Here is My Question:
I have RRMS and I’m taking Ocrevus. My dog just had the live bordetella intranasal vaccine for Kennel Cough and I read later that it should be avoided when the owner is on an immunocompromising medication. I was in the room and even kissed the puppies face and definitely was exposed to the vaccine. Should I be worried or take precautions? I read conflicting data but some highly regarded sites indicated it may not be safe. I can’t get in touch with my MS provider. 

Answer:
There are very rare reports of human cross contamination from intranasal bordetella vaccine sprays given to dogs.  Your risk of a serious infection would depend on your extent of immunosuppression, which, in turn, is likely related to your duration of treatment with Ocrevus. If you develop signs of infection or a respiratory illness within 2-4 weeks of exposure, inform your health care provider of your potential exposure, so that appropriate testing can be done. Bordetella is a gram negative coccobacillus that responds  to treatment with common antibiotics.

It is probably best to contact your primary care provider for this issue.

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:
I am going to be 3 weeks without being on Tecfidera, due to insurance issues. Can I restart it at the higher dose?

Answer:
Yes.

​A. Scott Nielsen MD MMSc
Neurologist and MS Specialist for Kaiser Permanente

Here is My Question:
How do you test to see if the Ocrevus is working? 

Answer:
There is no test that tells us directly if any disease modifying therapy is working. For some therapies it is very easy to determine if the drug is doing what it is supposed to  do, but this doesn’t mean that it is helping any particular person control their MS.
 
For instance, Ocrevus is a monoclonal antibody that binds to and destroys any B cell in your bloodstream expressing a protein on the cell surface called CD20. We can take a blood sample from a person after they are given Ocrevus and it will tell us if the ocrevus did what it is supposed to do; that is, destroy these identified cells. However, this doesn’t mean that the drug is benefiting a particular person with MS. We need to evaluate (by examinations, clinical outcome measures, self- report and MRI) how you are doing over a reasonable period of time after starting Ocrevus, usually 2 to 3 years, to determine if it is able to control your MS.

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:
I have been ordered to take Vitamin D (1x), iron (1x), and alpha lipoic acid (2x) daily. How should these be taken for optimal absorption with regard to taking them at the same time and with or without food?

Answer:
Alpha lipoic acid and vitamin D can be taken with or without food. Iron supplements should be taken one hour before or two hours after meals usually with water. All can be taken together.

​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:
Can a person on Avonex take Vascepa safely? Can it cause increased risk of liver and pancreas problems?

Answer:
Vascepa is essentially highly concentrated fish oil, used to lower triglyceride levels
There should be no interaction or problems using this medication if you are also taking an interferon such as Avonex, Plegridy, Betaseron, Extavia or Rebif.

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:
This question has been really been driving me nuts. I know there is research pointing to a possible like between MS and EBV but have you ever heard of or is it possible that human parvovirus B19 could trigger MS in the same way? I have RRMS diagnosed last year around May 2018. In 2015, I started having a bunch of crazy symptoms like muscle pain, difficulty walking, burning, dizziness, and a bunch of other weird things.

My smart PCP asked if my daughter recently had fifth disease and low and behold she had it the week before. It was severe and I ended up with a positive ANA and anti-RNP antibodies, liver inflammation and a ton other stuff. Had to see Rheumatologist to rule out mixed connective tissue disease etc. Eventually the ANA and anti-RNP became normal and we just left things at that. I wish I had an MRI around that time but didn’t. I kept getting weird symptoms for years and finally got a diagnosis of MS last year and have brain and spinal cord lesions and brain atrophy. I’m 38 :(.

I’ve just always been so curious as to whether it is possible for the parvo to trigger this but most of my MDs have never seen an adult with parvo.

Thanks!!!!

Answer:
I am aware of adults with Parvovirus B19 infections, but there is as yet no link between this virus and the development of  MS reported in the literature.

​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:
I am a SPMS patient and have had MS for 40 years. I am interested in starting Mayzent which is a new medicine for the SPMS patients. I would like to find out how patients have started on Matzent, How they are doing on the Mayzent...any reactions or anything else? Thank You.

Answer:
Mayzent (generic name Siponimod) is the newest SIP1 receptor modulator. The oldest, and currently the only other available, SIP1 receptor modulator is Gilenya (generic name Fingolimod). Mayzent is called a selective SIP1 receptor modulator because it only binds to the type 1 and type 5 receptors, whereas Gilenya binds to all SIP1 receptors. For practical purposes this has little effect on the side effect profile of these drugs.

The most common side effects are headache, elevated blood pressure and elevated liver enzymes. Less common or rare side effects include macular edema (usually beginning in the first 4 months of treatment), shortness of breath, cardiac arrhythmias (abnormal heart beat), various infections including shingles and a condition called posterior reversible encephalopathy syndrome. Physicians monitor regularly for these conditions, all of which are reversible with prompt identification and treatment

I am not aware of any other unexpected problems emerging since the drug was approved and released by the FDA.

​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:
Can my neurologist sign a letter for an emotional support animal?

​Answer:
Any licensed health care provider can provide you with a letter of justification for an emotional support animal. The letter must state that the person applying has a physical or mental impairment (no need to mention the actual diagnosis) that substantially limits one or more major life activities and  their is a disability-related need for an assistance animal.  Specifically, in the case of an emotion support animal, the animal provides emotional support that alleviates one or more of the identified symptoms or effects of a person's existing disability.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego