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Magill's Medical Guide
https://search.follettsoftware.com/metasearch/ui/37664/search/all?q=magill%27s%20medical%20guide

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On September 10, Donnie Heaton will celebrate his 21rst birthday. But unlike most 21-year-olds, Donnie weighs only 55 pounds. He is one of the oldest known individuals to have trisomy 18 (Edward syndrome). Each of his cells has an extra chromosome 18. One in about 6,000 newborns has the condition.

Trisomy 18 was in the news during the last presidential election because Rick Santorum's young daughter Isabella has it. Her mom was 48 when she gave birth to Isabella in 2008; Donnie's mom was 42 when he was born. The risk of producing an egg with an extra chromosome increases with maternal age.

I use a rather dire case to illustrate trisomy 18 in my human genetics textbook, a boy who died at age 22 days. And Google images pulls up photos of fetuses who never made it.

I've only encountered trisomy 18 a few times in genetic counseling, when the extra chromosome turned up with prenatal testing in women of "advanced maternal age" - over 35. Those cases ended with termination of pregnancy, either naturally or by choice. We called in a clergyperson for one case who candidly said he'd end the pregnancy, so bleak was the prognosis. In another case a couple had lost a child at 4 months, and the effect had been devastating on their then-preschooler, who lost his baby brother. Pregnant a third time, the couple wanted amniocentesis to avoid having another baby with the condition, although the empiric recurrence risk is only 1 in about 100.

A trisomy isn't inherited; the extra chromosome is an accident of meiosis, a chromosome pair that doesn't part as gametes form but instead overloads a fertilized egg. Technically this is called non-disjunction, and it just happens - it isn't anyone's fault.

PRENATAL TESTING
Today, thanks to cell-free fetal DNA testing (aka non-invasive prenatal diagnosis), many patients can avoid the slight risk of amniocentesis and chorionic villus sampling and find out about the more common autosomal trisomies (13, 18, and 21). Fetal DNA floats around in the maternal circulation in pieces smaller than the mom-to-be's, so it can be separated and compared. If chromosome 18 pieces outnumber pieces of other chromosomes by half, trisomy 18 is at hand.

The first two renditions of this type of test - Harmony and Materni-T became available in 2011, to a flurry of headlines. At the end of 2012, the American College of Obstetricians and Gynecologists gave the tests a thumbs-up, so far only for high-risk women who'd otherwise have more invasive testing. But further research may soon clear it for everyone. Shortly before that, DNA Science blog explained how pregnant women's bloodstreams harbor fetal DNA.

Prenatal testing has become so pervasive that perhaps we lose sight of the fact that the detectable medical conditions are variable. Not all fetuses, newborns, and toddlers lose the battle with trisomy 18. Not everyone chooses to avoid the birth of a child with trisomy 18, and not everyone chooses prenatal diagnosis.Karen Heaton, Donnie's mom, said no to prenatal testing. And her son, whom doctors predicted wouldn't survive more than a few months, is about to turn 21. I read about Donnie in a terrific article in the Tampa Bay Times by staff writer Lane DeGregory, then spoke with Karen.

Donnie, at 21, is very much an exception. Half of fetuses with trisomy 18 do not survive to be born and fewer than 5 percent of babies reach their first birthdays, most with severe problems: holes in the heart, kidney defects, an esophagus unconnected to the stomach. Growth is delayed, and the child never progresses developmentally beyond six months. The head is small, with a tiny jaw and low set ears. Two telltale signs are "rocker bottom feet" and a strange overlapping of fingers in the tiny clenched fists.

But a few children with the syndrome have grown into young adulthood. Donnie's mother Karen has devoted her life to him. Here is part of her story.

A MOTHER'S VIEW
"I was 42 when I became pregnant with Donnie. I didn't have amniocentesis, because I don't believe in abortion and I didn't think there would be anything wrong. I thought he'd be a healthy bouncing baby boy, until he was born.
They called him a vegetable at birth. Donnie's godmother is an RN and she was in the delivery room. She knew there was something wrong. The first doctor to see him knew what was wrong. He said, 'take him home and love him and he'll die in your arms.' They said he'd be blind and hearing impaired, and he's not. And he has full blown trisomy 18, he's not a mosaic. Donnie's low functioning. He's had pneumonia three times this year. He lived through a C. difficile infection. He has fevers, heart and bowel problems, and urinary tract infections, and he breaks his fragile bones. He doesn't walk or talk. He weighs 55 pounds, and he won't get any bigger. But he keeps on going. He's definitely not a vegetable. He's a little person. He reacts appropriately. I use a suction machine and when I put the part near him, he opens his mouth. He knows. He recognizes people. His face lights up when he sees people he knows. I can't quite comprehend that he's that rare, but according to the geneticist, Donnie is believed to be the oldest person in the world with trisomy 18. He loves his special needs school, and I'm heartsick because he's aging out of everything. He loves music, and being on the school bus with other kids. I'll have to stop calling him a kid! He vocalizes. I know when he's wet his diaper. He makes happy noises. We like watching game shows on TV. He likes the different colored lights, the sound of the clapping. He picks up on the excitement. He lies in a big lazy boy chair, and I sit on the couch right beside him. We like Wheel of Fortune, The Price Is Right, and Let's Make a Deal. There's a light inside those eyes, I can see it. Donnie amazes me."
For further information, to connect with others, or to donate, see:

Support Organization for Trisomy (SOFT)
Trisomy 18 Foundation

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A Very Special Birthday for a Young Man with Trisomy 18 | DNA Science Blog

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An extra chromosome 18 is devastating, but some children beat the odds and survive past infancy. On September 10, Donnie Heaton will celebrate his 21rst birthday. But unlike most 21-year-olds, Donnie weighs only 55 pounds. He is one of the oldest known individuals to have trisomy 18 (Edward syndrome).

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Free databases to look for good sources!

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Free databases to look for good sources!

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Smithsonian Libraries offers staff and visitors access to many scientific databases, including Zoological Abstracts, Anthrosource, and Web of Science. A complete listing of these databases is located on the Libraries' A-Z List of e-Journals & Databases.

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Breaking boundaries.Empowering researchers.Opening Science. PLOS is a nonprofit, Open Access publisher empowering researchers to accelerate progress in science and medicine by leading...

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PWC Public digital library (free with library card number)

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PWC Public digital library (free with library card number)

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Use these databases and you will not need to evaluate the sources. They are already vetted by professional librarians! Check out 'Science in Context" for great information both general and specific! This link is also on the Library Canvas page.

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ProDemand.com
Due to licensing restrictions, only available in library branches.Comprehensive information on domestic and import vehicles, wiring diagrams, tech bulletins and recalls, as well as a parts guide.

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ProDemand.com Due to licensing restrictions, only available in library branches.Comprehensive information on domestic and import vehicles, wiring diagrams, tech bulletins and recalls, as well as a parts guide.

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Tips for Teachers From Students With Cystic Fibrosis (Video) (for Parents) - KidsHealth

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Kids and teens explain what to expect and how to help in the classroom.

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channel ten hamish mclennan; ita buttrose; network director of morning television

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Rachael Clements joins us on Studio 10 to discuss Fragile X Syndrome - a genetic condition which her two children are living with. For more information, visit fragilex.org.au

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INDIANAPOLIS -- With Rare Disease Day approaching, an Indiana family is bringing awareness to their daughter's uncommon condition.

FOX59 in Indianapolis recently told the story of a 4-month-old girl named Symphony.

The girl suffers from Maple Syrup Urine Disease (MSUD), The disease is named for the maple syrup smell of the urine from untreated babies.

According to the U.S. National Library of Medicine, the disease is an inherited disorder in which the body is unable to properly process certain amino acids.

The peculiar urine smell isn't the disorder's only symptom. It is also linked to poor feeding, vomiting, lack of energy and developmental delay -- and if untreated, it can lead to seizures and even death, according to NLM.

FOX59 reports that only one in 100,000 children is diagnosed with the disease in Symphony's home state of Indiana.

The National Library of Medicine says the disorder affects about 1 in every 185,000 infants worldwide.

"She is a very sick kid with a rare disease," the girl's father, Phil Summers, told the station.

The girl's mother, Stacie Maynard, told FOX59, "I want people to realize that this disease is out there. It is rare, but it is out there. To raise awareness of the newborn screening and how helpful it is to be diagnosed early on."

Rare Disease Day takes place on the last day of February each year, according to the organization's Web site. The movement was founded in 2008 by the European Organisation for Rare Diseases.

Symphony is current staying at Riley Hospital for Children at IU Health. She needs to gain weight before she can leave the hospital, FOX59 reports.

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4-month-old girl fights rare 'maple syrup urine' disease

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INDIANAPOLIS -- With Rare Disease Day approaching, an Indiana family is bringing awareness to their daughter's uncommon condition. FOX59 in Indianapolis recently told the story of a 4-month-old girl named Symphony. The girl suffers from Maple Syrup Urine Disease (MSUD), The disease is named for the maple syrup smell of the urine from untreated babies.

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International Cri Du Chat Syndrome Awareness Video (Phase 1)

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As most of you know, Cri Du Chat syndrome affects every country, race, gender, religion, political affiliation, and social class. Most people may not have heard about Cri Du Chat syndrome, but we are here, and our goal is to be known. Our goal is to end the outdated misinformation given to our families.

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Compulsive Overeating: Kids with Prader-Willi Syndrome (Full Documentary) | Only Human |

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MUSKEGON, MI -- Spend a little time with Andy Cooper and you will soon succumb to his endearing personality and join in his contagious laughter.

Andy, 13, is a typical teenage boy who likes to hang out with friends, watch movies and play video games.

He has dreams of becoming a music producer or a band manager.

He does things what normal kids do with his siblings. Sometimes they argue and sometimes -- in his own words -- "We hang out with each other so much that we cannot stand each other."

You wouldn't immediately know that Andy has a genetic disorder called neurofibromatosis, a disorder in his nervous system that causes tumors to form on the nerves anywhere in his body at any time.
13 years of challenges
Andy was 9 months old when he was first diagnosed with neurofibromatosis. Now in seventh grade, he attends Reeths-Puffer Middle School.

"I go for long periods of time without it occurring to me that he has this disease," said Heidi Zuniga, Andy's special education teacher, who met him last year. "Some kids who have known him for years still ask him questions and I see him as being proud for being an advocate for it."

In his science class, Andy sat toward the front of the classroom as Zuniga went over their homework assignment.

"There are different levels of academic difficulties and I certainly think he is very fortunate he doesn't have as much difficulty," Zuniga said. "He doesn't give up and he perseveres through things."

Math is Andy's favorite subject and he is a book worm who reads whenever he has free time.

Despite some of his physical challenges, he certainly does not let his disease get in the way of going for the things he wants to do.

"He doesn't necessarily talk about it as a disease," Zuniga said. "He's very open when he has doctor appointments and he certainly doesn't shy away. If someone asks a question, he's not offended. "

When Andy talks about his disease, he talks about it from a personal perspective. Zuniga added.

Andy has embraced living with neurofibromatosis because his family has also worked hard ever since he was first diagnosed to bring as much normalcy to his life as possible.

During a two-day health awareness fundraiser about children's illnesses at the Lakeshore Sports Centre in Norton Shores, the Coopers were part of that effort to help bring awareness.

Andy bravely walked up to people, introduced himself and talked about what neurofibromatosis is and what it's like to live with it.

"You want other parents whose kids have NF to not be afraid of thinking like what other people would (think about) their kids," Andy said. "It doesn't matter because that's what they were born with."

Words fall short to describe the challenges Andy faces. It is Andy who talks about neurofibromatosis with such ease that his demeanor makes one feel comfortable to ask any questions.

"I'm just not afraid to talk about it," Andy said. "It's nothing to worry about. It's just tumors grow everywhere -- all (over) my nerves."
As normal as possible
Living with neurofibromatosis as a teenager certainly has not been easy. Andy has countless doctor appointments and has had many MRIs. He struggles with ADHD and has a learning disability.

He is in Zuniga's class with eight other students, where he gets the extra attention and the time he needs to get his work done.

He is a smart boy, just smaller in size and may be not as mature as his peers yet - all because of neurofibromatosis, said Julie Cooper, Andy's mom.

His peers don't always understand Andy's condition, such as why he is so hyperactive or why he acts impulsive sometimes -- all related to neurofibromatosis. That can be frustrating for him, Andy said.

"I want people to know about neurofibromatosis - that I have feelings too," Andy said. "It's just (sometimes) they don't have a heart or feelings of how other people would feel if they were treated like that."

But Andy is not alone. He has two "protectors" that are also in seventh grade at Reeths-Puffer Middle School: His friends Zack Vanderleest and Vincent Alvesteffer.

"I'm his bodyguard once in a while," Alvesteffer said. "Sometimes when he's socializing with people, he can be frustrating or sort of fight because he's hyper, so I watch him to make sure no one messes with him."

Alvesteffer was quick to add that Andy doesn't let his disease holding him back.

"We've had a lot of fun over the years," he said. "We've had snowball fights during the winter. We jump on the trampoline in the summer and spring. We have a lot of fun when we hang out."

Andy is a strong boy who has persevered through the difficulties of living with neurofibromatosis. He endears himself to the people that surround him with his charming smile and his remarkable perseverance.

"Sometimes there is this real kind of sweetness about him where he can understand other people," Zuniga said. "You can see empathy in him, you can tell by the way he acts and kind of just stands there without saying anything. He doesn't know what to say but you can see he understands, he's got a strong empathy for people."

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Living with neurofibromatosis as a teenage boy doesn't stop Andy Cooper from persevering (video)

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MUSKEGON, MI -- Spend a little time with Andy Cooper and you will soon succumb to his endearing personality and join in his contagious laughter. Andy, 13, is a typical teenage boy who likes to hang out with friends, watch movies and play video games.

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According To Us -- Hemophilia Teen Connection Video

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The Marfan Question: Q&A Video Series﻿﻿﻿The Marfan Question Video Series can help to answer your Marfan syndrome and related disorders questions. In these videos, some of the most frequently asked questions about Marfan syndrome are answered by real people whose lives have been affected by Marfan syndrome and related disorders, as well as doctors who are experienced with these conditions.

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This resource answers common teen questions head-on. If you have other questions, please know that the Marfan community is here for you.

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Darius Weems is on a mission, but even though he is only 23 years old, it's a race against time.

Darius, an aspiring rapper and star of the documentary, "Darius Goes West," suffers from Duchenne Muscular Dystrophy, a rare genetic disorder that results in the disintegration of muscle tissue. Legs and arms are seized, and eventually, so are the muscles that surround the heart. In the United States, the majority of people afflicted with this disease die by age 25.

For Darius, the disease has been a slow but steady progression. He could walk when he was little, but was then diagnosed with DMD around age 5. By age 9, Darius transitioned to a walker and then to a wheelchair at age 12, where he has remained for the past 11 years. Today, he can only wiggle his fingers and feet, but there is so much more he wants to do, like make music and find a cure for the disease that took his brother at age 19.

"In my situation, I would say I'm blessed," he said. "I can still brush my teeth and stuff."

He knows there may well be a day when he can't, but Darius said he doesn't see life like that.

In addition to raising money for DMD research, Darius is also a research subject. A patient at the Kennedy Krieger Institute in Baltimore, Darius is taking part in a clinical trial, designed to help cure the disease.

"As long as I'm here and being able to motivate people and being strong for them, hey, I'm living my life to the fullest," he said.

His hope is placed squarely on a clinical trial being run by Dr. Kathryn Wagner and Dr. Daniel Judge. The Kennedy Krieger Institute research team has collaborated with the Division of Cardiology in the Johns Hopkins University School of Medicine, to discover whether sildenafil, the active ingredient in Viagra, will help stimulate deteriorating muscles, especially around the hearts of Duchenne patients.

When faced with his odds of survival, Darius admitted he feels down sometimes, but that he is trying to live one day at a time.

"Just because I have a fatal disease doesn't mean any doctor can put any amount of time on my life," he said. "But you know, I think about the situation that is at hand, trying to cure this disease and trying to carry on my brother's legacy, and you know losing him kind of made me want to get out here and show people how fatal this disease is and how big of a problem it is."

We first met Darius back in 2007 when then-"Nightline" anchor Martin Bashir spent some time with 17-year-old Darius. Bashir had a particular interest in Darius' story because his own brother had died of DMD.
Read Martin Bashir's original reporter's notebook about his experience HERE
At age 15, Darius had taken an extraordinary journey across the United States in a van built to accommodate his wheelchair.

"I'm in a wheelchair but I'm just like a regular person," he said in 2005. "Never think I'm like somebody else. I'm just the same as other people. I've got talents."

The idea to travel across the country was Logan Smalley's. Logan had been a counselor at a camp where he had met Darius' brother, Mario. When Mario was dying he asked Logan to keep an eye on Darius. Logan promised he would and he took that promise seriously.
PHOTOS: Darius' Incredible Journey: From California to Clinical Trial
The California trip began as a bit of a lark. MTV's "Pimp My Ride" was popular, so Logan joked that maybe if they could get Darius from his home in Athens, Ga., to California, West Coast Customs, the company featured on the show, would "pimp" his wheelchair.

"I was definitely excited about the whole thing," Darius said. "But one thing that came to mind was how are we going to get the money for this, you know, how are we doing to convince our parents to let us go on this road trip."

But they did, and the trip became a documentary, " Dairus Goes West," which Logan directed and produced. Even though West Coast Customs refused to "pimp" Darius' wheelchair, the journey was a stunning success. The documentary is partly a coming of age story and partly a story of friendship and gratitude.

"He'll motivate me to do something that I never thought I would do," Darius said of Smalley. "Him actually taking on the goal of watching over me when my brother passed away, so he definitely gave me a lot of hope and being that brother when I lost my brother."
PHOTOS: Darius' Incredible Journey: From California to Clinical Trial
Dairus and his friends traveled to the Grand Canyon, where the view brought tears to his eyes, and to the Pacific Ocean, where Darius stood on his own for the first time in almost four years.

The power of the film is drawn from Darius and Smalley's incredible friendship and their belief in one another. The tale of two young men, who couldn't be more different on the outside or more alike on the inside.

"I think that Darius and I have a mutual respect for each other," Smalley said. "It's just like some strange mixture of brotherhood, parenthood, old married couple, best friends, like our relationship runs the gambit. I love him more than anybody and we just have so much fun together and it feels really good because it feels like we are making a difference."

Though the years, Darius and Logan have given each other a lot of laughs. One of the most poignant moments in the film happened by accident. While visiting the San Francisco Zoo, Logan and the other guys on the trip dared him to eat a spoonful of super-spicy wasabi, something he had never heard of before. He took the challenge and immediately started spitting as his friends collapsed into giggles. And that is part of the film's message: despite his illness, Darius is just one of the guys.

"When we were filming and we were all in the restaurant, and there was a lady by us and she thought they were picking on me and stuff like that," Darius said. "[But] it shows a good message and they are treating me like others."

It is that scene perhaps, more than any other in the documentary, that captivates the kids in the schools Darius and his friends now visit to talk about his journey. His story has become a popular way to raise money for medical research for DMD.

"Some schools from time to time do the wasabi challenge," Darius said. "I don't know how they ate the spoonful of wasabi like that. It's crazy, know what I mean, seeing people motivated enough and being brave enough to take a spoonful of wasabi."

So far, Darius has raised more than $2 million for the cause, much of it to the sound of laughter.
For more information about Darius, his cause and his clinical trial, visit our resources page HERE

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Darius Weems' Next Chapter: Rap Star With Duchenne Muscular Dystrophy Tries Clinical Trial

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Darius Weems is on a mission, but even though he is only 23 years old, it's a race against time. Darius, an aspiring rapper and star of the documentary, "Darius Goes West," suffers from Duchenne Muscular Dystrophy, a rare genetic disorder that results in the disintegration of muscle tissue.

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Huntington's Disease Youth Organization - Teens - Being at risk

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Because we inherit chromosomes from each parent, we end up with two copies of the each gene in our DNA - one from mum and the other from dad. Researchers discovered that the reason people develop Huntington's disease is because of one gene, in chromosome 4, that is longer than it should be.

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The myth of the "supermale" and the extra Y chromosome

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Introduction of my life with XXY Klinefelter Syndrome

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What Is XYY Syndrome?

XYY syndrome is a genetic condition found in males only. About 1 in 1,000 boys have it.

Boys with XYY syndrome - also known as 47,XYY - might be taller than other boys. Other symptoms can include problems with spoken language and processing spoken words, coordination problems, weaker muscles, hand tremors, and behavioral difficulties.

Most boys with XYY syndrome can grow up healthy, have normal sexual development and fertility, and lead productive lives.

Symptoms can vary greatly among boys. Depending on which symptoms a boy has and how severe they are, doctors may recommend various treatments.

What Causes XYY Syndrome?

Boys who have XYY syndrome are born with it. It's called XYY because they have an extra Y chromosome in most or all of their cells.

Usually, a person has 46 chromosomes in each cell, divided into 23 pairs, which includes two sex chromosomes. Half of the chromosomes are inherited from the father and the other half from the mother. The chromosomes contain genes, which determine an individual's characteristics, such as eye color and height. Boys typically have one X chromosome and one Y chromosome, or XY, but boys with XYY syndrome have an extra Y chromosome, or XYY.

XYY syndrome is not caused by anything the parents did or did not do. The disorder is a random error in cell division. This error can happen before conception in the reproductive cells of the mother or the father, or early in the embryo's development.

When the extra chromosome is the result of incorrect cell division early in the embryo's development, a boy may have a mosaic form of XYY syndrome. This means some of the cells have an extra Y chromosome, but not all do. Boys with mosaic XYY syndrome usually have fewer symptoms.

What Are the Signs & Symptoms of XYY Syndrome?

Noticeable signs and symptoms of XYY syndrome can vary greatly. Some boys have no obvious signs, while others have mild symptoms. Occasionally, the disorder causes significant problems.

Boys with XYY syndrome may have some or all of these physical symptoms to some degree:

taller than average height

low muscle tone, or muscle weakness (called hypotonia)

very curved pinky finger (called clinodactyly)

widely spaced eyes (called hypertelorism)

cystic acne during adolescence

Some boys also may have delayed development of their social, language, and learning skills. They also can have problems with reading and understanding math, and may have mild delays with coordination.

What Problems Can Happen?

Some boys with XYY syndrome may develop behavioral problems, such as ADHD, autism, explosive temper, impulsivity, or defiant behavior. These problems might ease as they get older and reach adulthood. Otherwise, treatment can help manage them.

A small number of boys may have increased testicular size for their age, or have an increased risk for asthma and seizures.

How Is XYY Syndrome Diagnosed?

Many boys with XYY syndrome are healthy and have no obvious symptoms. So sometimes the condition isn't diagnosed or is only found while a doctor checks for a different issue.

XYY syndrome often is found because parents talked with a doctor about concerns with their son's development. This can help boys receive a diagnosis early. Research has shown that early interventions and treatments are more effective.

To diagnosis XYY syndrome, a blood sample is checked for the presence of the extra Y chromosome. Before birth, the condition can be found through a chromosomal analysis. Testing is done on the fluid surrounding the fetus, tissue from the placenta, or the blood from the mother.

How Is XYY Syndrome Treated?

There's no cure for XYY syndrome, but there are treatment options that can help address specific symptoms.

Finding services early is important and can greatly increase their ability to help your son live a healthier, more productive life. Options vary greatly depending on how old a boy is at the time of his diagnosis, whether he has noticeable symptoms, and the severity of those symptoms.

Treatments can include:

Regular doctor visits. At periodic visits, a doctor can monitor a boy's development for delays, social and language disabilities, or health problems and treat these promptly.

Educational support services. Educational support can teach boys ways to keep pace in school. Some might be eligible for an individualized educational program (IEP) or 504 education plan, which are designed to help children with specialized needs.

Early intervention services. It can be very helpful and often more effective for a boy to have speech, occupational, physical, or developmental therapy in the early months of life or as soon as concerns are identified.

Speech therapy and physical therapy can improve your son's speaking, reading, and writing skills and help increase strength and coordination. Occupational therapy and behavioral therapy can help your son develop more confidence and interact better with other children.

Counseling. The whole family can benefit from counseling to better understand XYY syndrome and help a boy who has it to live a productive life.

Early inventions should be considered at infancy for physical therapy, at 15 months for speech delay, at 1st grade for reading and learning issues, and at 3rd grade for anxiety or depression.

Looking Ahead

Boys with XYY syndrome can develop speech, learning, or social challenges at a young age. This can make them more likely to have low self-esteem and lead to school or social problems.

If your son is having trouble making friends or struggles in school, talk to your doctor or the principal or school counselor. Counseling and therapy can teach your son practical skills to help him make friends and feel more confident in school, and educational services can help your son succeed academically.

It's important to speak to your doctor if you have any concerns about your son's physical and emotional development.

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XYY syndrome is a genetic condition found in males only. About 1 in 1,000 boys have it. Boys with XYY syndrome - also known as 47,XYY - might be taller than other boys. Other symptoms can include problems with spoken language and processing spoken words, coordination problems, weaker muscles, hand tremors, and behavioral difficulties.