HealthCare Journey for Multiple Sclerosis
  • About Us
  • Home
  • Virtual MS Center
    • Q & A for Virtual MS Center
    • Read About Our Virtual MS Center Staff
  • News & Resources
  • Seminar Registration
  • Health & Wellness
  • Blogs
    • Physician Blog >
      • Healthcare Provider Blog
    • Physical Therapy Blog
    • Patient Blog
    • Caregiver Blog
    • Research Blogs >
      • "Ask Dr. Debbie" Research Blog
      • Multiple Perspectives In Multiple Sclerosis Research Blog
  • About MS
    • What is MS?
    • Diagnosis
    • Treatment
    • MS Tips
  • Symptoms
    • Balance and Walking Issues
    • Breathing/Respiratory
    • Bowel Dysfunction
    • Cognitive Dysfunction
    • Crying/Laughing Uncontrollably (PBA)
    • Depression and Anxiety
    • Dizziness/Vertigo
    • Dysphagia
    • Fatigue
    • Foot Drop
    • Hearing or Smell or Taste Changes
    • Heat Sensitivity
    • Leg Weakness
    • Loss of Hand Dexterity and Coordination
    • Memory and Mutliple Sclerosis
    • Migraines
    • Numbness/Tingling/Altered Sensation
    • Nystagmus and Oscillopsia
    • Pain
    • Sexual Dysfunction
    • Sleep Issues
    • Spasticity/Spasms/Cramps
    • Speech/Swallowing
    • Urination/Bowel Problems
    • Vision
  • MS Clinics
  • MS Topics
    • Pregnancy and Infertility
    • Caregivers and Family Members
    • Employment and MS
    • Medical Costs and Insurance
    • Pediatric Multiple Sclerosis
  • Register With Us
  • Terms of Use/Privacy/HIPAA
  • MS HealthCare Journey

Welcome to the Virtual MS Center!

Ask any question you want about Multiple Sclerosis and one of our experts will answer it as soon as possible.
CLICK HERE TO ASK YOUR QUESTION!

Was this optic neuritis?

1/20/2023

0 Comments

 
Here is My Question:
Hello! I’m a 39 year old female. In September I began having a whooshing sound in my left ear. Met with an ENT who diagnosed me with Pulsatile Tinnitus and had an ultrasound on my ear and neck. Everything was normal. They did an MRI and found my ear to be fine, but found a lesion on another part of my brain. Told me to schedule an appointment with a neurologist, which I did. Appointment was scheduled 3 months out.

Then the week before Christmas, I woke up to my left eye unable to open due to pain. It hurt when I moved my eye. No redness, no swelling. Extremely light sensitive and blurry. Got in to see an eye doctor. Everything looked fine other than my vision was lower than it was. Diagnosed me with optical neuritis.

Did the test to check my peripheral vision, and that came back significantly decreased in my left eye. Told me to meet with a neurologist, which I already had scheduled. A few days later, my eye was seeing large blue/green spots. Persisted for about a day.


Randomly get headaches behind my left eye down through my neck.

My neurology appointment is set for the end of this month.

Does this sound like it could be or lead to MS? What steps would be taken next to find out?
Thank you so much for your time!!

Answer:
It sounds like you experienced optic neuritis. The colored (blue/green) spots are called phosphenes and are common with optic neuritis. This is from irritation of the optic nerve and retina by the inflammation.


Pulsatile tinnitus is common and rarely caused by vascular malformations or narrowing of the carotid artery. This is probably the reason they did the MRI before you experienced the visual problems

I hope your vision improves soon. The neurologist or neuro-ophthalmologists will help you discover what caused your optic neuritis. There are many causes other than Multiple sclerosis.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#multiplesclerosis #MS #opticneuritis
0 Comments

HOw can I alleviate foot cramps?

1/20/2023

0 Comments

 
Here is My Question:
I have painful cramps in my left foot that effect my big toe to move in an outward position away from the other toes. How can I alleviate them?

Answer:
For cramps in the foot do the following:
  1. Ask your doctor to make sure you have no problems with potassium, calcium or magnesium deficiency
  2. Stretch frequently
  3. Try taking magnesium citrate or lactate twice a day
  4. If above does not work, a trial of baclofen or tizanidine is worthwhile if you have spasticity
  5. If the problem involves a single muscle group as mentioned in this question, chemodenervation with botox may be beneficial
Your doctor should be able to help you with this process. Cramps are a very common problem

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#MS #multiplesclerosis #footcramps 
0 Comments

Can I take the morning after pill while on Tecfidera?

1/20/2023

0 Comments

 
Here is My Question:
Can I take the morning after pill while on Tecfidera?

Answer:
You can certainly take the 'morning after pill' on Tecfidera, but as always check with your doctor as I do not know of your particular health history.


Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#tecfidera #morningpill
​
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.
0 Comments

Is anyone ever misdiagnosed with MS?

1/20/2023

0 Comments

 
Here is My Question:
I actually stopped taking it for 4 years. I was totally fine and still am. I take liposomal glutathione, b12 and D3 and iron every day and am on a pescetarian (and mostly paleo) diet. I also do a lot of yoga and swimming.
...has anyone ever heard of someone being misdiagnosed with MS? I think my initial diagnosis was actually a reaction to a mix of vaccines I had before a vacation.

Answer:
Misdiagnosis of MS is very common. For many years now, approximately 10-20% of patients referred to our MS Center with a diagnosis of MS do not fulfill necessary criteria for this diagnosis. In many cases the reason for misdiagnosis is misinterpretation of and/or over-reliance on MRI findings.


Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#MS #multiplesclerosis #msdiagnosis
0 Comments

Where can my MS be treated?

1/14/2023

0 Comments

 
Here is My Question:
Is there a site where my MS diagnosis of 15 years can be treated? There are no local MS doctors and I have no reliable transportation to travel to another town. I'm in Decatur, AL

Answer:
You need an MS specialist who you can see in consultation at least once a year and who will work with your local primary care doctor or general neurologist. I would suggest traveling to the Vanderbilt University Multiple Sclerosis Center to see either Drs. Harold Moses or Ram Sriram or any of the other MS specialists in the program. Your local doctor should be able to provide a referral to their center. When I look up the travel distance from Decatur Alabama to Nashville it says it is only a 1 ½ hour drive. You can also contact the National Multiple Sclerosis Society for a list of certified compressive Multiple Sclerosis program within a reasonable driving radius.


Good Luck
Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
0 Comments

Is a MRI with contrast needed to see and/or detest active lesions and PML activity?

1/14/2023

0 Comments

 
Here is My Question:
I WANTED TO KNOW IF A MRI WITH CONTRAST IS NEEDED TO SEE AND/OR DETECT ACTIVE LESIONS AND PML ACTIVITY. I'VE ONLY HAD ONE MRI DONE WITHOUT CONTRAST. I TRIED LOOKING ON HERE AT PREVIOUS MRI QUESTIONS BUT I COULDN'T FIND A QUESTION SIMILAR TO THIS. THANKS IN ADVANCE!

Answer:
Good question.

An active lesion is defined as a new or enlarging non-enhancing lesion or an enhancing lesion. Strictly speaking it is not necessary to use contrast (i.e. gadolinium ) to detect active lesions since all enhancing lesions in MS are associated with a non-enhancing lesion on a non-enhanced study. Contrast can make it easier to identify active lesions, particularly in those people with lots of MS lesions.  

The problem with using non-enhanced studies to detect active lesions is the need to compare the image with a prior image done in a similar manner. Since you can only say that the new or enlarging lesion occurred since the last MRI was done, it is difficult to determine when the new lesion occurred. This is why MRIs are often done every 6 to 12 months in people with early relapsing MS.

New MS lesions tend to enhance for only a short period of time (a few days to 4 weeks), so an enhancing lesion is more predictive of very recent activity, unless the unenhanced MRI is obtained at short intervals (e.g., every 1-3 months).

In practice it is usually not that important to know if a new lesion developed in the past month or the past 6 months, if you are using the MRIs to monitor the response to a disease modifying therapy. However, it is important to obtain a baseline MRI after starting the therapy.

Contrast is also not required to detect PML. In fact, most PML does not show enhancement on an MRI scan unless and until your body mounts an immune response to the infection. Diffusion weighted images (particularly DWI trace images) in combination with FLAIR T2 weighted images are most useful for surveillance detection of asymptomatic PML.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
​#multiplesclerosis #PML

0 Comments

When Having Covid while on Ocrevus, should we expect to gain less protective antibody production, as is the case when getting the vaccine?

1/14/2023

0 Comments

 
Here is My Question:
When getting Covid while on Ocrevus, should we expect to gain less protective antibody production, as is the case when getting the vaccine?

I'm assuming that actual response would be impacted by b levels, from when the infusion took place, etc.?

(We know that b depleting therapies like Ocrevus will inhibit antibody creation when taking vaccines.)

Answer:
There are virtually no systematic studies about SARS-CoV-2 antibody responses post COVID-19 infection in people with MS (pwMS) on different disease modifying therapies, including Ocrelizumab. Most of out information comes from studies of antibody production after vaccination. This information can be summarized as follows:
  1. pwMS experience a dramatic decrease in IgG antibody production 4 weeks post vaccination if they are on active treatment with Ocrelizumab or rituximab
  2. Antibody responses to vaccination are better the longer the interval since last infusion
  3. One recent study suggested that antibody responses to SARS-CoV-2 vaccination may be higher with the Moderna mRNA vaccine, but this has not been replicated.

It is important to remember that you can not assume a SARS-CoV-2 antibody response will be protective against infection. Many arms of the immune system not measured with an antibody assay, especially T cell mediated immunity, are important in the immune response that creates protective immunity. Furthermore, not all antibodies are able to neutralize the SARS-CoV-2 virus, a step necessary for protection. There are studies showing an association between IgG antibodies directed against the spike protein and the ability to neutralize the virus, but this type of neutralizing antibody assay is not routinely done in clinical practice.

We continue to recommend  updated SARS-CoV-2 boosters in pwMS on anti-CD20 therapy. Many sources recommend waiting at least 3 months after an infusion to get a booster, but it is likely that your immune response to vaccination will improve if you can wait 6 or more months or obtain an additional booster when you are able to be off anti-CD20 therapy for more than 6 months.  

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
​#multiplesclerosis

0 Comments

Does anyone still get flushing from Tecfidera after taking it for several years?

1/14/2023

0 Comments

 
​Here is My Question:
Does anyone still get flushing from Tecfidera after taking it for several years?

Answer:
Flushing can persist even after many years of treatment with Tecfidera or any of the Fumarates. The frequency of flushing decreases over the first 3 months but there are some people who continue to experience flushing with one or both doses.


Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
​#MS #Multiplesclerosis #Tecfidera #flushing
0 Comments

Can a solidity T2 hyperintensity be indicative of MS?

1/14/2023

0 Comments

 
Here is My Question:
Can a solidity T2 hyperintensity be indicative of MS?

Answer:
Brain T2 hyperintensities, solid or not, are not specific for MS. If they occur in an appropriate clinical context (i.e. appropriate for MS), in the correct brain distribution with several other associated features, then the probability is higher that the T2 hyperintensity supports a diagnosis of MS in that particular case. 


Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#multiplesclerosis #MS

0 Comments

Can Ocrevus and Dupixent be used together?

1/14/2023

0 Comments

 
Here is My Question:
Can Ocrevus and Dupixent be used together?

Answer:
I can only find one case report of the concurrent use of an anti-CD20 monoclonal antibody (i.e., rituximab, ocrelizumab or ofatumumab) in a patient also on Dupixent, a monoclonal antibody targeting IL-4 and IL-13. We have anecdotally used anti-CD20 monoclonal antibody therapies in a few MS patients on Dupixent for eosinophilic syndromes and asthma. While we have not seen any adverse effects attributable to this combination therapy, we have not treated enough patients to confidently state that this combination of treatments is completely safe.


Physicians are trained to make treatment decisions when evidence is lacking. Your physicians will weigh the information available (risks and benefits) and advise you based on your circumstances. 

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#Ocrevus
​#Dupixent
​
0 Comments

    RSS Feed

    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.
    Read About Our Virtual MS Center Authors

    Archives

    September 2024
    June 2024
    March 2024
    January 2024
    December 2023
    November 2023
    October 2023
    September 2023
    July 2023
    June 2023
    May 2023
    April 2023
    March 2023
    February 2023
    January 2023
    December 2022
    October 2022
    September 2022
    August 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    July 2013
    June 2013

    Categories

    All
    Accessible Housing And Environmental Modifications
    Anxiety
    Balance
    Bowel Problems
    Caregivers
    Cognitive Function
    Compliance
    David Rintell Ed. D.
    Deborah Backus Blogs
    Depression
    Diagnosis
    Diet
    Dizziness
    Dosing
    Dr. Greenberg's Q&A
    Dr. Kinkel's Q&A
    Dr. Miravalle's Q&A
    Dr. Nielsen's Q&A
    Dr. Osborne's Q&A
    Exercise
    Experimental Treatments
    Eye Surgery
    Fatigue
    Fatique
    Flu Shot
    Foot Drop
    Herbs
    Immunosuppression
    JCV
    Lasik Surgery
    Lesions
    Lori Kostich's Q&A
    Lyme Disease
    Medications
    Migraines
    Mobility
    MRI
    MS Hug
    Other Diseases
    Pain
    PML
    PPMS
    Pregnancy
    Relapse
    Safety
    Sarah Wargo's Q&A
    Sexual Dysfunction
    Side Effects
    Smoking
    Spasticity
    Stem Cell Transplantation
    Steroids
    Stress
    Supplements
    Surgery
    Symptoms
    Treatment
    Urination
    Viruses
    Vision
    Vitamin D
    Vitamins
    Weakness


© 2023 HealthCare Journey, LLC. All Rights Reserved.
HealthCare Journey™ is a trademark of HealthCare Journey, LLC
Picture
  • About Us
  • Home
  • Virtual MS Center
    • Q & A for Virtual MS Center
    • Read About Our Virtual MS Center Staff
  • News & Resources
  • Seminar Registration
  • Health & Wellness
  • Blogs
    • Physician Blog >
      • Healthcare Provider Blog
    • Physical Therapy Blog
    • Patient Blog
    • Caregiver Blog
    • Research Blogs >
      • "Ask Dr. Debbie" Research Blog
      • Multiple Perspectives In Multiple Sclerosis Research Blog
  • About MS
    • What is MS?
    • Diagnosis
    • Treatment
    • MS Tips
  • Symptoms
    • Balance and Walking Issues
    • Breathing/Respiratory
    • Bowel Dysfunction
    • Cognitive Dysfunction
    • Crying/Laughing Uncontrollably (PBA)
    • Depression and Anxiety
    • Dizziness/Vertigo
    • Dysphagia
    • Fatigue
    • Foot Drop
    • Hearing or Smell or Taste Changes
    • Heat Sensitivity
    • Leg Weakness
    • Loss of Hand Dexterity and Coordination
    • Memory and Mutliple Sclerosis
    • Migraines
    • Numbness/Tingling/Altered Sensation
    • Nystagmus and Oscillopsia
    • Pain
    • Sexual Dysfunction
    • Sleep Issues
    • Spasticity/Spasms/Cramps
    • Speech/Swallowing
    • Urination/Bowel Problems
    • Vision
  • MS Clinics
  • MS Topics
    • Pregnancy and Infertility
    • Caregivers and Family Members
    • Employment and MS
    • Medical Costs and Insurance
    • Pediatric Multiple Sclerosis
  • Register With Us
  • Terms of Use/Privacy/HIPAA
  • MS HealthCare Journey