HealthCare Journey for Multiple Sclerosis
  • Home
  • About Us
  • Virtual MS Center
    • Q & A for Virtual MS Center
    • Read About Our Virtual MS Center Staff
  • News & Resources
  • 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!

Is it safe to inject botox for cosmetic reasons if you have MS?

5/20/2019

 
Here is My Question:
Is it safe to inject Botox for wrinkle removal/ cosmetic reasons for MS patient?

Answer:
Yes this will not affect your MS unless they accidentally give you two much botox

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

Am I experiencing SPMS?

5/17/2019

 
Here is My Question:
I am experiencing what seems to be SPMS, and having a huge hard time starting on Ocrevus since it was NOT approved for secondary progressive but rather for pimary!

Any advice from you would be greatly appreciated. I have had MS for about 25 years and have as of 4 or 5 years ago been experiencing a lot of fatigue and increased balance issues. 


Answer:
Let me try to help you frame your question in a way that will help you and your doctors. The information provided in your question suggests that you are at least 45 years old, and possibly over 60, with symptoms related to MS for at least 25 years. Whether you have secondary progressive MS is really in the eye of the beholder. As neurologists we define progressive MS as a measurable and consistent decline in your performance  for a period in excess of 6 months not caused by relapses, although having SPMS does not mean you can not also experience relapses. An example would be a patient with mild right leg weakness and a limp on visit 1 followed by gradual onset of more severe weakness in the right leg and mild weakness in the right arm  observed 12 months later associated with the need for a cane to walk followed by worsening weakness on the right side and greater difficulty walking 24 months after the first visit.  This is not to say that people with SPMS experience a continuous decline in function; Don Goodkin published a study in the 1980s showing that many people with SPMS remain stable over intervals as long as 2 years suggesting that the apparent or perceived progression of the illness is discontinuous in nature. 

There are other people with longstanding MS who initially experience a relapsing remitting course but eventually stop having verifiable relapses (or they become very rare) and also do not experience measurable worsening of function over intervals in excess of 2-3 years. Yet these same people accumulate a number of problems over time as a result of prior disease activity. These problems tend to involve symptoms such as  pain, mood disturbances, sleep disruption, fatigue, dizziness and impaired balance. These problems, in turn are often worsened by unnecessary medications, co-existent medical problems (e.g. diabetes), decreased activity levels and social isolation. To make matters worse your body and your nervous system continues to age but you have less resilience to the effects of age because of prior damage from the effects of multiple sclerosis. 

Regardless of whether you have SPMS as defined in the first paragraph or your condition is more appropriately characterized by my description in the second paragraph, the first step in management is to define your current problems and all contributing factors and work to address these issues, specifically. Disease modifying therapies will not be the solution; while some, such as the recently approved siponimod (Mayzent), may help prevent further progression in the correct circumstances, none of them will help with your fatigue and balance issues. So what do you do?

First, you identify all the potential causes of your fatigue including underlying medical problems (e.g. hypothyroidism), mood disturbances (anxiety and depression), sleep disruption and  especially medications. It is particularly common for people with longstanding MS to find themselves on a long list of medications that will worsen fatigue; in these cases we often find that gradually stopping all these medications under a doctors supervision is remarkably beneficial.

Balance issues are also commonly worsened by medicationsm, but usually require intensive neurorehabilitation to resolve (e.g. physical and occupational therapy) .

Start with this approach and avoid the trap of looking for a solution with a new disease modifying therapy. Once you’ve had some success managing the fatigue and balance problems, then you can begin discussing whether it is even appropriate to consider disease modifying therapy at your stage of the disease

Good luck

​Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

For years they told me it wasn't ms...but is it?

5/17/2019

 
Here is My Question:
I had an attack 4 years ago where my legs went completely numb and I had a tremor, but all resolved in a month. My MRI was all clear and my exams were normal. I have had right side weakness and my arms have become weak over the years. I have seen many neurologists over 4 years who say all my MRIs and exams are clean. Now over the past year I haven’t seen anyone and now I can’t lift my left foot up. It is like a 5 pound weight. My arms (mostly my shoulders) are very weak as I can only wash my hair once a week. Just the idea of moving my arms above my head is too hard or putting my bra on too difficult. My hands are strong. My right side is still a little weak and I do limp if I walk to much with right side.

​I just saw an Internist to figure this all out and he said my exam is positive with weakness but my spine was clear. Brain hasn’t been done in 2 years. They just ordered that and he wants me back to a neurologist!! So this has to be MS? Help! I am a 51 year old female. Is this PPMS? They all laughed and reassured me for years I was fine. The only other thing I remember is pain behind my right eye a few years ago and I felt some burning sensation on thoracic area a few years ago ? What advise can you give me?

Answer:
I’m very sorry to hear of your physical struggles which is worsened by the fact that prior evaluation couldn’t pin point a cause. MS shouldn’t be the only consideration. A skilled, inquisitive, and detailed neurologist can assist with careful exam to try and localize where the problem is focusing on (ie, muscle, peripheral nerve, central nervous system, etc). Based on that, a focused or expanded evaluation may be indicated. Unfortunately some neurological issues require longer periods of time to manifest what they are. For lengthy periods of time, they can even stay beneath the detection of an MRI.

In order to answer your ultimate question of what can be done, the neurologist can assist at this point in time to hopefully narrow down possibilities.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente

Can prolia be used with tecfidera?

5/17/2019

 
Here is My Question:
Can Prolia be used with Tecfidera?

Answer:

Prolia is a biological (protein) that should not interfere with a small molecule like Tecfidera.

A. Scott Nielsen MD MMSc
Neurologist and MS specialist at Kaiser Permanente

Does my optic neuritis mean I have MS?

5/17/2019

 
Here is My Question:
Hi, I'm a 23 year old male and have left side optic neuritis, a lot of plaques at periventicular and central semioval and juxta cortical areas on MRI, 3 enhanced lesions. This is my first attack, please tell me the next step after corticosteroid pulse therapy.

Answer:

You should see a neurologist who specializes in treating multiple sclerosis. Optic neuritis is frequently due to MS and the MRI findings you describe sound suggestive of MS but you need an neurologist with expertise in MS to confirm that diagnosis. If that diagnosis is confirmed, the neurologist will most likely recommend starting treatment for MS (there many different medications now approved by the FDA for treatment of MS).

Benjamin Osborne, MD
Associate Professor of Neurology and Ophthalmology
Director, Neuromyelitis Optica (NMO) and Neuro-Ophthalmology Clinics
Associate Director of the NIH/Georgetown Neurology Residency Program
Medstar Georgetown University Hospital

Can spasticity be caused by brain lesions in MS?

5/4/2019

 
Here is My Question:
Can Spasticity Be Caused By Brain Lesions in MS?

I’ve am diagnosed with MS and although I do not have any visible lesions on the spine with MRI, I experience generalized stiffness and tightness throughout my body. It is extremely apparent in both legs. I am unable to stretch my legs well when they are out straight and I have to bend my knee to do any type of stretching. This has gotten progressively worse over the past few years. 

Is it possible to have spasticity without spinal cord lesions? Are there certain areas of the brain that would be responsible for this? 


Answer:
It is certainly possible for people with MS to have spasticity in the extremities without any discrete lesions visible in the spinal cord. Spasticity can occur as a result of injury anywhere between the cortex of the brain up to but not including the anterior horn cells of the involved region in the spinal cord


Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

Does apitherapy (bee stinging) help treat MS?

5/4/2019

 
Here is My Question:
I've heard that apitherapy (practice of bee stinging), has been known to help treat systemic health issues like MS. Any information on that?

Answer:

Apitherapy has been hypothesized to help inflammatory conditions (including MS) due to its presumed anti-inflammatory effects.  To test this hypothesis, there is published data on a cross-over design clinical investigation study using bee stings.  The study collected the typical measurements of new/enlarging lesions on MRI, confirmed MS relapses, and even disability progression.  In addition, the study participants were asked about fatigue level and health-related quality of life while on bee sting therapy and off of it.  The final analysis did not see a statistically significant effect on any of these measurements.  So, we don't have good confirmed data for bee sting therapy.  The best we can say is that apitherapy is possibly ineffective at treating MS and MS-related symptoms.  

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente

    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

    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


© 2020 HealthCare Journey, LLC. All Rights Reserved.
HealthCare Journey™ is a trademark of HealthCare Journey, LLC
Picture
  • Home
  • About Us
  • Virtual MS Center
    • Q & A for Virtual MS Center
    • Read About Our Virtual MS Center Staff
  • News & Resources
  • 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