Multiple sclerosis is a lifelong disease that requires various modalities of treatment. Plan of care considerations include (1) the patient’s age at onset of illness; (2) sex; (3) the extent of the disability at the time of diagnosis as well as (4) the form of multiple sclerosis. Treatment will be a multidisciplinary approach that involves specialists such as neurologists, rehabilitation specialists, neuro-urology experts, psychiatrists, occupational therapists, physiotherapists and social workers. This method is essential to ensure that all aspects of the disease are considered to help improve their quality of life.
The management of multiple sclerosis consists of a four-prong approach that involves: (1) management of acute exacerbations; (2) reduction of the frequency of relapses; (3) administration of the complications and (4) management of permanent disability that has already occurred. These are the goals of the management. No cure for the disease has been established.
High-dose steroids such as corticosteroids are the cornerstone of treating acute exacerbations because they reduce and control inflammation. Steroids are generally reserved for patients with exacerbations severe enough to cause functional disability or in those that exacerbations are prolonged beyond the duration of 24 hours. Corticosteroids work by reducing the inflammation which is a primary cause of the systems of multiple sclerosis. They work by binding to receptors on the cell surface and preventing the formation of various proteins. This, in turn, leads to inflammatory activity suppression. 2014 guidelines recommend pulsing with intravenous methylprednisone or methylprednisone given orally at doses of 500mg to a maximum of 1 g and 2 g respectively for a total of 3-5 days. The steroids can then be tapered off over two weeks or, be followed by a dose of prednisone 60-80 mg once a day which can be tapered off over two weeks.
Pulsing with high-dose steroids helps to reduce the severity of the acute attack as well as reduce the number of days of disability. However, their benefit in preventing future relapses or halting disease progression has not been shown. Their use is limited to a maximum of three times a year due to the multiple adverse effects that result from chronic steroid use. These include: osteoporosis, psychosis, mood lability, cataracts, gastritis, fluid retention, weight gain, Cushing’s syndrome, increased insulin resistance and increased the incidence of infections. Proton pump inhibitors such as esomeprazole have been used for prevention of gastritis especially in patients who report the incidence of peptic ulceration. Histamine receptor antagonists have also been used. Lithium, a mood stabilizer, has been used in the management of the mood disorders that result.
Plasmapheresis has also been used in the management of acute episodes where corticosteroids fail. Its wide use is limited by resources as it is quite expensive.
The relapsing-remitting form of multiple sclerosis is characterized by episodes of attacks followed by periods of disease remission. One of the goals of treating these patients is to prevent the relapses. Disease modifying drugs are used to achieve this. The two main drugs used are Glatiramer acetate and Interferon beta (IFN β). These two drugs should be initiated before permanent disability sets in because they have no effect on permanent neurological deficits. Four conditions need to be met before therapy with these agents can be started. They are: (1) the patient should be physically fit and able to walk for a substantial distance without assistance; (2) they should have a history of at least two severe relapses in the past 24 months; (3) they should be above 18 years and (4) they should have no contraindications to the use of the two drugs.
Interferon β belongs to a group of cytokines in the body called interferons. It is classified under Class 1 of that group. The two forms of interferon β have been found to be useful in the management of relapsing/remitting multiple sclerosis are as follows: interferon β 1a (Avonex and Rebif) and interferon β 1 b (Betaferon). The mechanism of action of these drugs involves reducing the frequency and severity of attacks by (1) lessen the manifestation of Major Histocompatibility Complexes (MHC) on the surface of antigen presenting cells; (2) inhibiting cytokines that favor inflammation and increasing those that regulate the levels of other cytokines; (3) reducing T-cell proliferation and (4) lessen the entry of inflammatory cells into the central nervous system.
Avonex is given as an intramuscular injection, 30 micrograms once per week. Rebif is given subcutaneously, 44 micrograms three times a week. Betaferon is also given subcutaneously, 250 micrograms every other day. Some of the common side effects of interferon therapy include skin reactions at the sites of injection causing necrosis; lipoatrophy due to the subcutaneous injections and flu-like symptoms like headaches, fever, fatigue and muscle aches.
Glatiramer acetate is an immunomodulatory drug that contains four amino acids: glutamic acid, lysine, alanine, and tyrosine. It has been shown to reduce the frequency of attacks in patients with relapsing- remitting form. The mechanism of action is not well elucidated, but various theories exist. Some of these theories suggest that glatiramer can facilitate the conversion of inflammatory T cells into non-inflammatory forms as well as act as a decoy since it has a similar structure to the myelin which is the target of the inflammation. It has however not been shown to influence the permeability of the blood-brain barrier as the interferons do. Glatiramer is given as a subcutaneous injection, 20 mg daily. Just like Interferon β, it causes injection site reactions.
Other drugs that have been used in the prevention of attack rate include Natalizumab, Fingolimod, Teriflunomide, Mitoxantrone Hydrochloride, Cladribine, Intravenous Immunoglobulins, Methotrexate, and Cyclophosphamide.
The benefits of working out are known to all. Here are some of the effective exercises and workout tips from male celebs with great bodies.
David Harbour is known for his role in Hellboy, a hit franchise that showcased him in a bulky, strong body. Here is the workout routine to get this look.
This look can be acquired mainly by doing bodyweight workouts and following the workout tips from male celebs.
Here is the breakup of the same:
Do not do them continuously. Instead, do small sets repeatedly to achieve the given numbers.
Who doesn’t want to look like the Superman? The most iconic superhero after all. Henry Cavill went through a fat-burning workout to get the superhero look. It comprises of regular 3-week routines with increasing intensity.
Here’s what the third week should look like:
Include the corresponding exercises into each day to get a look similar to Henry Cavill.
If you are a big fan of massive arms, then The Rock should be your idol. You should follow workout tips from male celebs like The Rock. His biceps and triceps workout must be your mantra.
Here are the arm exercises you should focus on:
Overall, it is advisable to do loads of isolation movements to get huge arms. For high reps for arms, Dwayne Johnson is known to use the George Farah’s method. So focus on your biceps and triceps to get The Rock look. Keep it light initially and add extra sets as you go on. Make sure you pay equal attention to your triceps and biceps.
There is no single perfect workout, and it depends on what you want to achieve. However, you should follow the workout tips from male celebs, have clear goals, and stick to your routine for best results.
Myelodysplastic syndromes, or MDS, are a group of disorders caused by poorly formed blood cells or ones that don’t work properly. The MDS life expectancy varies greatly from patient to patient, depending on several factors, including age, overall health, and how well the disease responds to treatment. One of the major complications of MDS is that it can cause anemia, a condition characterized by a lack of red blood cells. It’s important to recognize the warning signs of MDS to seek early treatment. Here are ten signs that may indicate the presence of this disease.
1. Fatigue
One of the most common symptoms of MDS is fatigue. This is primarily due to anemia, which can make you feel tired and weak. If you’re feeling unusually fatigued, it might be worth discussing with your doctor.
2. Shortness of breath
Another sign of MDS can be shortness of breath, especially during physical activities. This symptom is also related to anemia, as your body isn’t getting enough oxygen due to a lack of red blood cells.
3. Frequent infections
MDS can cause your white blood cell count to drop, making you more susceptible to infections. If you find that you’re getting sick more often than usual, it could be a sign of MDS.
4. Easy bruising or bleeding
If you notice that you’re bruising easily or bleeding more than usual, it could be a sign of MDS. This is because MDS can affect your platelet count, which is responsible for blood clotting.
5. Skin paleness
Anemia, a common complication of MDS, can cause your skin to look paler than usual. This is due to the lack of red blood cells, which give your skin its color.
Now that we’ve covered the warning signs, let’s look at some FDA-approved treatments for MDS.
6. Blood transfusions
Blood transfusions are often used to treat anemia in people with MDS. This involves receiving healthy blood from a donor to increase your red blood cell count.
7. Medications
Several medications can be used to treat MDS, including growth factors to stimulate your body to make more blood cells, and immunosuppressive drugs to help your body accept these new cells.
8. Chemotherapy
Chemotherapy is often used to kill off abnormal cells in your bone marrow. This can help to slow the progression of MDS and alleviate some symptoms.
9. Stem cell transplant
A stem cell transplant involves replacing your diseased bone marrow with healthy marrow from a donor. This can potentially cure MDS, but it’s a complex procedure with significant risks.
10. Supportive care
Supportive care involves managing the symptoms of MDS, such as fatigue and shortness of breath. This can include medications, physical therapy, and lifestyle changes.
In conclusion, it’s important to recognize the warning signs of MDS and seek treatment early. With the right care, it’s possible to manage this disease and maintain a good quality of life.
Life insurance is a critical safety net for many individuals, especially those over 50 or seniors who want to ensure their loved ones are financially secure after they’re gone. But it’s essential to understand that not all situations are covered by life insurance policies. Here are seven things that life insurance does not typically cover.
1. Fraudulent information
One of the key aspects insurance companies look at when underwriting a policy is the honesty of the information provided. If you have lied or omitted important information on your application, your insurer can deny your beneficiaries’ claim. Always be honest and thorough when applying for life insurance.
2. Suicide within the exclusion period
Most life insurance policies include a clause that excludes coverage for suicide within the first two years of the policy. This period may vary depending on the insurance company and the specific policy, but it’s a standard exclusion across the industry.
3. Death from risky activities
If you regularly engage in high-risk activities such as skydiving, mountain climbing, or extreme sports, your life insurance policy may not cover death resulting from these activities. It’s crucial to disclose these hobbies when applying for insurance, as failing to do so could result in a denied claim.
4. Death in a war zone
Many life insurance policies exclude coverage for death occurring in a war zone. If you are a military personnel or a civilian working in a conflict area, you may need to seek a special policy or rider to cover this risk.
5. Illegal activities
If the policyholder dies while committing an illegal activity, the life insurance claim will likely be denied. This can include anything from driving under the influence to participating in criminal activities.
6. Certain health conditions
While life insurance for over 50 and life insurance for seniors are generally available, certain health conditions may not be covered. This is especially true for policies with a graded death benefit, which only pays out the full benefit if the policyholder lives a certain number of years after purchasing the policy.
7. Acts of God
Some life insurance policies may not cover deaths caused by acts of God, such as natural disasters. However, this exclusion is less common than others and can vary significantly between insurance companies and policies.
Now that you know what life insurance typically does not cover, it’s important to find a reliable provider. Some of the top companies that provide life insurance include New York Life, MetLife, Prudential Financial, and State Farm. These companies offer a variety of policies, including term life, whole life, and universal life insurance.
Remember, life insurance is a crucial part of financial planning, especially for those over 50 or seniors. Make sure to thoroughly read and understand your policy, and don’t hesitate to ask your insurance agent or company any questions you may have. It’s always better to be safe than sorry when it comes to protecting your loved ones’ financial future.
Embarking on home improvement projects is a rewarding journey that can elevate your living space and enhance its functionality. From addressing water damage with companies that clean up water in the basement to upgrading roofing and gutters, and even considering Anderson window replacement, these hacks are designed to transform your home seamlessly. In this article, we explore seven ingenious home improvement hacks that will breathe new life into your living space.
1. Water damage prevention and cleanup
Companies that specialize in cleaning up water in the basement play a crucial role in preventing and addressing water damage. Protect your home from potential disasters by addressing leaks, floods, or excess moisture promptly. Investing in professional services ensures a thorough cleanup and mitigation of water-related issues, preserving the structural integrity of your home.
2. Roofing and gutters upgrade
Upgrading your roofing and gutters is a fundamental home improvement hack that protects your property from the elements. Consider durable roofing materials such as asphalt shingles, metal, or architectural tiles. Additionally, ensure your gutters are clean and well-maintained to prevent water damage and potential leaks. Regular inspections and prompt repairs contribute to the longevity of your roof and the overall health of your home.
3. Anderson window replacement
Enhance your home’s aesthetic appeal and energy efficiency with Anderson window replacement. Anderson windows are renowned for their quality and durability. Upgrading to energy-efficient windows not only improves insulation but also adds a timeless and elegant touch to your interior and exterior spaces. The investment in high-quality windows pays off in energy savings and increased home value.
4. Creative storage solutions
Maximize your living space by incorporating creative storage solutions. Utilize under-the-stair storage, built-in shelving, or multifunctional furniture to optimize every square foot. These solutions not only declutter your home but also add a touch of innovation to your decor, making your living space both functional and stylish.
5. Smart home technology integration
Embrace the future of home living by integrating smart home technology. From smart thermostats and lighting to security systems, these technologies enhance convenience, energy efficiency, and security. Smart home devices can be easily controlled through mobile apps, providing remote access and customization options to suit your lifestyle.
6. DIY painting projects
A fresh coat of paint is one of the most transformative and cost-effective home improvement hacks. Whether it’s an accent wall, a room makeover, or refreshing exterior surfaces, painting projects can instantly breathe new life into your home. Experiment with different colors and finishes to create a personalized and updated look.
7. Energy-efficient lighting upgrades
Switching to energy-efficient lighting options is not only environmentally conscious but also financially savvy. Replace outdated incandescent bulbs with LED or CFL alternatives to reduce energy consumption and lower utility bills. Additionally, consider installing motion sensor lights in outdoor areas for enhanced security and energy efficiency.
Embarking on home improvement projects is an exciting endeavor that allows you to tailor your living space to your preferences and needs. From addressing water damage with professional cleanup services to upgrading roofing and gutters, considering Anderson window replacement, and embracing creative storage solutions, these home improvement hacks offer practical and innovative ways to transform your home. Whether you’re looking to enhance aesthetics, increase energy efficiency, or optimize functionality, these hacks provide a roadmap for a more comfortable and stylish living environment.
