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By D. Copper. National American University.

Try a little persistence if you feel that your symptoms are not being treated as carefully as you wish; you can always ask for a second opinion if necessary cheap cialis soft 20mg. Sensations Initially strange and sometimes uncomfortable sensations of many kinds are typical effects of MS. A person can feel these symptoms but the doctor may to be able to find clear physical evidence of why particular symptoms are caused. Doctors often regard these symptoms as relatively benign because, although they may be irritating, they do not, on the whole, tend to result in major problems in daily functioning. Many people with MS get to know the situations in which these sensations occur and adjust their everyday lives as much as possible to avoid those situations. Medically, this is often called ‘dysaesthesia’ and results from abnormalities in the sensory pathways in the nervous system. Unfortunately, ordinary pain medications do not usually have much effect on this kind of sensation. Antidepressant medications such as amitriptyline may be used for relief if it becomes too problematic, or other remedies, such as antiepileptic drugs (gabapentin and carbamazepine), may be used to try and alter conduction along the nerve fibres, which has produced the sensation. Depending on where the damage occurs, you may feel all sorts of unusual sensations in those areas. The sensation of pins and needles commonly occurs with the interruption and resumption of nerve signals to particular areas of the body. Closely related sensations, such as tingling, may also appear occasionally, as signals to and from the affected area vary. Some clinicians treat this symptom as relatively unimportant, albeit a disconcerting, symptom of MS, for it has generally a less direct effect on everyday activities than ‘motor (movement) symptoms’, and is associated with a slower course of MS.

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The average physician looks upon illness as a disorder of the body machine and sees his role as discovering the nature of the defect and correcting it cheap 20 mg cialis soft otc. Research in medicine rests heavily on the laboratory, and what cannot be studied in the laboratory is widely considered to be unscientific. Despite the obvious fallacy of that idea, it remains the guiding research principle for most medical investigators. CHARCOT AND FREUD In the late nineteenth century the famous French neurologist Jean-Martin Charcot gave new life to the principle of the interacting mind and body when he shared with the medical world his experiences with a group of intriguing patients. Called hysterics, they had dramatic neurological symptoms, like paralysis of an arm or leg, with no evidence of neurological disease. Imagine the effect on his medical audience, however, when he demonstrated that the paralysis could be made to disappear when the patient was hypnotized! One could not ask for a more convincing demonstration of the mind-body connection. Among the many physicians who came to Charcot’s famous clinics was a Viennese neurologist, Sigmund Freud. His name is now a household word, as well it should be, for he developed the concept of the unconscious mind (subconscious, if you wish), without which it would be impossible to understand human behavior. However, despite the fact that Freud began to write on this subject about one hundred years ago, awareness of subconscious emotional activity and its effect on what people do and how they feel is still largely limited to analytically trained psychiatrists and psychologists. This is particularly unfortunate since disorders like TMS, peptic ulcer and colitis originate in the subconscious and have to do with emotions that are generated there. Freud became intensely interested in patients with hysteria and began to work with them.

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For example discount 20mg cialis soft otc, difficult activities should be done before those that are easier to perform. The appropriate use 44 CHAPTER 5 • Weakness of assistive devices also may be extremely helpful in increasing overall efficiency. Strength also may be increased with the use of an aero- bic exercise machine such as an exercycle or a rowing machine. However, the principle of not becoming fatigued and exercising those muscles that can be strengthened to compensate for the weaker muscles must be applied. This symptom of MS often is associated with difficulty in bal- ance and coordination. There are many different kinds of tremors; some have wide oscillations (a gross tremor), while others are barely perceptible (a fine tremor); some occur at rest, others occur only with purposeful movement; some are fast, others are slow; some involve the limbs, while others affect the head, trunk, or speech; some are disabling, but others are merely a nuisance; and some are treatable, while some are not. As with all symptoms, proper diagnosis is essential before correct management decisions can be made. BALANCE Balance is necessary to perform coordinated movements, whether one is standing, sitting, or lying down. The cerebellum is the main center for bal- ance, but the eyes, ears, and nerves to the arms and legs also con- tribute to balance. An impairment in any of these areas may cause balance to worsen, and it may help to compensate for others that are 46 CHAPTER 6 • Tremor and Balance The Management of Tremor •Exercises for balance and coordination – patterning –vestibular stimulation – Swiss ball – computerized balance stimulation •Medications • Mechanical approaches –immobilization –weighting –stabilization with braces not working properly. For example, a person with a balance problem caused by poor sensation in the feet may use her eyes to see the ground and avoid falling; obviously, this is a problem in the dark. No medication is available to improve balance, so it is neces- sary to rely on exercises. Although there are no specific exercises for tremor, there are exercises for balance and coordination. Patterning refers to a technique that is used by physical and occu- pational therapists to trace and repeat basic movement patterns.

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