00:01
Okay, so if I have this myasthenia gravis,
what are my options for treatment?
Well, one is a thymectomy.
00:07
Now why would we do that?
We remember some patients
with myasthenia gravis,
they've got some things going on
with that thymus gland.
00:15
And if they consider removing
that thymus gland,
it can reduce their symptoms
and may cure some people.
00:21
It may kind of a rebalance
to the immune system.
00:24
But we've got some studies that found
that a thymectomy
is beneficial both for people
with thymoma
and people who don't have tumors.
00:31
So you may see a patient
that has a known thymoma
or one that doesn't,
and the decision will be made
to remove their thymus gland.
00:39
So that's why we included it here
as an option for treatment.
00:42
So a thymectomy--
Oh, cool, there's more
medical terminology for you.
00:47
"ectomy" means removal, right?
"Hysterectomy" is "ectomy"
removing the "hustera", the uterus.
00:55
This is an "ectomy" removing
the thymus gland.
00:59
Now we can also use
some anticholinesterase medications.
01:04
Okay, "anti" means against.
01:07
"Cholinesterase..."
Oh, cool.
01:10
Okay, so A-S-E
means an enzyme.
01:13
Enzymes' jobs are to break things down.
01:16
So, if I get medication
that is "anti," against,
the enzyme breaking down,
what's in the middle?
Yeah, choline.
01:25
So these are medications that will help
more acetylcholine be available
because they will block those enzymes
that typically break it down.
01:36
The idea is if I have
more acetylcholine at the junction,
then I'll have better use
of the skeletal muscles.
01:42
Immunosuppressive drugs.
01:44
Now before you read our words,
what would make sense?
What do you know
about myasthenia gravis?
How would an immunosuppressive drug work?
Well, since it's an autoimmune disorder,
the body turning on itself,
the immunosuppressive drugs
will help deal with that.
02:01
They help suppress the production
of abnormal antibodies.
02:04
So, we can look
at prednisone, azathioprine,
a whole list of medications
that might help this patient.
02:10
but keep in mind,
there's a price for these drugs,
and I'm not talking about money.
02:15
Any time you suppress
the immune system,
we don't just suppress the part
that deals with myasthenia gravis,
it suppresses
their whole immune system.
02:24
It also gives you
the side effects of the steroids.
02:28
So, you're going to have to work
with your patient to educate them,
what side effects to look for,
and also so they're aware
that there's going to be
some changes in your body
depending on how much
of the steroid the patient has to take.
02:40
They're also going to be
at a risk for infection
because we're suppressing
their immune system.
02:46
These patients
are going to be really at risk
for developing immune problems
when they're exposed to people,
like the flu, like the cold,
because they don't have an immune system
to fight those off
if we're suppressing it,
trying to deal
with their myasthenia gravis.
03:01
Now you can also do plasmapheresis
or some IV immunoglobulin.
03:06
Well, that's pretty cool.
03:08
But we just use these
in severe cases of myasthenia gravis.
03:12
So, if they have these antibodies
in their blood,
the plasmapheresis
will help us filter those out.
03:19
So plasmapheresis will help remove
those destructive antibodies,
but it only lasts
for a few weeks to months.
03:26
So, it's something that would have
to be repeated.
03:28
But keep in mind, we just use these
for more severe cases.
03:32
Now in plasmapheresis,
they use a machine,
they take your blood out,
they filter it,
kind of think of it that way
to try to get rid
of the harmful antibodies,
and replace the good plasma
or use a plasma substitute.
03:43
IV immunoglobulin are like
a highly-concentrated injection
of antibodies.
03:48
So they've taken multiple donors,
pooled their healthy antibodies,
and then they put them into a receiver,
a patient who has myasthenia gravis.
03:57
So, this will temporarily change
the way the immune system operates.
04:01
So it'd be great if we found
a permanent solution,
but the IV immunoglobulins
are also a temporary solution.
04:08
So we've got plasmapheresis
which will take the blood out,
filter it, get those nasty antibodies out,
and put the plasma back in,
or use a plasma replacement,
and we have IV immunoglobulin.
04:20
So we've taken
the really good antibodies
from lots and lots of donors,
and we've compacted them together,
concentrated them together,
and we'll inject them
into a patient with myasthenia gravis
who has pretty serious symptoms.
04:32
Both are temporary.