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By R. Vandorn. Western International University.

Sometimes speed of information processing may be affected in MS – things seem to take longer to think about and do generic nolvadex 10 mg mastercard women's health newsletter. It may be more difficult to find words order nolvadex 20mg mastercard breast cancer 30s, and concentration can tend to wander more readily. In addition it is possible that capacity to organize things spatially becomes more difficult – for example putting together self-assembly furniture is more of a problem. Memory problems are, of course, not limited to people with MS, and there is considerable research in this area. However, the cause of memory problems varies between different conditions, so drugs that might be helpful for people with Alzheimer’s disease, who have very severe memory problems, would not necessarily be useful for people with MS. Nevertheless, there is increasing research to see whether a number of drugs, often originally developed for other purposes, might help people with MS. There is some evidence that drugs used to assist fatigue may have modest effects on some cognitive problems. There are currently trials to see whether the drug pemoline might help cognitive function, and preliminary research on amantadine has suggested that it might have some effect on information processing. A drug with the proprietary name of Aricept, used for the treatment of memory disorders in Alzheimer’s disease, is being studied to see whether it has any similar effects in people with MS. However, whilst in Alzheimer’s disease this drug appears to increase the availability of a substance called acetylcholine, a neurotransmitter, this does not seem to be relevant to the cognitive problems in MS. It is possible that beta-interferons and other recent drugs used to help manage MS itself may have some effect on cognitive function, for, as we have noted, that function tends to be more problematic the larger the number of lesions in the CNS. If the speed with which this increase is lessened, then there could be some effect on cognitive function. However, until recently, it has not been usual to include neuropsychological tests in clinical trials of such drugs, so further detailed research is needed and is now being undertaken. Finally there has been publicity recently about the possible use of preparations of ginkgo biloba (made from the leaves of the Ginkgo biloba tree which grows in the Far East) for problems of memory and concen- tration. Trials of ginkgo biloba in people without MS have produced mixed results, early trials being promising but a major recent trial suggesting that it has little or no effect on memory and concentration. There have been no systematic trials on people with MS as yet and so no formal evidence that it could assist with their cognitive problems. In any case there are always problems in ensuring the purity of the active ingredient in such a product, and you should be cautious about its use. FATIGUE, COGNITIVE PROBLEMS AND DEPRESSION 85 Overall the investigation of possible drug therapies for cognitive problems is a large area of current research and it is hoped that major advances will be made in the next few years in this area. Professional help This is a very rapidly developing area of professional interest in relation to cognitive problems. Until recently, the main professions in these aspects of everyday living have been occupational and speech therapy. So, as part of the process of managing everyday activities, occupational therapy helps you to organize your environment, as well as your skills, to the maximum advantage. Speech therapy helps you with speech production problems, particularly if you take some time to articulate what you wish to say. Some occupational therapists, particularly in North America and now in Britain, are developing special skills to help people with their memory and cognitive problems – often described collectively as cognitive rehabilitation. This is an approach designed to try and improve the everyday functioning of people with cognitive impairments resulting not only from MS but also other central nervous system disorders, such as head injury or stroke. The first of these is to try to restore the lost functions, often through retraining, with the use of repetitive techniques such as learning lists, and helping people to re-acquire skills with progressively more complex tasks. The second is based on the idea that, because it will be difficult to regain the lost functions, compensatory strategies are needed, in which other devices and procedures are used, such as trying to minimize distractions, or using other means of reminding you about activities that you need to do. Both of these approaches are designed to help people manage their everyday lives better despite any cognitive impairment. We need to repeat that cognitive rehabilitation, as a formal programme, is not available everywhere for people with MS. At present, following assessments, you will probably have most contact with an occupational therapist, whose skills focus substantially on the abilities needed to accomplish everyday activities, but we expect that many such therapists will increasingly be using at least some of the key techniques for managing problems that you may have in the area of memory or concentration. Self-help People with MS can be affected by a range of cognitive problems, and it is difficult to advise you precisely without knowing exactly what they are. Sometimes the problem is that we have many things going on at the same time – television, other people talking and a whole range of other activities going on.

In general buy nolvadex 20mg free shipping breast cancer hope, physicians feel uncomfortable in dealing with a problem that is related to the emotions nolvadex 20 mg for sale menstrual juices. They tend to make a sharp division between “the things of the mind” and “the things of the body,” and only feel comfortable with the latter. Although some physicians would dispute the idea, there is fairly wide acceptance among practicing doctors that ulcers are caused primarily by “tension. But failure to treat the primary cause of the disorder is poor medicine; it is symptomatic treatment, something we were warned about in medical school. But since most physicians see their role only as treating the body, the psychological part of the problem is neglected, even though it’s the basic cause. In fairness, some physicians make an attempt to say something about tension, but it’s often of a superficial nature like, “You ought to take it easy; you’re working too hard. In doing so, however, they are chiefly responsible for the pain epidemic that now exists in this country. If structural abnormalities don’t cause pain in the neck, shoulder, back and buttocks, what does? Studies and clinical experience of many years suggest that these common pain syndromes are the result of a physiologic alteration in certain muscles, nerves, tendons and ligaments which is called the Tension Myositis Syndrome (TMS). It is a harmless but potentially very painful disorder that is the result of specific, common emotional situations. The ensuing sections of this chapter will discuss who gets it, in what parts of the body it occurs, the various patterns of pain and the overall impact of TMS on people’s health and daily lives. Following chapters will talk about the psychology of TMS (which is where it all begins), its physiology and how it is treated. Conventional diagnosis and treatment will be reviewed and I will conclude with a chapter on the important interaction between mind 4 Healing Back Pain and body in matters of health and illness. One might almost say that TMS is a cradle-to-grave disorder since it does occur in children, though probably not until the age of five or six. Its manifestation in children is, of course, different from what occurs in adults. I am convinced that what are referred to as “growing pains” in children are manifestations of TMS. The cause of “growing pains” has never been identified but physicians have always been comfortable in reassuring mothers that the condition is harmless. It occurred to me one day while listening to a young mother describe her daughter’s severe leg pain in the middle of the night that what the child had experienced was very much like an adult attack of sciatica, and since this was clearly one of the most common manifestations of TMS, “growing pains” might very well represent TMS in children. Little wonder that no one has been able to explain the nature of “growing pains” since TMS is a condition that usually leaves no physical evidence of its presence. There is a temporary constriction of blood vessels, bringing on the symptoms, and then all returns to normal. The emotional stimulus for the attack in children is no different from that in adults—anxiety. It is a substitute for a nightmare, a command decision by the mind to produce a physical reaction rather than have the individual experience a painful emotion, which is what happens in adults as well. At the other end of the spectrum, I have seen the syndrome in men and women in their eighties. The Manifestations of TMS 5 What are the ages when it is most common, and can we learn anything from those statistics? In a follow-up survey carried out in 1982, 177 patients were interviewed as to their then current status following treatment for TMS. At the other end of the spectrum, only 7 percent were in their sixties and 4 percent in their seventies. These statistics suggest very strongly that the cause of most back pain is emotional, for the years between thirty and sixty are the ages that fall into what I would call the years of responsibility. This is the period in one’s life when one is under the most strain to succeed, to provide and excel, and it is logical that this is when one would experience the highest incidence of TMS. Further, if degenerative changes in the spine (osteoarthritis, disc degeneration and herniation, facet arthrosis and spinal stenosis, for instance) were a primary cause of back pain, these statistics wouldn’t fit at all. In that case, a gradual increase in incidence from the twenties on would occur, with the highest incidence in the oldest people. Muscle The primary tissue involved in TMS is muscle, hence the original name myositis (as mentioned, myo stands for “muscle”). The only muscles in the body that are susceptible to TMS are those in the 6 Healing Back Pain back of the neck, the entire back, and the buttocks, known collectively as postural muscles.

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The marketing of such serv- ices represents a particular challenge for marketers who are faced with a disconnect between the service and the anticipated need generic nolvadex 10mg with visa menopause young living essential oils. A second factor is the fact that the end user may not be the target for the marketing campaign discount 10mg nolvadex mastercard menstruation machine. In virtually every other industry the end user is responsible for the purchase decision, and the decision maker actually consumes the good or service. Thus, a physician is likely to determine the what, where, when, and how much of the service provided. The decision maker may be a provider, a health plan, or a family member, not the party who eventually consumes the service. The marketer is faced with the chal- lenge of determining where to place the promotional emphasis under these circumstances. Healthcare is also different in that the product may be highly complex and not lend itself to easy conceptualization. This issue was raised ued through 1957, when it was modified to only restrict physicians from soliciting patients. These restrictions did not affect such traditional marketing activities as networking and entertaining would-be referring physicians, and it was even customary at that time for doctors to provide kickbacks (in the form of "fee splitting") to referring physicians. The AMA eventually backpedaled from its strong stance against physician advertising, and in the 1990s many physicians initiated aggressive marketing campaigns. While hospitals were not constrained to the same extent, many hospital administra- tors also had ethical qualms concerning marketing (or at least the advertising dimension of marketing). These qualms did not restrict marketing activities such as public relations, edu- cational activities, and communication strategies, but they did discourage many hospitals from overt media advertising. Ultimately, practical considerations on the part of hospitals and health systems overcame any lingering reluctance related to marketing. Much of the controversy surrounding marketing in healthcare has involved the pharmaceutical industry. The marketing of over-the-counter drugs is covered by federal regulations that control the claims that can be made with regard to their efficacy. The marketing of prescription drugs directly to consumers is tightly controlled by federal regulation; until the end of the twentieth century pharmaceutical companies were prohibited from marketing directly to consumers. Even today, there are strict limits on the claims that can be made in the advertising. Drug manufacturers have focused their marketing activities almost exclusively on the physicians who prescribe drugs to their patients, and this area has created the most controversy. Pharmaceutical companies spend up to 25 percent of their budgets on mar- 40 arketing Health Services keting and sales activities, and the bulk of this has historically been allocated to adver- tisements in medical journals, support of educational programs, and direct sales to physi- cians. Pharmaceutical companies’ longstanding practice of providing free samples of drugs to physicians eventually came under fire and is facing restrictions. More controversial, however, have been the blatant attempts to "buy" physician support for particular phar- maceuticals by providing gifts, trips, and other incentives designed to encourage physi- cians to endorse a particular drug through their prescribing practices. Legislation was eventually enacted to severely limit the ability of drug companies to provide incentives to physicians. Pharmaceutical companies have been particularly aggressive in their attempts to define new health conditions that could benefit from one of their products and to sub- sequently promote that product to both consumers and those writing prescriptions. Ostensibly engaged in raising public awareness concerning underdiagnosed and undertreated problems, pharmaceutical companies may attempt to promote a view of a particular condition as widespread, serious, and treatable. Demand is created by classify- ing ordinary processes or ailments of life as medical problems, portraying mild symptoms as portents of a serious disease, defining personal or social problems as medical ones, con- ceptualizing risks as diseases, or maximizing disease prevalence estimates to enhance the perceived size of a medical problem. Once a seed has been planted concerning the exis- tence of a health condition, the "solution" is aggressively promoted to consumers and prescribers. While such activities are not illegal, they do raise serious ethical questions related to the creation of anxiety (and subsequent drug sales) in individuals who may not actually be sick. While the marketing activities of health professionals will continue to be guided by self-imposed ethical standards, external controls are likely to be maintained and strength- ened. Because of the nature of healthcare products and services, continued oversight on the part of various regulatory agencies can be expected. As marketing activities expand in healthcare, they will continue to be affected by a combination of ethical restraints and legal regulations.

This system also contains myelin but buy cheap nolvadex 20 mg line womens health 3 week workout plan, like the PNS discount 20mg nolvadex fast delivery womens health initiative study results, it is not directly affected by MS. Although MS directly affects only the CNS, the disease has indi- rect effects on other systems and their functions because all com- ponents of the nervous system communicate with each other. SYMPTOMS OF MULTIPLE SCLEROSIS The most common characteristics of MS include: • Onset most commonly is between the ages of 15 and 50 years. Because different areas of the brain and spinal cord are respon- sible for different kinds of movements and sensations, the neuro- logic deficit that results from an area of scarring depends on the exact location of the abnormality (lesion). For example, when an area of demyelination occurs in the cerebellum, the area of the brain that is responsible for making coordinated movements, such No two cases of MS are exactly alike, and symptoms vary considerably from one individual to another. Because symptoms depend on the location of the area of scarring, no two cases of MS are exactly alike, and symptoms vary considerably from one individual to another. In one person, the extent of MS symptoms might be mild disturbances of gait and vision, whereas another person might suffer a severe or complete sensory and motor loss. Just as some tumors are malignant and others are relatively benign, some people with MS may have severe disease, whereas others may experience only mild effects of the disease. To better understand individual variations and to develop appropriate management plans, MS often is divided into categories. This form of MS is characterized by clearly defined acute attacks, with either full recovery or some remaining neurologic signs/symptoms and residual deficit upon recovery. Over time the 7 PART I • The Disease and Its Management course may change and then the person moves into a dif- ferent category. This form of the disease begins with an initial relapsing-remitting course, followed by progres- sion at a variable rate that also may include occasional relapses and minor remissions. About 10% of MS worsens right from the start and is called: • Primary progressive. The disease shows progression of dis- ability from its onset, without plateaus or remissions or with occasional plateaus and temporary minor improve- ments. This pattern of MS shows progression from the onset but without clear acute relapses that may or may not have some recovery or remissions. First, more than two thirds of all people who have MS are walking 20 years after diagnosis. The idea that MS is a progressive disease that inevitably leads to wheel- chair use does not fit the most common scenario. Second, even those who have "progressive" disease usually stop progressing at some point. Many MS experts fear the potential progression of the disease so much they often overlook the fact that the disease is not always progressive. Just why this occurs is not known despite lengthy inquiries into diet, lifestyle, and other factors. The MS Society has continued to estimate about 300,000 to 350,000 cases with MS in the United States. This estimate is undoubtedly low, because this number has not been altered in 15 to 20 years, despite thte fact that new cases develop, and the death rate is not high—most people with MS will live to a normal age. POSSIBLE CAUSES OF MULTIPLE SCLEROSIS Although a specific cause of MS has not yet been determined, sev- eral theories are plausible. MS generally is considered to be an autoimmune disease in which—for unknown reasons—the body’s own immune system begins to attack normal body tissue. In the case of MS, the cells that make myelin, the myelin itself, and/or the axons are attacked. The Immune System The nervous system is not the only system in the body that "talks" to other systems and to itself. This is especially true for the immune system, which is responsible for destroying foreign substances such as viruses and bacteria. Most people know about the immune system because they are familiar with the acquired immunodeficiency syndrome (AIDS), in which a virus attacks the immune system and makes it inactive. In MS the picture is different in that the immune system appears to be too active. It sends out "messengers" in the form of specific types of white blood cells that attack myelin as if it were a foreign substance.

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