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Liver cirrhosis and knee and joint pains
Hi,
My Mother is suffering from Liver cirrhosis 3rd stage. She has Osteo Arthritis (used to take Glucosamine and calcium tablest) and nerves weaknes (takes neurokind plus) because of which her knees are paining and could not walk. She is not able to take any medication because of Liver Cirrhosis and she is on bed for the past 14 days. Doctors say she cannot be given any medicine to reduce knee pains because of cirrhosis (has jaundice as well). Kindly suggest me a way so that I can see my mother walking soon.....
Regards,
Srikar
My Mother is suffering from Liver cirrhosis 3rd stage. She has Osteo Arthritis (used to take Glucosamine and calcium tablest) and nerves weaknes (takes neurokind plus) because of which her knees are paining and could not walk. She is not able to take any medication because of Liver Cirrhosis and she is on bed for the past 14 days. Doctors say she cannot be given any medicine to reduce knee pains because of cirrhosis (has jaundice as well). Kindly suggest me a way so that I can see my mother walking soon.....
Regards,
Srikar
Hello I am really sorry to hear about your Mom I am having knee pain and have found ultrasound therapy to be very helpful
Maybe you could ask the doctor
Good luck
Dee
Maybe you could ask the doctor
Good luck
Dee
COMMUNITY LEADER
I think this article will help you understand Autoimmune Hepatitis and its treatment.
http://emedicine.medscape.com/article/172356-overview
Autoimmune Hepatitis
Author: David C Wolf, MD, FACP, FACG, AGAF; Chief Editor: Julian Katz, MD
http://emedicine.medscape.com/article/172356-treatment#aw2aab6b6b2
Initial Therapy for Adults
Approximately 65% of patients respond to initial therapy and enter histological remission; however, 80% of these patients relapse after drug withdrawal. The practice guideline of the American Association for the Study of Liver Diseases (AASLD) provides recommendations for therapy.
Treatment might not be indicated in patients with inactive cirrhosis, preexistent comorbid conditions, or drug intolerances. On the other hand, patients with a histologic diagnosis of cirrhosis may respond well to therapy and should be offered treatment in an attempt to slow disease progression.
Treatment might not be appropriate in patients with decompensated liver disease. Such individuals might be better served by undergoing liver transplantation.
The AASLD (American Association for the Society of Liver Diseases) guidelines suggest 2 potential initial treatment regimens for adults. Recently, the British Society of Gastroenterology (BSG) has put forth their recommendations on treatment of autoimmune hepatitis. Essentially, the recommendations of both AASLD and BSG are the same and the differences are only in the wording. While BSG "strongly recommends" combination therapy with prednisone and azathioprine, AASLD recommends this option as "preferred."
BSG guidelines strongly recommend the combination of prednisolone and azathioprine as initial therapy, whereas the AASLD notes that combination therapy is preferred to prednisone alone.
Patients whose liver chemistries normalize after initial therapy then require maintenance therapy. In the authors' opinions, prednisone dosing can be further reduced after achieving normalization of liver chemistries. The authors commonly use azathioprine alone as a maintenance drug. Azathioprine therapy is withdrawn approximately 1 year after the patient's liver chemistries have normalized.
-------------------------------------------------------------------------------------
http://emedicine.medscape.com/article/172356-treatment#aw2aab6b6b9
Diet and Activity
Patients with acute autoimmune hepatitis and symptoms of nausea and vomiting may require intravenous fluids and even total parenteral nutrition; however, most patients can tolerate a regular diet. A high caloric intake is desirable.
Patients with cirrhosis secondary to autoimmune hepatitis may develop ascites. A low-salt diet (generally 1.3 g protein per kg body weight), given the catabolic nature of the disease and the high risk for developing muscle wasting.
Most patients do not need hospitalization, although this may be required for clinically severe illness. Forced and prolonged bed rest is unnecessary, but patients may feel better with restricted physical activity.
----------------------------------------------------------------------------------------------
"Can this be treated to stop the process of cirrhosis development at this stage? "
I depends upon how advanced her liver disease is before they start treatment. It appears the treatment can work in many people so it seems like something worth trying.
Good luck!
Hector
http://emedicine.medscape.com/article/172356-overview
Autoimmune Hepatitis
Author: David C Wolf, MD, FACP, FACG, AGAF; Chief Editor: Julian Katz, MD
http://emedicine.medscape.com/article/172356-treatment#aw2aab6b6b2
Initial Therapy for Adults
Approximately 65% of patients respond to initial therapy and enter histological remission; however, 80% of these patients relapse after drug withdrawal. The practice guideline of the American Association for the Study of Liver Diseases (AASLD) provides recommendations for therapy.
Treatment might not be indicated in patients with inactive cirrhosis, preexistent comorbid conditions, or drug intolerances. On the other hand, patients with a histologic diagnosis of cirrhosis may respond well to therapy and should be offered treatment in an attempt to slow disease progression.
Treatment might not be appropriate in patients with decompensated liver disease. Such individuals might be better served by undergoing liver transplantation.
The AASLD (American Association for the Society of Liver Diseases) guidelines suggest 2 potential initial treatment regimens for adults. Recently, the British Society of Gastroenterology (BSG) has put forth their recommendations on treatment of autoimmune hepatitis. Essentially, the recommendations of both AASLD and BSG are the same and the differences are only in the wording. While BSG "strongly recommends" combination therapy with prednisone and azathioprine, AASLD recommends this option as "preferred."
BSG guidelines strongly recommend the combination of prednisolone and azathioprine as initial therapy, whereas the AASLD notes that combination therapy is preferred to prednisone alone.
Patients whose liver chemistries normalize after initial therapy then require maintenance therapy. In the authors' opinions, prednisone dosing can be further reduced after achieving normalization of liver chemistries. The authors commonly use azathioprine alone as a maintenance drug. Azathioprine therapy is withdrawn approximately 1 year after the patient's liver chemistries have normalized.
-------------------------------------------------------------------------------------
http://emedicine.medscape.com/article/172356-treatment#aw2aab6b6b9
Diet and Activity
Patients with acute autoimmune hepatitis and symptoms of nausea and vomiting may require intravenous fluids and even total parenteral nutrition; however, most patients can tolerate a regular diet. A high caloric intake is desirable.
Patients with cirrhosis secondary to autoimmune hepatitis may develop ascites. A low-salt diet (generally 1.3 g protein per kg body weight), given the catabolic nature of the disease and the high risk for developing muscle wasting.
Most patients do not need hospitalization, although this may be required for clinically severe illness. Forced and prolonged bed rest is unnecessary, but patients may feel better with restricted physical activity.
----------------------------------------------------------------------------------------------
"Can this be treated to stop the process of cirrhosis development at this stage? "
I depends upon how advanced her liver disease is before they start treatment. It appears the treatment can work in many people so it seems like something worth trying.
Good luck!
Hector
Hi Hector,
Today I was told by my mother's doctor that, its Autoimmune Hepatitis, which lead to Cirrhosis. Also there are mild Vaginal discharge. Is this the complicated state. Can this be treated to stop the process of cirrhosis development at this stage?
Regards,
SrikarS
Today I was told by my mother's doctor that, its Autoimmune Hepatitis, which lead to Cirrhosis. Also there are mild Vaginal discharge. Is this the complicated state. Can this be treated to stop the process of cirrhosis development at this stage?
Regards,
SrikarS
Hi Ceanothus,
Thanks for your information. I will check for this as well.
Recently, the new symptom added to my mother is vaginal bleeding. Which means the bleeding started...... is it very critical condition?? Is it not manageable??
Regards,
SrikarS
Thanks for your information. I will check for this as well.
Recently, the new symptom added to my mother is vaginal bleeding. Which means the bleeding started...... is it very critical condition?? Is it not manageable??
Regards,
SrikarS
Hello Srikar. Hector is our most knowledgeable member, and his advice is always good (don't tell my doctor, but I trust Hector more than him). The only thing I can add is that sometimes non-drug interventions can help with pain problems. I'd try asking about getting hydrotherapy for those knees, gentle exercise and movement in very warm water. Most hospitals have the facilities for hydrotherapy. Another possibility would be acupuncture. It isn't likely to "fix" the problem, but it might help significantly with the pain. Good luck!
Hi Hector,
Thanks Hector. Your response is highly appreciated. My mother is in hospital form the past 10 days. I will update her status and treatment given once she is back.
Regards
SrikarS
Thanks Hector. Your response is highly appreciated. My mother is in hospital form the past 10 days. I will update her status and treatment given once she is back.
Regards
SrikarS
COMMUNITY LEADER
I am really sorry your mother is so ill. I would definitely follow the doctor's orders as they know your mother's condition and health history.
Thanks for the additional information. That is very helpful.
When a person has Fluid retention in the abdomen this is called "Ascites". It is usually the first sign of decompensation. I have had ascites myself and must take medicine to prevent it from occurring again. Again it depends on how ill her is how will treatment will work. It takes a week or two for the swelling to go down.
The fluid buildup in her lower legs is called "edema".
To learn more see this document and section "Treatment of ascites"
http://www.hepatitis.va.gov/provider/guidelines/2009cirrhosis.asp
This may help relieve some of the fluid build up and ease her pain.
****Please ask her doctor first.***
First-line treatment of patients with cirrhosis and ascites consists of sodium restriction (88 mmol/day [2000 mg/day]) and diuretics (oral spironolactone with or without oral furosemide). spironolactone 100 mg + furosemide 40 mg initially.
Learning points
• Ascites is the most common decompensating event in cirrhosis.
• Its pathophysiology is mostly explained by splanchnic and peripheral vasodilatation that lead to a decrease in effective blood volume.
• The natural history of ascites results from a progressively more deranged circulatory status; with ascites that initially responds to diuretics, then becoming refractory to diuretics, at which time the patient may develop hyponatraemia and, finally, hepatorenal syndrome.
• Most patients respond to diuretics. Patients who no longer respond should be treated with repeated large - volume paracenteses. Transjugular intrahepatic portosystemic shunt (TIPS) should be considered in those
requiring frequent paracenteses. Fluid restriction is recommended
in patients with hyponatraemia. Vasoconstrictors may reverse hepatorenal syndrome and are useful as a bridge to liver transplantation.
• Ascites per se is not lethal unless it becomes infected (spontaneous bacterial peritonitis). Infection often precipitates the hepatorenal syndrome leading to death. Antibiotic prophylaxis is indicated for secondary prevention of spontaneous bacterial peritonitis and in high - risk patients.
----------------------------------------------------------------------------------------
"The out - patient should adhere to the low - sodium diet, and abstain from alcohol where this is the cause of liver disease. Bathroom scales should be used to allow a record of daily weight at the same time of day, nude or
with similar clothing. This daily record should be kept and brought to the physician at each visit. The dose of diuretics depends upon the degree of
ascites and the severity of the liver disease. A usual regime is 100 – 200 mg spironolactone (or 10 – 20 mg amiloride) daily with frusemide 40 – 80 mg daily for the patient with more marked ascites initially, or with a
poor response to spironolactone alone. Serum electrolytes, creatinine, urea and liver function tests are monitored every 4 weeks for the stable out - patient. In the patient who has been treated initially as an in - patient,
an earlier check at 1 week after discharge allows an adjustment to the management plan before electrolyte or clinical imbalance has occurred. As liver function improves and the oedema and ascites resolve, it may be
possible to stop the frusemide first and then the spironolactone.
Symptoms such as postural dizziness and thirst indicate over - enthusiastic treatment. The ‘ no added salt ’ (70 – 90 mmol/day or 1.5 – 2.0 g/day) is maintained in the majority of patients."
---------------------------------------------------------------------------------------------
Most fluid buildup can be controlled by reducing sodium/salt intake and the use of diuretics. A person with ascites should be weighed daily. If they start gaining weight within a day or two they are retaining fluid.
I hope this helps you and your mother.
Hector
Thanks for the additional information. That is very helpful.
When a person has Fluid retention in the abdomen this is called "Ascites". It is usually the first sign of decompensation. I have had ascites myself and must take medicine to prevent it from occurring again. Again it depends on how ill her is how will treatment will work. It takes a week or two for the swelling to go down.
The fluid buildup in her lower legs is called "edema".
To learn more see this document and section "Treatment of ascites"
http://www.hepatitis.va.gov/provider/guidelines/2009cirrhosis.asp
This may help relieve some of the fluid build up and ease her pain.
****Please ask her doctor first.***
First-line treatment of patients with cirrhosis and ascites consists of sodium restriction (88 mmol/day [2000 mg/day]) and diuretics (oral spironolactone with or without oral furosemide). spironolactone 100 mg + furosemide 40 mg initially.
Learning points
• Ascites is the most common decompensating event in cirrhosis.
• Its pathophysiology is mostly explained by splanchnic and peripheral vasodilatation that lead to a decrease in effective blood volume.
• The natural history of ascites results from a progressively more deranged circulatory status; with ascites that initially responds to diuretics, then becoming refractory to diuretics, at which time the patient may develop hyponatraemia and, finally, hepatorenal syndrome.
• Most patients respond to diuretics. Patients who no longer respond should be treated with repeated large - volume paracenteses. Transjugular intrahepatic portosystemic shunt (TIPS) should be considered in those
requiring frequent paracenteses. Fluid restriction is recommended
in patients with hyponatraemia. Vasoconstrictors may reverse hepatorenal syndrome and are useful as a bridge to liver transplantation.
• Ascites per se is not lethal unless it becomes infected (spontaneous bacterial peritonitis). Infection often precipitates the hepatorenal syndrome leading to death. Antibiotic prophylaxis is indicated for secondary prevention of spontaneous bacterial peritonitis and in high - risk patients.
----------------------------------------------------------------------------------------
"The out - patient should adhere to the low - sodium diet, and abstain from alcohol where this is the cause of liver disease. Bathroom scales should be used to allow a record of daily weight at the same time of day, nude or
with similar clothing. This daily record should be kept and brought to the physician at each visit. The dose of diuretics depends upon the degree of
ascites and the severity of the liver disease. A usual regime is 100 – 200 mg spironolactone (or 10 – 20 mg amiloride) daily with frusemide 40 – 80 mg daily for the patient with more marked ascites initially, or with a
poor response to spironolactone alone. Serum electrolytes, creatinine, urea and liver function tests are monitored every 4 weeks for the stable out - patient. In the patient who has been treated initially as an in - patient,
an earlier check at 1 week after discharge allows an adjustment to the management plan before electrolyte or clinical imbalance has occurred. As liver function improves and the oedema and ascites resolve, it may be
possible to stop the frusemide first and then the spironolactone.
Symptoms such as postural dizziness and thirst indicate over - enthusiastic treatment. The ‘ no added salt ’ (70 – 90 mmol/day or 1.5 – 2.0 g/day) is maintained in the majority of patients."
---------------------------------------------------------------------------------------------
Most fluid buildup can be controlled by reducing sodium/salt intake and the use of diuretics. A person with ascites should be weighed daily. If they start gaining weight within a day or two they are retaining fluid.
I hope this helps you and your mother.
Hector
Hi Hector and Randy,
Thanks for your inputs.
Here is my mother's detail condition.
My mother (age 63) has Arthritis / Knee pains for which she is taking Calcium tables, Glucosamnine tablets, neuroking plus ( for Nerves) and Ayurvedic medication from almost 4 years. Last Month (September 2nd), she is diagnosed with Jaundice (Serum Bilirubin content at 8). She stopped taking medicines for Knee pains as local doctor suggested to do so. Later we went to Gastro Enterologist. He prescribed Total Health Checkup and We had a Serum Bilirubin test done again, which showed reading as 14. Basing on the TOTAL HEALTH CHEKUP reports doctor informed me that it might be Chronic Liver disease. Provided some medicines and request to come back after 15 days.
By this time, my mom became very weak. Her knee pain started to worry her and not able to stand and walk as knee is hurting her a lot. It started at left leg and passed to right leg. Both legs swelled a lot.... We took her to hospital for check up and admitted in hospital.
Doctor conducted tests such as
1. Liver Function test
2. complete Blood Picture
3. Endoscopy
4. Potassium/Sodium
5. Hepatitis A,B,and C-- result negative
6. AntiNuclear Antibody (ANA)-- result negative
7. ultra sound of abdomen and found ascitic fluid in abdomen, also ruptured liver external texture, on which he commented as Liver Cirrhosis and mentioned that it should be correlated with the patient condition.
Doctor mentioned that it is Cirrhosis, as My mother has
a. Ruptured liver texture
b. Loss of apetite
c. Fluid retention in Abdomen
d. Fluid retention in legs
5. Jaundice (Serum Bilirubin)
Also he mentioned that all these symptoms belongs to Liver Cirrhosis 3rd stage, still in Compensated stage.
Now, Since Liver is not functioning properly as still Jaundice is there, Doctor suggest that there cannot be any medication given and we have to wait and watch how liver behaves from now on.
But for my mother's knee pain, they suggested that pain killers can not be given as they can harm the liver further. And there is not alternate to this other than to suffer till we confirm Liver is working normally (in observation for 3 months) and then can think about using some mild medication to treat the knee pains.
Thanks for your inputs.
Here is my mother's detail condition.
My mother (age 63) has Arthritis / Knee pains for which she is taking Calcium tables, Glucosamnine tablets, neuroking plus ( for Nerves) and Ayurvedic medication from almost 4 years. Last Month (September 2nd), she is diagnosed with Jaundice (Serum Bilirubin content at 8). She stopped taking medicines for Knee pains as local doctor suggested to do so. Later we went to Gastro Enterologist. He prescribed Total Health Checkup and We had a Serum Bilirubin test done again, which showed reading as 14. Basing on the TOTAL HEALTH CHEKUP reports doctor informed me that it might be Chronic Liver disease. Provided some medicines and request to come back after 15 days.
By this time, my mom became very weak. Her knee pain started to worry her and not able to stand and walk as knee is hurting her a lot. It started at left leg and passed to right leg. Both legs swelled a lot.... We took her to hospital for check up and admitted in hospital.
Doctor conducted tests such as
1. Liver Function test
2. complete Blood Picture
3. Endoscopy
4. Potassium/Sodium
5. Hepatitis A,B,and C-- result negative
6. AntiNuclear Antibody (ANA)-- result negative
7. ultra sound of abdomen and found ascitic fluid in abdomen, also ruptured liver external texture, on which he commented as Liver Cirrhosis and mentioned that it should be correlated with the patient condition.
Doctor mentioned that it is Cirrhosis, as My mother has
a. Ruptured liver texture
b. Loss of apetite
c. Fluid retention in Abdomen
d. Fluid retention in legs
5. Jaundice (Serum Bilirubin)
Also he mentioned that all these symptoms belongs to Liver Cirrhosis 3rd stage, still in Compensated stage.
Now, Since Liver is not functioning properly as still Jaundice is there, Doctor suggest that there cannot be any medication given and we have to wait and watch how liver behaves from now on.
But for my mother's knee pain, they suggested that pain killers can not be given as they can harm the liver further. And there is not alternate to this other than to suffer till we confirm Liver is working normally (in observation for 3 months) and then can think about using some mild medication to treat the knee pains.
COMMUNITY LEADER
I am very sorry to hear about your mother. What is being done about your cirrhosis?
What do you mean by "Liver cirrhosis 3rd stage".
Do you mean End-Stage Liver Disease?
Is your mother in a hospital or at home?
See needs to see a liver specialist as soon as possible to help her with your cirrhosis and pain.
There are medicines she may be able to take! Talk to a doctor that treats liver disease. Acetaminophen up to 1,500 mg per day may be alright. "Acetaminophen/Paracetamol (Crocin - brand name popular in India) may also be used to relieve the pain of osteoarthritis (arthritis caused by the breakdown of the lining of the joints). Acetaminophen is in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers). It works by changing the way the body senses pain and by cooling the body." Again talk to her doctor it depends on her complete health.
Stage 4, Cirrhosis of the liver is when the normal liver cells are replaced by scar tissue. The anatomy of the structure of the liver is changed and the livers surface becomes nodular replacing the smooth, shiny, nutmeg colored liver that you see in a super market of butcher shop.
End-Stage Liver Disease (ESLD) is decompensated cirrhosis.The difference between compensated and decompensated is the when decompensated the liver is no longer able to perform all of its function and so complications manifest themselves. The classic signs of ESLD are; ascites, hepatic encephalopathy, varices, jaundice (yellowing of eyes and skin).
The Child-Pugh score is usually used to measure the 3 degrees of cirrhosis.
Class A - compensated cirrhosis
Class B - decompensated cirrhosis (very few treat with Hep C drugs too ill)
Class C - Very ill with life-threatening complications
Class A is score 5 - 6
Class B is score 7 - 9
Class C is score >9
If someon hasn't had any symptoms or complications other then fatigue than you a compensated Child-Pugh Class A.
If someone has experienced ascites, bleeding varices, hepatic encephalopathy, then they are decompensated.
If your mother lays in bed her muscles will atrophy and she will no longer be able to walk at all as she will lose all muscle mass and strength. Unless she is too ill to walk she should try to walk even if it is for a few steps.
Your mother needs all the medical help she can get. Each illness makes the other worse.
I wish you and your mother good luck.
Hector
What do you mean by "Liver cirrhosis 3rd stage".
Do you mean End-Stage Liver Disease?
Is your mother in a hospital or at home?
See needs to see a liver specialist as soon as possible to help her with your cirrhosis and pain.
There are medicines she may be able to take! Talk to a doctor that treats liver disease. Acetaminophen up to 1,500 mg per day may be alright. "Acetaminophen/Paracetamol (Crocin - brand name popular in India) may also be used to relieve the pain of osteoarthritis (arthritis caused by the breakdown of the lining of the joints). Acetaminophen is in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers). It works by changing the way the body senses pain and by cooling the body." Again talk to her doctor it depends on her complete health.
Stage 4, Cirrhosis of the liver is when the normal liver cells are replaced by scar tissue. The anatomy of the structure of the liver is changed and the livers surface becomes nodular replacing the smooth, shiny, nutmeg colored liver that you see in a super market of butcher shop.
End-Stage Liver Disease (ESLD) is decompensated cirrhosis.The difference between compensated and decompensated is the when decompensated the liver is no longer able to perform all of its function and so complications manifest themselves. The classic signs of ESLD are; ascites, hepatic encephalopathy, varices, jaundice (yellowing of eyes and skin).
The Child-Pugh score is usually used to measure the 3 degrees of cirrhosis.
Class A - compensated cirrhosis
Class B - decompensated cirrhosis (very few treat with Hep C drugs too ill)
Class C - Very ill with life-threatening complications
Class A is score 5 - 6
Class B is score 7 - 9
Class C is score >9
If someon hasn't had any symptoms or complications other then fatigue than you a compensated Child-Pugh Class A.
If someone has experienced ascites, bleeding varices, hepatic encephalopathy, then they are decompensated.
If your mother lays in bed her muscles will atrophy and she will no longer be able to walk at all as she will lose all muscle mass and strength. Unless she is too ill to walk she should try to walk even if it is for a few steps.
Your mother needs all the medical help she can get. Each illness makes the other worse.
I wish you and your mother good luck.
Hector
COMMUNITY LEADER
Hello and welcome to MedHelp.
I am very sorry to hear of your mothers condition. When reading you post the first thing that comes to mind is wether your mom is being treated for cirrhosis and what is the cause? She is at stage 3 that means her liver has the ability to compensate therefore she should be feeling quite well.
Symptoms of cirrhosis don't normally manifest until the final stage (stage 4) of cirrhosis. However she does need to be cautious with everything ingested to include medication to avoid rapid progression of her disease. She should be recieving treatment from a transplant facility as they have the ability to give her the best care possible. A private practice doctor of any type is likely to not have the ability to treat you mothers condition as well as a transplant center.
The next thing that comes to mind is a medication called Gabapentin. This medication is used to treat neuropathy (nerve damage) and it is metabolized in the kidneys.
This link will provide more information for you. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000940/
I hope this will help her get feeling better. Mention it to her doctor. Take care.
Randy
I am very sorry to hear of your mothers condition. When reading you post the first thing that comes to mind is wether your mom is being treated for cirrhosis and what is the cause? She is at stage 3 that means her liver has the ability to compensate therefore she should be feeling quite well.
Symptoms of cirrhosis don't normally manifest until the final stage (stage 4) of cirrhosis. However she does need to be cautious with everything ingested to include medication to avoid rapid progression of her disease. She should be recieving treatment from a transplant facility as they have the ability to give her the best care possible. A private practice doctor of any type is likely to not have the ability to treat you mothers condition as well as a transplant center.
The next thing that comes to mind is a medication called Gabapentin. This medication is used to treat neuropathy (nerve damage) and it is metabolized in the kidneys.
This link will provide more information for you. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000940/
I hope this will help her get feeling better. Mention it to her doctor. Take care.
Randy
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