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The seizure could additionally be preceded by an aura gastritis diet åäó purchase 20mg nexium otc, a warning that a seizure is imminent gastritis diet of augsburg nexium 20mg mastercard, that some patients describe as a spiritual feeling gastritis journal articles purchase nexium discount, flash of sunshine gastritis home treatment safe 40 mg nexium, or special noise. A hoarse cry may occur on the onset of the seizure because of air being compelled out of the lungs, and sufferers might temporarily lose bladder or bowel control. The clonic part is characterised by alternating contraction and leisure of muscles that are attribute of convulsions. The seizure often lasts 1 to 2 minutes, after which the patient becomes drowsy and disoriented and sleeps deeply. Absence seizures, previously often identified as petit mal seizures, most often happen in kids and last only some seconds. Approximately half of the sufferers with absence seizures may experience a minimal of one tonic�clonic seizure. Staring and transient loss of responsiveness are the commonest signs, but there could additionally be slight motor exercise with eyelid fluttering or muscular jerking actions. Children with absence seizures may experience poor academic efficiency as a end result of these episodes can occur several instances per day. Most youngsters who expertise absence seizures will "outgrow" the disorder and turn into seizure free in adulthood. Atonic seizures are generally generally known as drop assaults, as a outcome of the truth that the patient will stumble and fall for no obvious purpose. Although the seizure itself causes no serious harm, the affected person is susceptible to damage due to falls. Myoclonic seizures are generalized seizures characterised by jerking body movements, normally involving the muscle tissue of the neck, shoulders, and upper arms. Evidence the incidence of epilepsy over a lifetime has the very best frequency in the very young and the very old (Beghi, Savica, Beghi, & Gerattini, 2010). Other elements contributing to the development of seizures within the older grownup embody malignant and benign brain tumors, metabolic problems corresponding to electrolyte imbalances, diabetes, renal failure, and psychiatric sickness (Acar & Salinsky, 2010). The analysis and remedy of seizure problems in the older grownup is difficult by the existence of comorbidities. For example, diagnosis may be delayed when confusion, conduct changes, dysphagia, weak spot, or other signs are current and could be explained by one other illness process. In the older adult inhabitants, value have to be thought-about when a extra recent drug is prescribed (Beghi et al. Implications the nurse caring for older adult sufferers ought to at all times be alert to the potential of an underlying seizure dysfunction, notably when a patient is admitted who has fallen or has been discovered unconscious. Most patients with myoclonic seizures also exhibit tonic�clonic or absence seizures, or both. Myoclonic seizures normally begin around puberty and comprise 5% to 10% of all epilepsies. Although these seizures continue for the lifetime of the affected person, they are often managed with pharmacotherapy. Partial Seizures Partial (focal) seizures contain a restricted portion of the mind, with the abnormal neuronal discharges starting on one facet and touring solely a short distance before they stop. Some signs are delicate and mirror the simple nature of neuronal misfiring in limited areas of the mind, whereas other symptoms may be more advanced. Simple partial seizures have an onset that may begin as a small, regional focus, and subsequently progress to a generalized seizure. Patients with simple partial seizures experience a huge selection of signs relying on the particular region of the mind affected. If the motor cortex is affected, jerky, rhythmic contractions of a specific muscle group are famous. Consciousness is retained through the seizure, although the affected person may express amnesia about the occasion. Complex partial seizures (formerly generally recognized as psychomotor or temporal lobe seizures) originate from a single focus, often within the temporal lobe of the brain.

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Mechanism of Action: Erythromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit gastritis diet 600 cheap nexium line. Patient and Family Education: Shake liquid and pediatric drops nicely earlier than every use to mix the treatment evenly gastritis or stomach flu purchase cheap nexium line. The most frequent antagonistic results with clarithromycin are diarrhea gastritis and esophagitis buy cheap nexium 40 mg line, nausea gastritis bad eating habits nexium 40mg fast delivery, irregular taste, dyspepsia, belly discomfort, and headache. Fidaxomicin (Dificid): the latest of the macrolides, fidaxomicin was accredited in 2011 particularly for infections confirmed or strongly suspected to be caused by C. The drug ought to solely be prescribed for this indication as a end result of other makes use of may encourage the development of resistant strains. Fidaxomicin appears to have equal efficacy to vancomycin, the primary antibiotic used to treat C. Drugs Similar to Erythromycin (EryC, Erythrocin, Others) Other macrolides include azithromycin and clarithromycin. The macrolide dirithromycin (Dynabac) is now not available within the United States. Azithromycin (Zithromax, Zmax): Approved in 1991, azithromycin has a long length of action that allows for much less frequent dosing. A "Tri-pak" consists of three 500 mg tablets (taken over 3 days) and a "Z-pak" incorporates six 250 mg tablets (taken over 5 days). For acute otitis media in youngsters, a single dose has been discovered to be as effective as 3- or 5-day regimens. An ophthalmic solution (AzaSite) was accredited in 2007 for treating bacterial conjunctivitis. Azithromycin demonstrates larger exercise over gram-negative organisms than erythromycin. Azithromycin causes much less nausea than erythromycin and may be taken with or without meals. Clarithromycin (Biaxin): Approved in 1991, clarithromycin is just like erythromycin however causes significantly much less nausea, and the common release tablets could additionally be taken with or with out food. The drug is often prescribed for infections of the respiratory tract, sexually transmitted infections, H. The first aminoglycoside, streptomycin, was named after Streptomyces griseus, the soil organism from which it was isolated in 1943. Other aminoglycosides have since been isolated, and several have been produced semisynthetically. All have a typical chemical construction of two or extra amino sugars with a glycosidic, or sugar, hyperlink. The variations in spelling of a few of these medication, -mycin and -micin, displays the totally different organisms from which the medicine were originally isolated. Aminoglycosides bind irreversibly to the 30S ribosomal subunit of micro organism, altering its form and preventing the initiation stage of protein synthesis. Whereas most antibiotics that affect protein synthesis are bacteriostatic, aminoglycosides are bacteriocidal. Less than 1% of an oral dose is absorbed; subsequently they have to be administered parenterally to deal with systemic infections. In addition, aminoglycosides focus in renal tissue, which finally ends up in potential nephrotoxicity. Once degraded by the bacterial enzymes, these medication are unable to bind with the bacterial ribosome. Some resistance additionally occurs when mutations change the shape of the bacterial ribosome in order that it no longer binds the aminoglycoside. The emergence of aminoglycoside-resistant strains of Enterococcus faecalis and Enterococcus faecium has turn out to be a critical medical drawback as a result of there are few therapeutic options to treat these infections. Once resistance develops to an aminoglycoside, the mutant strain is often immune to the other drugs in this class. An exception is amikacin, which seems to have some exercise towards gentamicin-resistant strains. Several methods have been used to increase the effectiveness of the aminoglycosides. Administering these drugs in a single large dose per day somewhat than smaller divided doses ends in a greater bacteriocidal effect and fewer resistant microbes.

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The widespread use of sulfonamides for over 60 years resulted in a substantial variety of resistant strains gastritis cystica profunda definition buy generic nexium 40 mg. The mechanism of acquired resistance to sulfonamides is likely a mutation within the enzyme performing step 1 of folic acid synthesis gastritis operation order 40 mg nexium fast delivery. Resistance to one sulfonamide typically confers resistance to all members of this class gastritis diet àâèòî discount nexium 20 mg. In addition to resistance gastritis diet oatmeal generic nexium 20mg mastercard, a quantity of other factors have led to a big decline in using sulfonamides. The development of the penicillins, cephalosporins, and macrolides gave practitioners larger decisions of agents, a few of which exhibited an improved safety profile over the sulfonamides. The nurse notices that the patient is afebrile with a standard pulse, blood strain, and respiratory fee. The most up-to-date tradition indicates a decline within the variety of bacteria present within the urine. Other information found within the medical record indicates that the patient routinely takes medication for hypertension and arthritis. These agents are distributed to most tissues in the physique, and the amount of plasma protein binding could also be vital. Hepatic enzymes convert these medicine to inactive metabolites, and the medicine are excreted quickly by the kidney. Sulfasalazine (Azulfidine) stays unabsorbed within the alimentary canal to treat intestinal infections and gentle to average ulcerative colitis. Some systemic toxicity could also be observed with this drug, because considered one of its metabolic merchandise is absorbed from the gut and enters the systemic circulation. Silver sulfadiazine (Silvadene, Thermazene) is used for the prophylaxis and therapy of topical infections ensuing from wounds or burns. Sulfacetamide (Cetamide, Others) is out there as an answer to deal with conjunctivitis and other ocular infections. Like other topical sulfonamides, the drug may be absorbed across the skin, leading to important plasma drug levels. Sulfonamides have a low solubility, which may trigger crystalluria, crystals that kind in the urine and doubtlessly obstruct the kidneys or ureters. To decrease the potential of crystalluria, fluids in quantities up to 3,000 mL per day should be encouraged to obtain a urinary output of 1,500 mL in 24 hours. Although not widespread, sulfonamides may cause doubtlessly fatal blood abnormalities similar to aplastic anemia, acute hemolytic anemia, and agranulocytosis. Baseline and periodic blood laboratory values must be assessed to forestall the event of anemia or other hematologic issues. Patients with preexisting myelosuppression should be monitored fastidiously throughout remedy, because this will increase the risks related to drug-induced bone marrow despair. These medicine cause a quantity of dermal reactions starting from urticaria to photosensitivity and exfoliative dermatitis. Cross sensitivity exists with diuretics, such as acetazolamide (Diamox) and the thiazides, and with sulfonylurea antidiabetic agents. These brokers should be avoided in sufferers with a historical past of hypersensitivity to sulfonamides as a outcome of this could induce Stevens�Johnson syndrome. At the primary signs of rash, patients ought to be instructed to cease taking the drug and get in touch with their health care provider. Most sulfonamides readily cross the placenta, and may attain sufficiently excessive ranges to trigger antagonistic results within the fetus. Sulfonamides are contraindicated during being pregnant and lactation, because they enter breast milk. They are contraindicated for infants less than 2 months of age and for pregnant sufferers near term, as a result of sulfonamides displace bilirubin from plasma proteins. The displaced, free bilirubin is poisonous to the brain and causes kernicterus, a serious type of jaundice. Of most concern are antagonistic results on the urinary tract, hypersensitivity reactions, and blood abnormalities. The drug is used off-label for many different indications, depending on the sensitivity of the microbe. Trimethoprim decreases potassium excretion and is contraindicated in patients with hyperkalemia.

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Because nifedipine causes blood strain to fall gastritis diet apples buy nexium without a prescription, it ought to be used cautiously in patients with preexisting hypotension gastritis yahoo nexium 40 mg free shipping. Patients with significant hepatic impairment are at risk for drug accumulation and toxicity gastritis caused by stress discount nexium 40 mg free shipping. Older adults are at much greater threat of nifedipine toxicity and experience the next general mortality when treated with this drug gastritis pain in back order nexium 40 mg line. Do not drink alcohol whereas taking this drug as a outcome of this will trigger low blood stress and fainting. Approved in 1992, amlodipine has the longest half-life (35 hours) of the dihydropyridines, which allows for once-daily dosing. Like different dihydropyridines, amlodipine affects primarily arteriolar smooth muscle, together with that within the coronary arteries, and has no significant effect on cardiac conduction. The drug is well tolerated, with headache, dizziness, and dose-dependent peripheral edema being frequent adverse effects. The dose is doubled each 90 seconds until the blood strain approaches the goal, then the infusion is slowed, with dose adjustments each 5 to 10 minutes. Blood strain falls within minutes and must be monitored continuously in the course of the infusion. Patients with heart failure must be monitored fastidiously as a outcome of clevidipine could worsen this condition. Typical antagonistic effects are facial flushing, headache, peripheral edema, and reflex tachycardia. When given concurrently with nifedipine, other antihypertensive medicine have additive results on blood pressure. Nifedipine could improve the serum ranges of digoxin by as much as 45%, resulting in bradycardia and digoxin toxicity. Alcohol potentiates the vasodilation action of nifedipine and will lead to syncope brought on by a rapid drop in blood stress. Melatonin might scale back the effectiveness of nifedipine by increasing blood strain and coronary heart rate. Treatment of Overdose: Overdosage could result in pronounced hypotension, which is treated with rapid-acting vasopressors such as dopamine or dobutamine. Nursing Responsibilities: Key nursing implications for patients receiving nifedipine are included in the Nursing Practice Application for Patients Receiving Calcium Channel Blocker Therapy on pages 526�527. Lifespan and Diversity Considerations: Monitor the older grownup for the event of dizziness related to potential hypotension. Have the patient rise to standing slowly and help with ambulation as needed to forestall falls. Patient and Family Education: Immediately report palpitations, weight gain, swelling of ankles and ft, or rashes to the health care provider. Beta-adrenergic blockers or sublingual nitrates may be administered concurrently to scale back the possibility of reflex tachycardia in patients with angina pectoris. The actions, contraindications, and antagonistic results are similar to those of nifedipine. Peripheral edema, dizziness, headache, and facial flushing are the most typical antagonistic effects. Nimodipine (Nimotop): Approved in 1988, nimodipine is an oral calcium channel blocker with one very specific indication: to scale back the incidence and severity of ischemic deficits in patients with subarachnoid hemorrhage from ruptured intracranial berry aneurysms. The drug prevents vasospasm of the injured vessel and reduces the severity of the ensuing neurologic deficit. Nimodipine appears to have a larger clean muscle rest impact on cerebral arteries than arteries in other areas of the body. Nisoldipine (Nisocor, Sular): Approved in 1995, nisoldipine is selective for vascular clean muscle and has no significant impact on the myocardium. This condition may be successfully managed by skilled dental care and oral antiseptic rinses corresponding to chlorhexidine (Peridex) (Mejia, 2009).

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Fluoroquinolones might trigger extreme muscle weak point in patients with myasthenia gravis gastritis diet ðæä best nexium 40mg. Drug Interactions: Concurrent administration with warfarin could enhance anticoagulant effects and end in bleeding as a outcome of gastritis migraine generic 40 mg nexium with amex the decreased metabolism of warfarin gastritis diet ãîîãëå cheap nexium 20 mg without a prescription. Antacids and vitamin supplements containing calcium or aluminum gastritis diet óêð order 20 mg nexium amex, iron or zinc sulfate, and sucralfate lower the absorption of ciprofloxacin, thus inflicting decreased effectiveness of the antibiotic. Ciprofloxacin slows the hepatic metabolism of xanthines, including caffeine, theophylline, and theobromine. Herbal/Food: Patients ingesting massive quantities of caffeinated merchandise could expertise excessive nervousness, anxiety, or tachycardia. An increased threat of tendinitis and tendon rupture has been famous in this inhabitants. Patient and Family Education: Do not take any merchandise containing magnesium or calcium (such as antacids), iron, or aluminum with this drug, or within 2 hours of this drug. The commonest opposed results are nausea, headache, diarrhea, insomnia, constipation, and dizziness. Adverse effects of ophthalmic levofloxacin embrace transient blurred imaginative and prescient, international physique sensation, headache, burning, pharyngitis, and photophobia. Caution ought to be used for patients with certain dysrhythmias, as a end result of its effects on cardiac conduction. Although rare, hematologic toxicity, together with agranulocytosis and thrombocytopenia, and renal toxicity might happen after a number of doses. Moxifloxacin (Avelox): Approved in 1999, moxifloxacin is prescribed for pores and skin infections, community-acquired pneumonia, acute sinusitis, and acute bacterial exacerbations of chronic bronchitis. For the ophthalmic drops, eye irritation, pyrexia, and conjunctivitis are the common adverse results. The commonest adverse effects are nausea, headache, asthenia, rash, and stomach cramping. Other contraindications and adverse results (including the black box warning) are just like those of ciprofloxacin. An ophthalmic solution once used for bacterial conjunctivitis is now not out there in the United States. The most common opposed results are nausea, headache, insomnia, dizziness, and rash. Drugs Similar to Ciprofloxacin (Cipro) Other fluoroquinolones include besifloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin. With few exceptions, these medication have very similar actions and opposed results to ciprofloxacin. A black box warning regarding attainable tendon rupture is included for all oral and parenteral medication in this class. Besifloxacin (Besivance): Besifloxacin is amongst the newer fluoroquinolones, approved in 2009 for the therapy of bacterial conjunctivitis. If used for a prolonged time period, the affected person should be examined for the potential of overgrowth of resistant microbes. Gatifloxacin (Zymar, Zymaxid): In 2006, the drug manufacturer discontinued the distribution of the oral and parenteral forms of gatifloxacin. The most regularly reported adverse reactions after ophthalmic administration embody increased worsening of conjunctivitis, eye irritation, dysgeusia, and eye pain. Gemifloxacin (Factive): Gemifloxacin was accredited in 2003 for acute bacterial exacerbations of persistent bronchitis and community-acquired pneumonia. The drug undergoes solely minimal metabolism by the liver and is excreted nearly equally by the kidneys and in the feces. Assessment all through administration: Potential Nursing Diagnoses Infection (bacterial) Acute Pain Hyperthermia Impaired Physical Mobility, associated to adverse drug effects Deficient Knowledge (Drug Therapy) Risk for Injury, related to opposed drug effects Risk for Deficient Fluid Volume, related to diarrhea attributable to antagonistic drug effects Assess for desired therapeutic effects. Severe diarrhea, particularly containing mucus, blood, or pus, or decreased urine output must be reported immediately. Immediately report undiminished fever, changes in level of consciousness, or febrile seizures to the well being care provider. Continued fever may be a sign of worsening an infection, opposed drug effects, or antibiotic resistance.

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Compare and contrast the loop gastritis gluten order genuine nexium on line, thiazide gastritis gallbladder cheap nexium 20 mg fast delivery, potassium-sparing gastritis surgery nexium 40mg low price, osmotic gastritis diet 8 month buy nexium 20 mg, and carbonic anhydrase inhibitor diuretics. Failure of the kidneys to modify to changing inside conditions of the body may end in dire penalties, and pharmacotherapy is often used to appropriate these imbalances. This chapter examines diuretics, brokers that increase urine output, and different medicine used to treat sufferers with renal dysfunction. Approximately 10,500 of those patients receive organs from deceased donors, and 6,000 obtain organs from dwelling donors. Although this is actually true, the kidneys have many other essential homeostatic capabilities. The kidneys are the primary organs for regulating fluid steadiness, electrolyte composition, and the pH of body fluids. They additionally secrete the enzyme renin, which helps to regulate blood strain (see Chapter 34), and erythropoietin, a hormone that stimulates red blood cell manufacturing (see Chapter 42). In addition, the kidneys are responsible for the manufacturing of calcitriol, the lively form of vitamin D, which helps keep bone homeostasis (see Chapter 75). The urinary system consists of two kidneys, two ureters, one urinary bladder, and a urethra. Blood enters the kidneys via the large renal arteries, bringing 25% of the whole cardiac output to the kidneys every minute. After a collection of branches, blood enters the nephrons, the functional units of the kidney. Once within the nephron, the artery types the glomerulus, a specialised capillary containing pores. Plasma proteins and the formed elements of the blood-the erythrocytes, leukocytes, and platelets-are too large to move via the pores of the glomerulus and thus continue circulating via the bloodstream. Water and other small molecules in plasma, nevertheless, readily pass by way of the glomerular pores and enter the next section of the nephron. Essentially, the preliminary composition of filtrate could additionally be considered plasma minus proteins. The proximal and distal tubules are twisted and extremely convoluted, which tremendously increases the length of the nephron, allowing for enhanced processing of drugs within the filtrate. The filtrate eventually reaches frequent amassing ducts, which empty into more and more larger collecting structures contained in the kidney. Fluid leaving the collecting ducts and getting into subsequent parts of the kidney is identified as urine. Many medication are small enough to cross by way of the glomerulus and enter the filtrate. If the drug is certain to plasma proteins, however, will in all probability be too large and will continue circulating within the blood. The look of extra plasma proteins in urine (proteinuria or albuminuria) is an indication of kidney pathology. For example, during glomerulonephritis the glomeruli turn out to be infected and the size of the pores increases, permitting larger substances such as proteins to enter the filtrate. Some substances within the filtrate cross the tubule partitions to reenter the blood; this process is named tubular reabsorption. Over 65% of the filtered sodium is reabsorbed in the proximal tubule, and 25% in the loop of Henle. Glucose, amino acids, and important ions similar to chloride, calcium, and bicarbonate are additionally reabsorbed. This is essential to pharmacology as a end result of many medicine both improve or block the effects of hormones on tubular processes. Aldosterone, for instance, exerts a serious effect on the tubule by stimulating sodium reabsorption in the distal portions of the nephron. Under the affect of aldosterone, potassium excretion is elevated as a result of this ion is "exchanged" for sodium ions, that are reabsorbed.

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Ethosuximide (Zarontin) has been ordered and the nurse is instructing the client and family concerning the drug gastritis green tea nexium 40mg sale. The nurse is caring for a 42-year old shopper who was lately recognized with partial seizures and has been prescribed oxcarbazepine (Trileptal) gastritis diet 50 discount nexium 20mg visa. Serum sodium and renal perform studies An 80-year-old consumer is prescribed carbamazepine (Tegretol) for a newly diagnosed seizure dysfunction gastritis definition symptoms purchase nexium 40 mg overnight delivery. The nurse will implement safety measures as a outcome of this consumer is at an increased risk for which adverse results with the administration of this drug Sedation and falls A 23-year-old consumer has been taking gabapentin (Neurontin) for management of partial seizures gastritis zoloft purchase nexium 40 mg free shipping. He is admitted to the emergency department with slurred speech, dyspnea, reviews of double vision, and sedation. Continued to smoke regardless of prior shopper education that smoking interacts with the drug. Considering these findings, the nurse would suspect that the dose of the drug ought to be: 1. Carbamazepine (Tegretol) has been prescribed for a 24-year-old consumer for the management of partial seizures. How would you reply to the next questions from Matt about this new medication Demographic and historical backgrounds of the elderly with nonepileptic seizures: A comparative research. Utilization and costs of antiepileptic medication in the aged: Still an unsolved problem. Compare and distinction the etiology and pathophysiology of muscle spasm and muscle spasticity. Compare and contrast the actions of the centrally appearing and direct-acting skeletal muscle relaxants. Apply the nursing course of to look after sufferers receiving pharmacotherapy for muscle spasms and spasticity. The search for new medimuscle spasticity, 403 cations to chill out muscle tissue and relieve painful muscle spasms and spasticity tonic spasm, 398 continues at present. This chapter examines how these drugs produce their actions and their applications to the pharmacotherapy of muscle circumstances. A single, extended contraction is a tonic spasm; a quantity of, rapidly repeated contractions are known as clonic spasms or clonus. The etiology of muscle spasms may involve many body systems, including the nervous, musculoskeletal, endocrine, and cardiorespiratory systems. The commonest etiology of muscle spasm is damage to a skeletal muscle: Spasms often happen when a muscle is overused or subjected to trauma. Electrolyte imbalances, hypocalcemia, and dehydration can also cause muscles to spasm. Although each could occur in the same affected person, therapies methods differ considerably. Muscle spasms are involuntary contractions of muscular tissues which might be usually localized to a specific muscle group. As the muscles contract and tighten, the spasm causes sudden, intense pain, which slowly diminishes after a few minutes. A mixture of drug therapy and alternative therapies is usually the best remedy. Treating Spastic Cerebral Palsy in Children with Intrathecal Baclofen Clinical Question Can youngsters with cerebral palsy with spasticity be safely and successfully treated with intrathecal baclofen Nurses may also help educate school staff and nurses on the use and care of the pump and the monitoring required for antagonistic results. Considering the method of delivery (intrathecal), what other features of care should the nurse be concerned about Nonpharmacologic interventions that might be ordered by the health care provider or physical therapist embrace the applying of heat or chilly, hydrotherapy, therapeutic ultrasound, assisted train, massage, traction, and manipulation. The software of warmth or chilly to the affected site will reduce or relieve the muscle spasm and ache. A source of warmth applied to the area will work finest to reduce cramping and relieve localized pain. The software of cold to the location has the power to gradual the transmission of pain impulses and is more practical for pain aid than heat.