Multiple sclerosis (MS) is a neurological disease, or more specifically a demyelinating disease, that damages the protective fatty layer (myelin) of the nerves located in the brain and spinal cord. It is this damage that creates the scars visible to the doctor through x-ray examination and creates the physical impairments suffered by MS patients.
Though the most telling signs that a patient is suffering from MS are determined by X-ray, there are several distinct physical symptoms to assist the diagnosis
1. Cognitive impairment
This issue of cognitive impairment in MS patients may manifest itself in the form of memory loss, inability to concentrate or maintain attention
2. Vision problems
MS patients often suffer blurry vision, double vision, or inability to control eye movement. This is due to optic neuritis, or inflammation of the optic nerve, which is responsible for vision
3. Tingling and numbness
Many MS patients experience an inability to feel or move their limbs or an unexplained feeling of pins and needles throughout the body. This is often the earliest sign caused by nerve damage and experienced in areas such as the face, arms, or legs, and often on just one side of the body
4. Pains and spasms
Known as spasticity, MS patients may experience bouts of unexpected back pain and muscle spasms because of an imbalance in the electrical signals transmitted from the brain and spinal cord once nerve damage occurs. These mixed signals often result in uncontrolled muscle contractions and tense muscles
5. Difficulty walking
Due to frequent numbness and muscle spasms difficulty walking is a common symptom for a patient suffering from multiple sclerosis as the disease progresses
6. Bladder and bowel dysfunction
The damage to nerves creates an inability for the brain to communicate to other organs within the body. For the multiple sclerosis patient, this may translate into frequent bathroom visits or an inability to use the bathroom as often as the body should
The frequency of MS symptoms experienced may vary from patient to patient. For instance, it is possible for the patient to go for periods of time without any symptoms even though the damaged neurons are not healed. Because the damage is still present and attacks upon the body continue, symptoms may reoccur at any time. Doctors often prescribe a combination of relapsing MS treatment to curb the recurrence of MS symptoms, which can include medications, physical therapies, diet changes, counselor sessions to curb stress, and exercise and sleep support.
Multiple sclerosis creates an inability to manage the body. Acknowledging the early signs of MS through testing will assist the patient with gaining a sense of control. Once diagnosed the patient can then concentrate on managing the symptoms.
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.
Fashion is such an individualized thing. Everyone is different and therefore everyone has personal preferences when it comes to different types of dresses. One thing is true though; it’s important to have at least one versatile and flattering dress in your wardrobe. When determining what type to choose, there are several styles to consider that can be appropriate for different types of events and different figures.
Women today attend many events that require dressing up for the occasion. These may include weddings, dates, parties, work events, and brunch. When looking to buy a dress to suit a wide range of occasions, here are some flattering options for all ages and body types:
1. Wrap dresses
Wrap dresses are exactly what they sound like. These dresses are pulled together with a front closure. One side of the dress is wrapped across the front and then either goes behind the back part of the waist to either be attached by buttons or tied. The construction of this dress creates a v-neck front. It also accentuates the curves of the wearer in the chest area.
2. Maxi dresses
Maxi dresses are a great option for many occasions. They are long and go to the floor. Generally, they are designed to fit the body on the top, and then be flowy and long on the bottom. The fun thing about them is they can feature many different necklines and come in various patterns and colors. This makes them very individualized to the person.
3. A-Line dresses
A-line dresses are named after the shape they take on the body, which is an “A”. They fit to the top part of the body and begin to flare gradually out at the waist and hips, becoming wider as the hem progresses. A-line clothing can be found not just in dresses, but also in coats and skirts.
4. Little black dresses
Everyone has heard of the little black dress. This is such a versatile option that can be found in your closet. It can be dressed up or down for numerous types of events. As a general design, it is usually a simple dress that tends to be quite short. The elegance and simplicity create a fairly blank canvas that allows you to create the exact type of look that you want. Many designers provide limitless options for this much-needed wardrobe essential. Victoria Beckham cocktail dresses are one good brand to consider.
5. Mini dresses
A mini, or short dress that hangs just above the knees is a common style. This design became popular in the 1920’s. It was later revitalized in the 1960s, and has remained an integral part of many wardrobes ever since. A mini shift style dress is a loose-fitting dress that is very comfortable and does not fit tightly around the waist or any part of the body. It is loose at both the hips and the waist so the dress falls loosely down from the shoulders all the way down to the bottom of the dress. Darts are generally located in the bust area. It is a straight silhouette that can be flattering for those that have bodies that are shaped more like a column and it also elongates petite figures as it shows off the legs.
When shopping for dresses, every designer has his or her own individual interpretation. It is fun, and a great idea to look at the individual designers and fashion forward celebrities to find the one that fits your aesthetic most closely. Also, remember that designers also have many other clothing options. As an example, when looking at what stars wear, like Kourtney Kardashian or Victoria Beckham (blouses, skirts, dresses and pants), you might find a designer that the star tends to wear a lot that you can draw inspiration from.
The right handbag can really accentuate your outfit of the day. There are also many styles and functions for different handbags. You could have a handback that works as a daily driver – a bag that you take to run errands or to the store. You could also have a bag that’s perfect for traveling or for a night out. Whatever the case may be, these are five handbags that are sure to be everywhere this season:
1. Versace Chunky Chain Bag
This Versace bag features a chunky chain which really is the stand out feature on this bag. The chain provides a cool effect when you wear it, that really draws your eyes to it. In typical Versace fashion, the chunky chain bag is made of high quality materials and is a great value for the price.
2. Lanvin Puffy Cloud Bag
The Lanvin Puffy Cloud Bag is another bag you’ll be seeing a lot of in 2021. This bag is one of the top trends in handbags right now, and for good reason. The Lanvin quality is apparent and you can really wear this on any occasion, formal or casual.
3. Stella McCartney Hobo Bag
The Stella McCartney Hobo bag has a relaxed look about it. It appears slightly slouched in nature, which provides a really cool effect. This bag can be dressed up for a nice, formal event or dressed down for a nice casual day. This bag is incredibly versatile and provides enough room for all of your belongings. It has two slip pockets and an interior compartment for maximum storage. This is one bag that can really do it all.
4. Bottega Veneta Fisherman Shoulder Bag
The Bottega Veneta Fisherman Shoulder Bag is extremely trendy right now, and for good reason. The bag features a scale like pattern which is the standout feature. It also features a shoulder strap for great versatility and a super comfortable wear. The bag features high quality materials and enough room to keep all your belongings stored nicely. This bag leans a bit casual but is a great bag if you’re looking to make a statement throughout the day.
5. Fendi Fluffy Feathers Bag
The Fendi fluffy feathers bag is a bag that’s sure to make a statement. This bag is made of high quality materials, in typical Fendi fashion. The fluffy feathers bag is covered in ostrich feathers. This bag is incredibly unique and will turn all the heads. It’s also very versatile in that all of the straps are detachable so you could wear this as a shoulder bag or as a little handheld purse. When you pair this with a stunning dress, you will be sure to turn heads at any formal event or night out on the town.
These bags can be found at many of your favorite retailers and department stores. Make sure to shop Saks Fifth Avenue bags for the latest in deals and trends for the 2021 year.
Jewelry is the one of the best accent pieces for any outfit you choose to wear. The right necklace, or the right bracelet, can really put the finishing touch on an amazing outfit. You may opt to wear a necklace on a night out, or a set of bangles to run some errands. Either way there are a few styling hacks to help maximize your jewelry. Here are six jewelry styling hacks to follow:
1. Use earrings for a pop of color
It can be a great idea to match a few pieces of jewelry, however, when they’re all very similar in style and color, they can really blend together. To solve this issue, try using earrings to create that pop of color. Earrings can really balance out an outfit
2. Know when it’s too much
Jewelry can provide a great accent to your favorite outfit but you need to be careful you don’t overdo it. By having too much, you’re really taking away from the effect your jewelry adds to your outfit
3. Personalize with statement jewelry
Something like customized wrist bracelets can be super personal. This can be a piece that no one has that truly stands out on its own. These are often hard to duplicate because they’re one of a kind and customized. Check Kay Jewelers clearance sale and see if there’s anything that you could customize and make truly unique
4. Minimal jewelry with patterned clothing
When your outfit is full of patterns, it’s already incredibly loud. Something like stripes or plaid can be a super powerful statement in itself so when picking out jewelry, make sure to keep it minimal. When it’s overdone it can have the opposite effect of what you’re looking for. One simple necklace or bracelet can be a nice, quick addition to a loud outfit with many patterns
5. Create layers with necklaces and bangles
Sometimes when we wear jewelry it can be hard to get the most out of it. Sometimes our jewelry is too thin and won’t really pop with our outfits. That’s where layering comes into play. By layering bangles you can create a super nice, textured set of bracelets that will surely stand out. With necklaces, you want to look at the style and length. By mixing and layering different necklace lengths, you can create the illusion of a much bigger piece and have them all flow together seamlessly. Either way, you really can’t go wrong with layering
6. Mix metals in jewelry
Most jewelry is made of various metals like gold, silver, and platinum. By combining different metals, you can really make them pop. When mixing and matching gold and silver you really create a palate with different colors and materials. It helps them stand out. When you wear all your jewellery in one material or one color, the pieces tend to blend in with each other. Mixing metals will help your pieces to really make a statement
When choosing jewelry, make sure to follow these 6 hacks for best results!
