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Here is My Question:
I was diagnosed with MS (lesions on brain MRI) in Feb 2014. I had a Lumbar Puncture. Since that time I have a very uncomfortable feeling at the base of my neck in the center or the top of my spine (I think) that feels like pressure. It even get painful at times. What can I do, without medicine to relieve that feeling that won't cause damage to my spine? Answer: Your symptom is not one I can diagnose over a blog, but requires a face-to-face visit with your doctor. Occasionally, an unusual headache can occur after a spinal tap that is only present when sitting or standing up, but goes away when you lay down. This pain can be reflected in the neck as well. Usually this is self-limited and goes away on its own. Your symptoms sound different and require a formal evaluation in clinic. Once the cause is suspected/known, then your doctors can offer a course of therapy. -ASN Here is My Question:
What are the options for someone with primary progressive MS? I am 66 and was diagnosed after a spinal tap in 2008; am physically active (downhill ski, but less aggressively and at my own pace); have no visual changes due to MS; have some areas of cognitive impairment (mild) but other areas are very superior. My neurologist says that there is no treatment and the neuro-psychologist said to do activities like crossword puzzles or study a foreign language. I am satisfied with my physical status, but would like to limit my cognitive decline as much as I can. Answer: Please see Dr. Kinkel's excellent blog post on cognition and MS (posted 7/22/2014) READ MORE In addition, I would add that as we age, all can succumb to common problems that affect cognition. In this case, we can't assume that cognitive problems are solely due to MS (if at all). Your neurologist can help screen for other causes of cognitive dysfunction with the help of a neuropsychologist (which it appears you have already met). What we have learned is that medical conditions that can affect blood vessels (ie, "vascular disease") such as high blood pressure, high cholesterol, blood sugar regulation problems, smoking, etc can encourage disease progression and affect cognition and also cause "little white dots" on the brain scan as well. These problems are more prevalent as we age. Moreover, the litany of other ailments that Dr. Kinkel lists in his blog post which contribute to cognitive problems are also more common as we age and should be taken into consideration when trying to tease apart potential reasons for your symptoms. I do not have much more to add to what you are doing or what has been said in the aforementioned blog post. I would just emphasize the need to remain physically healthy to try and mitigate the other potential causes of cognitive difficulty. Specifically, work on aerobic exercise (with a goal of 30 minutes of continuous exercise a day, for 5 days a week), a balanced/healthy diet, and adequate and restorative sleep. Of course, consult with your doctors about the type and intensity of aerobic exercise that is appropriate for you. I would also add one last thing...Dr. Kinkel suggests in his blog that our disease modifying therapies very well may mitigate cognitive dysfunction over time. I agree. I would also point out that our approach to treatment of MS is shifting. The term "primary progressive MS" is becoming a relic with alternative terms such as "active and/or progressive" as descriptors to a patient's MS activity. Reason for this is that even the "primary progressive" patients can have inflammatory disease activity (even if not recognized clinically or symptomatically) noted on the MRI scans. If this is the case, even a patient with the label of "primary progressive MS" could qualify for a disease modifying therapy because they are demonstrating "active" or "inflammatory" disease activity that likely will respond to an MS therapy (and could impact cognitive decline). I'm am not advocating for frequent/routine MRI scanning of progressive MS patients, but under the right circumstances (ie, worsening cognition), it should be considered. -ASN Here is My Question:
Can a persistent cough, especially at night, be a symptom of MS, and if so is there anything that can be done to treat it? Answer: Lesions in/near the area postrema (the area where the brainstem and spinal cord meet) can cause nausea, hiccups, and cough. Such a symptom is unusual in MS and more common in rarer neurologic disease that can mimick MS. When this part of the nervous system is affected, it can cause intractable symptoms throughout the day as well. More common explanations for persistent coughing include certain medications (called ACE inhibitors), seasonal allergies, post-nasal drip, acid reflux disease, asthma, etc. The cause of your symptom can't be diagnosed over a blog (requires a clinic evaluation and examination). I would suggest speaking with your PCP first. Treatment varies depending on the identified cause of your cough. -ASN, MD Question:
Is it possible that my MS is causing instant hot flashes when I am upset or stressed? For example, if a particularly annoying person calls, as soon as I see their number displayed a hot flash sets in. Answer: My initial impression of the connection between MS and an immediate hot flash is dubious. MS symptoms tend not to come on suddenly but have a more gradual onset and also tend to be asymmetric (i.e., not a mirror image on both sides of the body which is usually the case in hot flashes). I think it is more likely a stress reaction independent of MS. With that said, medications such as gabapentin that is used for MS-related sensory disturbances can help hot flash symptoms as well if their severity warrants a medication trial. This is something you can bring up with your doctor. Other option, of course, is to block all annoying callers if feasible. :) -ASN Here is My Question:
I have been taking Copaxone for relapsing remitting MS for over a year. I just had to have outpatient surgery on my toes for ingrown toenails. It has been over a week and the toes have shown a daily digression as to healing. I have continued seeing my specialist and he is guessing I am having a reaction to the chemical they put on the nail matrix, but I'm not really sure. I'm on an antibiotic and have no infection. My toes ARE bright red down to bend of toe with some swelling and continued drainage. I am wondering if Copaxone is known to cause a delay in healing associated with surgery? I did not have general anesthesia, rather it was topical. The doctor says we just have to stay on the antibiotics and wait it out. Answer: Theoretically, any immunomodulator could alter the healing process. While I can’t exclude the possibility that Copaxone may be impairing wound healing, I think it is less likely. Patients on the injectable disease modifying therapies tend to continue their medication throughout the pre- and post-operative course without difficulty or deviation from normal recovery. As your surgeon pointed out, you may have a reaction to another drug used in the procedure. I would suggest speaking with your MS treating physician about the appropriateness of Copaxone during your recovery period. Clarity on the ‘cause and effect’ in your case may come with time and careful observation. —ASN PLEASE NOTE: The information/opinions on this site should be used as an information resource only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Here is My Question:
With my MS I have frequent bouts of irritable bowel syndrome and it causes interference with daily abilities, sometimes by making frequent trips to bathroom. What I am wondering is how do I decide if it is the irritable bowel syndrome or MS related?! I know there are bowel problems with MS but not fully educated on the symptoms and what not. I do avoid eating red meat and other foods that can trigger it.... but it seems to be more occasional lately. Answer: This is a great question and one that I think many patients with MS have on their mind when they see their neurologist, but may be too embarrassed to bring up at the clinic visit. Bowel symptoms are fairly common in MS and can lead to social isolation and to other health problems. There are many potential causes of bowel dysfunction and it is important to make the doctor aware of the issue so it can be properly evaluated and addressed. This is an expansive topic, and one that is impossible to fully answer in a blog post; however, I'll outline general principles about the symptoms of these conditions as well as initial steps a patient with MS can take to try and alleviate the problem. Irritable bowel syndrome (IBS) is a functional bowel problem which means that extensive medical evaluation cannot identify another cause for abdominal discomfort, pain, and variable symptoms of diarrhea/constipation. IBS is a prevalent condition in the general population and tends to affect younger patients and preferentially affects women more than men (similar demographic as MS), which makes the co-occurrence of these diseases common. Bowel dysfunction due to MS tends to manifest mainly as constipation, but some can also experience fecal incontinence (accidents). When a scar of MS involves the part of the nervous system that helps coordinate signaling to the bowels to evacuate (located primarily in the spinal cord--especially the lowest segment), these bowel symptoms emerge. Other contributors to bowel problems that are related to MS include: immobility or sedentary lifestyle, dehydration (ie, avoiding liquids because of bladder problems), poor dietary intake of fiber, and the acknowledgement that many different medications prescribed to treat other MS symptoms can cause bowel dysfunction as a side effect. All the more reason to review your symptoms with the MS specialist. For patients primarily experiencing constipation who are mobile and able to walk, general strategies include increasing fiber in the diet (men= 30 to 40 grams/day and women=21 to 25 grams/day), keep well hydrated (while avoiding caffeine and sugary alcohol), and establish a consistent exercise routine (check with your doctor first about exercise). Implementing this strategy is generally effective but should be done with patience because it can take a few weeks for the bowels to respond. If this does not improve bowel function, or you are not mobile, then the next step would be to set up an appointment with your MS specialist to specifically discuss the problem. Depending on how problematic your symptoms are, you may want to alert the doctor early on in the visit that this is your main problem (and other problems may need to take a back seat or be addressed at a future clinic visit). Occasionally, these symptoms are more difficult to manage with conservative strategies alone or your symptoms may suggest another problem other than MS that requires the help of a gastroenterologist (digestive system expert). The gastroenterologist can evaluate for inflammatory bowel diseases (which are seen in patients with MS more often than the general population), food allergies, and infections of the digestive tract which cause bowel symptoms as well. If you go see your doctor about bowel problems, you may want to print up this article published in the International Journal of MS Care (CLICK HERE TO DOWNLOAD) and take it with you to the appointment or provide it to your physician in advance so they can review it ahead of time. This article is a good reference for the doctor to help facilitate a productive clinic visit. I hope this helps. ASN The short answer is "no". There is actually no age limit in the diagnostic criteria for MS. Most individuals diagnosed with MS are between the ages of 20 and 50. Although this age range is most common, children as young as 2 years of age have been diagnosed and I have personally seen a patient in her 80's coming to medical attention with a first clinical attack. When an individual experiences the first recognized symptom of MS after the age of 50, we call this "late onset MS".
Even though there is no age criteria for the diagnosis of MS, a stipulation of the criteria warns that the physician needs to rule out alternative diagnoses that could mimic MS. That is not to say that every reportable mimic needs to be tested for (that would be quite expensive and submit many patients to unnecessary testing), but your personal story and neurologic examination can quickly rule out many possibilities. It is also important to remember that as we age, all are susceptible to common health problems including high blood pressure, diabetes, high cholesterol, vascular disease, etc. Patients with MS are no different, and as you may imagine, the diagnosis later in life can be more difficult to tease apart from problems of older age. If there is ever a question about a diagnosis, it is completely acceptable to seek a second opinion from an independent MS specialist. -A. Scott Nielsen, MD |
PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
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