Weakness

Weakness & Chemotherapy

Includes: Balance & Mobility, Managing Incoordination (ataxia), Weakness (asthenia).

Balance and Mobility

What helps us to keep our balance and mobility?

The body's nerves and muscles are highly involved in maintaining balance and mobility. Balance is the ability to keep us stable, on our feet, and perform certain activities. Balance also prevents us from falling down from a standing or sitting position. Mobility allows us to move around and react to our environment in a timely manner. There are certain areas of our body that help us to keep our balance. These include:

• The cerebellum, which is located behind the brain stem and controls functions of movement, balance, mobility and posture. If you have experienced damage to your cerebellum you will experience impaired mobility, imbalance and incoordination.
• The vestibular system of the inner ear also plays an important role in helping to maintain our balance. It sends and interprets signals from the environment to keep us erect, and the body in balance when we move.

Causes of imbalance?

Many medications, treatments, and diseases can effect these areas, which then can cause problems with imbalance and dizziness, which affects our mobility. Examples of conditions or medications that may affect the cerebellum or vestibular system in person's receiving chemotherapy include:

• Chemotherapy drugs that may affect the vestibular system of the inner ear include:
  • Cisplatin and carboplatin.
• Chemotherapy drugs that may affect the cerebellum include:
  • High dose cytosine arabinoside (Ara-C) and high bolus doses of fluorouracil (5-FU).
• Dehydration: If you are dehydrated, and you change positions, you may feel experience imbalance or dizziness. This is a result of low blood pressure (orthostatic hypotension). Your healthcare provider may check your vital signs (including your blood pressure and heart rate) while lying down, sitting up, and standing, to help in determining this.
• Weakness causes by stress, tiredness, fever, fatigue, anemia, heart problems, or stroke may cause dizziness, and imbalance.
• Infection or inflammation of the inner ear, brain or spinal cord.
• You may notice imbalance after prolonged bed rest, when your muscles weaken. This will also lead to problems with mobility.

What are some symptoms of imbalance and poor mobility to look for?

• Generalized weakness or tiredness, not being able to perform usual activities.
• Dizziness
• Double vision.
• Vertigo (feeling like the room is spinning around you).
• Hearing loss. Weakness of hearing.
• Blurred vision.
• Ringing in the ears.
• Nausea and vomiting
• Difficulty with tasks such as writing your name, changing position from sitting to standing.
• Fever and/or chills (if infection or flu-like syndrome causing dizziness or imbalance)

Dizziness and problems with mobility and balance may be a symptom or sign of a serious problem. Notify your doctor if you experience any of the symptoms of imbalance and poor mobility mentioned here.

Things you can do about imbalance and poor mobility:

• It is important to notify your healthcare provider if you notice any sudden changes with your mobility or balance, if you experience any dizziness, or any change in the pattern of dizziness you are experiencing. Also, notify your healthcare provider if you have any loss of vision, hearing, or if your symptoms become more severe, and do not improve.

Prevent dehydration:

• Drink 2-3 liters of fluid per day to prevent dehydration. This may include fruit juices, water, non-caffeinated sodas and coffee, and non-alcoholic beverages.
• Avoid alcohol and caffeine as these may cause dehydration.
• Always carry a "sipper" cup with you, filled with your favorite drinks.
• Change positions slowly. Allow your body a chance to adapt to the position change. For some people, lying down until the dizzy episode passes may be the best solution.

Safety:

• With moderate imbalance, walk slowly and often. Walk with assistance if you are having severe dizzy episodes, weakness, or imbalance.
• If you are at risk for falling down due to imbalance:
  • Remove throw rugs from your usual walking path in your home if you are at risk for falling down. Avoid clutter, if possible.
  • Place track lighting, or keep the areas that you spend the most time in, well lit. this will prevent your chance of falling, if you are able to see more clearly.
  • If you are at risk for falling down due to weakness and unsteady movements, and you live or spend most of the day alone, try to carry a cordless phone, or another device to notify someone if you fall down.
  • Wear well-fitting shoes. Make sure the shoelaces or Velcro straps are tied tightly.
  • Do not operate any heavy machinery. It is also important to be careful when taking new medications.
  • Use any braces, canes, walker or other supportive devices prescribed by your health care professional.

Other therapies:

• Physical therapy (PT): May be recommended or requested to evaluate for safety concerns, optimize mobility and for assistance with other interventions as appropriate such as exercise for muscle strengthening or assistive devices.
• Occupational therapy (OT): If you are experiencing imbalance or problems with mobility, in general, you may be taught in OT how to do many tasks that you normally do, in a more effective manner.
• If you have vertigo that is causing imbalance and poor mobility, your doctor or a trained therapist may teach you exercises, called "vestibular exercises", to try to decrease the level of your dizziness. These exercises involve sitting down, and changing into different positions. This may increase your imbalance or dizziness at first, while you are performing these movements, but should help to correct the vertigo. You may expect improvement in 2-6 months.

To help prevent problems related to poor mobility:

• Keep your bowels moving. People who move around less may become constipated (see managing side effects - constipation for additional information).
• Take deep breaths. It is necessary to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. This is especially important if you have poor mobility. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• If you smoke, you should quit. If you do not smoke, avoid smoke-filled rooms. Smoking can affect the way your medications work. Discuss with your healthcare provider techniques that can help you quit.
• Change position often (every 2 hours) to relieve pressure points.
• Move legs and arms to help improve mobility. Use "pressing down the gas petal" motion, or make circling motions with your ankles to help prevent blood clots.

Other:

• Depending on the cause of imbalance and poor mobility, your symptoms may last a few days to a few months. It is important to follow all the instructions your healthcare provides.
• Exercise, under the supervision of your healthcare provider such as walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood (oxygenation).
• Make sure to get enough sleep at night. This may help to lessen trouble in the daytime with incoordination, fatigue and weakness. If you have trouble sleeping:
  • Do not eat or exercise within 2 hours of bedtime
  • Make the room dark
  • If you have an electronic clock, or one with an illuminated face, turn the face away from you.
  • Use the bed only for sleeping
  • Keep a consistent schedule. Make sure you go to bed each night and wake up each morning, at the same time.
  • Minimize daytime naps. If you must take a nap, do not sleep for more than an hour at a time. Longer naps will make you feel more tired, and interrupt nighttime sleep.
  • If these techniques do not work, consult your healthcare provider.
• If you experience weakness symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Drugs or treatments that may be prescribed by your doctor for imbalance or poor mobility:

Treatment of balance disorders is based upon finding the underlying cause, and treating that condition.

• If your weakness is a result of a medication or treatment, removing that medication may help alleviate weakness.
• Depending on your overall health status, your doctor may recommend certain drugs that may help you. Some of the common drugs that are used to treat your weakness may include:
  • Antibiotics - If your doctor or healthcare provider suspects that you have an infection that has caused your imbalance and poor mobility problems, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once asthenia is relieved.
  • Meclizine (Antivert^®), Dimenhydrinate (Dramamine^®), or the Scopolamine Patch (Transderm-Scop^®). These medications may help to decrease the symptoms of poor mobility or imbalance, that may accompany dizziness.
  • Prochlorperazine (Compazine^®), and Promethazine (Phenergan^®) -Used to treat imbalance as a result of dizziness. These work by preventing a feeling of dizziness, or by preventing nausea and vomiting that may cause dizziness.
• Physical therapy or Occupational therapy assistance may be prescribed.

When to call your doctor or health care provider about weakness:

• If weakness becomes progressively worse.
• If you have a headache, blurred vision, numbness or tingling.
• If there is a change in mental status, such as confusion, disorientation, or increased sleepiness.
• Any sudden changes with your imbalance, dizziness, or any change in the pattern of dizziness you are experiencing.
• Fever of 100.5° F (38° C), and /or chills (possible signs of infection if you are receiving chemotherapy).
• Feeling your heart beat rapidly, or experience palpitations
• Constipation unrelieved by the use of laxatives
• Diarrhea (4-6 episodes in a 24-hour period), especially if it is becoming worse
• Nausea (interferes with ability to eat and unrelieved with prescribed medications).
• Vomiting (vomiting more than 4-5 times in a 24-hour period).
• Any new rashes on your skin

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about weakness and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.

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Incoordination (Ataxia)

What is incoordination or ataxia?

Incoordination is irregularity in movements resulting from inharmonious action of the muscles due to loss of voluntary control over them. Ataxia is incoordination of movements. The cerebellum is located behind the brain stem and controls functions of movement, mobility, balance and posture. When you are experiencing ataxia, it is often due to problems with your cerebellar function.

There are different forms of ataxia, but these all refer to problems with coordination. Some examples include:

• Cerebellar ataxia - Referring to problems with moving the limbs (arms and legs), eyes, or trunk. This is due to problems with your cerebellum, a part of your brain that controls motor skills (movement).
• Gait ataxia - Is incoordination of walking. This can be mild (shuffling gait) to severe (the person cannot walk at all).
• Postural ataxia - Refers to problems with coordinating movements in certain positions. For example, you may have trouble sitting or standing, due to your incoordination.

Ataxia may be a result of many diseases or conditions. Most commonly, it is due to medications. Some medications that may cause ataxia include:

• Chemotherapy drugs: High dose cytosine arabinoside (Ara-C), high bolus doses of fluorouracil (5-FU) or chlorambucil
• Antibiotics - such as aminoglycosides (gentamycin, tobramycin).
• Heart medications, such as betablockers, amiodarone

Other causes:

• Alcohol intoxication
• Problems with the anatomical structures of your body
• Endocrine diseases may cause ataxia
• Inflammation of your inner ear, caused by infection will lead to poor mobility, dizziness, ataxia, and imbalance.

What are some symptoms to look for?

• Changes in the way you walk, loss imbalance.
• The need to hold on to something to stay steady.
• Increasingly slow, irregular, or clumsy movements.
• Falling.
• Generalized weakness or tiredness, not being able to perform usual activities.
• Dizziness
• Double vision.
• Vertigo (feeling like the room is spinning around you).
• Hearing loss. Weakness in hearing. Muffled hearing.
• Blurred vision.
• Ringing in the ears.
• Changes in speech (i.e. slurred speech)
• Nausea and vomiting
• Difficulty with tasks such as writing your name, changing position from sitting to standing.
• Fever and/or chills (if infection or flu-like syndrome causing dizziness or imbalance)

Dizziness and problems with mobility and imbalance may be a symptom or sign of a serious problem. Notify your doctor if you experience any of the symptoms mentioned here.

Things you can do:

Notify your health care professional if noticing any of the symptoms described above so evaluation can occur.

Safety:

• With moderate imbalance, walk slowly and often. Walk with assistance if you are having severe dizzy episodes, weakness, or imbalance.
• If you are at risk for falling down due to weakness or ataxia:
  • Remove throw rugs from your usual walking path in your home if you are at risk for falling down. Avoid clutter, if possible.
  • Place track lighting, or keep the areas that you spend the most time in, well lit. this will prevent your chance of falling, if you are able to see more clearly.
  • If you are at risk for falling down due to weakness or unsteady movements, and you live or spend most of the day alone, try to carry a cordless phone, or another device to notify someone if you fall down.
  • Wear well-fitting shoes. Make sure the shoelaces or Velcro straps are tied tightly.
  • Do not operate any heavy machinery. It is also important to be careful when taking new medications.
  • Use any braces, canes, walker or other supportive devices prescribed by your health care professional.

Other therapies:

• Physical therapy (PT): May be recommended or requested to evaluate for safety concerns, optimize mobility and for assistance with other interventions as appropriate such as exercise for muscle strengthening or assistive devices.
• Occupational therapy (OT): If you are experiencing imbalance or problems with mobility, in general, you may be taught in OT how to do many tasks that you normally do, in a more effective manner.

To help prevent problems related to imbalance and poor mobility:

• Keep your bowels moving. People with poor mobility may become constipated (see managing side effects - constipation for additional information).
• Take deep breaths. It is necessary to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. This is especially important if you are unable to move around very often. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• If you smoke, you should quit. If you do not smoke, avoid smoke-filled rooms. Smoking can affect the way your medications work. Discuss with your healthcare provider techniques that can help you quit.
• Change position often (every 2 hours) to relieve pressure points.
• Move legs and arms for mobility. Use "pressing down the gas petal" motion, or make circling motions with your ankles to help prevent blood clots.

Other:

• Depending on the cause of imbalance and poor mobility problems, your symptoms may last a few days to a few months. It is important to follow all the instructions your healthcare provides.
• Exercise, under the supervision of your healthcare provider such as walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood (oxygenation).
• Make sure to get enough sleep at night. This may help to lessen trouble in the daytime with incoordination, fatigue and weakness. If you have trouble sleeping:
  • Do not eat or exercise within 2 hours of bedtime
  • Make the room dark
  • If you have an electronic clock, or one with an illuminated face, turn the face away from you.
  • Use the bed only for sleeping
  • Keep a consistent schedule. Make sure you go to bed each night and wake up each morning, at the same time.
  • Minimize daytime naps. If you must take a nap, do not sleep for more than an hour at a time. Longer naps will make you feel more tired, increase weakness and interrupt nighttime sleep.
  • If these techniques do not work, consult your healthcare provider.
• If you experience weakness symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Drugs that may be prescribed by your doctor to help alleviate weakness:

• Treatment of your ataxia is based upon finding the underlying cause, and treating that condition.
• If your weakness is a result of a medication or treatment, removing that medication may help.
• Depending on your overall health status, your doctor may recommend certain drugs that may help you. Some of the common drugs that are used to treat your weakness may include:
  • Antibiotics - If your doctor or healthcare provider suspects that you have an infection that has caused your ataxia, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once asthenia is relieved.
  • Corticosteroids: Corticosteroids work by decreasing inflammation (swelling) in many areas of the body.
    • You may be taking steroids if you have pain, or weakness due to tumors in your brain, or near your spinal cord.
    • Steroids will decrease the swelling in areas where tumors are located, which may decrease the pressure of the tumor on your nerve endings, and decrease your pain.
  • Narcotics -The central nervous system (CNS) is a way for our brain to send messages to our body in a timely manner. It is highly alert, especially when we are experiencing pain. You may develop weakness or fatigue from chronic pain. Many narcotic analgesic (pain medicines) work by blocking pain messages, such as morphine sulfate and oxycodone..
  • Make sure you discuss with your healthcare provider common side effects, such as constipation, drowsiness, nausea and vomiting, and how to control these side effects.
  • Since fatigue and weakness are a side effect of pain medications, discuss with your healthcare provider how you may be able to control your symptoms of fatigue and weakness.
  • Non-steroidal anti-inflammatory (NSAID) agents or Tylenol^®- NSAID's such as naproxen sodium and ibuprofen, may provide relief of many types of pain. Pain relief may improve mobility, and help alleviate weakness.
    • If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol^®) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help.
  • It is important not to exceed the recommended daily dose of Tylenol^®, as it may cause liver damage. Discuss this with your healthcare provider.
• Physical therapy or Occupational therapy assistance may be prescribed.

When to call your doctor or health care provider:

• Changes in your walking, or imbalance problems.
• You've fallen.
• If your weakness is progressively worse.
• If you have a headache, blurred vision, numbness or tingling.
• If there is a change in mental status, such as confusion, disorientation, or increased sleepiness.
• Difficulty with tasks such as writing your name, changing position from sitting to standing.
• Fever of 100.5° F (38° C), and /or chills (possible signs of infection if you are receiving chemotherapy).

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about weakness and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.

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Weakness (Asthenia)

What is asthenia?

Asthenia is the loss or lack of bodily strength also referred to as generalized weakness.
Persons undergoing chemotherapy treatments can have weakness for a variety of reasons both physical and mental. Causes of weakness may include:

• Cancer treatments; chemotherapy, biologic response modifiers, radiation therapy.
• Side effects of treatment.
• Anemia, (low red blood cell count).
• Decreased mobility, spending a lot of time in bed (muscles tend to weaken).
• Overexertion
• Poor nutrition, dehydration.
• Sleeplessness.
• Stress
• Uncontrolled pain.
• Depression.
• Endocrine diseases of metabolism, such as of the thyroid gland, may cause fatigue and weakness.

What are some symptoms of weakness to look for?

• Your symptoms will vary depending on the cause of your weakness.
• Tiredness.
• Muscle aches and pains.
• Difficulty changing positions; from sitting to standing.
• Dizziness and imbalance.
• Shortness of breath.
• Fever and/or chills (signs of infection)
• Depression

Things you can do about asthenia:

Notify your health care professional if noticing any of the weakness symptoms described above so evaluation can occur.

Safety:

• With moderate imbalance, walk slowly and often. Walk with assistance if you are having severe dizzy episodes, weakness, or imbalance.
• If you are at risk for falling down due to weakness or imbalance:
• Remove throw rugs from your usual walking path in your home if you are at risk for falling down. Avoid clutter, if possible.
• Place track lighting, or keep the areas that you spend the most time in, well lit. this will prevent your chance of falling, if you are able to see more clearly.
• If you are at risk for falling down due weakness or unsteady movements, and you live or spend most of the day alone, try to carry a cordless phone, or another device to notify someone if you fall down.
• Wear well-fitting shoes. Make sure the shoelaces or Velcro straps are tied tightly.
• Do not operate any heavy machinery. It is also important to be careful when taking new medications.
• Use any braces, canes, walker or other supportive devices prescribed by your health care professional.

Other therapies:

• Physical therapy (PT): May be recommended or requested to evaluate for safety concerns, optimize mobility and for assistance with other interventions as appropriate such as exercise for muscle strengthening or assistive devices.
• Occupational therapy (OT): If you are experiencing imbalance or problems with mobility, in general, you may be taught in OT how to do many tasks that you normally do, in a more effective manner.

To help prevent problems related to imbalance and poor mobility:

• Keep your bowels moving. People who move around less may become constipated (see managing side effects - constipation for additional information).
• Take deep breaths. It is necessary to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. This is especially important if you suffer from poor mobility. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• If you smoke, you should quit. If you do not smoke, avoid smoke-filled rooms. Smoking can affect the way your medications work. Discuss with your healthcare provider techniques that can help you quit.
• Change position often (every 2 hours) to relieve pressure points.
• Move legs and arms. Use "pressing down the gas petal" motion, or make circling motions with your ankles to help prevent blood clots.

Other:

• Depending on the cause of imbalance and poor mobility problems, your symptoms of weakness may last a few days to a few months. It is important to follow all the instructions your healthcare provides.
• Exercise, under the supervision of your healthcare provider such as walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood (oxygenation). Do not
• Make sure to get enough sleep at night. This may help to lessen trouble in the daytime with incoordination, fatigue and weakness. If you have trouble sleeping:
• Do not eat or exercise within 2 hours of bedtime
• Make the room dark
• If you have an electronic clock, or one with an illuminated face, turn the face away from you.
• Use the bed only for sleeping
• Keep a consistent schedule. Make sure you go to bed each night and wake up each morning, at the same time.
• Minimize daytime naps. If you must take a nap, do not sleep for more than an hour at a time. Longer naps will make you feel more tired, worsen asthenia and interrupt nighttime sleep.
• If these techniques do not work, consult your healthcare provider.
• If you experience weakness symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Drugs that may be prescribed by your doctor to treat weakness:

• Treatment of your weakness is based upon finding the underlying cause, and treating that condition.
• If your weakness is a result of a medication or treatment, removing that medication may help.
• Depending on your overall health status, your doctor may recommend certain drugs that may help you. Some of the common drugs that are used to treat your weakness may include:
  • Antibiotics - If your doctor or healthcare provider suspects that you have an infection that has caused your ataxia, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once weakness is gone.
  • Antidepressants - are used to treat depression and pain in adults. People who have pain for a long period of time (chronic), or due to your situation, may become tired and depressed. This will lead to weakness.
    • Medications, such as venlafaxine (Effexor^®) works by blocking the "reuptake" of the neurotransmitters serotonin and norepinephrine, thus decreasing your depressive symptoms along with weakness.
  • Corticosteroids: Corticosteroids work by decreasing inflammation (swelling) in many areas of the body.
    • You may be taking steroids if you have pain, or weakness due to tumors in your brain, or near your spinal cord.
    • Steroids will decrease the swelling in areas where tumors are located, which may decrease the pressure of the tumor on your nerve endings, and decrease your pain.
  • Erythropoeitin is a substance that your body produces naturally. This is a protein normally produced by the kidneys, which helps make red blood cells. Epoetin alfa and darbepoetin alfa are similar drugs that act like this natural substance to stimulate red blood cell production. During chemotherapy, patients may not be able to produce enough red blood cells, a condition known as anemia. Erythropoetic agents can treat anemia by increasing the number of red blood cells in the body.
    • Hemoglobin is the iron-containing substance in red blood cells that delivers oxygen throughout the body. Anemia and resulting decrease in circulating oxygen may contribute to confusion and cognitive problems. The normal hemoglobin range is approximately 12 to 18 g/dL, and varies according to age and gender. Doctors may prescribe erythropoetic agents to chemotherapy patients whose hemoglobin levels have fallen below normal levels.
  • Narcotics -The central nervous system (CNS) is a way for our brain to send messages to our body in a timely manner. It is highly alert, especially when we are experiencing pain. You may develop weakness or fatigue from chronic pain. Many narcotic analgesic (pain medicines) work by blocking pain messages, such as morphine sulfate and oxycodone.
    • Make sure you discuss with your healthcare provider common side effects, such as constipation, drowsiness, nausea and vomiting, and how to control these side effects.
    • Fatigue and weakness can be a side effect of pain medications, discuss with your healthcare provider how you may be able to control your symptoms of fatigue and weakness.
  • Non-steroidal anti-inflammatory (NSAID) agents or Tylenol^®- NSAID's such as naproxen sodium and ibuprofen, may provide relief of many types of pain. Pain relief may help improve mobility, and alleviate weakness.
    • If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol^®) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help.
    • It is important not to exceed the recommended daily dose of Tylenol^®, as it may cause liver damage. Discuss this with your healthcare provider.

Other therapies:

• Blood transfusion to treat severe anemia.
• Physical therapy or Occupational therapy assistance may be prescribed.

When to Contact Your Doctor or Health Care Provider:

• Changes in your walking, or imbalance problems.
• You've fallen.
• If your weakness progressively worsens.
• If you have a headache, blurred vision, numbness or tingling.
• If there is a change in mental status, such as confusion, disorientation, or increased sleepiness.
• Difficulty with tasks such as writing your name, changing position from sitting to standing.
• Extreme fatigue (unable to carry on self-care activities).
• Fever of 100.5° F (38° C), and /or chills (possible signs of infection if you are receiving chemotherapy).

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about weakness and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.