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Is it protocol to change a patient's medication based on new symptoms without ordering a new MRI?10/31/2021 Here is My Question:
Is it protocol to change a patient's medication based on new symptoms without ordering a new MRI? Answer: It is certainly appropriate to change DMTs without a repeat MRI, if there are meaningful alterations in symptoms, usually accompanied by changes on examination, that indicate significant disease activity. It is my opinion that a repeat MRI scan should be obtained in all relapsing remitting MS people with MS at least 3 months after starting the new treatment to establish a new baseline for monitoring the response to the new treatment. Repeat MRI scans are less useful in people with primary or secondary progressive MS unless there is a specific reason to be concerned that you may have recurrent or new inflammatory disease activity or another condition affecting the nervous system. The timing of repeat MRI scans is the subject of much debate and variance around the united states and elsewhere. I would recommend that you discuss your physician's reason for his or her decision. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego
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Here is My Question:
Since starting Ocrevus, I find I don’t heal from even the most basic/superficial cut or scrape. Now, I am booked for a full abdominal surgery (complete hysterectomy, including ovaries and tubes) in a few weeks. Wondering how I will ever heal from this, if cuts/scrapes don’t heal well at all? My last Ocrevus infusion was Sept 29th, and my surgery is Nov 22nd. Thank you. Answer: It is certainly possible that Ocrelizumab or related anti-CD20 monoclonal antibody therapies could impair normal wound healing. Although there is no literature to support this hypothesis, there are also few if any studies in humans that have looked at this specific relationship. I assume you do not have other conditions (e.g. Diabetes) that can delay wound healing. Waiting 2 months for the surgery seems prudent given the information available; it is even better if you can wait 3 months for complete clearance of the ocrelizumab from your system. It is more important to avoid any corticosteroids because of the well demonstrated effect of steroids on the delayed healing of wounds. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences 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. Here is My Question:
I have small fiber neuropathy and have problems dropping things and balancing. My doctor just looks at me like I'm crazy when I tell her this. I work as a correctional officers and it is getting worst. I'm a liability. What to do about this? Answer: Small fiber neuropathy is not a symptom of Multiple Sclerosis. Talk to you neurologist about your ongoing symptoms with this problem. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I drink everyday. How long should I wait to take Tecfidera? I am just starting medication today. Tecfidera is a gastric (stomach) irritant, and this effect could be enhanced by alcohol intake. Tecfidera can also damage the liver (usually mild and temporary), which could also be enhanced with daily drinking. Answer: I would advise no more than moderate drinking (1 drink daily for women and 2 drinks daily for men) and no more than 5 days per week (try to abstain at least 2 days out of the week). Avoid alcohol for about 2 hours after a dose of Tecfidera. Either stop drinking or stop Tecfidera if any significant elevations in Liver enzymes occur on treatment or if you experience significant gastrointestinal side effects and contact your doctor for further instructions. Obviously, you should avoid drinking altogether if you plan to drive, are pregnant or have a history of alcohol use disorder. You should also avoid drinking if you have other medical conditions or take other medications contraindicated by the use of alcohol. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
My husband and I are looking into egg freezing/ embryo banking. I know that I need to wait 6-12 months after receiving an OCREVUS (ocrelizumab) infusion to become pregnant, but does OCREVUS (ocrelizumab) affect my eggs? If so, how long after an infusion should I wait to harvest my eggs? Answer: There is no evidence that oocytes express CD20, the target of ocrelizumab and other B cell depleting agents. This means that Ocrelizumab should not have any effect on harvested oocyte (i.e. egg) cryopreservation. The medications sometimes used to produce ovulation or maturation of oocytes, particularly Gonadotropin releasing hormone agonists, may increase the risk of MS relapse in the 3 months following an ovulation cycle. This is postulated to be caused by ovarian hyperstimulation. In this case your B cell depleting therapy may protect you from post ovarian stimulation relapses. 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. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
I read all your answers about Ocrevus and Covid vaccine timing, but don't really understand! If I get the Covid booster, how long should I wait to get the Ocrevus? My last Ocrevus was nine months ago. Answer: If you are already receiving treatment with Ocrevus, it can be difficult to time vaccinations. Different individuals have different risks for COVID19 infection, and this risk should be considered when trying to decide on the timing of a primary vaccine or booster. Whenever possible we recommend waiting at least 3 months after your last Ocrevus infusion to receive either a primary vaccination or a booster. We then recommend waiting at least 2 weeks after your second primary vaccination (Moderna or Pfizer vaccines) or at least 2 weeks after your booster vaccine to receive any further Ocrevus infusions. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences 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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