Here is my question:
Hello, I have had MS for 14 years and I am 43 now. I was diagnosed with RRMS and have been on Copaxone since 2000. My MRI scans have been stable. I have had a lot of problems stemming from bladder infections after the use of steroids. I had a really bad relapse after I took liquid steroids in January. I finally got rid of the infection in March and have recovered pretty well with the help of PT. My question is, I am having trouble with my body deciding if it wants to stand up or not. Sometimes yes and other times it is like something is pulling me back. I am in a manual wheelchair. I have had one since 7/2000. I urinate etc. on my own. I do almost everything but walk. Which leads me to another question. In July of 2000 I had a big infection not treated right away and that led to paralysis for 7 months. Would that cause a lesion in my spine to not let me walk for 14 years? Sorry for the long question(s).

Answer:
Steroids can certainly increase your risk of infections including urinary tract infections. More importantly, repeated and frequent infections are associated with more rapid worsening of MS, especially in more disabled patients such as yourself. I know you mention urinating on your own but it is highly likely that your bladder function is abnormal because of your MS. This will increase your risk of urinary tract infections even further. You need to be seen by a urologist specializing in patients with MS and spinal cord disease. An evaluation is likely to find ways to decrease your future risk of infections.

Good luck
-Rip Kinkel, MD

Question:
I have been having persistent lower right pelvic pain for more than month now. I had a pelvic ultrasound, CT scan, and everything looked normal. They said it's probably IBS (which is basically anything that can't be explained) or food intolerance (unlikely because I have changed nothing recently). While it's good to know there's nothing serious going on, I still have to live with this pain. Is there any possible way that this could be due to MS?
 
Answer:
This depends on the nature of the pain; lancinating, burning, or needle-like superficial pain following sensory dermatomes could be related to MS or even a condition called zoster sine herpete (shingles pain without the rash). A tight squeezing sensation that can be intermittently painful may also occur with spinal cord involvement by MS.

Non MS related causes are far more numerous and more common for pelvic pain even in MS patients.

Rip Kinkel

Question:
How Would Someone Go About Finding A Gynecologist Who Specializes in MS?

Answer:
I am not aware of any gynecologists specializing in MS. Most gynecologists and obstetricians work with your MS specialist to find the cause and solution to your problems. Most spinal cord injury centers have therapists and counselors to help patients deal with changes in sexual activity that occur after injuries to the spinal cord and these outpatient treatment centers can be a good resource for MS patients as well.


Rip Kinkel

To the person who asked about insurance plans...We certainly accept Medicare and Medi-Cal plans at UCSD, so I suspect there was an administrative error. Please call Shivon on Monday at 619-543-3500 and she can help you straighten this out

Here is My Question:
I have been diagnosed with transverse myelitis MRI cervicodorsal spine showing long segment demyelination from C5-T7. I have gotten a penile implant but sex has become mechanical. Can you suggest any medication to enhance satisfaction with sex and is there any benefit from kegel exercises?

Answer:
Satisfaction rates after penile implants are usually high as long as the main problem prior to surgery was inability to get an erection.  I would discuss this further with your doctor and consider seeing a sex therapist. Sexual activity is certainly different after this type of surgery and often requires some counseling for both you and your partner. I doubt kegel exercises will help with this particular problem.

-Rip Kinkel, MD

Here is My Question:
IV steroids made my vagina hurt A LOT. It has been almost a month and the pain is not going away, in fact it is worse since my period ended. I have seen a gynecologist and I do not have an infection, UTI or yeast overgrowth. My neurologist thought that I got an infection from my immune system being suppressed but also mentioned that steroids affect hormone levels. How do I go about pursuing this possibility? Do I get my hormone levels tested? Is there a course of therapy neurologists use for women who take IV steroids and then experience this side effect? How do I level things out again?

Answer:
All solutions in medicine revolve around a good history and exam by an individual with experience. You need to see a gynecologist who specialized in sexual dysfunction. Your question as stated provides insufficient information to arrive at a diagnosis. There are many possible reasons for the vaginal pain and it may not be related to the steroids at all.  Keep an open mind and get several opinions. It is doubtful that a neurologist will be the doctor who discovers the cause and the solution.
Good luck

Rip Kinkel, MD

Here is My Question:
What vitamins or minerals help people with M.S. (i.e., magnesium deficiency)?

Answer:
Very few people with MS are deficient in vitamins or minerals; supplementation in most cases is based on symptoms of deficiency or a measurement suggesting lower than normal amounts stored in the body. Most people with a deficiency are strict vegetarians, take medications associated with deficiency states (examples include dilantin or phenytoin and carbamezipine or tegretol),have a disease associated with malabsorption or have undergone gastric bypass or bowel resections in the past.

A couple of vitamins and minerals are often recommended as supplements for most people with MS

1. Many people with MS are Vitamin D deficient and benefit from supplementation with vitamin D3 per day. It is usually best to take calcium carbonate as well.
2. Some people with MS are relatively deficient with Vitamin B12 and supplement with this vitamin.
3. Magnesium, usually as magnesium oxide, can help with some MS symptoms such as cramps and spasms.
   

I would suggest discussing this issue with your doctor and getting his or her advice on appropriate supplements. Please also refer to previous blogs on Vitamin D3 supplementation.

Rip Kinkel, MD