Transverse Myelitis Case Study

Both France and England sent colonists to the Americas to profit their homeland, but when France and England colonies fought against each other in the seven years' war most of the native Americans chose to ally with France. But what made the French so popular with the natives? There was a huge difference in how the French colonists treated the natives and how the English treated the natives. The French were nonintrusive and friendly, while the British were more violent.

The treatment of patients with mild disease consists of acid suppression (esomeprazole) and a short course of steroids (prednisolone). Those patients who have moderate to severe disease should be treated aggressively in the following way: acid suppression (esomeprazole), a longer course of steroids with prednisolone, and consideration of immunosuppressive therapy with azathioprine. Infliximab should be considered in refractory patients in order to prevent the complications of stricturing and fistula formation. Treatment with balloon dilatation of the stricture followed by injection of a long-acting steroid such as triamcinolone can also help to alleviate symptoms. Surgery may be required for severe, refractory symptoms, but it has a high morbidity

Although these studies showed an improvement in the neurological deficits, there is no advantage of using corticotrophin (ACTH) over intravenous (IV) methylprednisolone in clinical outcome. These agents do not modify the long -term course of the disease. It should be stressed that neither Acthar Gel, nor IV steroids alter the course of her underlying disease MS. This member is not on an immune modulating agent.

12/21/15 Progress Report noted that the patient has a history of pain in the neck and left arm. He is s/p C7-T1 interlaminar injection on 11/17/15. She reports some improvement post injection overall, but still some pain. Current medications: Gabapentin, Butalb/Acetaminophen/Caffeine (Fioricet). Tramadol, Hydrocodone/Acetaminophen (Norco 5/325 mg), Paroxetine (Paxil), Tizanidine, Alprazolam, Meloxicam, and Valsartan/Hydrochlorothiazide (Diovan). She has pain from the down the left arm to the elbow. She

Dr. Sanchez refers this 30-year-old, RH, active duty Coast Guard male for evaluation of myalgias. He states he was doing well until 03/2017. Around that time he started noting achiness in his muscles in his upper and lower extremities and felt the joints were involved to a certain degree. He recalls that when he was on the Coast Guard ship, he had trouble getting out of his bunk-type bed. He was feeling weak overall. He denied any fevers. The patient had been on Lipitor at that time for almost two years, he states, for elevated lipids, which runs in his family. When he saw Dr. Sanchez, I believe in May 2017, he was taken off the Lipitor. At that time he had CK, myoglobin, RF, and TSH, which were all normal. He also had a normal neurologic exam. He was referred to my office on 05/30/2017.

The panic in the eyes of the Aztec emperor’s victim escalated hastily, making nothing comprehensible and fearing what the life ahead of him has in store. Taking advantage of each element of the human body, the most important reason for sacrificing humans was donating the blood to their god. The Aztecs utilized every resource available to them to make them a proficient and accomplished civilization. The Aztec civilization adapted their way of life in Mesoamerica to become a notorious culture; from their advanced rituals and authority they have continued their legacy to today.

The main treatments are medications, therapy, and surgery. Some medications used to treat Myasthenia Gravis are anticholinesterase agents such as neostigmine and pyridostigmine. These medications help improve neuromuscular transmission and to increase muscle strength. Victims may also take Immunosuppressive drugs, such as prednisone, azathioprine, cyclosporine, mycophenolate mofetil, and tacrolimus. These medications also help improve muscle strength. The medications work by suppressing the production of abnormal antibodies. When taking these medications you must be carefully monitored by a physician. An important therapy used to treat the disease would be plasmapheresis, this procedure is when a specialist removes blood that is infected with abnormal antibodies. Therapies may be used especially during difficult periods of weakness. Lastly surgery is an option, one of the surgery procedures is thymectomy, this is the surgical removal of the thymus gland. This is often abnormal in some cases. With the surgery it reduces symptoms in some cases without thymoma and may cure people by rebalancing the immune system. Typically thymectomy is recommended for individuals with thymoma. Thymoma is an uncommon tumor in the thymus. A Neurologist will determine which treatment option is best for a patient, it all depends on the severity of the weakness, which muscles are affected, the age of the patient, and any other associated medical

The aim of the pharmacology is pain management. The medications given are able to reduce the frequency and severity of the attacks seen with the disease. One of the medication is corticosteroids which is able to cut an attack time short. Corticosteroids, such as Prednisone, are a class of drug based of a component of the hypothalamic- pituitary-adrenal axis that control immune responses and reduce inflammation. The mechanism of action of the class is reducing the body’s autoimmune response and inhibits it from attacking its own tissues as it does in MS. The decrease in time and inflammation can result in decrease damage to the brain and spinal cord leading to a reduce progression of the disease. The steroids should only be used for a short period of time because long-term side effects. Some side effects include insomnia, headache, and suppression of immune system. The steroids sometime has to be given in combination therapy with antibiotics such as Sulfamethoxazole to fight possible infections. The chance of infections increases with the suppression of the immune system. Other drugs take care of symptoms such as muscle spasms, incontinence, and

utilized IVUS to confirm a diagnosis of MTS in 36 out of 58 patients; (62.1%) and defined the IVUS criteria for an MTS diagnosis as the lack of an evident venous lumen proximate to the IVUS catheter.[6] In a small scale study conducted by Forauer et al., IVUS was not only used to confirm a diagnosis of MTS in all patients (n=16), but information provided by the study was also found to influence the endovascular management of approximately 50% of the cases while also assisting with stent placement choice and accuracy.[10] Moreover, in some studies, IVUS was found to have a higher success than venography in identifying obstructions.[27-29] Overall, IVUS is a useful modality in the diagnosis of MTS, although more studies are needed to truly evaluate its advantages over other diagnostic

This week I gathered medical data on a 71 years old white male with a medical diagnosis of Transvers Myelitis and other comorbidities. I have never heard of such a disease and was keen to know more of this pathophysiology. I knew what Myelitis was but the Transverse part baffled me. From the charted notes, I read that the patient complained of and was treated for pain and had paresthesia and paralysis. He was also wheelchair bound and had chronic venous stasis ulcers and a sacrum wound. I decided to research the disease so I can be knowledgeable about its effect and therefore better able to provide the best possible care to my patient.

Per the medical report dated 02/09/16, the patient reported that the steroid injection on 01/07/16 did not help. There is occasional worsening of pain with certain, random activities. He is having occasional sharp pain at night. A steroid injection was administered on this visit on the right shoulder. Patient was advised to continue medications, home exercise program (HEP) and activity modification.

There is treatment for attacks, treatments to help modify disease progression, treatment for multiple sclerosis signs and symptom severity, and alternative medicines that help patients to cope daily with the disease. Treatments for attacks may include corticosteroids including oral prednisone and intravenous methylprednisolone- prescribed to reduce nerve inflammation- and plasma exchange in which plasma is removed and separated, then mixed with albumin and returned to the body (Multiple). Many drugs are prescribed to multiple sclerosis patients to reduce the progression of the disease, or specifically to eliminate the amount of active lesions in the brain. These drugs can include beta interferons which are injected under the skin or into the muscle and can help reduce the frequency and severity of relapse, glatiramer acetate which can help to block the immune systems attacks on the myelin sheaths and is also injected beneath the skin, dimethyl fumarate a daily oral medication that can help reduce the amount of relapses, fingolimod also a once-daily oral medication to help reduce the relapse rate, teriflunomide which has shown improvement in the relapse rate when taken daily, natalizumab has been shown to block the movement of damaging immune cells from the bloodstream to the brain and spinal cord, alemtozumab that targets a protein on the surface of damaging immune cells and depleting white blood cells, and mitoxatrone

However, those treatments differ based on MS patients needs. There are two main types of treatments, signs and symptoms treatments and modifying progression treatments. The first type, signs and symptoms treatment is also divided to two types, physical therapy and drugs. Furthermore, the physical therapy helps the affected patients learn how to live with MS disease. For example, the physical therapist will give a MS patient with muscle stiffness some exercises to strengthening and stretching the muscles, however, these exercises have to be associated with the muscles relaxation drugs, so the symptoms can be effectively controlled. Furthermore, MS medications can be used to reduce the symptoms or modify, limit the progression of it. The medications depend mainly on the symptoms and how severe they are. These medications include fatigue reducers, nerve inflammation reducer (Corticosteroids), and plasma exchange which are used when the symptoms are severe and do not respond to steroids. However, sometimes the patient has mild symptoms, so they will not need these

Incontinence is one of the major problems faced by the elderly. Nurses can play a significant role in discovering continence problems (Lea R.et.al.2007). Urinary incontinence is the unintentional passing of urine. It is a very common problem and is thought to affect more than 50 million people in the developed world.(NHS.UK). To identify the problem and provide necessary treatment at the early stage, a thorough physical assessment is necessary.

Rantell added that urological symptoms of OAB must be differentiated from the other urological-related conditions, such as urinary tract infection and bladder tumor, and even the use of medication so that appropriate treatment can be given to the patients (2013). He enumerated the most common symptoms of OAB which includes “daytime frequency, urgency, urgency incontinence, nocturia, and nocturnal enuresis” (Rantell, 2013). It is predominant in the hospital to see these symptoms; it is important to investigate further to rule out co-existing conditions and to diagnose OAB correctly. He suggested also to include abdominal and vaginal examination during the physical examination to rule out cyst and mass in the pelvic that might affect the function of the bladder and may cause OAB symptoms (Rantell,