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Diagnostic procedures to confirm suspected multiple myeloma include blood analyses, quantitative immunologic assays of serum and urine, urinalysis, bone marrow aspiration and biopsy, and skeletal x-rays. Findings indicative of the disease are an increased number of plasma cells in the bone marrow (usually over 10 per cent of the total), anemia, hypercalcemia due to release of calcium from deteriorating bone tissue, and elevated blood urea nitrogen, Bence Jones protein in the urine, and osteolytic lesions that give the bone a honeycomb appearance on x-ray and lead to vertebral collapse.
Transfusions with packed red blood cells can help alleviate and minimize some of the more severe symptoms of anemia. It is important that the patient be adequately hydrated to improve viscosity of the blood and circulation, to help avoid hypercalcemia, and to maintain kidney function for excretion of the products of protein metabolism. Continued ambulation and moderate exercise help slow down the loss of minerals, especially calcium, from the bones. Other problems are related to the administration of highly toxic antineoplastic drugs.
The course of the disease is usually prolonged, with remissions and relapses over many years. Brief exacerbations, even with acute and severe symptoms, are thought to be the result of a transient inflammatory depression of neural transmission. Recovery occurs when there has been no permanent damage to the myelin sheath during the attack. Repeated attacks can, however, eventually permanently denude the axons and leave the yellow sclerotic plaques that are characteristic of the disease. Once the disease process reaches the stage of sclerosis the affected axons cannot recover and there is permanent damage.
The prevalence of MS is not certain because the disease is not one that is reported, and mild cases can be either misdiagnosed or never brought to the attention of a health care provider. It is far more common in the temperate zones of the world than in tropical and subtropical climates. The onset of symptoms most often occurs between the ages of 20 and 40 years, and the disease affects both sexes about equally.
The cause of multiple sclerosis is unknown. It is likely that an inherited immune response is somehow responsible for the production of autoantibodies that attack the myelin sheath. Some authorities believe that infection by one of the slow viruses occurs during childhood and after some years of latency the virus triggers an autoimmune response. Others believe there is an antigen or environmental trigger for the disease.
The diagnosis of multiple sclerosis is difficult because of the wide variety of possible clinical manifestations and the resemblance they bear to other neurological disorders. There is no definitive diagnostic test for the condition, but persons with objectively measured abnormalities of the central nervous system, a history of exacerbation and remission of symptoms, and demonstrable delayed blink reflex and evoked visual response are diagnosed as having either possible or probable multiple sclerosis. With time and progressive worsening of symptoms the diagnosis can become definite.
Supportive measures include a regimen of rest and exercise, a well-balanced diet, avoidance of extremes of heat and cold, avoidance of known sources of infection, and adaptation of a life style that is relatively unstressful while still being as productive as possible.
Therapeutic measures include medications to diminish muscle spasticity; measures to overcome urinary retention (such as credé's method or intermittent catheterization); speech therapy; and physical therapy to maintain muscle tone and avoid orthopedic deformities. Management of MS has been greatly enhanced by the availability of interferons beta-1a and beta-1b. Research support is strong that these medications reduce the frequency and severity of relapses.
Many multiple sclerosis patients and their families receive valuable support and encouragement from communication with others coping with the condition. A local chapter of the National Multiple Sclerosis Society is within reach of most persons in the United States. Information and assistance in all phases of the disease are available by writing to The National Multiple Sclerosis Society, 733 Third Ave., 6th floor, New York, NY 10017, or consulting their web site at http://www.nmss.org.
multiple organ dysfunction syndrome,
Patients at risk should be closely monitored to help prevent MODS by prompt recognition and correction of perfusion problems, infection, and organ dysfunction. Patients with MODS often have pulmonary, cardiovascular, renal, and hepatic failure, often followed or accompanied by gram-negative sepsis and disseminated intravascular coagulation. Appropriate medical interventions are initiated for each failing system's problems. Nursing responsibilities include assessing for hemodynamic, acid-base and fluid and electrolyte balance, monitoring and assessing diagnostic study results, coordinating and carrying out prescribed therapies and evaluating patient responses while simultaneously assessing for adverse effects, protecting the patient from nosocomial infections and environmental stressors, and providing emotional support for the patient and family through this type of devastating illness, which has a 90% mortality rate.
The respiratory therapist assists the physician in determining when to intubate the patient and initiate mechanical ventilation. Mechanical ventilation ensures adequate oxygenation and carbon dioxide retention, protects the patient against aspiration, and serves to rest the muscles of breathing and reduce oxygen consumption. The health care provider frequently measures arterial blood gases and pulse oximetry, continually monitors cardiac rhythms, assesses electrolyte and renal function, ensures patient and family comfort and understanding, and protects the patient against complications, including deep venous thrombosis, pressure ulcers, malnutrition, and hospital-acquired infections.
Patient discussion about MODS
Q. Type 2 Diabetics solution My uncle is suffering from type 2 diabetics and i want to know that is there any permanent solution for type 2 diabities. Very worried about weight loss too. Any one there to give us a permanent solution?
There is a web site given below which provides information on alternative medicines for diabetes. Alternative medicines - ayurveda herbs, homeopathy, yoga and acupressure treatments.
Q. Women with diabetes are in general found with type 1 or with type 2 diabetes during pregnancy and why?
Q. Is Diabetes type 2 a chronic disease? I have been diagnosed with Diabetes; does this mean I will always have it from now on?