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Every time you finish working out your muscles feel overly exhausted. Your first guess is that youve overworked those muscles. However you and 14 out of 100,000 similar Americans may be suffering from the muscle disease by the name of Myasthenia gravis. Myasthenia gravis is an autoimmune disease. An autoimmune disease in simple terms is a condition in which the body attacks its own cells, destroying them. In myasthenia gravis the acetylcholine receptors at the neuromuscular junction are destroyed. There is not any known cause of the disease to date. The disease is most visible in the age groups between 20 and 401. Women appear to be common carriers of the disease. An estimated 12% of the infants born to women with Myasthenia gravis have a syndrome called neonatal myasthenia caused by antibodies passively crossing the placenta2. The most common symptoms of myasthenia gravis are ptosis, dipolia, and muscle weakness. Ptosis is also called "drooping eyelid." It is caused by weakness of the muscle responsible for raising the eyelid, damage to the nerves that control those muscles, or looseness of the skin of the upper eyelids. Cues that would indicate ptosis are drooping one or both eye lids, increased tearing, and depending on severity, interference with vision. Dipolopia is also known as double vision. Myasthenia gravis is an

Bozarth, Michael. "University at Buffalo SUNY." Synopsis of Myasthenia Gravis. Suny Buffalo, 11 09 2001. Web. 28 Apr 2010. <http:/wings.buffalo.edu/aru/MyastheniaGravis.html>. 2 Bozarth, Michael. "University at Buffalo SUNY." Synopsis of Myasthenia Gravis. Suny Buffalo, 11 09 2001. Web. 28 Apr 2010. <http:/wings.buffalo.edu/aru/MyastheniaGravis.html>.

autoimmune illness that blocks the stimulation of muscles by nerves inside the head. If a muscle in one eye is weak, that eye can't move smoothly with the healthy eye. Gazing in directions controlled by the weak muscle causes double vision. Muscle weakness is the most common symptom. There is a large range and degree of muscle weakness. Muscle weakness includes: swallowing difficulty, frequent gagging, or choking, paralysis, drooping head, difficulty climbing stairs, difficulty lifting objects need to use hands to rise from sitting positions, difficulty talking, and difficulty chewing. The most severe type of muscle weakness includes respiratory muscles weakness, which cause difficulty breathing, which can be fatal. There is no known cure for myasthenia gravis. However, treatment may result in prolonged periods of remission. Physician may recommend some medications, such as neostigmine or pyridostigmine; they improve the communication between the nerve and the muscle. Prednisone and other medications that suppress the immune response (such as azathioprine, cyclosporine, or mycophenolate mofetil) may be used if symptoms are severe and there is inadequate response to other medications3. Plasmapheresis is also a treatment method which can be used to inhibit the disease symptoms. Plasmapheresis is a technique in which blood plasma containing antibodies against the body is removed from the body and replaced with fluids (donated antibody-free plasma or other intravenous fluids), it does not directly affect the immune system's ability to make more antibodies, and therefore may only offer temporary relief. It may reduce symptoms for up to 4 - 6 weeks and it is often used to optimize conditions

Goldenberg MD, William. "Myasthenia Gravis: Treatment & Medication." E medicine. E Medicine, 01 30 2009. Web. 26 Apr 2010. <emedicine.medscape.com>.

3 before surgery. Crisis situations, where muscle weakness involves the breathing muscles may occur. These attacks seldom last longer than a few weeks. Hospitalization and assistance with breathing may be required during these attacks. Often plasmapheresis is used to help end the crisis. When all methods of treatment fall short, the physician my recommend intravenous immunoglobulin, which is a blood product administered intravenously. It contains the pooled IgG (immunoglobulin (antibody) G) which is extracted from the plasma of over one thousand blood donors. IVIG's effects last between 2 weeks and 3 months. It is mainly used as treatment to combat autoimmune diseases4. Surgical removal of the thymus (thymectomy) may also be an alternative treatment because it would deplete the production of the t cells that destroy the muscle receptors5. This procedure may result in permanent remission or less need for medicines. Several medications may make symptoms worse and should be avoided. Therefore, it is always important to check with the physician about the safety of a medication before taking them. Special consideration or interventions that the nurse can implement to alleviate the symptoms of the disease are: to plan times after activities to allow patient to have a scheduled rest time, promote use of an eye patch if recommended by physician, if vision is bothersome, and provide a comfortable environment for the patient including but not limited to providing adequate lighting and temperature; it avoids the patient from undergoing stress and excessive heat exposure which can worsen symptoms.

Clynes R (January 2005). "Immune complexes as therapy for autoimmunity". J. Clin. Invest. 115 (1): 257. doi: 10.1172/JCI23994. PMID 15630438. 5 Calhoun R, et al. (1999). "Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients.". Annals of Surgery 230 (4): 555561. PMID 10522725

4 Myasthenia like any other muscular disease is an extremely complex disease. As a nurse your role is to implement different interventions that can aid a patient to adapt and operate at his or her optimal level of wellness while promoting the use of the maximum amount of independence. Patient teaching and special nurse considerations are vital keys that enable a patient to be able to adjust and cope with the various symptoms of the disease.