MitoAction provides support for individuals and families affected by mitochondrial disease. Their vision is to create a worldwide community for mitochondrial disease patients. Mitochondrial disease is caused by failures of the mitochondria, which act as the cell's powerhouse. Symptoms can vary widely and affect multiple body systems. Management of mitochondrial disease focuses on treating symptoms, managing energy levels, addressing nutritional needs, and preventing triggers. Comprehensive care involves monitoring for complications and coordinating with multiple medical specialists.
A presentation prepared for my psychiatry residency class discussing the molecular biology and clinical presentation of MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS).
A presentation prepared for my psychiatry residency class discussing the molecular biology and clinical presentation of MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS).
Western blotting (protein immunoblotting) is an analytical technique used to identify and locate specific proteins in a sample of tissue homogenate or extract, based on their ability to bind to specific antibodies.
Social Security Disability Insurance (SSDI) and Supplemental Security Income ...mitoaction
Please join us on Friday, August 7, 2015 as we welcome two experts in the field of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) provide an overview of these public benefits for Mito patients. Topics to be covered in this conference call include:
Overview of SSI and SSDI programs;
The differences between SSI and SSDI;
Social Security’s definition of disability as it pertains to mitochondrial disease;
How SSDI is designed to work, eligibility criteria, and the full range of SSDI benefitts;
The application and appeals processes for SSI and SSDI;
Resources available to support SSI and SSDI applications and appeals processes;
Information on SSI and SSDI benefits for adult disabled children;
Returning to work after obtaining social security benefits (the "Ticket to Work Program");
Specific challenges for individuals with mitochondrial disease in applying for SSDI and how to address them; and
The benefits of professional representation and how to evaluate representation options.
Western blotting (protein immunoblotting) is an analytical technique used to identify and locate specific proteins in a sample of tissue homogenate or extract, based on their ability to bind to specific antibodies.
Social Security Disability Insurance (SSDI) and Supplemental Security Income ...mitoaction
Please join us on Friday, August 7, 2015 as we welcome two experts in the field of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) provide an overview of these public benefits for Mito patients. Topics to be covered in this conference call include:
Overview of SSI and SSDI programs;
The differences between SSI and SSDI;
Social Security’s definition of disability as it pertains to mitochondrial disease;
How SSDI is designed to work, eligibility criteria, and the full range of SSDI benefitts;
The application and appeals processes for SSI and SSDI;
Resources available to support SSI and SSDI applications and appeals processes;
Information on SSI and SSDI benefits for adult disabled children;
Returning to work after obtaining social security benefits (the "Ticket to Work Program");
Specific challenges for individuals with mitochondrial disease in applying for SSDI and how to address them; and
The benefits of professional representation and how to evaluate representation options.
Diagnostic Testing for Mitochondrial Diseasemitoaction
Review traditional diagnostic pathways
Discuss newer testing that has become available in recent years
Review new approaches to attempt to shorten time to diagnosis and increase precision
Exercise and nutrition in Mitochondrial Diseasemitoaction
Mark Tarnopolsky, MD, PhD, FRCP,
Depts. of Pediatrics (Neuromuscular + Neurometabolic Disease) and Medicine (Cell Biology/Metabolism, Neurology and Rehabilitation), McMaster University, Hamilton, CANADA
The procedure is called as "three-parent" in vitro fertilization because the babies, born from genetically modified embryos, would have DNA from a mother, a father and from a healthier female donor to prevent some serious incurable diseases passing on.
About us: FertilityConsultants.ca is people choice of consulting firm International Surrogacy in Canada which is fully devoted in helping couples who are having difficulty in trying to conceive.
Three parent babies will be reality soon happy hoHappy HO
While the method has raised a number of ethical concerns, the latest study published in the journal Nature, suggests there should be no worries about its technical feasibility nor about the risks for embryos safety.Happyho
Audio and slides for this presentation are available on YouTube: http://youtu.be/Tt8WlPsohCU
Fatigue is a common side effect of cancer treatment. Fatigue from treatment can make everyday tasks and activities difficult to complete or enjoy. Join Jean Boucher, RN, an Oncology Nurse and Clinical Inquiry Specialist from the Nursing Department at Dana-Farber Cancer Institute, and discover how to manage cancer fatigue, improve sleep, mood, and nutrition habits, and boost energy levels.
Geriatric Dentistry with Nutrition in Geriatrics...Prosthodontics and Geriatrics...Management of Geriatric Patients in Prosthodontics...Full prepared seminar.. Have a look :)
Maintenance of Wellness by Dr. Kenneth DickieKenneth Dickie
Dr. Kenneth Dickie from Royal Centre of Plastic Surgery in Barrie, Ontario explained Age Management. He discussed the signs and symptoms of aging, dementia, metabolic syndrome, diet and more.
If you have any questions, please contact Dr. Kenneth Dickie at http://royalcentreofplasticsurgery.com/
Ethical issues in medicine and research:Special reference to IndiaJishnu Lalu
A detailed discussion on Ethical consideration concerning physician, patient, co-workers and research. It also discusses publication ethics and Ethics in India
Similar to Day-to-Day Management of Mitochondrial Disease (20)
-What are Standards of Care and why does the Mito community need such standards?
-Review the MMS's Standards of Care for Mitochondrial Disease and how they were developed.
-Outline upcoming MMS projects.
What you should know about genetic testing for mitochondrial disordersmitoaction
Amanda Balog, CGC, Senior Genetic Counselor, Mitochondrial and Metabolic Genetics, of GeneDx discusses: "What You Should Know About Genetic Testing for Mitochondrial Disorders."
Richard Frye, MD, PhD, FAAP, FAAN, CPI, will discuss:
*The enteric (gut) microbiome has an important influence on health and disease states in humans.
* The enteric microbiome influences the human host using chemical mediators, some of which can directly affect mitochondrial function
* Short chain fatty acids produced by gut bacteria not only modulate mitochondrial function and cellular regulatory pathways, but can also be used as mitochondrial fuels.
How to Build Your Mitochondrial Medical Homemitoaction
Topics include:
The importance of a medical home for a mitochondrial disease patient.
Definition of a medical home.
How to establish a medical home.
Why a medical home is an important component of good patient advocacy.
Tips on maintaining a healthy medical home relationship.
Wees will describe theses issues primarily from a pediatric perspective, but she will give adult examples as well.
Wees is a patient advocate with Empowered Medical Advocacy. She assists parents and caregivers each week in navigating toward improved quality of life for their child and their families.
Mitochondrial Medicine Society MitoAction Updates 4.1.16mitoaction
Areas of discussion include: Transplantation in Mito patients, Stroke protocol for MELAS, Standards of care for Mito patients, Centers of Excellence and the need for community involvement/input (v2 slides)
Incapacity Planning and Guardianship 2016mitoaction
As patients or caregivers, it is frightening to think about what would happen if we could not advocate for ourselves. Fortunately, there are legal documents that can be used to communicate our wishes under such circumstances. This type of legal preparation is called incapacity planning and guardianship.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. MitoAction’s vision is to create a
community of support that reaches
every child, adult, and caregiver
affected by a mitochondrial
disease.
3. While helping families living today with
mitochondrial disease, we strive
3
• To improve quality of life for adults and children affected by
mitochondrial disease.
• To raise awareness internationally about mitochondrial disorders
and their relationships to other diseases.
• To provide specific and practical materials that help patients to
manage their symptoms.
• To aggregate and connect the international mitochondrial disease
community and to engage the pharmaceutical industry working
toward therapeutic approaches to mitochondrial disorders.
• To create tools that empower patients and caregivers to be
advocates for themselves or their children.
5. •
Mitochondria, tiny organelles within the cell -- the powerhouse
of the cell -- create 90% of cellular energy.
• Mitochondrial failure causes cell injury that leads to
cell death. When multiple cells die within an organ,
symptoms of organ failure arise.
www.bbc.com
5
7. Symptoms are variable!
7
• Multi-system symptoms typically involve three
or more body systems which may appear
unrelated or without identifiable cause.
• Body functions and organ systems that are high
demand are impacted most significantly: brain
and nerves, GI, eyes, ears, liver, heart,
pancreas, kidneys, and muscles.
8. Red Flag Symptoms
8
• Non-vascular stroke-like lesions, neurodegeneration,
ataxia, MRI findings consistent with Leigh's disease
Hypertrophic cardiomyopathy, unexplained heart block in
a child, cardiomyopathy with lactic acidosis
Retinal degeneration with night blindness, ptosis
Severe GI dysmotility, unexplained or valproate-induced
liver failure
Rhabdomyolysis, FTT, hypersensitive to general
anesthesia, exercise intolerance not in proportion to
weakness
•
•
•
•
Described in detail on Mitochondrial Medicine
Society website (www.mitosoc.org)
9. Associated Symptoms
9
• Hypotonia, intractable epilepsy, hearing loss
• Tachycardia, including postural
• Optic nerve hypoplasia, pigmentary retinopathy
• CVS, chronic, unexplained constipation or
diarrhea
• Hypothyroidism, hypoparathyroidism
10. •
10
Renal tubular dysfunction, aminoaciduria,
nephrotic syndrome
• Basal ganglia lesions, CNS atrophy
• History of SIDS, multigenerational maternal
inheritance patterned migraines, depression, or
anxiety
• Go to www.mitosoc.org for a full list
11. Diagnostic Process
• Mito is difficult to diagnosis for many and may
take many years, especially for the adult patient.
• Ruling OUT other more common diseases takes
time.
• Negative tests have a high false-negative rate,
which adds to confusion!
11
12. Keep in Mind
12
•The classification system for mitochondrial disease is
incomplete and not clinically oriented.
•The abnormality can vary from tissue to tissue within
the same person, and perhaps within the same organ
as well.
•There is no consistent diagnostic abnormality for all
patients with mitochondrial disease (Haas, 2007).
13. •
13
Metabolic screening of blood and urine
• Metabolic screening of CSF if
neurological symptoms
• Evaluating systemic or
organ involvement
• Genetic studies if above points to Mito
Testing typically includes:
14. Mito Specialists
14
• More are needed across the USA and beyond
• Difficult to get initial appointment because of
demand
• Primary care is needed to forge a path to diagnosis
• MitoAction -- http://www.mitoaction.org/doctors
• MMS Interactive map -- http://www.mitosoc.org/clinics/
15. Referral Process
15
• Establish a working relationship with
medical team: primary, neurologist,
ophthalmologist, and/or any area where
symptoms are of concern and not explained by
other causes.
• Primary care doctors can order many of the initial
tests required to begin the diagnostic process.
• Medical evidence consistent with a mitochondrial
issue strengthens a referral to a specialist.
16. FirstAppointment!
• Tool Kit http://www.mitoaction.org/mito-navigator-toolkit-
overview
• Communication
• Medical Records
• Support
16
17. Social Media
Guidelines
PCP Interaction
Medical Home
Medical Professionals
Record keeping
for Improved
Communication
Sharing Research
Findings
Becoming a
Great Advocate
17
Ge t More f rom
Ever y Appointment
Communication Resources
www.mitoaction.org
18. Records
18
• Obtain copies of medical records -- part or whole
• PCP as keeper of full records -- Medical Home
• Emergency Protocol letters
20. Symptom Management
20
• The treatment of Mito includes treating each body
system with dysfunction, even with Mito as the
underlying cause.
• Many Mito patients, therefore, see multiple
specialists, making effective communication
vital.
• Nutrition, hydration, energy management and the
Mito cocktail are the cornerstones to management.
21. Dysautonomia
21
Disorder of the Autonomic Nervous System
• POTS
Temperature dysregulation
Cardiac, GI, nervous, respiratory system and
more
•
•
22. POTS
22
Can severely impact life!
Types -- Partial, Hyperadrenergic, & Secondary
Highly recommend watching Dr. Blair Grubbs’
podcasts and reading his publications.
23. Under supervision of a physician:
23
• Reconditioning program -- 20-30 minutes
of aerobic exercise three times per week
• Resistance training of lower extremities
“LOW AND SLOW!”
Use PT or cardiopulmonary rehab for support
Exercise!
Grubb, B., Journal of Cardiovascular Electrophysiology, 2006
24. Under supervision of a physician:
24
• Fluids -- 2-3 L+ a day. Gatorade and milk preferred.
• Salt (3,000-10,000 mg daily) in pill form, salty snacks,
or added to food
• Compression stockings (30-40 mmHg pressure, waist
high)
• Raise HOB
• Avoid substances and situations that worsen
symptoms (dehydration, extreme heat, prolonged
sitting and standing, alcohol, caffeine)
http://www.dysautonomiainternational.org/
26. Heat Intolerance
May be associated with inability to sweat, elevated body
temperature, red or mottled skin, dramatic loss of
stamina and/or muscle tone.
26
•
•
•
•
•
•
Hydrate -- begin before going out!
Cooling vests
Light, breathable layers of clothing
Baggies with wet wash cloths
Avoid being outside at hottest times of the day
Plan ahead -- shade, fans, water to cool off
27. Cold Intolerance
27
Exposure to cold temperature can cause muscle pain and
fatigue as the muscles work harder to generate heat.
• Layers of clothing, especially wool
Be aware of malls, hotels, conference, offices, and
restaurants with A/C
Hand and foot warmers, seat warmers, electric blanket
and mattress pads
Warm car before heading out
Consume hot foods and drinks
Plan ahead with extra clothing (damp/wet clothes)
•
•
•
•
•
28. Protocols
MitoAction has printable protocols and strategies
developed by Dr. Mark Korsen and Maggie Orr, RN,
including:
28
• Fever and Infection
• Vomiting
• School
• Anesthesia, procedures and surgery
http://www.mitoaction.org/protocol
29. Nausea, Vomiting, Diarrhea,
Constipation, GI Pain,Anorexia
29
Mitochondrial function and energy production are dependent upon good
nutrition and hydration. Fasting can cause critical energy shortages in a child
or adult with Mito. A team approach is vital to maintain hydration and nutrition.
• Small, frequent meals of easy to digest food/drinks
• GT or JT feeding when needed: TPN when oral feeds fail to maintain weight
• Overnight feeds may be especially beneficial
• Zorfran and Benadryl for nausea
• Stool softeners, laxatives and extra fluids for constipation
• Abdominal pain may be treated by combination of medications such as
amitriptyline and prokinetics to improve motility
30. Vomiting and Diarrhea
30
Gut may not be able to tolerate much for 12-24 hours after
virus and may takes weeks or months to fully recover. Use
IV support if needed.
• Begin small! 1 tsp of clear liquid every 30 minutes
and progress slowly if tolerated.
• BRAT diet when tolerated
• Balance high-calorie foods with digestible foods
• Treat underlying causes aggressively. Germ avoidance!
Protocol: http://www.mitoaction.org/files/protocol-vomiting.pdf
31. Fever
Fever dramatically increases the body’s energy
demand, which can be associated with lethargy,
regression, weakness, and metabolic crises.
31
Fever should be treated aggressively with fluids
and medications (ibuprofen and acetaminophen).
Have a plan in place of when to call Primary,
what actions to take, and when to go to ER.
Protocol: http://www.mitoaction.org/files/protocol-
fever-and-infection.pdf
32. Pain, Fatigue, Weakness
32
• Pain -- one of the greatest challenges as pain
consumes physical and emotional energy
• Chronic pain is difficult to treat effectively
• Pain often leads to depression, anxiety, and feelings of
hopelessness, especially when ignored by family and
medical team
• Migraines, abdominal, muscle, & nerve pain are common
• When pain is controlled, other symptoms are easier to
manage
33. Migraines
33
• Avoid triggers -- Sleep, timing of meals, infection,
exhaustion, dehydration, hormone fluctuations.
• Keep headache, food, sleep, and general trigger
logs to find potential triggers!
• Have a plan for acute pain relief.
• Hydration, nutrition, rest, and exercise are key!
34. Nerve Pain
34
Neuropathy -- ranges from tingling to deep,
burning, aching pain, or stabbing shocks.
Numbness can occur.
• May be helped by Mito supplements, namely
ALA, CoQ10, and Carnitine
• PT, hydration, and Neurotin (gabapentin) are
frequently prescribed
35. Muscle Pain
35
Deep aching pain, especially in arms, legs and back that tends to
be worse when lactic acid levels are high.
• Pain management should be a priority. Keep a pain/trigger log.
• Medications, including Marinol, may be needed to stay ahead of
the pain.
• PT, OT, exercise, yoga
• Accupressure, chiropractic measures, relaxation techniques
• Palliative care, focus on quality of life, and pain centers offer
big picture approaches to pain.
36. Myopathy
36
• Includes weakness, low stamina, “floppy,” low
tone, pain, exercise intolerance
• Adhere to plans for hydration and nutrition
• Carnitine, creatine, and CoQ10
• Build rest periods into day -- respect limits
• Exercise -- Builds better mitochondria
37. Seizures & Stroke-Like Events
37
Literature suggests that over 60% of Mito patients
have seizures or will develop seizures. Many
children have difficult to manage seizures.
• Again -- log to uncover triggers -- hypoglycemia,
fatigue, stress, hydration
• Ketogenic Diet under direct medical care
• Meds often vital -- although avoid valproic acid
38. Stoke-like episodes (SLE) – cardinal feature in
lactic acidosis, encephalomyopathy, and MELAS.
SLE is not a true vascular stroke, but considered to
be a metabolic stroke.
38
• Can look like vascular strokes with aphasia,
hemiparesis, and facial weakness.
• Acute in onset, often transient/reversible, and
occasionally associated with a febrile illness.
• Vastly different medical histories than typical
stroke patients.
39. (JAMA Neurology, 2016).
“Although much information is still needed regarding the
appropriate dosage and timing of arginine therapy in
patients with MELAS, urgent administration of nitric
oxide precursors in patients with MELAS ameliorates
the clinical symptoms of stoke-like episodes.”
www.ncbi.nlm.nih.gov/pubmed/26954033
(JAMA Neurology, 2016)
39
MitoAction summary of MMS full update: http://www.mitoaction.org/blog/mitochondrial-medicine-society-
update-2016
MMS Consensus Protocol - SLE
40. MMS Protocol
IV Arginine -- 0.5 gm/kg/day for 3-5 days while
patient has symptoms
Maintenance -- PO Arginine 0.3 gm/kg/day
40
41. Depression & Anxiety
41
• The human brain uses 23% of a body’s daily energy
-- the biggest energy demand of all!
• Mito causes disregulation of the cells’ ability to make
energy, causing symptoms throughout the body.
• Dysregulation in the brain causes depression,
anxiety and other issues.
• Approximately 80% of patients with Mito experience
anxiety and/or depression.
• Coping with chronic illness is also tied to depression.
42. Reality for Many
42
• Psych symptoms are overlooked due to medical
crises, therefore little help or support is offered.
• Body and mind are not viewed as interactive
parts of whole body.
• Psych symptoms are viewed as hypochondria,
overreacting, somatoform, or Munchausen
Syndrome.
• Bottom line -- patients suffer and QOL is
impacted.
43. • Cognitive Behavior Therapy
• Medications -- and doses may not be
typical (think outside the box!)
• Mito cocktail -- especially B vitamins, creatine
and CoQ10
• Exercise, yoga, stress management
43
44. Puberty
•
•
•
•
Metabolic stress of puberty onset
Added energy demands of growth
Changes in hormones
Change in sleep patterns
For some teens, add:
•
•
•
•
•
Social changes
School pressures
More losses
Unique differences compared with peers
Increased awareness of their future
44
www.zits.com
45. Puberty Brings
• Increase in severity of symptoms/new symptoms
• Increase in autonomic system symptoms
• Menstruation
• Depression, anxiety, irritability, mood swings
• Non-compliance with treatment
• Desire for independence
www.zits.com
45
46. Hints
46
• Puberty is hard on the parent, too -- find support.
• Teens need MORE support during this time -- emotionally and physically.
• Shortened school day, fewer classes, home instruction, extended year,
online classes
• Technology aids to save energy (voice to type)
• Support for school stress and life stress
• Extra set of books, IEP, 504 plans
• Hobbies are vital!
• Be available to listen, guide, and adapt current plans.
• Throw away time frames -- Let school and life happen at its own pace.
• Be mindful of the pros and cons of social media.
47. Doggie Bag*
(*take-home points)
• Plan ahead for everything to save time and energy in the long
run!
• Consistency matters -- rest, fluids, nutrition, exercise, meds.
• Avoid all triggers, including germs.
• Remember to breathe and LIVE life (focus on the important
things that bring joy to your day and take a break from Mito!).
• Protocols can help take the pressure off the family.
• Seek support -- setback are likely and the losses are real.
• Continue to raise Mito awareness -- become an advocate!
47
48. Thank you to all for listening today, for your ongoing
support, and for sharing your stories with our Mito
community.
48