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Folk202608/0 Manuscript/Chapter 01 - Jake/01 Charlie.md

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+A gleefully shrieking bundle of black and gold flashed by, and Mrs. Miller laughed. "Isn't it wonderful?"
+
+"It's terrifying," Jake said. "He's going to kill himself."
+
+"On the contrary, his mother says Charlie's actually living now, acting like a boy for the first time in two years. He started dying when he lost the use of his arms and legs and got that AFM diagnosis. That scooter has been the motivation he needed to take physical therapy seriously." She wrapped an arm around Jake's waist. "Cassandra would love to meet with you. Says she wants to hug the stuffing out of you. Since you're such a reclusive fuddy-duddy I'll do it for her."
+
+He smiled, at the same time edging away from his housekeeper. "I didn't do anything."
+
+"Of course you didn't. Only pulled strings to get them into that Pittsburgh clinic, bought them a van, paid for ramps at their house, bought the scooter, paved the trail so he can get to the woods" --
+
+"I did a google search for specialists and made one phone call."
+
+"During which you made a significant financial contribution."
+
+"That's my job. It's not even my money." He scowled. "Sometimes I get tired of taking credit for things they" - he nodded toward the north - "pay for and do. And things you and Nancy do, of course."
+
+"As you say, Steward, it's your job." She gave up trying to hug him. "Are you going to Rotary?"
+
+"Ugh," he said. "I guess I skipped last week--"
+
+"You've skipped the last four."
+
+"Ugh," he repeated. He stared out the window for another few seconds - the boy was zooming back up the hill - and then drifted toward the back of the house. A minute later she heard his shower start.
+
+How long was he going to mope? Maybe she should buy him a scooter.

Folk202608/0 Manuscript/Chapter 01 - Jake/02a The judge.md

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+"What has Mrs. Miller been baking recently?" she asked, working her way through his kitchen cabinets.
+
+"She keeps cookies above the stove," he said. "You're in your pajamas?"
+
+The woman paused to look down at herself. "They're perfectly modest pajamas. Anyway, it's" - she looked at the microwave - "one in the morning. Lots of people are in their pajamas."
+
+"Well, yes," he said. "But most of them are in their own houses. Why, exactly, are you in mine?"
+
+"Careful," she said, her mouth full of snickerdoodle. "You'll make me feel unwelcome. And I'm here because you put fifteen minutes on my schedule today, and then used it to tell me I could have a Supreme Court-ready case on my docket sometime soon. We need to talk."
+
+"Fifteen minutes was all your clerk would give me."
+
+"Yeah, that's my fault. When they did my background check I had to give them a list of intimate partners, and since you were on that he assumed" --
+
+"We were never intimate. You were engaged to Tim before I even met you."
+
+In response she stepped close to him and leaned her face up to his. He felt a flutter against his cheek, and she whispered, "You don't consider butterfly kisses to be intimate?"
+
+Shivering a little, he stepped away. "I guess I shouldn't argue grammar with a judge."
+
+"Vocabulary, you mean." She grinned at him, but then transitioned to a scowl. "So this community behind your property, these people who've I've always been told were particularly conservative Amish" --
+
+"Not people," he said, "Folk."
+
+She continued as if he hadn't spoken. "Are, in reality, a sentient non-human race" --
+
+"Multiple races, I think."
+
+-- "who, being non-human, have no defined legal standing, and so choose to regard themselves as chattel" --
+
+"They don't regard themselves that way. They present themselves to humans that way for legal purposes."
+
+-- "and so have appointed you as their agent" --
+
+"'Steward.'"
+
+-- "and you legally possess all their assets" --
+
+"'Legal' versus 'moral' becomes an interesting distinction here."
+
+-- "which run into... How much money?"
+
+"Lots," he said. "If I tell you a number, I guarantee it will make it harder for you to think clearly. Their balance sheet has gotten scary over the last few years."
+
+She nodded. "And you want me, as the new president judge for Jefferson County, to be aware of this because sometimes these people" --
+
+"Folk. Not people."
+
+-- "interact with the human world" --
+
+"They try hard not to."
+
+-- " and need protection because this is all a big secret" --
+
+"Not exactly 'protection.' Kinda goes both ways."
+
+-- "which, if it ever came out, would probably have to be addressed by the US Congress and Supreme Court."
+
+"Except they're convinced they wouldn't survive long enough for that to happen, and if you look at history of humans interacting" --
+
+She held up a hand. "Jake. You know this is all nuts, right?"

Folk202608/0 Manuscript/Chapter 01 - Jake/02b The judge, continued.md

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+Then she frowned. "What do you mean, protection goes both ways?"
+
+She had green eyes. Jake's college roommate had once compared them to wolf's eyes, but Jake thought of them in King James terms: "Piercing even to the dividing asunder of soul and spirit." For sure a discerner of the thoughts and intents of the heart. Those eyes were probably an asset to her as an attorney and judge, and they were now focused squarely on Jake.
+
+He looked away first, saying, "Give me a second. I only get one chance to explain this."
+
+She nodded without losing any intensity.
+
+"The folk don't exactly regard human laws as applying to them, but they've adopted most of them as a reasonable way for civilized beings to live, and they recognize that they're immersed within us, so staying compatible with us is a good idea."
+
+"That's opening a door I don't much like," she said.
+
+He nodded. "Yes. It's something I've been sensitive to, and... well, we can talk about that. But they have a specific perspective about self-protection." He took a deep breath. "Okay, point one. In our society, if an intruder enters my home with demonstrable intent to harm me, I have the right to protect myself, even if the intruder is hurt or killed in the process, right?"
+
+"Of course," she said. "There are some nuances, but generally speaking, you have the right to protect yourself."
+
+"Point two. In the history of civilizations meeting, spread of disease was disastrous. For example, the European explorers brought small pox that practically wiped out the Aztecs."
+
+Unbelievably, her gaze sharpened. "Are they susceptible to human disease?"
+
+"Yes, or so they tell me," he said. "They've had times in history where a human disease has swept through them. A hundred years ago Spanish flu killed something like two-thirds of them."
+
+"So they regard trespass -- human trespass -- as a deadly threat. And they respond with deadly force," she said. A statement, not a question.
+
+"Historically, yes," he said, "To avoid all that, I've asked them to install passive barriers. Mostly fences, really good fences. Now it's almost impossible for a person to get near them by accident."
+
+"*Almost* impossible? Have they killed anyone lately?"
+
+"They..." He paused. "They don't tell me everything. In their words, they don't 'burden me' with things that don't translate well between the Folk world and the human world."
+
+"Again, that's opening a window I don't much like," the judge said.
+
+"I've tried to watch out on my own. We finished the fences twelve years ago. Since then there have been two people who have disappeared without explanation in this area, where I've suspected Folk involvement. One was that prisoner who escaped while they were transporting him across I-80" --
+
+"Ralph Stanton," she said. "Multiple murderer. Including children. Nasty human being. Being extradited from New Jersey to Oklahoma so he could face the death penalty."
+
+"Yep. Johnny" -- the Jefferson County sheriff -- "said the trail got close to my land, Folk land, and the guy just evaporated."
+
+"Okay," she said. "Except for the uncertainty and legal loose end, I'm not going to cry too hard about that. Who was the other one?"
+
+"Kevin Ossler," he said. "Five years ago. Got drunk and said he was 'gonna go have himself some Amish women.' Last seen headed toward Folk land. Armed."
+
+"I'm betting," she said, "he didn't say 'women'."
+
+"Yeah, that might have gotten cleaned up along the phone tree."
+
+She nodded. "Another rather nasty human being. And a legitimate threat by any standard." She glanced at the microwave's clock and sighed. "There's more I need to ask, but I should get home and get a few hours of sleep before the girls are up. It's amazing how teenagers tromp around the house. It's like raising elephants." She took another cookie and returned the container to the cabinet. Mouth full, she said, "I'd have to recuse myself if a case came in with your name on it. That's part of the reason prospective judges have to make those lists."
+
+"I'm not too worried about my name being involved," he said. "Should I make another appointment with you so you don't have to run around town in your pajamas?"
+
+She leaned into him, her nose touching his chin and her green eyes blinking innocently. "Don't you enjoy cuddling with me?" Then she laughed. "Remember that night on the water tower, when MJ's fooling around cost me my shirt?"
+
+"I don't remember it being her fault."
+
+"You literally gave me the shirt off your back. Kept me out of trouble and probably saved my future judicial career." She wrapped her arms around him for a long-ish hug, and then spun around and walked away. "Let me think a bit. I'll be in touch. Thank Mrs. Miller for the cookies."
+
+"Okay," he said to the closed door.
+

Folk202608/0 Manuscript/Chapter 02 - Succession plan/201 Nancy's visitors.md

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+The Folk first visited on Nancy's fifth birthday. She'd thought they were angels. Her birthday was in January, so she'd just heard about the angel visiting Mary.
+
+She was eight when she heard someone preach about how people -- including Mary -- were always frightened by angels. Practically the first thing most angels said to people -- including Mary -- was "Don't be afraid." Nancy realized she'd never been afraid of her visitors, not even a little, and she didn't think she was braver than Mary, so she decided they must not be angels after all.
+
+Fairies, maybe. They were tiny and delicate and so blond you could practically see through them, all of which fit fairies. It was disappointing that she couldn't see any wings, but she'd figured those might be folded up under their shirts. How bulky would gossamer be, anyway?
+
+It wasn't until sixth grade, when she started talking -- really talking -- with her cousin Jake that she figured things out. Her visitors were Folk, and they were cultivating her to give birth to a future Steward. Unlike the Messiah, Stewards had to be replaced every twenty or thirty years, and she was nominated for the lead female role.
+
+The visits had been annual when she was a child, then more frequent when she was a teenager, but slowed dramatically when Jake decided -- well, _she and Jake_ decided; it had been a mutual thing for sure -- not to propagate the system.
+
+Now the Folk only came when they wanted something, which was always for her to influence Jake. She still wasn't afraid, but she hated these visits.
+
+Three of them were at her kitchen table when she got home. They always dressed identically and all of the females looked a lot alike, so it took her a minute to realize that something was wrong. "Where's Melissa?" she said. Of the bunch who had visited, Melissa felt the most like a friend, or at least like an advocate for Nancy. She'd come every single visit since the beginning.
+
+The Folk looked uncomfortable and the one at the foot of the table -- Val, Nancy remembered -- said, "Melissa has moved on. Thirty years is a very long time for one of us to serve." She nodded to her right. "This is Melanie."
+
+Something felt off. "What do you mean, 'moved on'? Retired, do you mean? She didn't seem very old."
+
+Val waved a hand in front of her face, a Folk gesture that meant she wasn't going to give any more information, and probably didn't know anything more herself. "Retired, yes. Melanie has been trained and is ready to step in. It will be seamless."
+
+"I guess I don't get a say in the matter," Nancy said. There was nothing she could do short of getting Jake to make a stink, and he was likely to fail. 
+
+She shook her head slightly, preparing herself for whatever battle they'd brought with them, and said, "What do you want?" She'd given up being polite a long time ago. It didn't change anything, and didn't seem to matter to the Folk.
+
+Melanie spoke. "It's more what you want." Reaching into a carrier bag -- one of them always had a carrier bag -- she brought out a stiff white envelope about nine by twelve inches. One of the fancy kind, woven of tough material that was somewhere between paper and plastic. Tyvek, Nancy remembered. Of course Folk would never use anything cheap. 
+
+Melanie put the envelope face-down on the table, which Nancy now saw was pristine, although she wasn't at all sure she'd wiped it after breakfast this morning. After carefully undoing the flap, held in place by a sort of Velcro, Melanie slid out a piece of card stock. There were a few words printed on it, but before Nancy could read them Melanie flipped it over and placed it on the table, perfectly centered in front of Nancy.
+
+Nancy's breath caught, and her hand involuntarily flew up to cover her mouth. She saw the Folk exchange a satisfied glance, but she didn't care.
+
+The photo was of an infant. Tiny, newborn. Swaddled in pink, with a pink bow in her dark hair.
+
+Her face was scrunched up as if annoyed by the photographer.
+
+And she was perfect.
+
+
+

Folk202608/0 Manuscript/Chapter 02 - Succession plan/20x Mrs. Miller interrupts.md

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+She stood in his office doorway watching him work. He was using two computer screens, a laptop, a tablet computer, and a big paper ledger, switching among all of them, and seemed almost frantic. Frenetic, that was the word. Finally she said, "Knock knock."
+
+He looked up and blinked, seeming to need a few seconds to actually recognize her. When he finally did he smiled and said, "Hi, Mrs. Miller. I hope you haven't been waiting long. I was in another world."
+
+"Their world," she said, putting a plate with a sandwich and a glass of iced tea in front of him. "Bad month?"
+
+"Yeah," he said between bites. "Seasonal market shift that I under-anticipated. I'm going to have to convince them to forego some profit, which they'll hate. But if they'd gear up to meet it we'd have a worse problem five quarters out." He waved a hand. "Thank goodness for AI. And thank you for this sandwich, by the way. It's delicious."
+
+"Avocado from Steffy's, ham from them, bread from me," she said. "Now that I've interrupted, may I make a few requests?"
+
+"Of course. I'm sorry you had to wait."
+
+"First," she said, "Nancy's car is in the shop again. I think it's time for her to buy a new one."
+
+"Past time," he said. "That car is ten -- no, twelve! -- years old."
+
+"She's okay financially?"
+
+"Oh, goodness," he said. Then he laughed. "She doesn't spend anything, and the Folk have done really well with her investments. If she wanted to buy a car *manufacturer* we might need to have a conversation, but anything short of that amounts to spare change for her." He looked up. "Same story for you, by the way. I'm grateful that you keep coming here, but financially you have plenty of money if you decide to quit and take it easy."
+
+"And sit around looking at my husband, waiting for one of us to show signs of dementia?" she said. "No, thank you. Nancy saw a red Honda on Vanleer's lot" --
+
+"She's thinking *used*?"
+
+"Well, she's worried about the process. She doesn't want to negotiate. And she trusts Ted Vanleer."
+
+"Brother." He turned to his computer monitor, clicking and typing. "Okay, that's a three year old CRV at Vanleer's. The Honda dealer in Indiana has ten new CRV's available, a choice of colors. They could deliver it into her driveway this afternoon and take her old car away."
+
+"Blair won't give her old car back," Mrs. Miller said. "He said the frame is rusted through. He's going to junk it."
+
+"Oh, boy. Blair's gonna kill me. He's always had a sweet spot for Nancy. Anyway," he waved a hand. "You don't need to be in the middle of this. I'll call her."
+
+"Thank you. Blair gave her a loaner, so she's not without a car, but..."
+
+"Yeah," he said. "I'll call her right away."
+
+The housekeeper nodded. "Second, Cassie Wing asked if you'd have a few minutes to meet with her." Noting his blank expression, she added, "Charlie's mother. They live next door."
+
+"Oh," he said. "This is the woman who wants to hug me?"
+
+She laughed. "I'd forgotten she said that. She's very nice, so if she does you should relax and enjoy it. But I think this is different. She said she wanted to ask you something about, her words, 'the people to the north.' She understands it's not something we talk about, but this involves Charlie."
+
+"She didn't say Amish? Everybody says Amish. You don't think Charlie's been messing around at the fence, do you?"
+
+"No," Mrs. Miller said. "He's seven years old and doesn't have full use of his legs. He couldn't get within half a mile of the fence. If there's any contact, they initiated it, not Charlie."
+
+"Why would they do that?"
+
+"Well," the older woman said, "let's think. Their whole existence depends upon having a human steward. The current steward and my daughter were supposed to get together and make new little stewards, which they haven't done."
+
+"Mrs. Miller" --
+
+"I'm not speaking from my point of view, but from theirs. So they're probably looking for new ways to get a steward. A succession plan. Charlie's bright, and his disability wouldn't interfere. They started visiting Nancy when she was five. Charlie's seven, so my guess is they're cultivating him." She held a palm up, but then went on, "You should talk to Cassie. She might not see it as the disaster you do. And maybe I've got it all wrong."
+
+"I have pushed them to get themselves recognized--" he began.
+
+"And they're convinced they wouldn't survive the process, I know. Historically they've always had three human families to draw from. Regardless of what you've tried, I would bet money they're starting at least three paths to get a new Steward."
+
+"Yeah," he said. "Well, I guess we should hear what this woman has to say."
+
+"Cassandra. I'll set something up," the housekeeper said. "Probably later today. She's anxious, but of course it's her child."
+
+"Right," he said. 
+
+"And finally, that awful college professor is still making a nuisance of herself. She's been pestering me, and Nancy, and Debi down at Representative Samuels' office" --
+
+"What does she want from the Pennsylvania legislature?"
+
+"I believe," Mrs. Miller said, "she's just trying to annoy everyone she can so either we'll let something slip, or we'll pressure you to talk with her. You'd said you were going to get a background check on her?"
+
+"Oh, yeah," Jake said. "That came overnight. Goodness knows what hours those guys work." He turned again to his computer, and Mrs. Miller walked around to read over his shoulder.

Folk202608/0 Manuscript/Chapter 02 - Succession plan/20x Nancy and Jake.md

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+"First things first," Jake said. "Let's be aware that they're manipulating you. Us, I mean."
+
+"No," Nancy said. "First things first, let's agree that she's real." She pointed to the photo on Jake's desk. "And if she's real, that she's in danger."
+
+Jake closed his eyes for five long heartbeats, and then nodded. "Yes. You're right. Her existence changes everything. Just as background, let me note that they've outmaneuvered us. It took them seventeen years, but they did it."
+
+"So you think she's real?" Nancy said.
+
+"Yes," he said. "They wouldn't risk offering you a baby if they couldn't follow through."
+
+"And you think she's at risk? That they'd..." She swallowed. "Have no use for her if I don't take her?"
+
+"I'm afraid so," he said. He looked away, out the window. "I've never told you all the reasons I refused to be Steward, that first time."
+
+"You told me they didn't respect human laws, that they were into drugs and fraud. And killing hunters. Do you mean there's more?"
+
+He nodded. "I thought I could change that stuff, and in fact we have changed it. It was in their best interest to change. Sooner or later a drug-spotting plane was going to fly over, something like that." He shook his head. "I can't imagine how many bribes my predecessors paid. But..." His voice drifted off and he stood quiet, apparently lost in thought.
+
+"But?" she prompted.
+
+"Every six months they update their long-term resource plan. It goes out seventeen years. They like prime numbers. And they look at, quarter by quarter, how many 'resources' they need. Resources including, especially, Folk. By skill set: laborers, knowledge workers, leaders."
+
+"Okay..." 
+
+"But the thing is, they're a closed community. Five hundred of them, more or less."
+
+"So," she said, "seventeen years is enough to raise a new 'resource'? Guide a Folk baby into the career the community will need?"
+
+"What about the extras?" he said desperately. "What do they do when demand decreases?"
+
+"I don't" --
+
+"I see the numbers, Nanc. They pride themselves on being efficient. When demand decreases, they maintain seven percent margin for three months, and three percent margin for seven months. And then the 'extras' just drop off the books."
+
+"Drop... where?" She thought about Melissa. About the look on Val's face when she said Melissa had 'moved on.'
+
+"Gone," he said. "Just gone. No longer eating any food or requiring any housing. Gone."
+
+"Jake," she said, "that's..."
+
+He opened the top drawer of his desk and grabbed an eleven by seventeen inch notebook. Opening it, he gestured wildly at column after column of numbers. "I try like crazy not to have extras. Propose new initiatives, stockpile to anticipate short-term surges, cross train Folk. Every way I can think of to keep the numbers steady."
+
+"That sounds" --
+
+"But sometimes I fail. Often. Practically every quarter. And they laugh at me, say I'm too emotional. That I don't understand, and that this is what comes from not having enough time overlapping with my fath--"
+
+His voice turned into a sob.
+
+She stepped across and wrapped her arms around him. His voice muffled by her hair, he said, "My father, my grandfather... However many generations back. They bought into all this. I think they thought of the Folk as sub-human, and what's bizarre is the Folk leaders regard themselves as super-human. Two paths to the same horror story."
+
+"I'm so sorry," she said. "My ancestors too."
+
+"Yeah," he said. "No clean hands here." Then he drew a deep breath. "Well, I got rid of the drugs and the fraud, or at least I think I did. And my best guess is only two humans have disappeared since we built the fences, and they were both intentional intruders planning to do harm." 
+
+He shifted so his right arm was around Nancy's waist, and with his left hand touched the photo. The perfect baby girl. 
+
+He said, "Maybe our daughter can stop the genocide."

Folk202608/0 Manuscript/Chapter 02/201 Angels.md

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+They'd first visited just before Christmas, the year she turned five. 

Folk202608/2 Characters/Folk.md

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+Val at head of table
+Melissa - long term but no more
+Melanie - Melissa's replacement
+
+Fairies, maybe. They were tiny and delicate and so blond you could practically see through them, all of which fit fairies. It was disappointing that she couldn't see any wings, but she'd figured those might be folded up under their shirts. How bulky would gossamer be, anyway?
+
+Of the bunch who had visited, Melissa felt the most like a friend, or at least like an advocate for Nancy. She'd come every single visit since the beginning.

Folk202608/2 Characters/Nancy Miller.md

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+January birthday
+35 years old in story

Folk202608/2 Characters/Wing family - Charlie, Cassandra, Chuck.md

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+Charlie 7 years old, AFM for the last two years.

Folk202608/9 Research/AFM - Acute Flaccid Myelitis.md

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+https://my.clevelandclinic.org/health/diseases/17991-acute-flaccid-myelitis
+Acute Flaccid Myelitis
+Medically Reviewed.
+Last updated on 11/29/2022.
+
+Acute flaccid myelitis (AFM) is a rare neurological condition that causes your muscles and reflexes to become weak. It often affects your upper limbs and can affect the muscles you need to breathe as well. Because of this, it’s important to seek medical care as soon as possible if you or your child develop symptoms.
+
+What is acute flaccid myelitis?
+Acute flaccid myelitis (AFM) is a rare and serious neurological condition that causes certain muscles and reflexes to become weak (flaccid). The symptoms come on suddenly and can also affect your ability to breathe.
+
+AFM causes inflammation in the gray matter of your spinal cord. You have grey matter in your brain and spinal cord (central nervous system). Of all the types of central nervous system tissue, it plays the most significant part in allowing you to function normally. Gray matter in your spinal cord specifically plays a role in controlling movement.
+
+AFM is a relatively new diagnosis — researchers first described it in 2014. Previously, healthcare providers and researchers thought it was a type of transverse myelitis.
+
+What is the difference between acute flaccid myelitis and Guillain-Barré syndrome?
+Acute flaccid myelitis and Guillain-Barré syndrome (GBS) are both rare neurological conditions that cause muscle weakness, but they’re different.
+
+In GBS, your body has an autoimmune response that damages peripheral nerves — the nerves that connect your central nervous system (brain and spinal cord) to your limbs and organs. AFM affects the gray matter of your spinal cord.
+
+The muscle weakness in GBS usually begins in your feet and legs and travels up your body. In AFM, muscle weakness can begin in your legs or arms.
+
+Another difference is that AFM typically affects children, whereas GBS most commonly affects adults aged 40 or older.
+
+Who does AFM affect?
+About 90% of acute flaccid myelitis cases affect young children between the ages of 1 and 7, but adults can get AFM, too.
+
+How common is acute flaccid myelitis?
+Acute flaccid myelitis is rare. Researchers estimate that fewer than 1 person per 1 million people per year in the U.S. develop AFM. However, the number of cases has been rising.
+
+Cases have usually occurred in clusters in certain geographical areas with a distinct seasonal biennial pattern (every other year). For example, there was a cluster of cases in California in 2012 and a cluster in Colorado in 2014.
+
+
+Symptoms and Causes
+What are the symptoms of acute flaccid myelitis?
+Symptoms of acute flaccid myelitis include the sudden onset of:
+
+Arm or leg weakness.
+Loss of muscle tone.
+Loss of reflexes (areflexia).
+Loss of coordination and balance.
+These symptoms develop over a few hours or days.
+
+Other symptoms include:
+
+Difficulty moving your eyes or drooping eyelids.
+Facial droopiness or muscle weakness.
+Difficulty with swallowing (dysphagia).
+Slurred speech.
+Pain in your arms, legs, neck or back.
+Bladder and bowel dysfunction.
+AFM can affect any or all of your limbs, but it most commonly affects your upper limbs.
+
+Sometimes, AFM can affect the muscles you need to breathe. This can lead to respiratory failure, which is life-threatening and requires immediate treatment.
+
+Signs of respiratory failure include:
+
+Rapid and shallow breathing.
+Extreme fatigue and sleepiness.
+Restlessness.
+If you or your child develop any symptoms of AFM, seek medical care right away.
+
+What causes acute flaccid myelitis?
+Researchers don’t know the exact cause of acute flaccid myelitis, but they think that viruses, especially non-polio enteroviruses, play a role in causing the condition. Most people with AFM had a mild respiratory illness (such as the common cold) or fever before they developed AFM.
+
+Researchers and healthcare providers have suspected enterovirus D68 and enterovirus A71 in many AFM cases. Enterovirus D68 most often causes a respiratory illness and circulates in the United States during the summer and fall every other year.
+
+Diagnosis and Tests
+How is acute flaccid myelitis diagnosed?
+It can be difficult for healthcare providers to diagnose AFM, as it’s rare and resembles other neurological conditions, such as transverse myelitis, Guillain-Barré syndrome and polio.
+
+Your provider will ask about your symptoms and medical history. They’ll likely perform or order several tests to help diagnose AFM and/or rule out other conditions. Tests include:
+
+Physical exam.
+Neurological exam.
+MRI of your spinal cord and brain to look for changes in the gray matter of your spinal cord. This is the most useful test for confirming AFM.
+Spinal tap to check cerebral spinal fluid (CSF) to look for signs of inflammation.
+Nerve response tests like nerve conduction studies.
+Muscle response tests like electromyography.
+Management and Treatment
+What is the treatment for acute flaccid myelitis?
+There’s no cure or specific treatment for acute flaccid myelitis. Instead, managing symptoms is the goal. If possible, it’s best to see a neurologist who has experience in treating and researching AFM.
+
+Physical therapy and occupational therapy can help with arm and/or leg weakness. Neurologists typically recommend other treatments on a case-by-case basis. For example, peripheral nerve surgery that prevents muscle atrophy has been effective in some people with AFM.
+
+As AFM is a rare and relatively new diagnosis, scientists and providers still have a lot to learn about it and its treatment.
+
+Outlook / Prognosis
+What is the prognosis for acute flaccid myelitis?
+As acute flaccid myelitis is a newly recognized condition, researchers don’t yet know the long-term prognosis (outlook) for people with the condition.
+
+Most people continue to improve over time with ongoing physical therapy. Less than 10% of people with AFM recover completely.
+
+What are the possible complications of acute flaccid myelitis?
+AFM can affect the muscles you need to breathe properly. This can result in respiratory failure, which is a medical emergency. People with respiratory failure require machines to help them breathe. About a third of people with AFM require intubation and ventilation.
+
+AFM can also cause serious neurologic complications, such as body temperature changes, blood pressure instability and irregular heart rate, which can be life-threatening.
+
+Get medical care as soon as possible if you or your child experience these symptoms.
+
+Prevention
+Can I prevent acute flaccid myelitis?
+As researchers don’t know what specifically triggers acute flaccid myelitis, there’s no known way to prevent it.
+
+Viruses, including enteroviruses, can lead to AFM. There are steps you can take to lower your risk of getting sick from a virus, including:
+
+Wash your hands often with soap and water, including before and after eating, after using the bathroom, after touching an animal and after taking care of someone who is sick.
+Avoid touching your face with unwashed hands.
+Avoid close contact with people who are sick.
+Stay up to date on recommended vaccinations.
+Clean and disinfect surfaces that you frequently touch.
+Living With
+When should I see my healthcare provider?
+If you or your child have sudden muscle weakness in one or more limbs, seek medical care as soon as possible. AFM can progress quickly and lead to issues with breathing.
+
+If you or your child have a diagnosis of AFM, you’ll need to see your healthcare team regularly to receive treatment, such as physical therapy, and to monitor your symptoms.
+
+A note from Cleveland Clinic
+It’s important to seek immediate medical care if you or your child have sudden muscle weakness. Researchers and healthcare providers are still learning about acute flaccid myelitis (AFM), but know that they’ll carefully monitor your symptoms and suggest treatments to manage them.

Folk202608/9 Research/Hebrews 4_12.md

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+King James Bible
+For the word of God is quick, and powerful, and sharper than any twoedged sword, piercing even to the dividing asunder of soul and spirit, and of the joints and marrow, and is a discerner of the thoughts and intents of the heart.