Archives

The key to living with Crohn’s Disease, a chronic condition for which there is no cure, is to manage symptoms and slow the progression of the disease by identifying the best treatment plan for you. Here we explain your options:

What is Crohn’s Disease?

First, what is Crohn’s disease? According to the Crohn’s & Colitis Foundation, Crohn’s is a chronic inflammatory condition of the gastrointestinal tract and is one of the Inflammatory Bowel Diseases (IBD). Unfortunately, IBD affects an estimated 3 million Americans, and equally affects men and women. While the disease can occur at any age, often it is diagnosed in adolescents and adults between the ages of 20-30.

Treatment for Crohn’s must include a complete approach, incorporating medication, dietary and lifestyle changes. Here are several options that will help you best manage your condition.

Medication

The Crohn’s & Colitis Foundation suggests a medication regimen designed to treat Crohn’s disease by suppressing your immune system’s abnormal inflammatory response. This is what triggers your symptoms. Medication can offer relief from common symptoms like fever, diarrhea, and pain but it can also allow intestinal tissue to heal. Additionally, medication typically decreases the frequency of flare ups. This means that through proper treatment over time, which can often include a combination of therapies, periods of remission from Crohn’s symptoms can be extended while symptom flare ups will decrease.

Combination Therapy

Often, your treatment plan will include combination therapy. With Crohn’s, it’s common for a specialist to prescribe a biologic and an immunomodulator. While combination therapy can increase the effectiveness of IBD treatment, it also can increase the risks of additional side effects and toxicity.

Diet

It’s important to note what your individual trigger foods are—and avoid them. As discussed in our “How to Have a Crohn’s-friendly Holiday” blog, here are some general guidelines for minimizing triggers at mealtime:

• Limit your intake of greasy foods
• Decrease your fiber consumption
• Keep dairy intake to a minimum
• Avoid nuts and sweets
• Eat smaller meals more frequently
• Stay hydrated and drink lots of water
• If you drink alcohol, drink in moderation
• Make sure vegetables are cooked through to make them more easily digestible
• Limit spices

Remember, Crohn’s disease often reduces your appetite while increasing your body’s energy needs, so maintaining a healthy diet is highly recommended. Because one of the common Crohn’s symptoms is diarrhea, your body can have a reduced ability to absorb protein, fat, carbohydrates, and other key nutrients and minerals that your body needs.

Surgery

As many as 18 percent of people with Crohn’s disease will require surgery at some point during their lives. Surgery is still not a cure for Crohn’s; however, it can conserve portions of the GI tract, allowing for the best quality of life possible. If your medication and/or diet modifications no longer control your symptoms, or if you develop a fistula, fissure, or intestinal obstruction, surgery may be required. During surgery, the diseased segment of bowel is removed (resection). Then, the two remaining ends of the healthy bowel are joined together, also known as anastomosis. Again, this doesn’t cure Crohn’s. You may experience many years without flare ups, although Crohn’s frequently recurs again later in life.

Additional Help for Mental Health

Unfortunately, people living with chronic illnesses often suffer from mental health issues as a result. According to the Cleveland Clinic, “up to one-third of individuals with a serious medical condition have symptoms of depression.” Therefore, it’s highly recommended you find a way to find peace with your new journey. Here we explain how you can cope with your chronic illness.

Living with Crohn’s requires an individualized treatment plan that often includes medication, diet and lifestyle changes, and mental health care. Specialty Infusion Centers collaborates with your specialist to provide infusion therapy for Crohn’s based on your predetermined treatment plan. Our centers offer private suites, amenities, and flexible evening and weekend appointments. All you have to focus on is feeling better! Reach us to learn more or get started today

Psoriatic arthritis is caused by an immune reaction that affects your joints and skin. The actual cause of psoriatic arthritis is unknown, but medical experts believe it’s caused by a combination of environmental factors and genetics. Understanding this chronic illness is important in determining the best course of treatment for alleviating all the symptoms associated.

The Difference Between Psoriatic Arthritis and Psoriasis

Psoriatic arthritis (PsA) is a chronic illness where the swollen, sore joints of arthritis are typically combined with the skin condition psoriasis. Psoriasis can start at any age and typically causes itchy, scaly red patches on your skin and scalp.

How Many People Suffer from PsA?

More than 7.5 million Americans have psoriasis, and 30 percent of these people will develop psoriatic arthritis. PsA can start at any age and can also affect children. However, it commonly appears between the ages of 30-50, and typically 10 years after someone develops psoriasis. But there are instances where someone is diagnosed with PsA without ever developing or experiencing psoriasis of the skin.

What are the Symptoms of PsA?

PsA may develop slowly, with mild symptoms. In other cases, it can appear quickly and severely. In some instances, people develop PsA in a joint after an injury. Additionally, scientists estimate that at least 10 percent of the general population inherits one or more of the genes that creates a predisposition to psoriasis.

According to the National Psoriasis Foundation, the most common symptoms of PsA include:

• Fatigue
• Tenderness, pain and swelling over tendons
• Swollen fingers and toes that sometimes resemble sausages
• Stiffness, pain, throbbing, swelling and tenderness in one or more joints
• Reduced range of motion
• Morning stiffness and tiredness
• Nail changes, such as pitting or separation from the nail bed
• Redness and pain of the eye

Remember, there is little correlation between psoriasis and PsA severity. While you may have only a few skin lesions, many of your joints can be affected by arthritis.

Types of PsA

There are several different types of PsA:

• Symmetric arthritis. Typically, this is when the same joints on both sides of the body are affected. For example, the right and left knees can experience PsA symptoms. It is similar to rheumatoid arthritis, but it’s often milder and usually affects five or more joints on both sides of your body.
• Asymmetric arthritis. Often, this affects the fingers and toes first, and gives them an enlarged and sausage-like appearance. However, it won’t necessarily affect the same joints on both sides of the body, and it often only affects less than five joints.
• Distal interphalangeal (DIP) predominant. This type of PsA affects the joints in the fingers and toes closest to the nail. Because of this, nail changes are a common symptom.
• Spondylitis. Spondylitis PsA causes people with this disease to have stiffness in the neck, lower back, or spinal vertebrae. Often, this makes those who suffer from spondylitis PsA have difficult, painful motions.
• Arthritis mutilans. Finally, this form of PsA affects the small joints at the ends of the hands and feet. Sadly, this is a very severe form, and it causes deformity.

How is Psoriatic Arthritis Treated?

Unfortunately, there is no cure for PsA. However, there are treatment options that help alleviate symptoms that include both the joint pain of PsA and also the skin condition. Your specialists (usually Dermatologists and Rheumatologists) will recommend a “treat to target” approach, so your treatment plan is based on collaboration and your individual condition. This allows your doctors to determine how to measure progress and allow you to select treatments that specifically focus on your personal goals. There are a variety of medications and therapies that have proven successful in managing symptoms for the varied levels of this condition:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) – over-the-counter medications
2. Disease-modifying antirheumatic drugs (DMARDs) – administered orally or via injection or infusion
3. Biologics – administered via injection or infusion
4. Steroids – typically injected into the affected joint(s)
5. Immunosuppressants – not used as commonly since the introduction of biologics
6. Topical treatment – cream, gel, lotion, or ointment can be prescribed or purchased over-the-counter
7. Light therapy and other PsA medications – specific medication injected under the skin followed by exposure to bright light treats psoriasis skin rashes

How We Can Help

At Specialty Infusion Centers, we believe understanding psoriatic arthritis and how it affects you is a critical part of your treatment plan. We specialize in the management of chronic conditions and fully collaborate with you, your insurance carrier, and your physician to provide a highly personalized care plan. Our centers are 5-star rated and offer private suites, amenities, and convenient evening and weekend appointments.

For more information, contact your specialist or reach us to get started today.

Did you know 1 in 2 women in the US over 50 will experience an osteoporosis-related fracture in her lifetime?  Here’s what you need to know about treatment with Evenity® should you be diagnosed.    

What is Evenity®?

Evenity® is the brand name for romosozumab-aqqg, a drug often used in the treatment of osteoporosis. Evenity® is an anabolic treatment that’s unique in the sense that it is the first and only osteoporosis medication that works in 2 ways; to both build new bone, and to a lesser extent, slows down bone loss at the same time.

On April 9, 2019, Amgen received FDA approval for Evenity® for the treatment of osteoporosis in postmenopausal women at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy.

How it Works

So, how does Evenity® work? It works with the body’s natural ability to increase bone formation and, to a lesser extent, decrease bone resorption.  Evenity® is a humanized monoclonal antibody that binds and inhibits sclerostin, a regulatory factor in bone metabolism.  This makes it different from commonly used osteoporosis drugs called bisphosphonates (such as alendronate, aka Fosamax), which block the osteoclasts that break down bone tissue but don’t cause new bone to form.

What this means to you is that this treatment will not only slow the breakdown of bone in your body, but it will also spur new bone growth equaling less pain and reduced risk of fracture.

How Do You Take Evenity®?

Evenity® is the only bone-building treatment given over 12 months. Each dose consists of 2 shots given under your skin every month at your doctor’s office or at an infusion and injection therapy center like Specialty Infusion Centers!  It is also recommended to take calcium and vitamin D as your doctor advises while you are receiving Evenity® injections.

The 2020 AACE/ACE guidelines state Evenity® should be considered as initial therapy for patients with any of the following: 

• Recent fracture (within the last 12 months)
• Fractures while on osteoporosis therapy
• Multiple fractures
• Fractures while on drugs causing skeletal harm
• T-score < −3.0
• Very high fracture probability
• High risk for falls or history of injurious falls

Side Effects

As with any medication, some patients may experience some side effects. The most common side effects occurring ≥5% of the time or more were joint pain and headache.  Possible more serious side effects include: 

• Serious allergic reactions including rash; hives; swelling of the face, lips, mouth, tongue, or throat which may cause difficulty in swallowing or breathing.
• Low calcium levels in your blood (hypocalcemia) which can cause symptoms such as: spasms, twitches, or cramps in your muscles; numbness or tingling in your fingers, toes or around your mouth.
• Severe jaw-bone problems (osteonecrosis) may occur. 
• Unusual thigh bone fractures – symptoms of this type of fracture include new or unusual pain in your hip, groin, or thigh.

Call your healthcare provider or get emergency help right away if you have symptoms for any of the side effects listed above. 

To get the full benefits of Evenity®, it’s important to complete all 12 doses. After finishing, your doctor may transition you to a follow-up osteoporosis treatment. For more information on what you should know about Evenity®, speak with your medical team. To learn more or start your Evenity® treatment at Specialty Infusion Centers, CLICK HERE.  

On June 7, 2021, the United States Food and Drug Administration (FDA) granted accredited approval for Biogen’s drug ADUHELM™ for the treatment of Alzheimer’s Disease. 

ADUHELM™ was given approval using the accelerated approval pathway. When a drug can be used for a severe or life-threatening illness that provides a significant therapeutic advantage over existing treatments, the FDA can approve it faster. Accelerated approval of a drug can be based on a drug’s predicted results using a marker or measurement that is thought to predict clinical benefit but is not a measure of clinical benefit. 

Alzheimer’s Overview 

Alzheimer’s is a progressive, irreversible brain disease that causes the brain to shrink (atrophy) and brain cells to die, destroying a person’s memory and other vital mental functions. It also accounts for 60%-80% of dementia cases, a continuous decline in cognitive symptoms, such as memory loss, confusion, and declining reasoning skills that affect a person’s ability to function effectively and independently.

Prevalence Rate

The Alzheimer’s Association estimates that “6.2 million people of all ages have Alzheimer’s disease in the United States”. Other quick facts about this disease:

• By 2050, this number is projected to hit 13 million.
• People are usually affected in their mid-60’s and older, although there are cases of early-onset. 
• More than 1 in 9 people (11.3%) age 65 and older have Alzheimer’s disease.
• The percentage of people with Alzheimer’s dementia increases with age: over 34% of people ages 85 and older have been diagnosed with Alzheimer’s.

Causes of Alzheimer’s

There is no single cause of Alzheimer’s. The disease possibly occurs as a result of multiple factors, such as genetics, lifestyle, and environment. Alzheimer’s isn’t a normal part of aging. However, the most significant known risk factor is increasing age. 

Symptoms 

In the early stages, memory loss is mild. People may have some difficulty for example, recalling an event, finding the right words or they may misplace an item.

As Alzheimer’s advances, symptoms become more pronounced. Often there are changes in a person’s mood and behavior. A person may start to feel withdrawn and experience delusions, which can cause them to become distrustful of others. They may even grow violent and become unfamiliar with their surroundings. It is common for them to require more help with everyday tasks. 

In the later/end stages, the symptoms become more severe. In addition to increasing memory loss, people also lose much of their ability to communicate and have difficulty swallowing and walking. The need for around-the-clock care is often the case as they become more reliant on help with daily activities and personal care. 

Prognosis

Sadly, Alzheimer’s Disease is the sixth-leading cause of death in the United States. A person with Alzheimer’s lives on average, 4 to 8 years after their initial diagnosis, but can live as long as 20 years, depending on other factors.

Aspiration Pneumonia (caused by inhaling food or drink into the lungs), falls, infections, malnutrition, and dehydration are all common causes of mortality in Alzheimer’s cases.

ADUHELM™ Overview 

ADUHELM™ represents the first FDA-approved therapy to address the underlying biology of Alzheimer’s and has been the only new treatment approved for the disease since 2003. 

By targeting the fundamental pathophysiology of the disease, this new drug can help reduce amyloid plaques, therefore, slowing down the cognitive and functional decline of people living with early Alzheimer’s. 

How Does ADUHELM™ Work to Treat the Symptoms of Alzheimer’s?

The active ingredient in ADUHELM™ is aducanumab-avwa. 

In Alzheimer’s disease, protein pieces called beta-amyloid clump together to form plaques in the brain. The plaques obstruct nerve signals within the brain, stimulating the immune system, and triggering brain inflammation.

The active ingredient, aducanuman-avwa in ADUHELM™ binds to the beta-amyloid plaques, stimulating the immune system to help disband the plaques and eliminate them. In clinical trials, patients taking ADUHELM™ showed a reduction in their amyloid-beta plaques, signifying that the drug can work as a potential treatment for the disease. 

ADUHELM™ IV Administration 

ADUHELM™ is administered to patients through 45 to 60-minute intravenous infusions (IV) once a month. The infusion can be administered at hospitals or infusion therapy centers. 

Side Effects 

Common side effects of ADUHELM™ found in the clinical trials included ARIA-E (swelling in the brain) and ARIA-H (small hemorrhages on the brain). While ARIA usually doesn’t have any symptoms, it can be severe. Swelling and small spots of bleeding on the brain are often temporary. Still, some people may experience: 

• headaches
• confusion/altered mental status/disorientation
• dizziness
• vision changes
• falls
• diarrhea
• nausea.

When taking ADUHELM™, you should also look out for signs of allergic reactions, such as hives and swelling of the face, eyes, lips, mouth, and tongue. 

As a result of the FDA’s approval of ADUHELM™, patients with Alzheimer’s disease now have a critical new treatment to help them potentially fight this challenging disease. At Specialty Infusion Centers, we provide the latest infusion and injection treatments, including ADUHELM™. Visit one of our conveniently located centers for all your infusion and injection needs.

How did medical practitioners begin performing infusions? Here is the history of infusions.

While infusion pumps are a new invention, intravenous therapy began in the Middle Ages. The first infusion device was successfully created by Oxford scientist Sir Christopher Wren in 1656 from a pig’s bladder and a writing quill. While successful, Wren found the device to lack durability and was difficult to secure. Wren garnered a reputation as the Father of Intravenous Therapy because of this.

In 1662, Johann Major was the first to successfully infuse humans. Major’s work involved both blood transfusion and the injection of medicinal substances. Unfortunately, many deaths resulted in Major’s work because of infection at the infusion site.

In 1665, Richard Lower saved an animal’s life by performing a blood transfusion from another animal.

Two years later, Jean Baptise Denis infused lamb’s blood into a 15-year old boy. While the boy survived, Denis would perform the procedure again on another man, who died.

Because of this, Denis was tried for manslaughter. He was acquitted, but the Edict of Chatelet banned all transfusions without the approval of the Paris Faculty of Medicine. Both Rome and England followed suit.

In the 1830s, Dr. Thomas Latta discovered that injecting salty water into a patient’s bloodstream had a measurable impact on fighting cholera, which removes water from the bloodstream. During this same period, Dr. James Blundell proved that transfusing animal blood into humans was unsafe. Only human blood can be transferred into humans.

Toward the end of the 19th century, the Luer Company developed the Luer connection, which is still used today. This allows the head of the hypodermic needle to be easily attached and detached. In 1900, Karl Landsteiner identified four main classifications for human blood, thus proving not all human blood is alike.

Rapid advancements in infusion therapy came in 1914. Sodium citrate was found to prevent blood from clotting. Dextrose was used as an infusant in 1925. In 1930, infusions were switched from open containers to vacuum-sealed glass bottles. Ten years later, nurses were allowed to administer infusions. Before 1940, only doctors were permitted to perform infusions.

1960 marked the year when infusion pumps became standard in all hospitals!

As you can see, the history of infusions shows the tremendous progress the field has made. At Specialty Infusion Centers, we provide the latest infusion treatments and first-class patient care. Visit one of our centers conveniently located near you for all your infusion needs.

What is the importance of hydration before your infusion? Here we explain how proper hydration benefits you.

Most Americans are Dehydrated

Here’s a scary thought—doctors say that 75 percent of Americans are chronically dehydrated. So, three out of four people aren’t getting enough water. Proper hydration is vital to health. Drinking enough water everyday helps achieve the following:

• Regulates body temperature
• Keeps joints lubricated
• Prevents infections
• Delivers nutrients to cells
• Helps organs properly function

In fact, proper hydration improves sleep quality, cognition, and your overall mood. So grab a glass of H2O. You’ll thank yourself for it.

Increases Blood Volume

Also, the importance of hydration before your infusion is critical for both patients and healthcare workers. Drinking enough water increases blood volume. This makes veins more prominent, so the nurse practitioner has an easier time getting a line started. Obviously, this helps improve the overall experience you have as a patient.

Important During the Summer

In the summer, being hydrated is especially important. People are constantly sweating. Unfortunately, this can cause dehydration without you even realizing. And, if you perform any vigorous activity, you’ll need to drink water even more. Again, you need to be properly hydrated before your appointment so the nurse practitioner can easily find the vein.

Help Prevent Side Effects

Finally, drinking water benefits you because it can help prevent side effects. Often, patients can experience fatigue and/or headaches after an infusion. Proper hydration can help prevent this.

At Specialty Infusion Centers, we provide complimentary snacks and beverages to ensure your infusion experience is relaxed. So, make sure you are properly hydrated before your infusion, and we’ll be sure to make your infusion as comfortable as possible.

A lot of patients ask, “Why are some medications given IV or injected?” Here we explain.

The Background on the Medications

First, let’s start with the background about the medications. According to the FDA, “biologics” include a wide range of products like vaccines, allergenics, recombinant therapeutic proteins, and more. Often, they are composed of sugars, proteins, nucleic acids, or a combination of these substances.

How Oral Medications Work

Typically, medications are taken orally. This route – which refers to the method of taking medicine – involves a pill, capsule, or liquid form of the medicine. Then, the medication is broken down in either the stomach or intestines, similar to how food is broken down, and absorbed by the gastrointestinal tract. After, the medicine passes through the liver before entering the bloodstream. Finally, it circulates to the site where it’s needed.

Through this process, the concentration of the drug is reduced because a fraction of the drug is lost when absorbed through the GI tract and metabolized in the liver. This is call first pass metabolism and is associated with taking medication orally.

Alternatively, medications given IV are what we call 100% bioavailable, because no drug was lost through any type of metabolism. The drug can get to the site where it’s needed directly through the bloodstream completely bypassing the GI tract.

How This Affects Your Treatment

So, how does this relate to why are some medications given intravenously? Not only are IV medications 100% bioavailable, it also needs to be given IV to bypass the GI tract as these medications are delicate molecules. If they are taken orally, our stomach acid would break them down before they ever got to the site they are needed.

Why Specialty Infusion Centers

At Specialty Infusion Centers, we offer many infusion options for your treatment needs. Our flexible scheduling means we’re open seven days a week and provide evening hours. And, we make sure to provide a world-class experience in state-of-the-art suites. During your treatment, we provide free snacks, drinks, Netflix, WiFi, and other amenities to offer you a serene environment.

Finally, our highly skilled clinical team is trained to expertly administer treatment and handle any type of infusion or injection reaction that may arise. We also stay in constant contact with your healthcare team, updating your provider after each infusion and carrying out specific requests, such as lab work. So, come to Specialty Infusion Centers for all of your medication infusion needs.

Patients with multiple sclerosis (MS) often ask, “Should I exercise if I have MS?” Here’s why we suggest they do exercise.

Background

In the past, people with MS were advised not to exercise. The medical community thought exertion exacerbated symptoms and caused balance issues and difficulty walking. However, now we know this was not good advice. In fact, the Mayo Clinic advises patients with MS to exercise—after they consult their doctor.

How Exercise Benefits MS Patients

First, exercise can help MS patients with many of their symptoms. It can increase stamina, strength and balance, improve bowel and bladder control, and decrease spasticity related to MS. Also, regular exercise improves a person’s general quality of life. In particular, at least 150 minutes of moderate activity per week for MS patients has positive effects.

Types of Exercises

Most importantly, before starting any new exercise regimen, we advise you to consult an MS-certified physician. Your medical team can create a workout routine that’s best suited for you and your condition.

Some general exercises we recommend include:

• Aerobic Exercises – Medical News Today claims these regimens improve lung capacity, strengthen core muscles, and improve balance and coordination.
• Stretching – In particular, yoga helps MS patients with stiffness, muscle weakness, and loss of mobility.
• Progressive Strength Training – This involves you starting with light weights and minimal repetitions. Gradually, you increase the weights and reps over time as you build more muscle and stamina.

Some Precautions to Be Mindful Of

Keep in mind, there are some precautions you should take. For starters, don’t overexert yourself. It’s important to listen to your body and not try to push yourself too hard too fast. Build up your stamina and strength. Also, make sure you exercise the right way. Do your best to have good form on all your moves. And, make sure you stay hydrated and cool. If you get too hot, this can temporarily exacerbate MS symptoms like fatigue and muscle tightness.

If you still have additional questions after reading “Should I Exercise If I Have MS?” please consult your physician or contact us at Specialty Infusion Centers. We’re happy to help in any way we can!

The right Valentine’s Day present for someone with chronic illness may be easier to find than you think. Here are some great Valentine’s gift ideas for a loved one with chronic illness.

Give People Permission to Share What They Need

Valentine’s Day is a great day to take a moment to celebrate the love you have for someone. We all want to get the people we love a gift that makes them feel special. If someone you love has a chronic illness, their ideal gift may look different than the traditional Valentine’s Day gift.

One of the greatest gifts we can give a loved one is to hold space for them and allow them to fully share whatever is they need. These needs may be tangible, but they also can be emotional. You may find some people are stoic and afraid to ask for help—especially if they have a chronic illness. They may not want you to see how challenging certain tasks can be, so they bravely endure. Encouraging and welcoming your loved one to be vulnerable and ask for help or share how they are feeling can be incredibly powerful.

Simply asking your loved one what it is that they need and following through on that can be one of the greatest gifts of all.

Offer to Take Errands off Their Plate

If your loved one wants to be surprised on Valentine’s Day, a thoughtful gift can be an act of service. Performing daily errands for someone with chronic illness can be exhausting and more challenging than it is for the average person. Do they have prescriptions to pick up at the pharmacy? Are they running low on groceries and need to go to the store? Does the house need tidying up and cleaning? You can do these errands yourself or hire services, like a maid service or use Task Rabbit to take some of these items off your loved one’s plate. This gift allows them to relax and unwind and even have them conserve their energy to be able to comfortably celebrate with whatever you have planned later.

Self-Care and Pampering Gifts are Appreciated

Generally, you can never go wrong with a pampering gift. Going the extra mile to not just give a gift card to a spa, but also researching spas that are taking good Covid precautions, can provide a relaxing and safe experience for your loved one. If your loved one doesn’t feel comfortable going to a spa, then you can always act as the masseuse and give a back rub or foot rub yourself.

There are also so many great guided meditation and yoga class subscriptions for your loved one to really elevate that self-care from the inside out.

Here are some other self-care and pampering gifts you can offer:

• Cook a romantic dinner for them. Keep in mind, you should cook foods that comply with their dietary restrictions. Read about dietary nutrition for chronic illness here.
• Buy a nice face mask or other relaxing skin care items.
• Offer to perform an act of service, like doing their laundry.

Valentine’s Day offers you a chance to show a loved one how special they are to you. Sometimes, the best gift of all is simply asking what they need or what they want. If your loved one likes a nice a surprise, hopefully some of these suggestions will do the trick!