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.
Here is My Question:
Is it dangerous to take iron supplements if you fear I may have MS? I was diagnosed with low iron, scared to take my supplement. Please help!! Answer: There is no problem taking an iron supplement regardless of the presence or absence of MS. Follow the instructions of your physician. A. Scott Nielsen MD MMSc Neurologist and MS Specialist at Kaiser Permanente There are many different Herpes Viruses (all DNA viruses) that are implicated in many different diseases:
Many Herpes viruses including Herpes Simplex may also be associated with reactivation of the disease and relapses. This presumably occurs when the virus starts actively replicating and triggers and immune response that triggers inflammation in the brain and spinal cord. Hope this helps. Revere (Rip) Kinkel MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego AnswerHere is my question:
What do I do if my new insurance won't approve Rituxan or Ocrevus? I've been on Rituxan for 3 years and I am doing well on MRI. I am losing my insurance because I am quitting my job. It is just too much for me to work anymore (I only work a couple of hours per week, so I cannot reduce more than that). I am going on my spouse's health insurance plan, but that plan plainly states it will not cover Ocrevus. It will only cover Rituxan after failing two other drugs first. I am afraid of what failure looks like with the amount of lesions and locations of them. What would you prescribe your patients? What do I do? Answer: It is hard to completely answer your question without knowing a little more about your condition. First of all, if you have progressive MS there are no other drugs approved other than anti CD20 agents such as Ocrevus or rituximab. Therefore, insurance really can not deny coverage in this circumstance unless you are too disabled (wheelchair bound) or too old (over 65). If you have relapsing MS, use of the anti-CD20 agents is discretionary by insurance companies. Here are my thoughts in this situation: First things first: if you've been receiving rituximab every 6 months for 3 years, it is likely that the benefits of this treatment will last for several years without requiring any further treatments. There is no evidence that either rituximab or Ocrelizumab needs to be administered every 6 months indefinitely. In fact there is good evidence that the effect of a single treatment lasts more than a year. This means you can relax for the time being. What you need to do is get your neurologist to monitor your condition with yearly MRIs and regular visits to determine if there is any evidence of worsening function. Your neurologist can also monitor your CD19 blood counts. This will determine when the effects of rituximab are wearing off. Normally, your CD19 count is approximately 10 to 15 % of your total lymphocyte count. Following a single infusion of rituximab or Ocrelizumab at standard doses, CD19 counts in the blood remain very low or undetectable for 6 to 18 months. After repeated infusions of rituximab every 6 months (for 3 years in your case) the counts will sometimes remain low for more than 18 months. Since the main effect of rituximab is to deplete (kill off) the CD19 positive lymphocytes in your blood stream, this is a pretty good marker of drug effect. Interestingly, in MS patients the activity of your MS does not tend to return when the CD19 count normalize in your blood stream. This may be a result of prolonged beneficial effects of treatment on immune regulation. If you do need another treatment with rituximab anytime soon, we can provide your doctor with a draft letter of medical necessity that is often helpful during peer to peer negotiations. Revere (Rip) Kinkel MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is my question:
Are Patients with MS More Susceptible to Increased Levels of Chronic Pain? I have had MS for a few years and I have noticed that since the disease first manifested, I have experienced chronic, unremitting pain that is out of proportion to the original injuries. Before this, I had a very high pain tolerance and never needed pain medication or ibuprofen beyond a couple of days after being injured or having surgery. For example: Since I have developed MS, I have had shingles along my trigeminal nerve and developed bilateral sciatica due to foraminal stenosis (no cord involvement). Doctors have assumed that, due to my age (early 30’s) I would have a relatively uneventful recovery from both. This is not the case. It’s as if the pain signals have been switched on permanently. Neither of these conditions were caused by MS, but I am wondering if having MS makes us more susceptible to something like a central pain syndrome even with injuries sustained outside of the CNS. Could it be caused by sub-clinical damage to the tracts within the CNS that regulate pain, even if no lesions appear in those areas on MRI? Answer: Your question and observations are extremely astute. MS specialists have observed for years that MS patients experience pain differently and chronic pain in MS patients modifies pain thresholds and responses to other non MS related conditions and injuries. The best approach is to work on modifiable risk factors for chronic pain. This includes doing the following:
Revere (Rip) Kinkel MD Professor 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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