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The basis of the use of these drugs is that they have some effect on the immune system buy cheap fucidin 10gm online. In relation to what can be described as inflammatory eye disease purchase fucidin 10gm visa, it is thought they could help in reducing the inflammation purchase fucidin 10 gm without a prescription. A combination of methylprednisolone and prednisone may be given generic 10 gm fucidin mastercard, although this may vary buy cheap fucidin 10 gm on-line. Because in most cases (even the most severe), vision returns to something like its previous state in a reasonable period of time, some neurologists are reluctant to give powerful steroid drugs, which can have significant side effects. So, although it is worrying for people with a sudden onset of these symptoms, waiting for the return of vision or the lessening of visual disturbances is often the strategy that is followed. With the advent of beta-interferon type drugs in MS (where optic neuritis can be one symptom), there has been increasing pressure to give such drugs at an earlier stage in the condition. In principle, if the MS could be detected earlier – and optic neuritis is a frequent symptom occurring before MS has been diagnosed – then optic neuritis would probably be a symptom that responded to such a treatment. However, definitively diagnosing MS at such an early stage may not be easy, and there is still much debate about how appropriate the beta-interferons are to give to all people at that stage of MS. EYESIGHT AND HEARING PROBLEMS 143 Eye movement abnormalities Eye movement abnormalities are quite common in MS. They might involve rapid but regular eye movements (usually described as ‘nystagmus’) or take a range of other forms including a temporarily fixed gaze. Many of these abnormal movements may not even be recognized by the person with MS, and are more likely to be noticed by others. Occasionally people with MS experience a more troubling form of nystagmus, which involves very slow but regular eye movements associated sometimes with dizziness and nausea. Nystagmus is a difficult condition to treat successfully, for the damage that causes it can be very different in different cases. Clonazepam (Rivotril) can sometimes help the problem, as can baclofen or gabapentin and scopolamine, although it is often a case of trial and error in their use. Uhtoff’s phenomenon Another occasional symptom is a visual disturbance after exercise, a meal or hot bath (‘Uhtoff’s phenomenon’), almost certainly due to increased body heat affecting nerve conduction. Other sight problems Although it is unusual for someone with MS to lose their sight completely (even if this is only temporary), many people have episodes during which their sight will become worse. Only one, or both eyes may be affected, and your sight may be disturbed in various ways, including: • double vision (‘diplopia’) • a blank field or spot in the middle of your vision (‘scotoma’) • loss of peripheral vision • blurring of vision • problems with colour vision, or certain contrasts, such as an unusual balance between light and shade in the visual field • pain on eye movement from inflammation of the optic nerve. Visual disturbances may be especially noticeable at night when light is much less, although there may be the impression in daylight of colours being pale or ‘washed out’. You may feel you need to leave a light on at night to assist your vision in the evening. Although these disturbances can be very disconcerting, they do usually settle down on their own over hours, days or, occasionally, weeks, but there may be some residual loss of vision over time. Probably the most sensible approach is to wait, if you can, for the visual distur- bances to correct themselves. You may be able to deal with the double vision temporarily by putting a patch over one eye, but this strategy will slow the natural adaptation of the brain to double vision. Sometimes prisms placed in glasses can help to reduce the effects of double vision by bringing the two images together. High-dose corticosteroids (such as methylprednisolone or dexamethasone) can clear problems earlier, but like other powerful drugs, they can cause side effects. You will need to be aware that visual problems can increase with fatigue, infection, stress, etc. Cataracts Cataracts (clouding of the lens of the eye) may occur more frequently in people with MS partly because they are linked with the extensive use of cortisone treatments, which have been relatively commonly used in MS. Cataracts can, however, be surgically removed and this can result in a substantial improvement in vision. Hearing problems MS is not known to cause significant symptoms in hearing (although there can always be the occasional exception), even if a test called an ‘auditory evoked response’ reveals some damage to the relevant nervous pathways. Very, very occasionally some hearing loss may occur temporarily as a result of the MS but, if your hearing loss is gradual or persistent, it needs investigating for other causes. Sometimes in order to diagnose and help problems with your speech, an audiological assessment may be carried out; however, any problems – as we have noted – are almost certainly not caused by the MS itself. Considering how the diagnosis is going to affect your current job and future career is therefore a matter of considerable importance. Many issues arise in this context, including how or indeed whether to tell your employer; whether it might still be possible to continue work and, if so, on what basis, and what the implications might be financially.

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Fortunately buy cheap fucidin 10 gm, the development of new lightweight materi- als cheap 10gm fucidin free shipping, including plastics and aluminum buy fucidin 10gm on-line, has decreased the need to use the more cumbersome heavy metal (Klenzak™) braces cheap fucidin 10gm online. If your hip muscles also are weak buy 10 gm fucidin free shipping, you will swing your leg out in front to allow the foot to clear the ground. To maintain stability while doing this, the knee often is forced back farther than it should be, resulting in a condition termed hyperextension. To prevent this condi- tion from developing, a device called a Swedish hyperextension cage may be fashioned to prevent the knee from snapping back. A cus- 56 CHAPTER 8 • Mobility: Putting It All Together tom-made knee brace may be necessary if the knee cage cannot be fitted properly. With the aid of such devices, walking with less fatigue may again become realistic. However, if balance also is a problem, another assistive device may be needed such as a cane. Braces, canes, and crutches should be regarded as "tools" in the same way that a hammer or a drill is a carpenter’s tool. If a carpenter wants to drill a hole, he must use the proper drill or the hole will be wrong. A person with impaired mobility who does not use the right tool cannot accomplish the job of walking. Although it may be difficult at first, try not to have negative emotional feelings about using assistive devices. The activity of walking is reciprocal; that is, the left hand goes forward with the right foot, and vice versa. When a person walks with a cane, the cane should precede or accompany the weak leg. The same reciprocal pattern applies: the left foot and right hand go forward together; the right foot and left hand go together. Walking in this fashion is slower, but there always are three points on the ground to provide increased balance and stability. When walking stairs, the saying that applies is "up with the good, down with the bad. If a rail- ing is on the same side as the cane, merely shift the cane to the other hand and use the stair-walking pattern described. If balance and weakness are more severe, it may be necessary to use forearm (Lofstrand™) crutches. These crutches provide greater stability than a standard cane, and their use does not require 57 PART II • Managing MS Symptoms as much strength in the upper extremities. The patterns described for walking with a cane apply equally to walking with the aid of forearm crutches. The usual pattern to be used is as follows: walker forward at arms length, weak leg, then strong leg. They can move very smoothly and allow you to take rest periods by locking the brakes and sitting. To measure the proper height for all assistive devices, place the device six inches away from the side of the foot, and adjust the han- dles so that the elbow is bent approximately 25 degrees. As with any specialized tool, it is important to have the right tool, to have it fitted properly, and to know how to use it correctly. If walking is still extremely difficult or impossible despite the selection of excellent devices, a wheelchair may be your correct choice. You should not resist using a wheelchair; try to view it sim- ply another mobility tool. Selecting from the many types of wheel- chairs available depends on many factors, including your size and weight, strength, and level of energy. A standard manual wheelchair often does not offer people with MS sufficient independence because of the fatigue that is generated by operating the chair and the coordination that is necessary to control it. Three-wheeled motorized scooters are a boon for people with MS because they do not carry the negative stigma with which reg- ular wheelchairs may be inappropriately perceived. Although scooters are extremely useful, they are best used by people who have retained some means of walking, because their seating sys- tems are not designed for sitting all day. Those who do not possess the ambulatory skills necessary to use a three-wheeler appropri- ately may achieve independence with one of the newer lightweight motorized wheelchairs.

The acceptance of marketing by health professionals opened the door for a variety of new activities on the part of healthcare organiza- tions discount 10gm fucidin visa. This development led to the establishment of marketing budgets and the creation of numerous new positions within the organizations purchase fucidin 10 gm overnight delivery, culmi- nating with the establishment of the position of vice president for market- ing in many organizations order 10gm fucidin with mastercard. This development opened healthcare up to an influx of concepts and methods from other industries and helped to intro- duce modern business practices into the healthcare arena order fucidin 10gm with amex. While most would agree that trusted fucidin 10gm, after years of grudging acceptance, mar- keting has become reasonably well established as a legitimate healthcare func- tion, the process has not been without its fits and starts. Healthcare has demonstrated surges of interest in marketing, followed by periods of retrench- ment when marketing, and marketers, were considered unnecessary and/or inappropriate. Periods of prosperity for marketing have alternated with peri- ods of neglect over the past 25 years. There have been periods of exuberant, almost reckless, marketing frenzy and periods of retrenchment. There has xi xii Introduction been ongoing tension between those who eagerly accepted marketing as a function of the healthcare organization and those who doggedly resisted its intrusion into their realm. With each revival of marketing in healthcare, new wrinkles have been added that made the "new" marketing, if not better, at least different from previous approaches. Once the dam broke and marketing made its initial incursion into healthcare, a stampede ensued as healthcare organizations, led by major hospitals, established aggressive marketing campaigns. Urged forward by marketers recruited from other industries, hospitals and other healthcare organizations embarked on a whirlwind of marketing activity. The effec- tiveness of these initial marketing campaigns did not match their propo- nents’ enthusiasm, and it was soon realized that marketing healthcare was not the same as marketing hamburgers. The approaches required for the healthcare arena were not easily adapted from other industries, and much of what was effective elsewhere was not necessarily effective in the health- care industry. The evolution of marketing in healthcare is discussed in a later section within the context of developments in the healthcare field. Today, healthcare is still struggling to find the appropriate role for marketing, and marketers continue to strive to find their niche within health- care. The industry still suffers from a lack of standardization when it comes to marketing, and this has not been helped by the fact that few graduate programs offer coursework in healthcare marketing. Today, healthcare mar- keting appears poised to play a greater role in the new healthcare envi- ronment. But, as the chapters illustrate, this is likely to be a different kind of marketing than that envisioned in the mid-1970s when the first mar- keting efforts were introduced into healthcare. Before the 1980s, marketing campaigns targeting healthcare con- sumers were relatively rare. In fact, the marketing activity that existed was primarily on the part of industry segments that were not involved in patient care (e. The industry was product driven and most "producers" of services oper- ated in semimonopolistic environments. There was an almost unlimited flow of customers (patients), and revenues were essentially guaranteed by third-party payers. Along with a num- ber of other significant changes in healthcare, competition was introduced for the first time. Healthcare organizations began to realize that to survive in this new world, they would have to adopt business practices long estab- lished in other industries. This involved, among other things, a shift from a product orientation to a service orientation. For the first time, then, the Introduction xiii market became a factor for the industry. These developments resulted in the introduction of marketing as a legitimate function in healthcare. By the mid-1980s, marketing departments had been established in most of the large healthcare organizations. Once introduced to each other, marketing and healthcare passed through a tentative getting-to-know-you period. By the mid-1980s, however, it was a romance in full bloom with the two being seen everywhere together. Healthcare organizations were spending feverishly on their newfound consort, and marketers rushed to take advantage of the sudden burst of interest.

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