Past Medical History
Apart from symptoms of M.S. There is no relevant medical history, However it should
be noted that this person is an honours graduate in French language, horse rider and has travelled extensively in France. This may be relevant to a possible link with Borreliosis (Lyme)
In 1995 she developed paraesthesiae in her toes as her first symptom of a rapid
primary progressive form of M.S. Diagnosed by a neurologist and MRI scan, which demonstrated numerous plaques.
When seen on 8 May 06, she had marked spasticity and spasms in the lower limbs,
which produced ulcerated heels. She had athetoid movements of the arms on the slightest touch. She was unable to turn her head to the left.
There was uncontrolled nystagmus. Colour vision was impaired through the whole
range. She had swallowing difficulty, loss of intellectual capacity (though a graduate in the French language she could no longer speak or translate English/French or French/English).
Her verbal content and affect were low. She had an indwelling suprapubic catheter.
Baclofen 135 mgs daily by pump driver - Baclofen reduced to zero by 8 Oct 07
Diagnostic Veracity 4
Diagnostic Severity 13 areas involved - Maximum score possible = 65. Higher = more severe.
(N.B. bladder and urinary tract not included for scoring because of Suprapubic drainage)
08 May 06 score 32.5 = 50.0% severity in affected areas
17 July 06 score 22.0 = 33.8% severity in affected areas
03 Mar 08 score 15.5 = 23.8% severity in affected areas
01 Dec 08 score 12.0 = 18.5% severity in affected areas
Total improvement in 2 yrs 7 mths = 31.5%
Intellectual capacity now increased ++ (can now translate French/English and vice versa)
Verbal content improving still (parent report that her vocabulary is increasing).
Her affect is normal and her mood is good.
Parents intimate that her speech, mood, affect and verbal intellectual content, continue to improve.
A series of independent reports from Patricia Shelley MCSP. HT. HPC. Registered IBITA. Senior Bobath Tutor
The patient and her parents have requested that I write you a small report as to the observational effects that I have seen from the goat serum. I saw xxxxx on 12 June. Her whole appearance had improved in that she had more neck extension, she looked more alert, her ataxia in her head and neck had decreased about 20%. Her breathing was calming and the overall excitation of her nervous system was improved.
From a handling perspective, I could touch xxxxx arms and treat her upper limbs with ease. This is a tremendous breakthrough for me as a physiotherapist. It would appear that the hypersensitivity of the skin was greatly reduced. Due to this fact alone, I could work towards head and neck and upper limb alignment without xxxxxx complaining of pain.
I saw xxxxx again on 3 July. This time there was a huge difference in the lack of swelling in xxxxxx face. Again she was more alert, it would also appear that her vision had improved as she commented about the cat picture on the wall. This she has never done before. On this occasion, I was able to release the muscle spasm in her arms and was able to get her arm more comfortable on the wheelchair arm rest. At the end of the session I managed to get xxxxx arms down by the side of the wheelchair with no pain. Her head and neck were straighter. She had an increase of range of movement in the upper limbs, albeit very small but there was no pain until 40% of flexion in the right upper limb.
Since I last wrote to you xxxxxx is now having weekly physiotherapy at home as well as coming to me as and when she can. She has just had two weeks at home where mum and dad have been doing lots of arm exercises and it would appear that this has been very beneficial as both arms can now come down by the side of the wheelchair which we haven’t been able to do for over eighteen months. The ataxia when we take the arms out to the side is initially worse but then settles off and xxxxx is in much less pain. Her legs can also be straightened out easier and all in all things are on the upward scale and she she is doing reasonably well.
Her head and neck movements are much improved in that she can turn both left and right without her head and neck shaking too much.
I hope that perhaps we can start to do some dual sessions with the other physiotherapist so that we can actually think about sitting her on the side of the bed and start to get some better sitting balance now that this right shoulder is less painful.
I have seen xxxxxx on three more occasions since I last wrote to you. There have been some more positive changes in that I can definitely do far more in an hour than I was able to do before the treatment started from you. I have been concentrating very much on trying to get head, neck and shoulder girdle alignment.
The head stays longer in the midline, her facial muscles are more symmetrical, jaw opening and closing has more symmetry, although the temporo-mandibular joints on both sides are still not in the true plane. The head ataxia is stopped very easily now with pressure on the forehead towards the occiput which gives more length posteriorly in her neck and trunk musculature. This has resulted with increased alignment in the coronal plane of her head and shoulder girdle which is very important for her breathing and swallowing maintenance.
Breathing is more symmetrical and she now has increased air entry in both apical lobes at the end of the the session today. In respect of active movement in her head and neck she is now able to tuck her chin in by herself and this gives her more control of her head going backwards.
It would appear that we are therefore, progressing with increasing her posture and extension. Selective movement in her head and neck is definitively positive and the pain in her upper limbs is reduced at rest although there is still pain with therapy albeit greatly reduced and tolerable for xxxxxx.
Since her Baclofen pump has stopped she still has no pain at rest in her limbs. However, on movements, when at the end of her range then xxxxx response is very definite. Her legs are a little stiffer than they were but still relatively easy to straighten and certainly in the wheelchair she has no spasms, which is obviously for us all to manage. On a positive note her voice is louder and she is able to hum for a few seconds, her ataxia in her head and neck is greatly reduced at rest with almost no shakes. However, on movement there is still difficulty although frequency and range of tremor is much less.
xxxxxx can now hold her head off the back rest for a short time.
Her responses to questions are much quicker. She has been going out with a carer and so stimulation has been improved. She can now lift her arms up albeit they are shaky and her eyes are less mobile. I am still concentrating on the head and neck and breathing difficulties. On handling xxxxxx there is a very strong deep pull to the left which I have to work very slowly to decrease. The carry over here is very difficult. I am hoping to visit xxxxx at home later this month and do a joint session with the physiotherapist in order to ascertain future
La décision clinique : les infections urinaires Dr Marc BONY email@example.com 1 Infection urinaire Orientation diagnostique SIGNES FONCTIONNELS ETIOLOGIES Pyélonéphrite aiguë simple Pyélonéphrite aiguë compliquée Obstacle sur infecté Abcès du rein Urétrite Prostatite aiguë Cystite aiguë 2 Les examens diagnostiques toilette à la compresse,
Uusi n sorkkaraportteihin on tulossa kolme uutta koodia: valkovi van paise, sorkkasyylä ja sorkkavälin li kakasvu. Nimet on muutettu kansankielisiksi, mutta ni den tarkoitus on antaa tarkempaa ja yksityiskohtaisempaa informaatiota ontumaa aiheuttavista valkovi van ongelmista ja toisaalta tarttuvista sorkkasairauksista. edustavat sekä syylää että ajotulehdusta ja ne pitää hoitaa antibi