Fibromyalgia (FM) Symptoms, Causes and Treatments

Fibromyalgia (FM) Symptoms, Causes and Treatments B. Trimble Fibromyalgia Fibromyalgia (FM) is a condition of unknown etiology, characterized by extensive pain, atypical pain processing, sleep disruption, fatigue, and often psychological distress. People with fibromyalgia may also have added indications, such as morning rigidity, tingling or numbness of the hands and feet, headaches, migraines, irritable bowel syndrome, sleep disorders, cognitive problems, problems with thinking and memory (often called fibro-fog), and additional pain syndromes (CDC, 2010). The American College of Rheumatology (ACR) 2010 criteria is used for clinical diagnosis and severity classification of fibromyalgia (CDC, 2010). The diagnosis is centered on: Widespread pain index (WPI) of greater than or equal to seven and symptom severity scale (SS) of greater than or equal to five, or WPI of three to six and SS of greater than nine (CDC, 2010). Symptoms have been existent at a similar level for at least three months (CDC, 2010) The patient does not have another disorder that would otherwise explain the pain (CDC, 2010). Fibromyalgia often occurs with other rheumatic conditions such as rheumatoid arthritis, up to 25 – 65%, systemic lupus erythematosus, and ankylosing spondylitis (CDC, 2010). The tender point test is replaced with widespread pain index and a system severity scale. The widespread pain index score is determined by counting the number of areas on the body where the patient has had pain in the past week. The checklist includes nineteen areas of the body (Rush University Medical Center, 2010). The symptoms severity score is determined by rating on a scale of zero to three, three being the most prevalent, the severity of three collective symptoms: fatigue, waking tired and cognitive symptoms (Rush University Medical Center, 2010). An additional three points can be added to account for additional symptoms, such as numbness, dizziness, nausea, depression, or irritable bowel syndrome. The final score is between zero and twelve (Rush University Medical Center, 2010). To meet the criteria for a diagnosis of fibromyalgia, a patient would have seven or more pain areas and a symptoms severity score of five or more, or three to six pain areas and a symptoms severity score of nine or more (Rush University Medical Center, 2010). Some criteria remain untouched. The symptoms must have been existent for a minimum of three months, and the patient does not have another disorder that would explain the pain (Rush University Medical Center, 2010). To develop and test the new criteria, researchers implemented a multi-center study of formerly diagnosed fibromyalgia patients and a group of patients with rheumatic non-inflammatory disorders using a physician physical and interview examination (Rush University Medical Center, 2010). The pervasiveness of fibromyalgia affects an estimated five million adults, with more women than men affected (CDC, 2010). Most people with fibromyalgia are diagnosed during middle age, and the incidence increases with age. Although the rates are higher in women, men and children can have the disorder. Women with the disorder that are hospitalized are ten times more likely to return to work, but four times less likely retain work at one year after hospitalization. It is shown that adults with fibromyalgia average around seventeen days of missed work per year compared to six days for those without the disorder (CDC, 2010). The causes and/or risk factors for fibromyalgia are associated with stressful or traumatic events, such as car accidents, post-traumatic stress disorders, repetitive injuries, illnesses (such as viral infections), certain diseases ( such as Rheumatoid arthritis), chronic fatigue syndrome, lupus, genetic predispositions, and obesity (CDC, 2010). People with fibromyalgia respond strongly to things that other people would not find uncomfortable by exhibiting an abnormal pain perception. The ACR recommends a multi-disciplinary treatment plan including screening and treatment for depression, as evidence indicates that depression is a major occurrence with fibromyalgia (CDC, 2010). The recommendation for treatment includes pharmacotherapy, aerobic exercise and muscle strengthening and, education and relaxation therapy (CDC, 2010). Many hormonal, metabolic, and brain chemical deviations have been indicated in studies of fibromyalgia (CDC, 2010).Variations seem to occur in some brain chemicals, although no regular pattern was identified as relevant in most patients with the disorder. Fibromyalgia may be the result of the properties of pain and stress on the central nervous system that leads to alterations in the brain, rather than a brain disorder itself (CDC, 2010). Researchers are concerned with serotonin and the effects on fibromyalgia. Serotonin facilitates feelings of well-being, adjusts pain levels and promotes deep sleep (CDC, 2010). Low levels of serotonin have been noted in patients with fibromyalgia. Research has also found abnormalities in the hypothalamus-pituitary-adrenal gland axis (HPA axis). The HPA axis regulates sleep, stress response, and depression. Changes in the HPA axis may lead to lower levels of stress hormones norepinephrine and cortisol. Lower levels of stress hormones lead to diminished responses to psychological or physical stress (CDC, 2010). According to the ACR, people with fibromyalgia can have irregular levels of substance P in their spinal fluid (FDA.gov). This substance P helps convey and intensify pain signals to and from the brain. Researchers are considering the function of substance P and other neurotransmitters, and studying why people with fibromyalgia have amplified sensitivity to pain and whether there is a gene or genes that cause a person to be more prone to have it (FDA.gov). Many steps have been taken in research in supplying patients with opportunities to understand and address the symptoms of fibromyalgia and quality of life issues. Research continually indicates that a multi-disciplinary approach is the most helpful for the physician and the patient (National Fibromyalgia Research Association). The examination the physician completes when considering a diagnosis of fibromyalgia should include a basic neurologic examination, a referral to a neurologist, and MRI if the exam indicates minimal deficits (National Fibromyalgia Research Association). Exercise is important for fibromyalgia patients. It has an influence on the quality of sleep and helps to keep unaffected muscles strong. Aerobic exercise, strengthening and relaxation assist in decreasing the effects of the disorder (National Fibromyalgia Research Association). There is no one medication that works for all patients (National Fibromyalgia Research Association). Medical professionals and patients must work together to determine which medication or combination of medications are most effective for the individual (National Fibromyalgia Research Association). People with fibromyalgia are normally treated with pain medications, antidepressants, muscle relaxants, anticonvulsants, and sleep aids (FDA.gov). In June 2007, Lyrica (Pregabalin) became the first FDA approved drug for the specific treatment of fibromyalgia; one year later, June 2008, Cymbalta (duloxetine hydrochloride) became the second, and in January 2009, Savella (milnacipran HCL) became the third (FDA.gov). Lyrica, Cymbalta, and Savella reduce pain and improve function in some people with fibromyalgia (FDA.gov). While people with fibromyalgia suffer pain differently from other people, the mechanism by which these drugs yield their result is unknown. There is information proposing that these drugs influence the release of neurotransmitters in the brain (FDA.gov). Lyrica was previously approved to treat seizures, as well as pain associated with damaged nerves in diabetic peripheral neuropathy and those who develop pain from the shingles rash (FDA.gov). Side effects of Lyrica include drowsiness, dizziness, blurred vision, weight gain, swelling of the hands and feet, dry mouth, and difficulty concentrating (FDA.gov). Cymbalta was previously approved to treat depression, anxiety, and diabetic peripheral neuropathy (FDA.gov). Cymbalta side effects include nausea, dry mouth, somnolence, constipation, decreased appetite, and increased sweating. Cymbalta may increase suicidal thinking and the risk of suicidal actions. It may also increase depression in some people (FDA.gov). Savella is the first drug introduced primarily for the treatment of fibromyalgia (FDA.gov). It is not used to treat depression in the United States, but acts like anti- depressants that are used to treat depression and other mental disorders (FDA.gov). Lyrica and Cymbalta are approved for the use in adults eighteen years and older. The drug companies have agreed to study their drugs in children and breastfeeding women (FDA.gov). Other medications used to treat fibromyalgia are pramipexole, tramadol, pindolol, ketamine, sodium oxybate, and gabapentin (National Fibromyalgia Research Association). Many patients achieve pain relief from complementary and alternative medications (CAM). Acupuncture, biofeedback, and massage are popular treatment alternatives. Herbal supplements and medication may also provide chronic pain relief and relieve fatigue (FDA.gov). Much of the research on complementary health approaches for fibromyalgia is still preliminary, and evidence of effectiveness is limited. Some studies have shown that practices such as TaiChi, gi-gong, and massage therapy may help with fibromyalgia symptoms. (Kowlowitz E.J.) Aerobic and strength-training exercises have been associated with important improvements in pain levels, tender point counts, and sleep disturbances. Maintenance of exercise programs indicates that compliance is a problem with patients. Discussion on strategies on improving compliance can be discussed with the patients (Millea Holloway, 2010). A considerable meta-analysis of studies using acupuncture in the treatment of fibromyalgia validates the empiric findings of medical acupuncturists that acupuncture is extremely useful adjunctive treatment for many patients. Acupuncture is not curative but enhances the patient’s quality of life (Millea Holloway, 2010). Cognitive behavioral training has shown improvement in some patients. The training of relaxation response training and movement therapy was found to be effective in patients with fibromyalgia. Training in coping skills was shown to be more effective than physical fitness, but evidence indicates that combining the different types of therapy may be more effective than one therapy alone (Millea Holloway, 2010). Myofascial pain syndrome is a condition commonly found in patients with fibromyalgia. It is a condition in which fascial limitation and trigger points cause extensive pain. A 2010 review suggests that irritation and defectively working fascia encompassing muscle cells were causing the â€Å"all-over† pain of fibromyalgia and may be due to a dysfunctional healing response (Lipton, 2010). Myofascial release on trigger point’s method is a massage technique in which the therapist uses gentle, sustained pressure in the problem areas to release adhesions and smooth out the fascia (Lipton, 2010). Multiple studies show that the Myofascial release can result in decreased pain, better posture, reduced symptoms, increased range of motion, and improved quality of life (Lipton, 2010). Many patients benefit from discussing their day to day lives with others who are also affected by fibromyalgia. Support groups may be located through the local chapter of the Arthritis Foundation (Millea Holloway, 2010). References CDC. (2010). Fibromyalgia. CDC.gov. Retrieved from http://www.cdc.gov/arthritis/basics/fibromyalgia.htm FDA.gov. (n.d.). Living with fibromyalgia, drugs approved to manage pain. Retrieved from http://www.fda.gov/es/umc107802.htmForConsummers/ConsumerUpdates/ucm107802.htm Kowlowitz E.J., M. (n.d.). Fibromyalgia treatment. Retrieved from Spine Universe: http://www.spineuniverse.com/conditions/fibromyalgia/fibromyalgia-treatments Lipton, G. (2010, January 14). Fascia: A missing link in our understanding of the pathology of fibromyalgia. Journal of bodywork and movement therapies, 1, 3-12. doi:10.1016/j.jbmt2009.08.003 Millea, P., Holloway, R. P. (2010). Treating fibromyalgia. American family physician, 62(7), 1575-1582. Retrieved from http://www.afp.org/afp/2000/1001/p1575.html National Fibromyalgia Research Association. (n.d.). Fibromyalgia treatment options. Retrieved from National fibromyalgia research association: http:www.nfra.net/nfra-resource.htm Rush University Medical Center. (2010). New criteria proposed for diagnosing fibromyalgia. Retrieved from http://www.sciencedaily.com/releases/2010/05/100524143427

Factory Labor and the Domestic Sphere in the Lowell Offering Essay

In 1822, a group of Boston merchants and traders began their campaign to transform a riverbank below the thirty-foot falls of the Merrimack River into "the greatest textile manufacturing establishment in the country." These capitalists dug and improved the Merrimack canal, constructed machine shops, and built housing for mill executives, foremen and operatives. The cotton mills of Lowell, Massachusetts, and other New England sites began to employ the first female industrial labor force in the United States. Almost twenty years later, factory workers wrote and edited the Lowell Offering, a literary magazine showcasing the virtues and talents of the female operatives in verse, essays and short fiction (Eisler, 13-22). This ESSAY discusses the female Lowell factory worker as portrayed in the Offering. Although the magazine never expressed an overtly feminist view of the factory girls' condition, nor invoked a working-class consciousness similar to later labor expressions in Lowell, there is evidence of a narrative strategy and ideology speaking both to the factory women and the middle-class readership outside of the mill town. The paper's short stories, epistolary narratives and commentaries seek to legitimize an operatives' role within the feminine ideal of domesticity. In conforming to the norms of feminine literature, the Offering reconstructs the operatives' character. It subordinates the evidence for independence or autonomy to relate stories of familial or sentimental ties binding the factory girl to the world outside of factory life. The magazine sought to provide an answer to this question: given her new liberties, what kept the "factory girl" from losing contact with her moral sentiments? To a great degree, the economi... ..., 1820-1865. Columbia Studies in American Culture Series (New York: Columbia University Press, 1942): 13-14. Cott, Nancy F. The Bonds of Womanhood: "Woman's Sphere" in New England, 1780-1835. New Haven, CT: Yale University Press, 1977. Dublin, Thomas. Women at Work: the Transformation of Work and Community in Lowell, Massachusetts, 1826-1860. New York: Columbia University Press, 1979. Dublin, Thomas. "Women, work and protest in the early Lowell Mills: `the oppressing hand of avarice would enslave us.'" Labor History 16(1975): 99-116. Eisler, Benita. The Lowell Offering: Writings by New England Mill Women (1840-1845). New York: Harper Torchbooks, 1977. Welter, Barbara. "The Cult of True Womanhood." The Many-Faceted Jacksonian Era: New Interpretations. Contributions in American History, number 67, Edward Pessen, ed. Westport, CT: Greenwood Press, 1977.

Ethics of Starbucks Corporation Essay

Starbucks Corporation is the international coffee and the largest coffeehouse in the world based in seattle, Washington. The company has expanded rapidly with over 16,858 stores in 50 countries, including 11,000 in the united states, over 1000 in Canada and over 700 in uk. Starbucks don’t sell only coffee but there are variety in the consumer products that they offer such as hot and cold sandwiches and Panini, pastries ,snacks and other hot and cold drinks. The company’s products are seasonal or specific to the locality of the store. Starbucks also has an entertainment division and hear music brand, the company also markets books, music and films. Starbucks brand ice-creams and coffee are also offered at grocery stores. The Mission statement of Starbucks is to † inspire and nurture the human spirit – one person, one cup and one neighborhood at a time†. Starbucks believe that conducting business ethically and striving to do the right thing are vital to the success of the company. However, Starbucks corporation have been a target of protests and vandalism in the previous years on issues related to sustainability. But Starbucks have always been socially responsible and made it a priority to the development of new ways of addressing diverse impacts of business in society. Like every corporation, Starbucks has its own Standard of Business Conduct which facilitates legal compliance and ethics training; investigates sensitive issues such as potential conflicts of interest; and provides additional channels for partners to voice concerns. Partners are encouraged to report all types of issues or concerns to the program through their choice of the offered communication channel. The key goal and the important aspect of Business ethics is Sustainability. Sustainability is emerged from the environmental perspective because of the effective management of physical resources that are conserved for the future. But the concept of sustainability is not only broadened to include environment but also economic and social consideration. Starbucks have made its priorities in addressing ethical issues related to the environment through formal and public relations. Starbucks is committed to a role of environmental leadership in all facets of our business. This is done by understanding the environmental issues, developing innovative and flexible solutions to bring about change, attempt to buy, sell and use environmental friendly products, instilling environmental responsibility as a corporate value, measuring and monitoring our progress for each project. However, The Three components of Sustainability actually represent in terms of goals for business ethics. a) the environmental perspectives for Starbucks Corporation In 1999, Starbucks started† grounds for coffee† where they would give away the grounds to anyone for composting. They also reduced the size of their paper napkins and garbage bags to reduce wastage and lightening their solid waste to 816.5 metric tons. In response to the excessive water consumption ,Starbucks have replaced pitcher and dipper wells with push button faucets for rinsing utensils. Starbucks are trying ways to make recycling services available for its plastic cups as the services are very limited. By 2015 it is will make these services available in every store across the country. Previously, there were issues that plastic cups were non-recyclable because of the plastic coating that prevents the cup from leaking also prevents it from being recycled so they changed the material from prolypropylene (PP) to polyethylene teraphthale (PETE) which can be recycled. Starbucks is now considering the use of biodegradable material instead of plastics to line the cups. Starbucks gives 10 cents discounts to its customers for using its own mug and it now uses corrugated cup sleeves made up of 60% post consumer recycled fiber. As a Corporate Citizen, Starbucks have taken the ethical responsibility by conserving energy and increasing efficiency to reduce contribution to climate change. Purchasing of renewable resources to avoid impact on the climate yt and investing in new lighting and improving the efficiency of HVAC (heating, ventilation and cooling systems) and other equipments. Starbucks also has build greener stores which include a mix of design elements such as using recycled floor tiles, improve light efficiency, installing low flow valves throughout the stores, using paints with lower amount of volatile organic chemicals. b) the economic perspective for starbucks corporation A broader concept of economic sustainability would include the company’s attitude towards and impacts upon economic framework. Starbucks Corporation responsibly grows coffee and launching its Fair Trade Coffee has undeniably made a significant contribution to their family farmers through rapidly growing FTC coffee volume. Starbucks has established support centers for the farmers in Rwanda and Costa Rica to provide them with necessary resources and expertise to help lower the cost of production, reduce fungus infections, improve coffee quality and increase the production of premium coffee. During the growing and harvest cycles, many farmers find it difficult to cover the expenses prompting them to sell their crops for less to the local buyers. To avoid such situation, starbucks provides funding to the organization that make loans to the coffee growers which will sell their crops at the best time to get the right price. It will also help the farmers to invest in the farms and make capital improvements. Starbucks coffee and cocoa buying is designed to long-term supply of high-quality, ethically sourced cocoa and coffee while contributing positively to the environment and to cocoa-farming communities. Starbucks argues that it pays above market prices for all of its coffee. According to the company, in 2004 it paid on average $1.42 per pound ($2.64 kg) for high-quality coffee beans. This is in comparison to commodity prices which were as low as $0.50–$0.60 in 2003–04. c) the social perspective for Starbucks corporation The key issue in social perspective on sustainability is that of social justice. Starbucks Corporation is involved in communities’ services bringing people together, inspiring change and making a difference in people’s lives. Engaging young people to identify and address the needs of their community. Young people also receive advocacy ,training, financial help and other resources for their efforts. This is done by providing monetary aid and establishing relationship with International Youth foundation and Youth Venture. Starbucks is also involved in combating HIV/Aids to coffee growing community in Africa. Starbucks began selling RED goods in November 2008, enabling the supply of AIDS medicine for 3800 people for a year. The Starbucks Foundation has served the society for many years providing access to clean waters to the developing countries from its brand water bottled ETHOS, fostering education in china, rebuilding the Gulf coast. Although these goals and targets are identified by the UN are essentially the responsibility of the government to achieve, some of them have direct significance for business. Finally we have identified sustainability as a crucial concept that helps to determine the goals and objectives of the business activities from ethical point of view.

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