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38 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7 education PATHOLOGY PERSPECTIVES Guillain-Barré Syndrome A Zika Virus Complication That Can Affect Adults By Ruth Werner My first phone call for a massage (that wasn't from someone I already knew) was from a very nice lady. She got my card from someone else, and she was really hoping she could schedule an appointment with me. I was so excited! I opened my brand-new appointment book and got ready to take down her information. Then, she said it: "By the way, I'm recovering from Guillain-Barré Syndrome. That won't be a problem, will it?" This was in 1984. It was pre-Google. It was even before I owned the American Medical Association Family Medical Guide or any other resources. All I had was an out-of-date medical encyclopedia, and I didn't know how to spell "Guillain" or "Barré"—and neither did she. All she knew is that it had something to do with her nerves. Reluctantly (but ethically), I told her I didn't have enough information to know if I could treat her safely. I didn't make the appointment. It broke my heart, and I decided that would never happen to me again. That phone call led to an amazing career of learning and teaching about the interface between massage therapy and complicated health challenges. I don't remember that lady's name. If I could, I would send her flowers, and give her a great massage. The last Pathology Perspectives column in Massage & Bodywork focused on Zika virus (November/December 2016, page 40), with the promise that in this issue we would look at the Zika virus complication that is most likely to affect adults: Guillain-Barré Syndrome (GBS). ZIKA REVIEW Here's a quick synopsis of the last article: Zika virus is a pathogen that can be spread by mosquitoes or through sexual activity. An outbreak in Brazil in 2016 spread through much of South and Central America and into the southern part of the United States. Travel-related Zika has been now diagnosed in all 50 states, but mosquito-borne infections have only happened in Florida as of this writing. Zika infections are totally silent in about 80 percent of everyone infected; those people may never know they've been exposed. Symptoms, when any emerge, include fever, body aches, headache, fatigue—it looks a lot like flu. The infection runs its course within two weeks, and then the person appears to have resistance to any future viral attacks. For a small number of people, however, exposure to Zika carries two important risks: women who are pregnant when they contract Zika have a risk of serious birth defects for their babies, and older adults who are infected with Zika have a low risk of developing GBS—a serious autoimmune condition that can damage the peripheral nervous system. WHAT IS GUILLAIN- BARRÉ SYNDROME? GBS is an autoimmune attack on the myelin sheaths of peripheral nerves. It was first documented in England in 1859, but a team of French doctors (including neurologists Georges Guillain and Jean-Alexandre Barré) named the condition after studying it in 1916. With GBS, white blood cells and antibodies destroy patches of myelin on spinal or cranial nerves. Some forms of GBS can extend the damage to the neuron fibers themselves. It usually begins in the extremities—bilaterally in the fingers and toes—and then moves toward the core. One form, called bulbar GBS, affects the vagus nerve and can dramatically impair swallowing, breathing, and other vital functions.

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