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September 2017


Sprains & Strains: What is Recommended?

A sprain occurs when ligaments are stretched or torn, commonly in the area of the ankle. A strain occurs when a muscle or tendon is stretched or torn, commonly in the lower back or hamstring. Ligaments are a connective tissue, connecting one bone to another. Tendons connect muscles to bones. Both sprains and strains cause pain, swelling, and limitations of movement of the affected area. Bruising may occur in association with sprains, while strains may be accompanied by muscle spasms.

Properly warming-up prior to exercise can help to prevent both sprains and strains. Sprained ankles can be managed with RICE (rest, ice, compression, elevation). Rest can be achieved through the use of crutches or avoiding placing weight on the affected ankle. Ice may be applied every couple of hours at fifteen minute intervals to decrease swelling in the affected area. Wrapping the ankle with a bandage can also reduce swelling. Also, the affected foot should be raised above the level of the heart. Nonsteroidal anti-inflammatory drugs (NSAIDs) available over-thecounter, such as ibuprofen (Advil, Motrin), or acetaminophen (Tylenol) may be suggested by a physician to relieve pain. If the injury is severe, a brace or splint may be used to stabilize the affected area. Surgery may be needed to correct the injury.

Treatment Options for Adult Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune condition of the central nervous system (CNS). The immune system attacks myelin, the protective layer surrounding nerves in the CNS (the attack is called demyelination). Symptoms of MS include vision loss, sensations of numbness or tingling, and muscle weakness. The condition occurs in a relapsingremitting (RRMS) or progressive manner. MS is most commonly diagnosed between 20 and 40 years of age, and occurs more commonly in women than in men.

Glucocorticoids, such as methylprednisolone (Medrol) and prednisone, are used for treatment of acute MS attacks. Disease-modifying therapies such as glatiramer acetate (Copaxone), interferon beta-1b (Betaseron), and interferon beta-1a (Avonex, Rebif) may be prescribed for remitting MS. These medications modulate the immune system to decrease the amount of relapses and the progression of disability. Natalizumab (Tysabri) is reserved only for persons who no longer respond to other treatments, due to potentially life-threatening side effects. Figolimod (Gilenya) interferences with the immune system’s destructive effects on the CNS. Mitoxantrone (Novantrone) works to modulate the immune system in individuals with progressive MS who are unresponsive to other available therapies.

Prevention of Malaria for Travelers

Malaria is transmitted by the bite of a mosquito that is infected with a malaria-causing parasite. Travelers to malaria endemic areas are at a high risk of malaria because they generally do not have previous exposure and thus no pre-existing immunity has developed. After a bite from an infected mosquito, symptoms typically appear after about 1 to 2 weeks or longer. Symptoms include fatigue, chills, headache, sweating, muscle aches, and stomach pain.

Travelers can take measures to prevent mosquito bites, such as wearing protective clothing, using insect repellant (DEET and picaridin), and staying indoors when possible. Additionally, medicines for malaria prevention are available for travelers to malaria endemic areas. The Yellow Book, available at the Centers for Disease Control and Prevention (CDC) website, contains current information regarding use of antimalarials for travelers. Preventive therapy should be started prior to travel and should continue for a period of time beyond departure from the travel destination, depending on the medication. These medications work to prevent malaria by causing damage to the parasite. They include atovaquoneproguanil (Malarone), chloroquine (Aralen), hydroxychloroquine (Plaquenil), and mefloquine.

Treatment for Friedreich’s Ataxia

A condition called Friedreich’s ataxia is a rare genetic neurological condition, characterized by muscle weakness, loss of sensations, and the loss of control of body movement (ataxia). The central and peripheral nervous systems, heart, and pancreas are affected. Approximately 1 out of 50,000 Caucasians are affected. Initial signs and symptoms typically occur around the second decade of life. Several years after disease onset, the ability to speak may be severely affected. Difficulty swallowing may also occur, however later in the progression of the condition. The abilities to walk, stand, and sit unsupported are generally lost after 10 to 15 years of disease progression.

There is currently no cure or treatment to halt the progression of Friedreich’s ataxia. Idebenone (Catena) is an antioxidant medication that is structurally related to the antioxidant co-enzyme Q10. Since oxidative stress potentially plays a role in the destruction caused by the condition, the antioxidant may decrease this effect. This medication may work to improve adverse cardiovascular effects of this condition. This medication is not yet approved by the FDA for use in the U.S. Currently, individuals affected by the condition in the U.S. may be eligible to obtain this medication through a special program currently in place.

Medicines Prescribed for Meniere’s Disease

Meniere’s disease is a condition of the inner ear, characteristic of episodes of vertigo, progressive hearing loss, and ringing in the ears (tinnitus). Nausea and vomiting may occur during severe attacks. A sensation of pressure in the ear may also occur. Although the exact cause of Meniere’s disease is unknown, a virus, allergy, genetics, or abnormal immune response could lead to the condition.

There is currently no cure for Meniere’s disease, although treatments are available to alleviate symptoms. However, progressive hearing loss will likely occur over time despite available treatments for other symptoms associated with the condition. A hearing aid may assist with hearing loss. Meclizine (Antivert, Dramamine) works in the inner ear to treat vertigo. Promethazine (Phenergan) works in the brain to treat nausea and vomiting associated with vertigo. Pressure in the ear due to excess fluid may be relieved by a diuretic medication, such as triamterene-hydrochlorothiazide (Dyazide, Maxzide). An injection of gentamicin to the inner ear during local anesthesia may decrease vertigo attacks. This antibiotic has toxic effects on the inner ear, which minimize the balance function of the affected ear and allow the unaffected ear to properly assume balance functions.


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