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WBC count is 2300. Hip fracture 8 months ago resulted in 3 pins inserted in bone. I am very thin and my doctor said I might need them removed eventually because they cause pain in thin people. I am having MS symptoms - pseudo exacerbation. Could this be the cause? Answer: If I understand you correctly, you are experiencing pain at the hip fracture site and a pseudo exacerbation related to the pain. This is certainly possible since hip pain or any lower limb pain can dramatically increase spasticity and spasms and worsen mobility. If this is the case, see the orthopedic surgeon to determine the source of the pain. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego
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RRMS diagnosed age 14 immediately following onset. Treated with Rituxan x 3.5 yrs, full health, then switched to Ocrevus age 18 yrs in 8/21. Soon began chronic infections for months, advanced severe bacterial and COVID pneumonia. Now completing IVIG and recovering. 1) How now to manage MS? 2) lower dose/Rituxan/Kemsimpta, other DMT? 3) can I consider no DMT for at least a period of time to restore my immune system? 4) any suggested dietary plan- Best Bet? Thank you! Answer: Not knowing the details of your case, let me provide some information so you can ask your neurologist (MS specialist) some important questions.
Good luck . See what your doctors think and work with them to find a good solution. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego 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. Here is My Question:
I'm taking Tecfidera and have no issues so far but I'm expecting supply disruption that can take up to 1 week, now my question is am I going to experience any issues when I get on the tablets again? Thank you Answer: It is possible that some of the initial side-effects you experienced when first starting Tecfidera may reappear after restarting Tecfidera a week later, but these should be minimal and resolve quickly if you are not having problems now. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Can chronic inactive lesions still cause problems and can these problems get worse? My balance is getting worse as are my eyes. Thanks Answer: There is no sure way at present to differentiate chronic inactive from chronic active MS lesions during life with a tissue biopsy. These terms are pathological descriptions without a definite correlate on MR imaging. That said, there are many ways for MS to progressively worsen in those individuals who do not appear to show any changes on MR imaging over many years. Examples of ways in which MS can worsen over time despite no change on standard MR imaging of the brain or spinal cord include the following:
Good luck Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
I stopped using Butrans patches for scoliosis pain 3 weeks ago. My leg strength and mobility have really deteriorated. Will this pass? Is there a connection? Thanks. Answer: You should direct this question to your neurologist. He will know the strength of your prior Butrans patch, other medications that may be contributing to your sense of weakness and the reason you needed such a strong narcotic for pain. This will go a long way to answering your question. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Recently been smelling strong cigarette smoke, pain and weakness in left arm and leg, neck and shoulder pain and shooting pain in head. Rectal spasms when the weird smell occurs. I have Crohn's Disease and convinced I have MS. Being referred to neurologist. Alongside depression and memory lapses. I’ve had this in episodes for past few years on and off. Hip pain etc. can’t find anything on MRI. Docs says not stroke but I know this is nervous system. Could this be start of MS flare? Answer: I suppose your symptoms could be related to any number of things including MS. Your upcoming neurological evaluation should provide you with the necessary answers to your question. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Does a person's height have anything to do with the effects of medications such as Baclofen?3/29/2022 Here is My Question:
Does a person's height have anything to do with the effects of medications such as Baclofen? I am very short and wonder if the medicine lasts longer for me and I should take it less frequently. Answer: The size of a person, which is partially governed by height, can affect the volume of distribution and half-life of many medications. Doctors and pharmacists should be well trained in these particulars. This is particularly important for medications with a small "therapeutic window". For drugs with small therapeutic windows the concentration in the blood stream must be kept within a relative narrow range to be effective without causing side effects or toxicity. Baclofen does not have a small therapeutic window and the effective dose can vary dramatically from one individual to another for a variety of reasons. We therefore start with low doses and gradually increase the dose until a desired effect is observed or unacceptable side effects occur. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Do I need to go to the hospital for new symptoms of MS if I don’t have a neurologist? Answer: You should contact your primary care physician, if you do not have neurologist to determine if a trip to the hospital is necessary for any new or recurrent symptoms. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Does MS make you loose hair? Answer: MS is not associated with loss of hair (called alopecia). Loss of hair has many causes including some of the medications used to treat MS. Contact your primary care physician for further information. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis #MS #hairloss Question:
Can I get a nose piercing with MS? Answer: There are no problems, related to the diagnosis of MS, of any body art including piercings and tattoos. Some tattoo dyes may have ferromagnetic properties that can heat up in a magnet and cause irritation. Piercings do not create a problem unless they cannot be removed during the MRI procedure. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
The one neurologist in town that did a lot of tests on me, now refuses to do any follow up appointments. My question is, where can I seek another neurologist when I’m having all the symptoms of MS and it’s debilitating my day to day life? Answer: A physician has a continuing responsibility of care until they discharge you back to your primary care physician (PCP) or you establish care with another specialist in the same field. Please check with your PCP to see if the neurologist sent a final consultation note with recommendations. If the neurologist did not send such a note, your PCP should request that this be done. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
My legs are feeling stiff and hurt after sitting or laying down. I'm also a bit off balance. I first felt knee pain, then stiffness. Thank you. Answer: It is very common for people with MS and people with arthritis to experience stiffness and discomfort in the legs after prolonging rest sitting or lying down. It helps to stand, walk, and stretch every 20 minutes. There are many reasons this problem can worsen from time to time. For instance, this program is often worsened by colder weather. I would suggest discussing this further with your doctor. If no obvious problem discovered, I would suggest stretching more frequently before starting new medications Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
I have asked for reasonable accommodations at my work. I teach. One semester it was provided. The last three it was not. I have asked repeatedly and they said they would process it, but it had not been handled. I have a lecture podium and a really tall chair with wheels. I’m 5’4 and have weakness sometimes. I have straight up fallen trying to get into the chair in front of my class. My department says they would handle it, but nothing ever gets done. I have noticed they’re putting pressure on me in other areas that are ridiculous and irrelevant…inconsistent with how they treat my colleagues. I sent ANOTHER request for my accommodation (chair without wheels and a lower desk….totally not unusual). I also contacted my union representative. What gives?? What can I do?? Answer: Discrimination in the workplace against those with disabilities is usually more subtle. Meet with your union representative and approach human resources together. Make sure the supporting documentation from your MS specialists meets all your workplace needs. Unfortunately, you may need to find an attorney who handles workplace discrimination law. Remember, you are a protected class. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
I have a lumbar puncture (spinal tap) procedure scheduled one day prior to me receiving the second half of my first Ocrevus infusion. Does it matter if I have a spinal tap the day before receiving my Ocrevus infusion? I am a college professor who has tried to schedule all doc appointments & procedures during my students spring break week to avoid having to cancel more classes for my appointments. I had a severe relapse recently and had to alter my class formats and take time off. I would like to avoid taking more if possible. Thank you. Answer: It should make no difference when you undergo the Lumbar puncture if it is being done to diagnose MS. Ocrevus does not cross the blood brain barrier well and does not typically affect intrathecal (within the CSF space) production of immunoglobulin, at least not in the short term. The CSF lymphocyte count may be lower but nothing else that we analyze routinely in clinical practice for MS diagnosis should be affected. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
My MRI is stable. What does that mean? Answer: A stable or non-active MRI in clinical practice means there are no new or enlarged T2 lesions (White spots) identified and no new enhancing lesions after the administration of contrast. Therefore an "active" scan does not meet this criterion and is not stable. To interpret this information, remember the following:
Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego JOIN EITHER IN PERSON OR VIRTUALLY! CLICK BELOW TO GET FREE TICKETS!  Here is My Question:
Hello, I am JCV positive and have been assured that a 6/8 week interval between each Tysabri is not dangerous as far as developing PML goes, would you agree? Answer: You ask for assurance that something is not "dangerous". Dangerous is a loaded term, especially in medicine. We prefer to compare risk with benefit, the so-called risk/benefit ratio and allow people to make their own decision. So here are the facts as we know it.
Lastly, it is always important to emphasize that all treatments for MS have potentially severe risks. These risks are generally manageable if patients and physicians follow accepted protocols for mitigating these risks. Not adhering to agreed upon dosing schedules, missing visits, forgetting to monitor blood work or failure to monitor MRI scans are all recipes for unsatisfactory and rarely, "dangerous" outcomes. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Has anyone had a MS flare after getting a tattoo?? Answer: I am not aware of Tattoos affecting MS in any way except in cases of infection. 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. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego |
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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