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Amyotrophic lateral sclerosis, often referred to as "Lou Gehrig's disease," is a progressive motor neuron disease (MND) that attacks cells in the brain (nerves) and those of spinal region(cord), damaging both upper and lower motor neurons(Rachele, 1998). Motor neurons in the brain moves towards the spinal region and the same time from the spinal cord and invades the muscles in the whole the body (Cornblath, 1993). When the neurons (motor) die, the brain’s ability to initiate and control the movement of muscle is lost. With voluntary muscle action progressively affected, patients in the later stages of the disease might become totally paralyzed. Yet, through it all, the vast majority of people maintain sharp, unaffected minds.

A myo strophic is a Greek language. "A" means no,  "Myo" refers to muscle as  "Trophic" means nourishment. Literally, the word stands for "without muscle sustenance." When a muscle has no nourishment, it "atrophies". "Lateral" identifies the areas in a spinal cord where nerve cells portions that control and gives signals to the muscles (Corcia, 2003). As the region degenerates it leads to scarring ("sclerosis") in the place.

As motor neurons degenerate, they can no longer send any impulses within and around the muscle fibers that normally result in muscle vibration. Early symptoms of ALS often include increasing muscle weakness, especially involving the hands and legs, swallowing as well as breathing within the system (Corcia, 2003). When muscles no longer get any messages from and within the neurons that they require to function, these muscles begin to reduce in size, or become less significant. Limbs instigate to look "thinner" as muscle handkerchief atrophies.

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Ethical Issues That Rick Stone May Face In The Future

The diagnosis is an incurable disease which causing progressive and simultaneously disability unaffected by life-prolonging measures which gives rise to many ethical challenges that Rick stone and family member faces. Rick stone and his family will face a lot of ethical issues in the future these issues involve the good and the evil as perceived by the society.

To begin with, Rick stone may be faced with the option of physician assisted suicide (PAS), tis is the act where physicians gives patients the lethal dose or medication which is used by the patients   to end their own lives. In PAS, the physician provides the possible means that the patient can use to kill him or herself (Poloni, 1997). Ricks tone may perceive the decision of PAS to be fair on his part so as not to experience all those bad symptoms that ALS disease brings with it such as sleep disturbance, pain, pseudo bulbar affect, gait disturbance, spasticity, orthopnea, cramps, limb weakness, siolorrhea, axial weakness, constipation, constipation,dyspnea, truisms, and depression.

Secondly, he maybe faced with clinical tests that may or may not work. These clinical tests may give him false hope and disappoint him later on if they don’t achieve the expected results this clinical tests involve such like “stem cell therapy” which may or may not be successful. The concept of motor neuron death in ALS has been unclear for many years. It is not been conformed that transplanted stem cells might have any resistant to the same source(s) of damage that makes motor neurons to die. Stem cells may have to be changed s as to protect against any toxic from environment(Camu, 1994). There is also some possibility that cultured stem cells which are used in transplant medicine might face resistance by the body's immune system. Cell transplantation experiments have been undertaken for several decades and continue to be pursued in several countries but the success rate of new trials is unknown. Ricksone and his family have to face the difficulties of choosing between a rock and a hard place of these trials and decide on whether it will be safe for him to undertake these trials.

Rick stone and his family

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Finally, Rick stone and his family may be faced with having to seek professional care giving if and when his ALS progresses since all those severe symptoms may not be able to be managed by just his family but rather a professional caregiver who will offer palliative care to Rick stone.

Decisions that Rick and his family may need to make

Rick and his family need to learn as much as they can about the disease so as to be able to find out what exactly is haappening and to enable them to anticipate for the worst symptoms that ALS disease brings with it as it progresses and also how to take care of the patient and the disease itself in the best way possible.

Another decision the family may want to consider is how much treatment they want for the problems caused by the disease since this is a personal choice that only involves them and Rick himself. Values, wants, and needs will be the most important things Rick and his family need to take into consideration while making their decisions (Camu, 1994). This will help them make informed choices that they deem fit for Rick as well as themselves.

Thirdly, ALS gets worse as the days get by, they may have to choose which treatments they want for issues such as breathing and eating problems. For example, if they want a tracheotomy if Rick’s breathing becomes severe and if he will want to use a feeding tube placed in his stomach if he loses his ability to swallow. Decisions regarding to safety, planning, timing and utility of internal feeding tube placement will be crucial in the management of Rick stone’s disease.  The Placement of an internal feeding tube has be considered first before the forced vital capacity reduces to 40%  so as body mass index will be less than 15.5 kg/m.3,3.9 (Poloni, 1997).

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As they make these choices, they have to keep in mind that what's right for Rick stone may not feel right for another. It's also okay to revisit their choices throughout the course of the disease. They may change their mind over time and talk about the treatment options and share their concerns with Rick stone’s doctor.

It will be advisable to put their choice in writing. This is called advanced writing. It will give them control over Rick stone’s medical care. If they won’t be able to speak for themselves they may choose a family friend or relative to speak on their behalf. This is described as a durable power of attorney (Rachele, 1998). Planning ahead of time will always help Rick stone and his family makes sure that his health care choices are followed.ALS disease is a tough call and will require Rick stone and his family to be well prepared on what to expect as the disease progresses and to be well informed on the disease and new findings.

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