James S. Tiff a 19-year old male is immobile and hospitalized for pneumonia. He has a long history Show more James S. Tiff a 19-year old male is immobile and hospitalized for pneumonia. He has a long history of progressive weakening of his muscles. In the first year of his life James reached many gross motor skill milestones such as holding his head up rolling over sitting and standing at normal times. However he did not walk until age 16 months and by age two started to assume a lordotic posture while standing but not while sitting. A Gowers sign was noted by age four as was a Trendelenberg gait. Over the next several years he suffered progressive muscle weakness most notably in the proximal musculature of the arms pelvis and legs. By age 9 he required orthotic braces to assist his walking and by age 11 he was confined to wheelchair ambulation. In his early teen years James was still able to use eating utensils write and type on a keyboard though these functions have declined over the past year. At 16 he was hospitalized with bronchitis requiring antibiotic treatment but recovered. Throughout the years James has had no history of muscle pain or spasm chest pain or irregular heartbeat. He was diagnosed with a learning disability in the fourth grade but has progressed through the grades with tutorial assistance. The only medications that he normally takes are calcium and fluoride supplements. James has a younger sister in good health and a younger brother (age 10) who is confined to a wheelchair with problems similar to Jamess. No other immediate or distant family members have musculoskeletal difficulties.? a) What disease does James suffer from? b) What muscles are most severely affected by this disease process? c) Why did Jamess calves enlarge? What is the condition called? d) Why is it important for James to take calcium and fluoride supplements? Show less
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