MS usually start?

In the UK people are most likely to find out they have MS in their thirties, forties and fifties. But the first signs of MS often start years earlier. Many people notice their first symptoms years before they get their diagnosis.

How does multiple sclerosis begin?

Multiple sclerosis is likely to begin due to a mix of factors – something in your environment and some lifestyle factors. No one knows for sure why people get MS.

Read more about the possible causes of MS

How is MS diagnosed?

Only a neurologist can diagnose MS. If your GP thinks your symptoms need further investigation, they’ll refer you to a specialist.

Some people describe this period of time as ‘limbo’ – where they don’t have a diagnosis but they’re experiencing symptoms.

Read more about getting a diagnosis and coping during this time

Metabolic syndrome

Experts from the World Health Organization have characterized MS developing against the background of obesity as a “pandemic of the 21st century” or “plague of the 21st century”, “a disease of civilization.” MS occurs in 20-40% of the population, incl. and in children. In middle-aged and older people, MS is detected in 30-40% of cases.

Metabolic syndrome (MS) is a complex of metabolic, hormonal and clinical disorders against the background of obesity, which are observed more often in combination than separately, and represent risk factors for the development of the main diseases of modern human civilization: diabetes Type 2, atherosclerosis and hypertension.

Metabolic syndrome , first designated by G. Reven in 1988 as “syndrome X” or, according to the figurative definition of D. Kaplan, in 1989 as a “deadly quartet”, today is defined as a disease of civilization – a combination of factors – excess weight body, high blood pressure, impaired metabolism of “fats” (dyslipidemia or hypercholesterolemia) with an increase in triglycerides, a decrease in high-density lipoprotein cholesterol, an increase in low-density lipoprotein cholesterol, insulin resistance (increased fasting blood sugar).

Causes of the “disease of civilization”

Smoking, habitual intoxication, psycho-emotional stress, excess nutrition, environmental pollution.

Sometimes it seems that evolution will look like SO

MS today is considered as a special condition of the patient, which is not a diagnosis, the outcome of which can be such dangerous diseases as type 2 diabetes mellitus, severe obesity, hypertension, coronary heart disease. atherosclerosis of peripheral blood vessels, gout, polycystic ovary syndrome, erectile dysfunction (impotence) and fatty liver.

In addition, MS is dangerous not only as a risk factor for the development of the aforementioned diseases, but also in the long term with the occurrence of severe complications of these diseases: myocardial infarction, cerebrovascular stroke, thrombosis, diabetic retinopathy (blindness), “diabetic foot”, as well as infertility and severe forms of liver pathology.

The presence of MS in 3-6 times increases the risk of developing type 2 diabetes mellitus and hypertension, the likelihood of developing coronary heart disease and stroke in obese persons is 3-3.5 times higher, the risk of death is four times more likely , and in the presence of cardiovascular diseases – 5.5 times more often than in patients without MS.

The mechanism of MS development is based on the development of insulin resistance of body tissues. This condition is called insulin resistance. In the blood, the level of both glucose (hyperglycemia) and insulin (hyperinsulinemia) rises at the same time, however, glucose does not enter the cells (due to their “insensitivity” to insulin) in the required amount for normal functioning. As a rule, the state of insulin resistance occurs against the background of the leading symptom of MS – abdominal obesity.

Overweight, impaired fat metabolism, increased glucose levels accelerate the process of changes in the structure of the vascular wall and the formation of arterial hypertension.

Data from clinical and experimental studies suggest that in metabolic syndrome, visceral obesity triggers the development of a condition similar to chronic inflammation. The components of this process are the release of inflammatory mediators and other factors by adipose tissue, which is the mechanism for the development of hypertension, a tendency to thrombosis and other pathological disorders.

Disorders united by the MS framework, while asymptomatic, often begin to form in adolescence and adolescence. It should be noted that not all components of the metabolic syndrome occur simultaneously and not always clearly.

IMPORTANT

Metabolic syndrome can be reversible, with the timely detection and prevention of MS, both in terms of changing the patient’s lifestyle and prescribing drug therapy by the doctor.

IT IS NECESSARY TO UNDERSTAND

The success of solving this problem largely depends on the patient himself and his lifestyle, since the main factor in the occurrence of MS in 70% is overweight.

Our center offers a profile study based on the assessment of the key criteria for MS (main and additional) recommended by the GFCF – a screening for the detection of Metabolic Syndrome, which includes the following studies:

• ECG
• Measurement of height and weight, calculation of body mass index
• Study of the elasticity of arterial vessels using the VaSera-1500 apparatus
• General blood test
• General urine test
• Biochemical blood tests (albumin, alkaline phosphatase, urea, blood creatinine, total bilirubin, AST, ALT, GGT, CPK, LDH , total protein, uric acid, total cholesterol, high-density, low-density lipids, triglycerides, blood glucose, glycated hemoglobin)
• Conclusion and recommendations of the therapist.

RESTRICTIONS ON THE STUDY:

1. The study is clinically impractical to perform the study in patients with established diagnoses: hypertension, coronary heart disease, atherosclerosis, type 2 diabetes mellitus and patients taking medications for the treatment of these diseases.
2. The study is not advisable to perform the study in patients who regularly take medications for the prevention and correction of previously identified metabolic syndrome.
3. The study is not performed on persons under 20 years of age.

Create a simple select query

If you need to select specific data from one or more sources, you can use a select query. A select query provides you with only the information you need, and also helps you combine information from multiple sources. Tables and other similar queries can be used as data sources for select queries. This section briefly discusses select queries and provides step-by-step instructions on how to create them using either the Query Wizard or the Designer.

If you would like to learn more about how queries work with the Northwind database example, see Query Overview.

This Article

General

When there is a need for some data, it is rarely necessary to have all the contents of one table. For example, if you need information from a contact table, as a rule, we are talking about a specific record or just a phone number.Sometimes it is necessary to combine data from several tables at once, for example, to combine customer information with customer information. Select queries are used to select the required data.

A select query is a database object that is in table mode. The query does not store data, but displays the data stored in tables. A query can show data from one or more tables, from other queries, or a combination of the two.

Benefits of inquiries

The query allows you to perform the following tasks.

• View values ​​only from fields that interest you. When you open a table, all fields are displayed. You can save a query that only gives a few of them.

  Note: The query only returns data, does not store it. When you save a request, you do not save a copy of the relevant data.

• Combine data from multiple sources.In a table, you can usually see only the information that is stored in it. The query allows you to select fields from different sources and specify how exactly you want to combine the information.

• Use expressions as fields. For example, a function that returns a date can act as a field, and you can use the formatting function to control the format of values ​​from fields in query results.

• View records that meet the conditions you specify.When you open the table, all records are displayed. You can save a query that only gives a few of them.

Main steps for creating a select query

You can create a select query using the wizard or the query designer. Some items are not available in the wizard, but you can add them later from the designer. While these are different ways, the basic steps are similar.

1. Select the tables or queries you want to use as data sources.

2. Specify the fields from the data sources that you want to include in the results.

3. You can also specify conditions that limit the set of records queries returned.

After creating a select query, run it to see the results. To run a select query, open it in Grid View.Once you save the query, you can use it later (for example, as a data source for a form, report, or other query).

Create a select query using the Query Wizard

The wizard allows you to automatically create a selection request. When using the wizard, you do not have complete control over all the details of the process, however, this way the request is usually created faster. In addition, the wizard sometimes detects simple errors in the request and prompts you to choose a different action.

Preparation

If you are using fields from data sources that are not related to each other, the Query Wizard suggests creating relationships between them. It will open the relationship window , however if you make any changes, you will need to restart the wizard. Thus, before starting the wizard, it makes sense to immediately create all the relationships that your request will require.

For more information on creating relationships between tables, see Tables Relationships Guide.

Using the Query Wizard

1. On the tab Create , in the Queries group, click Query Wizard .

2. In the dialog box New Query , select Simple Query and click OK .

3. Now add the fields.You can add up to 255 fields from 32 tables or queries.

   For each field, do the following two steps.

   1. Under Tables and Queries , click the table or query that contains the field.

   2. Under Available Fields , double-click a field to add it to the Selected Fields list.If you want to add all fields to your query, click the two right arrow (>>) button.

   3. After adding all the required fields to the query, click Next .

4. If you did not add any numeric fields (fields containing numeric data), skip to step 9. If you add a numeric field, you will need to choose whether the query returns details or totals.

   Do one of the following.

   1. If you want to view individual records, select detailed and click Next . Go to Step 9.

   2. If you need numerical totals, such as averages, select totals and click totals.

5. In the Totals dialog box, specify the required fields and types of totals. Only numeric fields will be available in the list.

   For each numeric field, select one of the following functions.

   1. Sum – the query will return the sum of all the values ​​specified in the field.

   2. Avg – the query will return the average value of the field.

   3. Min – the request will return the minimum value specified in the field.

   4. Max – the request will return the maximum value specified in the field.

6. If you want the query results to display the number of records in the data source, select the appropriate check box Count the number of records in (data source name) .

7. Click OK to close the dialog box Totals .

8. If you did not add any date and time fields to your request, go to step 9.If you added date and time fields to your query, the query wizard prompts you to choose how to group date values. Suppose you added a numeric field (“Price”) and a date and time field (“Transaction_Time”) to your query, and then, in the Totals dialog box, indicate that you want to display the average of the numeric field “Price”. Since you added a date and time field, you can calculate the totals for each unique date and time value, such as each month, quarter, or year.

   Select the period you want to use to group date and time values, and then click Next .

   Note: In Design mode, you can use expressions to group values ​​by period, but only the options listed here are available in the wizard.

9. On the last page of the wizard, specify a name for the request, indicate whether you want to open or edit it, and click Finish .

   If you choose to open a query, it will display the selected data in table mode. If you choose to edit your query, it will open in design mode.

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Create a query in design mode

In design mode, you can manually create a select query. In this mode, you have more complete control over the process of creating a request, but it is easier to make a mistake and it takes more time than in the wizard.

Create request

Step 1: Add Data Sources

When you use the designer to add data sources, their sources and fields are added in separate steps. However, you can always add additional sources later.

1. On the tab Create , in the Other group, click Query Builder .

2. Double-click each data source you want to use, or select each one, and then click the Add button.

Automatic connection

If relationships are already defined between the added data sources, they are automatically added to the query as connections. Joins define how data from related sources should be combined.Access also automatically creates a join between two tables if they contain fields with compatible data types and one of them is a primary key.

You can customize connections added by Access. Access selects the type of connection to create based on the relationship that matches it. If Access creates a connection but does not have a relationship defined for it, Access adds an inner join.

If Access automatically created the correct connection types when adding data sources, you can skip to Step 3 (Add Output Fields).

Reusing a single data source

In some cases, you need to join two copies of the same table or query, called a self-join query, that combine records from the same table when the values ​​in the join fields match. For example, suppose you have an Employees table that displays the name of the manager instead of the name in the REPORT field for each employee record.Instead, you can display the manager’s name yourself in each employee’s records.

When you add the data source a second time, Access will end the name of the second instance with “_1”. For example, if you re-add the Employees table, the second instance will be named Employees_1.

Step 2: Connect Linked Data Sources

If the data sources you add to your query already have relationships, Access automatically creates an internal join for each relationship.If there is data integrity, access also displays “1” above the link to show which table is on the “one” side of the one-to-many relationship, and the infinity symbol (∞), to show which table is on side “many”.

If you added other queries to your query and did not create relationships between them, Access does not automatically create connections between them or between queries and tables that are not related. If Access does not create connections when you add data sources, you usually need to create them manually.Data sources that are not connected to other sources can lead to problems in query results.

Alternatively, you can change the join type from inner to outer join so that the query includes more records.

Add connection

• To create a connection, drag a field from one data source to the corresponding field in another data source.

  Access will add a line between the two fields to indicate that they are connected.

Change connection

1. Double-click the connection you want to modify.

   The dialog box , Connection settings , opens.

2. Review the three options in the Dialog Box Connection Parameters.

3. Select the desired option and click OK .

After creating the connections, you can add display fields: they will contain the data that should be displayed in the results.

Step 3: Add Output Fields

You can easily add a field from any data source added in step 1.

• To do this, drag the field from the source in the upper pane of the query design window down to line Field of the query form (at the bottom of the design window).

  When you add a field in this way, Access automatically fills in row in Table in the designer table according to the data source of the field.

  Tip: To quickly add all fields to the Field row of a query design, double-click the table or query name in the top pane to select all the fields in it, and then drag them all down onto the design at once.

Using an expression as an output field

You can use an expression as an output field for calculations or for generating query results using a function. Expressions can use data from any query source, as well as functions such as Format or InStr, constants, and arithmetic operators.

1. In an empty column of the query table, right-click row Field and select Scale from the context menu.

2. In the Scale box, enter or paste the expression you want. Before the expression, enter the name you want to use for the result of the expression, followed by a colon. For example, to designate the result of an expression as “Last Updated”, type Last Updated: before it.

   Note: You can use expressions to perform a wide variety of tasks.Their detailed consideration is beyond the scope of this article. For more information on creating expressions, see the article Create expressions.

Step 4. Specify conditions

This step is optional.

Using conditions, you can limit the number of records returned by a query by selecting only those records in which the field values ​​meet the specified criteria.

Define conditions for the displayed field

1. In the query designer table, on line Criterion of the field you want to filter on, enter an expression that must be satisfied by the values ​​in the field to be included in the result.For example, to include in your query only records that have Ryazan in the City field, enter Ryazan on line Criteria below this field.

   For various examples of query condition expressions, see the article Examples of query conditions.

2. Enter the alternative conditions on line or below line Criteria for selection .

   When alternative conditions are specified, a record is included in the query results if the value of the corresponding field satisfies any of the specified conditions.

Conditions for multiple fields

Conditions can be set for multiple fields. In this case, to include the record in the results, all the conditions on the corresponding line must be met. Criteria for selection are or or .

Set up conditions based on a field that is not included in output

You can add a field to a query, but not include its values ​​in the output.This allows you to use the content of the field to limit the results, but not display it.

1. Add the field to the query table.

2. Uncheck the box for it in line Show .

3. Set the conditions as for the displayed field.

Step 5.Calculate the grand total of

This step is optional.

You can also calculate totals for numeric data. For example, you might want to know the average price or total sales.

The query uses line Total to calculate totals. By default, line Total is not displayed in design mode.

1. With a query open in the designer, on the Design tab, in the Show / Hide group, click Totals .

   Access displays line Total on the query design.

2. For each required field on line Total , select the desired function. The functionality available depends on the type of data in the field.

   For more information about the Total row functions in queries, see Sum or count values ​​in a table using the Total row.

Step 6.View

results

To see the results of the query, on the Design tab, click Run . Access displays the results of the query in table view.

To return to design mode and make changes to your query, click Home > View > Design .

Customize fields, expressions, or conditions and rerun the query until it returns the data you want.

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Google Chrome – Privacy Policy

Last updated: September 23, 2021

Previous versions:
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Learn how to manage the data that Google receives, stores, and uses when you are using the Google Chrome browser on a computer or mobile device, in Chrome OS, or in Safe Browsing mode. While the rules below apply to the Chrome browser, all personal information you provide to Google or store in your account is handled strictly in accordance with Google’s Privacy Policy, which changes from time to time.For information about data storage by Google, see the relevant policy.

If you can install apps from Google Play on your Chromebook, the use and protection of your data collected by Google Play or Android is governed by the Google Play Terms of Service and Google Privacy Policy. In this Note, you will find additional rules regarding Google Chrome.

About Note

In this Note, for convenience, we will use the term “Chrome” to refer to the entire range of Chrome products identified above.If the rules differ for different products, this will be discussed separately. Sometimes the provisions of the Note change.

Chrome (beta), Chrome Developer, and Chrome Canary allow you to test new browser features that have not yet been officially released. This Note applies to all versions of Chrome, but may ignore features in development.

Learn more about how to change privacy settings in Chrome…

Contents

Browser Modes

You can start using Chrome without providing any personal information.However, in some modes, the browser may collect data about you for your convenience. Confidentiality measures depend on the selected mode.

Main browser mode

When the browser is in main mode, information is saved on your computer, including:

• Site browsing history. Chrome saves the URL of visited pages, cache files with text, images and other content from the pages, as well as a list of IP addresses of some resources that are linked to on the visited pages (if pre-rendering is enabled).

• Personal data and passwords for quickly filling out forms and entering sites you have visited before.

• List of permissions granted to websites.

• Cookies or other data from the websites you visit.

• Data saved by add-ons.

• Information about website downloads.

You can:

Personal information from Chrome is sent to Google only if you choose to store it in your Google Account by turning on sync.Payment details, cards and passwords are only transferred if you have saved them in your Google Account. Read more…

How Chrome handles your information

Information for site owners. Websites you open with Chrome automatically receive standard log data, including your IP address and cookie data. By using Chrome to work with Google services (such as Gmail), you do not provide Google with any additional information about yourself.If Chrome automatically detects that a user of a Google service or a partner site has become a victim of a man-in-the-middle attack, this data can be sent to Google or to the resource where the attack took place. This is necessary to determine its seriousness and the principle of the organization. Site owners working with Google receive reports of attacks that have been carried out on their resources.

Pre-visualization. To load web pages faster, Chrome can look up the IP addresses of links hosted on the current page and create network connections.Android sites and apps also sometimes ask the browser to preload web pages that you can navigate to. Requests from websites are always fulfilled and independent of the Chrome prediction system. If a request is made from the Chrome browser, website, or app to pre-render the page, it will store and read cookies as if it had already been visited (even if it hasn’t). Read more…

Location. In order to provide you with the most relevant information, some sites may request your location data.Chrome warns about this and provides such data only with your permission. Chrome uses Google’s geolocation services to find your location and can send the following information there:

• A list of nearby Wi-Fi routers.
• identifiers of cellular base stations nearby;
• data on the strength of the Wi-Fi or cellular signal;
• The current IP address of your mobile device.

Google is not responsible for third party websites and their privacy practices.Be careful when giving them your location information.

Updates. Chrome sometimes sends requests to Google to check for updates, determine connection status, sync time settings, and find out the number of active users.

Search functions. If you are logged into your Google account and are using the default Google search engine, queries through the omnibox or search box on the Chrome quick access page will be saved to your Google account.

Search hints. To help you search for information faster, Chrome offers query options. To do this, it sends the characters that you enter in the omnibox or the search box on the quick access page to your default search engine (even if you haven’t pressed the “Enter” key yet). If you’ve selected Google as your default search engine, it offers suggestions based on your search history, other people’s searches, and topics related to your omnibox and search box searches on the quick access page.Learn how to speed up your Google searches in this article. Hints can also be based on browser history. Read more…

Similar pages. If you can’t open the webpage you want, Chrome will send its address to Google and suggest similar sites.

Autofill, payments and password management. When autocomplete or password management is enabled, Chrome sends anonymous information to Google about the web forms you open or submit (including the hashed web page URL and input field data).This information allows us to improve our autocomplete and password management services. Learn more…

If you’re signed in to Chrome with your Google Account, you may be prompted to save passwords, payment methods, and similar information to your account. Chrome can also populate web forms with passwords and payment methods from your Google Account. If passwords and other data are only saved in Chrome, you’ll see a prompt to save them to your Google Account. If you use a payment method from your Google Account or save such a payment method in it for the future, Chrome will collect information about your computer and transfer it to Google Pay to protect against fraudulent transactions and to provide the service.You will also be able to pay for purchases through Chrome using Google Pay if supported by the merchant.

Language. Chrome remembers the language of the sites you visit most often and sends this data to Google to make your browsing experience more convenient for you. If you’ve turned on Chrome sync, the language profile will be linked to your Google account. If you’ve added Chrome history to your app and web search history, the language information can be used to personalize other Google services.Activity tracking can be configured here.

Web Apps for Android. If you add a site optimized for fast and reliable operation on mobile devices to the home screen of your Android device, Chrome will contact Google servers and create an original application package on your device. Thanks to it, you can use the web application like a regular Android application. For example, a web app will appear in the list of apps installed on the device.Learn more…

Usage statistics and crash reports. By default, this data is sent to Google so that we can use it to improve our products. Usage statistics contain information about settings, button clicks, and memory resources used. Typically, statistics do not include web page URLs and personal information. However, if you have turned on the “Help improve browsing and search” or “Send the URL of visited pages to Google” feature, the statistics will show which pages you have opened and how you used them.If you have Chrome sync turned on, the gender and age data entered in your Google account can be used in conjunction with our statistics. This allows us to create products for all groups of the population. For example, we can collect statistics to identify pages that are loading slowly. We use this information to improve our products and services, and to help developers improve their sites. Crash reports contain system information at the time of the crash, and may also include web page URLs and personal information (depending on how you used your browser).We may share aggregated information with partners (such as publishers, advertisers and developers) that cannot be personally identified. You can prevent or re-allow Chrome to send statistics and reports to Google at any time. If you use apps from Google Play on a Chromebook and have allowed Chrome to send statistics, diagnostics and Android usage information will also be sent to Google.

Media licenses. Some sites encrypt media content to protect it from unauthorized access and copying. If the site is built in HTML5, the exchange is done using the Encrypted Media Extensions API. At the same time, the license and session ID can be saved on the user’s device. To erase them, use the Browser Browsing Data tool (check the box next to Cookies and other site data). If your site uses Adobe Flash Access, Chrome provides the site or content provider with a unique identifier that is stored on your system.To block access to your ID, in the Chrome menu, select Settings> Advanced> Content Settings> Protected Content, or use the Browsing Data Cleanup tool (check the box next to Cookies and other site data). When you want to access protected content on Chrome for Android, HD, or offline content on Chrome OS, the content provider may require confirmation that the device is eligible to play it. In this case, your device will transfer an identifier to the site that confirms the security of the encryption keys.Read more…

Other Google services. This Note covers the Google services that are included with Chrome by default. Chrome may offer you other Google services, such as Google Translate, if you open a page in a different language. The first time you use these services, their settings will appear. More information can be found in the Chrome Privacy Policy.

IDs in Chrome

Chrome uses a variety of unique and non-unique IDs that are required for features to work properly.For example, when pushing, the browser is assigned an identifier for the correct delivery of notifications. We try to use non-unique identifiers, as well as remove unnecessary ones in a timely manner. In addition, there are several identifiers that are needed to improve and promote Chrome, but are not directly related to custom features.

• Tracking installations. Every copy of Chrome for Windows contains a randomly generated number that is sent to Google on first launch and then deleted the first time Chrome is updated.We use this temporary identifier to estimate the number of browser installs. Chrome mobile uses a kind of device ID instead, which also helps us find out the number of installs.

• Track promotions. To monitor the effectiveness of promotions, Chrome generates a unique token that is sent to Google when you first launch and use the browser. If you downloaded or reactivated your browser on your computer during an advertising campaign and chose Google as your default search engine, Chrome also sends a non-unique promo tag to Google from the queries you enter in the omnibox.All requests in the Chrome mobile omnibox also contain a non-unique promo tag. Chrome OS devices can do the same (for example, during the first installation and when submitting search queries). Read more…

• Testing. We sometimes organize closed tests of new features. On first launch, the browser is assigned a random ID, which is needed to select focus groups. Testing may be limited by country (determined by IP address), operating system, Chrome version, and other parameters.A list of test functions that are currently active in your Chrome browser is attached to all requests that are sent to Google. Learn more…

Sign in and sync modes Chrome

You can use the Chrome browser that is signed in to your Google Account, regardless of whether sync is turned on.

Login to your account. If you sign in to or sign out of any Google service using the desktop version of Chrome, you will be signed in or out of your Chrome account automatically.This feature can be disabled in the settings. Learn more… If you sign in to any Google web service on the Android or iOS version of Chrome, you may see a prompt to sign in with your Google Accounts that are already in use on that device. This feature can be disabled in the settings. Learn more … If you’re signed in to Chrome with your Google Account, you may see a prompt to save passwords, payment methods, and other similar information to your account. This personal information is subject to the Google Privacy Policy.

Synchronization. When you sign in to Chrome or a Chromebook and turn on sync with your Google Account, your personal information is stored in your account on Google servers. This allows you to access your data from any device you’re signed into Chrome on. Personal information is subject to the Google Privacy Policy. Here’s what can be synchronized:

• history of page visits;
• bookmarks;
• tabs;
• passwords and auto-complete options;
• Other browser settings, such as installed extensions.

Synchronization will only work if you enable it. More … In the “Settings” menu, you can select specific information that will be synchronized. Learn more… To manage Chrome data stored in your Google Account, you need to go to this page. There you can also turn off synchronization and delete all account-related data from Google servers (if the account was not created through the Family Link service). Learn more … Signing in to Google Accounts created with Family Link is required and cannot be disabled for syncing because it is used by parents to control children’s devices, such as access to certain sites.However, children with managed accounts can delete their data and turn off sync for most types of data. Learn more … Data stored in these accounts is subject to the Privacy Notice for Google Accounts created for children under 13 and managed by Family Link.

How Chrome handles synced information

When Google sync is enabled, we use the saved data to make your browsing experience as comfortable as possible.To make it easier for you to use our other products, you can add Chrome history to your app and web search history.

You can change this setting on the activity tracking page and manage personal information as you see fit. If you decide not to use Chrome data in other services, it will only be processed by Google anonymously and after it has been combined with data from other users. We use this data to create and improve features, products and services.If you want to use the Google Cloud to store and sync your Chrome data, but don’t want to give Google access to it, turn on passphrase encryption. Learn more…

Incognito and Guest Mode

Use Incognito or Guest Mode to limit the amount of information Chrome stores on your computer. In these modes, some information is not saved, for example:

• basic information about your browsing history, including URLs, cached page text and IP addresses associated with the websites you visit;
• thumbnails of the sites you visit;
• records of file downloads (the downloaded files will be stored in the folder you specified on your computer or mobile device).

How Chrome handles your information in incognito and guest mode

Cookies. Chrome does not allow sites to access cookies if you are using incognito or guest mode. When operating in these modes, sites may store new cookies in the system, but they will all be deleted when you close your browser window.

Changes to the browser configuration. When you make changes to the browser configuration, such as bookmarking a web page or changing settings, this information is saved.In incognito mode and in guest mode, this does not happen.

Approvals. The permissions you grant in incognito mode are not saved in the existing profile.

Profile information. In incognito mode, you have access to information from an existing profile, for example, hints based on the history of page visits and saved passwords. In guest mode, the profile data is not used.

Managing Chrome Users

Managing Users in Personal Chrome

You can create a separate profile in Chrome for each person who uses a computer or mobile device.In this case, any user of the device will have access to all information of all profiles. If you want to protect your information, use different accounts in the operating system. Learn more…

Manage users in Chrome for Enterprise

If your company or school controls your Chrome browser or Chromebook, your system administrator can set rules for that. When the user first starts working in the browser (except for guest mode), Chrome contacts Google and receives the necessary rules and then periodically checks them for updates.

An administrator can enable Chrome status and activity reporting, which will include location data for devices running Chrome OS. In addition, the administrator can have access to information on the managed device, as well as track and disclose it.

Safe Browsing

Google Chrome and other browsers (including some versions of Mozilla Firefox and Safari) support Google Safe Browsing. With Safe Browsing, your browser receives information about suspicious websites from Google’s servers.

How Safe Browsing works

The browser periodically contacts Google servers to download a constantly updated list of sites found to be phishing and distributing malicious software. The current copy of the list is stored locally on your system. However, Google does not receive any account information or other identifying information. Only standard log information is transmitted, including IP address and cookies.

Every site you visit is checked against the uploaded list.When a match is found, the browser sends a hashed partial copy of the URL to Google for more information. It is impossible to determine the real URL based on this information. Learn more …

A number of Safe Browsing features only work in Chrome:

• If you have enabled Advanced Security with Safe Browsing, Chrome uses additional protections. This sends more data to Google (see Chrome settings).More … When standard mode is enabled, some protections may also be available as standalone functions. These features are customizable.

• If you’ve turned on Safe Browsing and the Help improve browsing and search / Submit URLs of visited pages to Google option, Chrome sends the full URL of every site you open to Google. This helps determine if the resource is safe. If you’ve also turned on browser history sync without a passphrase, these URLs will be temporarily linked to your Google account.This will provide more personalized protection. This feature does not work in incognito and guest mode.

• Some versions of Chrome use Safe Browsing technology to detect potentially dangerous sites and file types that are not yet listed on Google. Information about them (including the full website URL or download file) can be sent to Google for verification.

• Chrome uses Safe Browsing technology and periodically scans your computer for unwanted software.Such software may interfere with changing browser settings or otherwise impair its security and stability. If it detects unwanted programs, Chrome may prompt you to download the Chrome Cleanup Tool to remove them.

• To help us improve the Safe Browsing mode, you can configure the sending of additional data. They will be transmitted when you go to a suspicious site or when unwanted software is found on your computer. Learn more…

• If you are using Chrome Password Manager, when you enter a saved password on a suspicious page, Safe Browsing checks that page to protect you from phishing attacks.However, Chrome does not send your passwords to Google. Plus, Safe Browsing protects your Google account password. If you enter it on a suspicious site, you will see a prompt to change your Google account password. If your browser history syncs, or if you are signed in to your account and have allowed Google to notify, Chrome will flag your Google account as a phishing attack.

• Google. When you enter a website, Chrome sends part of your username hash and encrypted password information to Google, and Google returns a list of possible matches from information that was made available to outsiders as a result of known leaks.Chrome uses the list to determine if your data has been disclosed. At the same time, the username and password, as well as the fact of their leak, do not become known to Google. This feature can be disabled in Chrome settings. More …

• You can turn off Safe Browsing in Chrome settings on your Android device or computer. In the iOS version, safe browsing technology is controlled by Apple, which may send data to other companies that provide safe browsing services.

Privacy measures for apps, extensions, themes, services, and other add-ons

You can use apps, extensions, themes, services, and other add-ons in Chrome, including pre-installed or integrated ones. Add-ons developed and provided by Google may send data to its servers and are controlled by Google’s Privacy Policy, unless otherwise stated. Third-party add-ons are controlled by their developers, who may have different privacy policies.

Manage add-ons

Before installing an add-on, check what permissions it is asking for. Here are some of the possible permissions:

• store, view and publish data from your device or from your Google Drive account;
• to view content on the sites you visit;
• Use notifications that are sent through Google’s servers.

Chrome can interact with add-ons in the following ways:

• Check for updates.
• download and install updates;
• Send add-on usage metrics to Google.

Certain add-ons may request access to a unique identifier for DRM or push notification delivery. To revoke access to your ID, remove the add-on from Chrome.

We occasionally learn that certain add-ons pose a security risk, violate the Chrome Web Store for Developers, or other legal agreements, regulations, laws, and regulations. Chrome periodically downloads a list of such add-ons from servers in order to disable or remove them from your device.

Confidentiality of server logs

Like most sites, our servers automatically record which pages were requested by users when they visit our resources. Server log records typically include your internet request, IP address, browser type, browser language, date and time of the request, and one or more cookies that uniquely identify your browser.

Here is an example of a typical log entry for the search term “machines”.The following explains what each part means.

123.45.67.89 - 25 / Mar / 2003 10:15:32 - https://www.google.com/search?q=machines - Firefox 1.0.7; Windows NT 5.1 - 740674ce2123e969

• 123.45.67.89 is the IP address assigned to the user by the ISP. This address can change every time the user connects to the Internet.
• 25 / Mar / 2003 10:15:32 – date and time of the request.
• https://www.google.com / search? q = machines – the requested URL, which includes the search query.
• Firefox 1.0.7; Windows NT 5.1 – browser and operating system used.
• 740674ce2123a969 is the unique cookie ID assigned to this computer the first time they visited Google. The user can delete cookies. In this case, the unique cookie ID added the next time you visit Google from the same computer will be listed here.

Additional Information

All information Google receives from Chrome is processed and stored in accordance with Google’s Privacy Policy. The data received by the owners of other sites and add-on developers, including cookies, is governed by the privacy policies of those sites.

The level of data protection and legislation in this area may differ from country to country. We protect information in accordance with our Privacy Policy, regardless of where the data is processed.In addition, we comply with a number of legal restrictions regarding data transfer, including the European framework agreements described on this page. More …

Basic concepts

Cookies

A cookie is a small file that contains a string of characters and is sent to your computer when you open a page. This allows the website to identify your browser when you visit it again. These files are used for different purposes, for example, they allow you to remember your settings.You can prevent the browser from saving cookies or enable notifications about them, but sometimes this leads to incorrect operation of sites and services. Learn more about how Google uses cookies and similar data from partners…

Google Account

password). It will be used to authenticate and protect against unauthorized access to your account.You can change data or delete an account at any time in its settings.

Bile cancer – Dobrobut clinic

Cancer of the gallbladder: causes, symptoms and diagnosis

The development of neoplasia in the gallbladder and ducts occurs in 2-8% of cases from the total number of registered oncological neoplasms. On average, people aged 55 and over are more susceptible to the disease, women are sick more often than the male part of the population.

Risk factors

Among some patterns that increase the risk of developing pathology, there are such as:

• Gender – statistically, women are exposed to the disease twice as often as the male part of the population.
• Age – In 70% of cases, cancer of the gallbladder and biliary tract occurs in older people.
• Presence of stones in the gallbladder. It is believed that stones larger than 3 cm increase the risk of developing cancer by 10 times, and calcification of the bile wall (the so-called “porcelain” bladder) increases the risk by 10-60%.
• Benign neoplasias. Inflammatory and cholesterol polyps provoke the risk of developing cancer. Malignancy of an adenoma larger than 1 cm often occurs.
• Primary sclerosing cholangitis, which occurs in 13% of patients, is accompanied by cancer.
• Chronic cholecystitis. Against the background of this pathology, the risk of development is seriously increased. For example, in chronic cholecystitis of typhoid-parasitic etiology, the likelihood of occurrence is increased 167 times *.
• Anomalies of intrauterine growth and development of the bile ducts.
• Ulcerative colitis.
• Occupational hazards – the development of tumors can be traced in people working in the production of paper, rubber, in the shoe and textile industries.

Varieties of gallbladder oncology

Gallbladder cancer is macroscopically divided into several forms.

• Diffuse-infiltrative type of tumor.It is characterized by the growth of the oncological process in the thickness of the bladder wall throughout its entire area, it becomes thick, bumpy. The neoplasia quickly spreads to the liver, colon, and duodenum.
• Nodal type. It is a malignant node that grows inward or outward of the lumen of the bladder, the occurrence is rarely traced.
• Papillary variant. It has the shape of papillae growing into the lumen of the organ, and is also rare.

Bile duct neoplasias are macroscopically divided into two forms:

• Exophytic – grow towards the surface of the ducts.
• Endophytic – spread into the lumen of the organ.

Tumors of the gallbladder and ducts metastasize in two ways:

• The lymphatic system, from where malignant cells can enter the lymph nodes surrounding the pancreas, the abdominal aorta through the vessels.
• Blood vessels, from where the process spreads through the liver, peritoneum, lungs, pleura.

Stages of development of gallbladder oncology

Malignant pathological conditions of the gallbladder are divided into several stages:

• Stage 1 is manifested by the germination of the oncology process only into the mucous wall of the bladder.
• Grade 2 is characterized by the occurrence of the process throughout the entire thickness of the wall, up to the perforation of its outer layer and germination into the liver or any other surrounding organ.
• Stage 3 is characterized by the penetration of the tumor into any two adjacent organs.
• Grade 4 gallbladder cancer is diagnosed when metastases are found in distant organs.

Gallbladder cancer: symptoms

The oncological process has no special signs and is clinically difficult to diagnose.The following manifestations are distinguished:

• skin and mucous membranes of an icteric shade;

90,053 itching of the skin;

• pain in the right hypochondrium,
• dark urine and colorless feces;
• palpation (to the touch) enlarged biliary or lumpy, inactive neoplasm in the abdominal region;
• inflammation of the bile ducts;
• increase in the size of the liver;
• symptoms of intoxication: fever, feeling unwell, muscle weakness, exhaustion.

Clinical types of gallbladder cancer are also distinguished:

• Jaundice is characterized by a gradual increase in symptoms that begin with intoxication and continue with the onset of jaundice with mild pain in the right hypochondrium, which progresses over time.
• The tumor form is manifested by a gradually increasing pain syndrome in the projection of the gallbladder in combination with general oncological symptoms (weight loss, appetite).
• Dyspeptic appearance is characterized by aching pain in the epigastric abdominal region, bloating, flatulence and pronounced symptoms of cancerous cachexia (exhaustion).
• With a septic type, gallbladder oncology is complicated by purulent pathological conditions (cholangitis, abscesses).
• In the “mute” form of the disease, the manifestation of symptoms in the organs affected by metastases is characteristic, while the main tumor does not make itself felt.

Diagnostics of gallbladder oncology

Laboratory tests include several important tests:

• Complete blood count – in advanced forms, a decrease in hemoglobin and red blood cells is determined, and in case of concomitant purulent diseases – an increase in leukocytes, the rate of sedimentation of red blood cells.
• General urine analysis – in the presence of jaundice in it, a high level of bile pigments and the absence of urobilin can be determined.
• Stool analysis – with obstructive jaundice, stercobilin will not be determined.
• Biochemical blood test – increased indicators of liver enzymes, bilirubin levels, etc.
• Determination of the presence of tumor markers.

Research by instrumental methods includes:

• Ultrasound is the primary method that determines disorders in 98% of patients, it is the main one at the initial stage of diagnosing gallbladder oncology due to its simplicity and informational content.It is possible to reveal an increase in the gallbladder, its deformation, an increase in local lymph nodes, a thickening of the wall. With the help of ultrasound, it is very difficult to distinguish a tumor of the gallbladder from its other pathological conditions.
• Investigation of the oncological process with the help of a computed tomograph allows one to very clearly visualize the neoplasia and the places of its spread, to describe the degree of damage to the surrounding structures.
• Examination with a magnetic resonance imaging apparatus will supplement and improve the information content.
• Endoscopic retrograde cholangiopancreatography is needed for visual examination of the state of the upper part of the digestive tract and bile ducts. In some cases, it allows you to take a biopsy for further research.
• Puncture biopsy – with the help of ultrasound, a section of the tumor is taken with a special needle for histological manipulations.
• Laparoscopy allows you to visually assess the state of the abdominal organs, determine the operability of the tumor, and take a site for histological verification.

Treatment of gallbladder cancer

Treatment of oncology of the gallbladder and ducts is performed with the help of surgical operations and chemoradiation therapy.

Complete cure for gallbladder cancer can be achieved only in the initial stages of neoplasia. For this, radical operations are performed, the purpose of which is the complete removal of the tumor. Such surgical interventions include:

• Cholecystectomy – the usual removal of the gallbladder, which can be performed by the classical or laparoscopic method.It can be used only if the tumor has grown no further than the mucous membrane of the bladder, which cannot be visually confirmed. This factor is determined only during the postoperative histological examination of the organ.
• Extended operations – used in the early stages with operable tumors and the absence of metastases. At the same time, parts or whole nearby organs or organocomplexes can be removed.

In advanced cases, palliative and symptomatic surgical interventions are used.They do not cure cancer, but they can prolong and improve the quality of life. Such operations include:

• Cytoreductive cholecystectomy – removal of the maximum possible volume of the neoplasm.
• Cholecystostomy or percutaneous cholangiostomy – the connection between the gallbladder / duct and the environment to drain bile and eliminate obstructive jaundice.
• Stenting – placing a stent in the lumen of the bile duct to improve the outflow of bile.It is performed using endoscopic retrograde cholangiopancreatography or laparoscopy.
• Biliodigestive anastomosis – the creation of a new anastomosis between the bile ducts and the gastrointestinal tract.
• Endoscopic papillosphincterotomy – dissection of the papilla of the bile duct of the duodenum.
• Nasobiliary Drainage – Endoscopic placement of a catheter during retrograde cholangiography and removal of the free end through the nose.

When diagnosed with gallbladder cancer, the prognosis will be favorable only in the initial stages of the disease; over time, the chances of full treatment are significantly reduced.

Prevention of gallbladder cancer

It is impossible to completely prevent oncology, however, the risk of development can be minimized by taking into account some points. Important:

• Timely carry out the treatment of cholecystitis and gallstone disease, if necessary, carry out cholecystectomy.
• Surgical treatment will help reduce the risk of developing neoplasms with gallbladder polyposis.
• Observation by a specialized doctor (especially in the presence of the above diseases) with an ultrasound examination of the abdominal organs is mandatory.
• Reducing the effects of carcinogens on the body will help reduce the risk of cancer.

If suitable symptoms occur, an urgent need to visit a specialist for the timely diagnosis of pathology and determining the order of further actions.

Adult Autism: How It Lives for Those Who Are Diagnosed with Autism in Adulthood

• Eva Ontiveros
• BBC World Service

April 2, 2021

Photo Credit, Getty Images

Caption,

A diagnosis, no matter how late it is, can help a person deal with everyday life with greater confidence.

“I was finally able to understand what was wrong with me.You can’t imagine how relieved I was! “- says Sudhanshu Grover in an interview with the BBC.

” I have two sons with autism, and I work with children with autism, but I never suspected that this also applies to me, says Sudhanshu. She lives in New Delhi and was diagnosed at about 40 years old.

“That explained everything in my life!” – echoes Alice Rowe, who was also diagnosed in adulthood.

“I have lived my whole life in anxiety and isolation, feeling that I am different from those around me.It seemed to me that my life is much less understandable than others. It was very comforting and rewarding to realize that there is a justification for my problem and that I am not alone in this, ”says Alice, who lives in the UK.

To mark World Autism Awareness Day, the BBC talks about autism and about the significance of this diagnosis in people’s lives

Autism in adulthood

Photo author, Getty Images

Photo caption,

Many live feeling “different”, but do not understand why they are so feel

Worldwide data on autism spectrum disorders (ASD) is often difficult because the condition is recognized and diagnosed differently across countries.

The Centers for Disease Control and Prevention (CDC) estimates that in the United States, where data were collected systematically, 2.21% of adults have ASD.

WHO describes ASD as a developmental disorder that affects communication and behavior and can be diagnosed at any age.

Autism refers to a spectrum of these disorders: each person with autism has a different combination of autistic traits with varying degrees of intensity.

This is usually found in childhood because symptoms tend to appear in the first two years of life, but many people realize that they are only living with autism in adulthood, or are not diagnosed at all.

Late diagnosis is especially common in women. One reason for this may be that women are often better at copying the social cues they see around them, hiding or masking unusual behavior from those around them.

It is important to note that autism is not a disease. The brain of a person with ASD works differently than the brain of other people, according to the website of the British National Health Service.

There is no cure for autism — if you have autism, it’s for life — but people with ASD can greatly benefit from having the right support for their specific needs.

Why not all cases of ASD are detected?

Photo author, Getty Images

Photo caption,

“ASD is a difficult condition that cannot be” seen, “says Alice

Sudhanshu Grover is the head of education services at Action for Autism, an Indian non-profit organization.

” My children were diagnosed 20 years ago, at the age of three. That is why I started working with children with autism, says Sudhanshu. “But I myself never thought that I could have autism as well.”

For two decades, Sudhanshu has worked with children and parents to help them better understand autism.

It was not until she was 48 that she began to think that perhaps she also had autism.

“I began to notice how difficult it is for me to communicate with people and how difficult it is for them to understand things the way I wanted … or they understand them in a completely different way than I do,” she says. “In general, it was difficult for me to communicate and make friends … I thought it was all out of shyness. When I got along with people, I did it well, so I always had one or two close friends, but never large groups of acquaintances. “

But Sudhanshu more and more often realized that communication was not easy for her: “I was just numb when the situation was too tense. Or I analyzed it too carefully.”

At this point, Sudhanshu knew enough about autism to understand that it does not only occur in children, and that many adults may not be aware of their diagnosis all their lives.

“Given the opportunities, conditions and benefits available to people with autism in India, I knew that at my age I would not be diagnosed in a public hospital,” says Sudhanshu, “so I had to go to a private company.”

“It’s been almost a year and a half, and I’m still trying to figure out what this means to me. Until the end of this I have not yet realized, but I was able to understand why sometimes I behave this way and not otherwise,” she says.

In the end, there were some positive aspects to this diagnosis.

“I work with children with autism. When parents ask how their children’s life might turn out, I tell them about my own autism. I’m very frank about this because I believe that the situation will change when people start paying more attention. what you are doing.It makes life easier for everyone, “says Sudhanshu.

Fighting prejudice

Photo author, Sanjiv Soni

Photo caption,

Sylvia Moraa Mochabo:” The diagnosis of autism can be labeled on you in society, and not everyone wants to bear it’s a burden “

” On the African continent, many adults find it very difficult to simply accept this diagnosis, ”Sylvia Moraa Mochabo tells the BBC. “Autism continues to be a stigma in society.”

Sylvia is a technology entrepreneur in Kenya and founder of Andy Speaks 4 Special Needs Persons Africa.

Under the pseudonyms Ms. Africa Elite 2020, Ms. Africa United Nation 2020 and Ms. Elite Face of Africa 2020 she is also leading an awareness-raising campaign on neurodevelopmental disorders and autism.

“Lack of knowledge leads to a lack of diagnoses later in life. In three years, I only knew of three cases of autism in adults. But doctors do not diagnose even children, and we lack early diagnosis,” adds Sylvia.

Two of her three sons have autism, and Sylvia worries that they will not be able to live a fulfilling life, because “being branded as a person with autism is still a very serious problem for an adult.”

Natalia works in the media, in adulthood she was diagnosed with ASD. She does not want to reveal her full name, because this has already affected her work in the past.

“We all have dreams and a desire to succeed in life … it never goes away because we are different. We all share the same basic feelings and aspirations,” she says.

“I know quite a few people who just live without an official diagnosis. They know that they are different from others, but they have enough opportunities to adapt,” adds Natalia.

Photo author, Getty Images

Photo caption,

“Autism affects the way a person thinks, so it is difficult to diagnose the disease based on someone else’s thoughts,” says Alice

But Sylvia says it is much worse not to know what happens to you: “Our doctors’ curriculum does not cover ASD in detail. Therefore, when they see a patient with certain characteristics – a child or an adult – they may not think that it is autism. As a result, the diagnosis is not made, and people continue living with this disease without even understanding what it is. “

“In our culture, if you exhibit certain behaviors, you will be labeled as ‘mentally ill,’” says Sylvia. deal with problems. But what if there is no such possibility? ”

According to Sylvia, reaching adulthood with undiagnosed autism can make life difficult.

“If students with certain problems are not helped, they are more likely to drop out.By the time you matured, you were already labeled as ‘stubborn’ or ‘stupid’ and no one thinks autism could be the cause. “

However, for many in Africa, the diagnosis of autism is” terrible news, “says Sylvia.” However, this does not mean disaster, “she says. “You need to keep working with this person to reveal their best sides.”

Sylvia claims that from her job and from her own parenting experience, she knows that the key point for both the person and society is the acceptance of people with autism as they are.

“What do you need? Help with sensory problems? Speech therapist? You must access the right treatment if you want to be more active in society. It is impossible to support a person or seek the right therapies if you do not understand what they need and what they are experiencing, “she says.

Why diagnose an adult?

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“The advantage of diagnosis is better relationships with others,” says Alice

“I would advise all adults who believe they may have a disorder in the ASD spectrum to get a diagnosis because it gives a deeper understanding of the problem.When you know what you’re facing, you can better prepare for the challenges you will face, “Sylvia says.

Sudhanshu agrees,” Now I realize that I know people who were no different from me, but received better marks or have achieved greater success in life because they did not have to deal with the peculiarities and disadvantages of such a life every day. “

” There were so many things in my head, but I could never understand it. There were things that I really couldn’t do, so now that I have been diagnosed, I feel much better, “she says with relief.

Alice Rowe, a writer and entrepreneur who was diagnosed at 23, understands this relief well.

“I would feel much less isolated and unhappy if I knew that there are other people who feel the same way as me. As a teenager, I felt very lonely,” says Alice.

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Alice: “My friends now understand that I need a lot of time alone with myself, and I do not worry about spending little time with them.”

This is exactly what prompted her to create The Curly Hair Project, a social project to support people with autism and their loved ones.

“Probably many people are not diagnosed at an early age because they feel like everyone has the same problems and just need to“ try your best, ”says Alice.

Sometimes,“ people with autism even They don’t understand that they are “different”, and some may even deny it, so they are in no hurry to get a diagnosis, “she adds.

Alice’s diagnosis really helped:” My friends now understand me better, and we have a stronger relationship. I also feel that I can be myself among people, less pretending to be like them.This is really important for good mental health. “

Understand the” invisible state “

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” It would be nice if more people accepted rather than condemned this condition. ” says Sudhanshu

“It’s hard to explain to people that I have some problems because they don’t see them. My diagnosis came as a surprise to many of my old friends and acquaintances, “says Alice.

Sudhanshu agrees.”Without understanding these features, everyday life is difficult. And even you have a diagnosis, people do not always understand them.”

“There are many things that can be difficult to deal with: noise, smells, crowded places … when you have autism, life can be very difficult because even simple everyday things give you away,” adds Sudhanshu.

“Some problems are so trivial that others cannot even imagine that they are really problems,” says Alice.- For example, how can you explain that even if you like someone, you are not always comfortable dating them? That even a minor change in plans can ruin your entire day and keep you awake at night? Or that it might not be obvious to you how to use the turnstile because you can’t figure out where to drop your ticket and which turnstile to go through? “

In some ways, restrictions during a pandemic can help people who don’t have autism understand what it feels like to be stressed when someone invades your personal space or touches your things.

“Now everyone understands how people like me live!” – says Alice.

“I have always taken care of hygiene, and it is physically more convenient for me to be two meters from others,” she adds.

Help yourself

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“We all have the same feelings and aspirations,” says Natalia

“Diagnosis is not the answer to all your problems, but in some cases it can be useful if it helps to get help or to be understood by others, says Natalia.