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Ask any question you want about Multiple Sclerosis and one of our experts will answer it as soon as possible.
Question: I am continuing to lose muscle mass in my legs in spite of physical therapy specifically addressing this area. Do you know of any supplement such as creatine that would help build it back up or protect from further loss? Answer: Sustaining or increasing muscle mass requires normal innervation of muscle by the nerves supplying them and the repeated activation of the muscle that occurs with everyday activity and muscle strengthening programs. Supplements will not help activate muscles but resistance training programs or electrical stimulation may help activate muscles enough to increase muscle mass. Please discuss this further with your doctor or physical therapist. Question: Which yearly vaccinations are safe for the MS patient? My primary doctor wants a flu, pneumonia and shingles vaccination, but I am not sure they are safe with a compromised immune system. Answer: There is no single answer when it comes to vaccinations. Whether an individual should be vaccinated depends on their risk factors and age. You should discuss this with your doctor. Generally speaking all MS patients, even immunosuppressed patients, may receive inactivated vaccines as required by circumstances or on a regular basis. However, an immunosuppressed patient may not be able to benefit from an inactivated vaccine as well as required (i.e. you may not mount a protective immune response). Live or live attenuated vaccines should be avoided in pregnant and immunocompromised patients unless required because of an epidemic. Remember, as an MS patient you ARE NOT immunocompromised unless you receive a treatment that could definitely or potentially create immunosuppression. Even then most patients will likely mount a relatively normal immune response to vaccinations. Medications definitely associated with immunosuppression include chronic steroids (not just occasional steroids for a relapse), azathioprine, methotrexate, cyclophosphamide (cytoxan), mitoxantrone, cyclosporin and mycophenolate (cellcept) to name a few medications possibly associated with immunosuppression include Aubagio, Gilenya and Tysabri. The list of live attenuated viruses to avoid if pregnant or immunocompromised include the following:
So the yearly injectable flu vaccine is safe and the one time pneumonia vaccine is safe The Shingles vaccine is safe if your doctor does not think you are immunocompromised. It is also only recommended if you are over 50. Here are previous blogs you might be interested in regarding shots for the flu and shingles: http://www.healthcarejourney.com/q--a-for-virtual-ms-center/the-flu-shot-and-multiple-sclerosis http://www.healthcarejourney.com/q--a-for-virtual-ms-center/should-i-get-a-shingles-vaccine-if-i-have-multiple-sclerosis 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:
I have recently had blood tests which show that I am iron deficient. I am considering iron supplements but have read somewhere that those with MS have a compromised blood brain barrier and should not be taking iron. What are your thoughts on this? Answer: Iron supplementation is required if you are iron deficient and will not have any effect on your MS. As an FYI, iron supplements can cause constipation, so make sure your doctor gives you something to prevent constipation. Here is My Question:
I'm a former Tysabri patient now on dimethyl fumarate and am JCV positive, can I ask for a antibody test again, just to see what mine is now? Answer: There is little reason to repeat the JCV antibody test in this circumstance Here is My Question:
Hi, I recently tested positive for JCV, after nearly 40 months of taking Tysabri. I have been offered the chance to take Rituxan off label for my MS. My question is this: Would I be at increased risk for PML on Rituxan having taken Tysabri? I've noticed in my reading that PML with Rituxan is often affected by prior therapies that affect immune function....How long after my last Tysabri infusion would I wait to start the Rituxan? Would the protocol of 1,000mg every six months be advisable? Or is there another dosing schedule that might be more effective? Thank you in advance for answering my question. There seems to be so little information out about Tysabri patients using Rituxan.... Answer: You are correct; there is little written about Rituximab in general since it is not approved by the FDA for an indication to treat MS. All very good questions. Please see some of my prior postings which consider this subject in more detail. (Just go to the search box at the top right of the page and type in PML). Let’s break your question down:
If you start the Rituximab immediately, you will need to have your MS specialist continue to monitor you for the development of PML. 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:
l feel pain in my shoulders.l often suffer from this pain.would you please tell me if Difen Flex woud be effective. Answer: Pain the shoulder of MS patients can be caused many different things all treated differently. Two of the most common causes are wear and tear injuries in people with severe leg weakness from constantly lifting themselves out of chairs, leaning on walkers or self propelling wheelchairs. Another common cause is bursitis which can occur in both disabled and non disabled MS patients. See your doctor about this discomfort early, so he or she can help you or refer you to an orthopedic shoulder specialist. The longer you wait the more difficulty this becomes to treat; and treat the cause, don’t just take Difen Flex. Here is My Question:
On my last MRI it looks like one cervical lesion has disappeared (it was already less visible on the MRI 6 months ago). What does this mean? Answer: As people with MS recover from acute inflammation, the areas involved become smaller and less noticeable on MRI; at times they improve so much that you can no longer differentiate the abnormal region from normal regions on the MRI. This is usually a good thing. Congrats! Rip Kinkel, MD Here is My Question:
Can MS come back if you were diagnosed as a young person and never had any symptoms until old age? I was told at 27 that I had it but never had any symptoms until now at the age of 79. I had a weakness in my left side always but nothing major. Lately I have been listing to the right which is very embarrassing and have had a lot of pain. Does any of this indicate a symptomatic of MS? Please see my blog on Neuronal Reserve CLICK HERE to answer your great question. Rip Kinkel, MD Question:
Is PLEGRIDY another interferon? How might it be different from the interferons already used in the treatment of MS? Answer: PLEGRIDY is pegylated interferon 1-a, the same active interferon molecule used in the branded drugs, Rebif and Avonex. Pegylation is the process of covalently attaching polyethylene glycol polymer chains to a protein, to increase its duration of action by slowly releasing the active molecule. This has been done with several other biological molecules used to treat other diseases like rheumatoid arthritis. Because of the pegylation process, PLEGRIDY only needs to be administered every 2 weeks by subcutaneous administration but with the usual interferon side effects. The clinical trial results with PLEGRIDY were nothing short of amazing for a first line therapy; the Advance study (PLEGRIDY clinical trial in relapsing MS) reported a 36 % reduction in relapse rate and a 38 % reduction in sustained disability progression over 1 year compared to placebo. There were also significant reductions in MRI activity and a very low rate of neutralizing antibody formation. The FDA is still reviewing the drug application for PLEGRIDY but I suspect it may replace most interferons as first line therapy if it is as well tolerated as reported and the costs are reasonable compared to other first line agents for MS. Rip Kinkel, MD 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. |
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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