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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 my hip pain related to my MS?

5/10/2022

0 Comments

 
Here is My Question:
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

0 Comments

What should I do to best manage my MS?

5/10/2022

0 Comments

 
Here is My Question:
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.
  1. You are very young and already immunosuppressed. But because you are young, your immune system will be restored over time. After prolonged repeated rituximab and ocrelizumab treatments, this repletion of your immune system can take several years. 
    Your physicians can monitor your B cell subsets to determine when they are repleted. It will be important to know when central memory B cells and Plasmablasts begin to return. ARUP (a commercial lab) has a nice B cell subset analysis panel that can be used for this purpose
  2. Ask your physicians to consider continued immunoglobulin replacement therapy until your IgG levels remain normal; 
  3. One option for treatment that may help control viral infections and benefit your MS is  Beta-Interferon. There are many brands available including long acting Pegylated Interferon. These are all administered by subcutaneous injection. The Beta Interferons are still quite useful treatments for MS but may cause flu like side effects when started. The side effects can usually be controlled with acetaminophen and ibuprofen. If you do start a Beta Interferon therapy, make sure your physicians monitor you closely with repeated MRI scans beginning 3 and 9 months after starting treatment. If your MRI scans are stable at 9 months, you can lengthen the interval between scans.
  4. Most of the other treatment options may lower lymphocyte counts to an unacceptable level, which is to be avoided in your immunosuppressed state. You can reconsider these options with your physicians after your B cells subsets and immunoglobulin levels are both repleted.

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.​
0 Comments

Will not taking Tecfidera for a week cause problems?

5/10/2022

0 Comments

 
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​

0 Comments

Can chronic inactive lesions cause problems like balance and vision issues?

5/10/2022

0 Comments

 
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:
  1. Progressive demyelination and axonal injury in the spinal cord. The spinal cord, particularly the thoracic spinal cord, is difficult to image and detect enlarging or new lesions during the progressive phase. Accurate measurements can usually detect atrophy of sections of the spinal cord, but this is not done in standard practice.
  2. The demyelination is occurring in the cerebral cortex. Demyelination in the cortex is not visible at all with standard imaging techniques
  3. The worsening is due to progressive axonal transaction or energy failure in chronic lesions on MR imaging. This often takes years to become visible
  4. The worsening is due to widespread synaptic or axonal injury in gray matter or white matter networks that appear normal on MRI
  5. The worsening could be due to the normal aging process superimposed on prior damage from MS. Remember, our brains normally atrophy at a rate of 0.1 to 0.2 percent per year in health individuals. If there is already damage from years of MS, this further rate of "normal" age related atrophy will become more apparent because of exceeding the threshold of neurological reserve.
I'm sure I could think of other reasons, but these are the most important. Some people take an over-the-counter supplement, Alpha lipoic acid (600 mg twice a day), to help prevent further injury and deterioration from inflammatory stress in the nervous system. There are some very preliminary studies suggesting this may be helpful.

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 there a connection to my leg strength and Butrans Patches?

5/10/2022

0 Comments

 
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
0 Comments

Do I have MS?

5/10/2022

0 Comments

 
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​

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    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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  • 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
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    • Pregnancy and Infertility
    • Caregivers and Family Members
    • Employment and MS
    • Medical Costs and Insurance
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