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Can I regain mobility? I am completely paralyzed due to MS Answer: The ability to recover useful movement in the legs depends on the duration of paralysis, the cause of paralysis and the extent of irreversible damage to the spinal cord. Without further information and an evaluation, it is difficult to answer your question with more precision. This is a question your neurologist should be able to answer for you. Good luck Revere P (Rip) Kinkel, MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego
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Here is My Question:
Every time I inject Copaxone in my left side I experience left groin pain immediately. Is this normal? Answer: If you are injecting in the lower abdomen (below the bellybutton) this may cause swelling in the superficial inguinal (groin) lymph nodes, which may be painful. Injecting into the upper left leg could potentially do this as well, but typically this region drains into the deep lymph nodes; I wouldn't think these deeper lymph nodes would be as painful, but this is possible. I am not sure of a solution except to inject higher in the abdomen or in the arm Good luck Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Unorthodox question here... Do I need to notify my life insurance company of my new diagnosis of MS? The internet is great at giving contradicting information. Answer: If you already have an insurance policy, there is no need to notify anyone. This would only be relevant if applying for insurance coverage. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #msdiagnosis #multiplesclerosis Here is My Question:
I was had my first clinical symptoms in 2010 had an MRI with active lesions. The symptoms were tingling in the left side of my body, took 5g cortisone the symptoms almost fully subsided. In 2012 i had blurred visions and the diagnosis of MS was affirmed. I started Gilenya and after that my MRI has always been almost stable with little new non-active lesions. The problem is that I have a neurological deficit in the tips of my left fingers and I don't know if they could ever improve or not. I do have cervical lesions. Answer: Thank you for the detailed description of your problem. When you state that, "you have a neurological deficit in the tips of [your] left fingers", I assume you are describing numbness or a loss of discriminative sensation. Some people describe the fingertips feeling larger or the skin as being thicker. If the "neurological deficit" involves all of the finger of your left hand, it is almost certainly related to the spinal cord lesion mentioned in your message. If the deficit involves a more restricted pattern, the cause could be something as simple as carpal tunnel syndrome (thumb and index finger and possibly middle finger) or an ulnar neuropathy (ring finger and little finger), both treatable conditions. If you have this kind of restricted pattern of involvement in your left hand, you need to be evaluated for these non-MS related causes. Let's assume for the purposes of your question that the cause of these symptoms is your MS. Whether this symptom can improve depends on the duration of the symptoms and the extent of damage to the involved region in the spinal cord. Generally speaking, persistent symptoms present for more than 6 months rarely resolve, although they may evolve and become either less or more noticeable; by less noticeable we usually mean more intermittent, less prone to worsening or simply a symptom that you are able to suppress and ignore; by more noticeable we are usually describing abnormal sensations that evolve to develop painful characteristics such as burning, deep aching or stabbing discomfort. If and when people develop symptoms with these painful characteristics, we often offer them treatment with medications (e.g. gabapentin, pregabalin and others) to help block the painful characteristics. Hope this helps. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis Here is My Question:
What is peripheral white matter of both cerebral hemispheres? "Peripheral white matter" is an inappropriate term. Whoever used the term was either referring to the subcortical white matter or the leukocortical (also called juxtacortical) white matter. We generally use the term leukocortical or juxtacortical when the U fibers are involved, whereas subcortical white matter excludes the U fibers. U fibers are the white matter tracts immediately adjacent to the cortex that supply white connections between one area of the cortex and an adjacent area of the cortex. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis #peripheralwhitematter Here is My Question:
My eosinophil count has been high for the last 2 years. I just got it tested Friday and it’s 767. Why is it consistently to high? Answer: Eosinophils are a type of white blood cell named for the intense pink staining of their cytoplasmic granules that stain strongly with the acid loving dye eosin. They are commonly associated with allergic responses, atopic conditions (asthma and eczema), parasitic infections, some inflammatory conditions and certain cancers. In medicine we often see a temporary increase in eosinophils associated with an allergic reaction to a drug which subsides after the drug is discontinued. You have a mild and apparently chronic elevation in your eosinophil count. This is usually not a serious issue but one that should be evaluated to determine a likely explanation. A full evaluation in most cases only requires a complete medical history, examination and some basic tests. Good luck Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Does Ocrevus contribute to weight loss? Answer: Ocrevus should have no affect on weight (either loss or gain). Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #Ocrevus #multiplsclerosis Here is My Question:
I have been told recently that I either have fibromyalgia or MS by my doctor, but I lost my insurance a few months ago, and haven't been able to get my MRI to get my final diagnosis. I am on Cymbalta for fibromyalgia treatment, but it's only helping my depression, if I'm honest. My symptoms are daily and worsening, to the point that my body gets so weak that I'm stuck in bed, barely able to move (like right now). My question is a two-parter: Should I expect an MS diagnosis, and is there anything I can do while I wait on insurance? Answer: It is impossible for me to say, based on the information provided, if there is a possibility of MS in your case. While it is true that people with MS can have symptoms consistent with fibromyalgia, these symptoms are not characteristic or defining for MS. We hope you get some answers and feel better soon. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
My feet started swelling and are very cold and painful. I cannot walk long or without assistance. My neurologist suggested I may have a spinal injury but the MRI did not show anything. Is there anything else that could reverse my mobility issues or another approach I need to take? Nerve conduction or GI specialist? Answer: It is relatively common for people with spinal cord disease from any cause, including those with severe multiple sclerosis, to develop dependent swelling of both feet, if both legs are weak, or just one foot, if only one leg is week. The affected foot or feet will often feel cold and painful. The feet may also appear reddish or even purple. This is generally due to inactivity (sitting in a chair most of the day). Getting up and about more, if possible, passive range of motion exercises and massage can all help. A neurologist can determine if a spinal cord problem is causing these symptoms. Neurologists will take a thorough history and exam and usually obtain an MRI scan of all or just part of your spinal cord. Additional testing may also be required. Peripheral neuropathies (not a spinal cord problem) can cause similar symptoms and are usually evaluated by interview, examination and nerve conduction studies with electromyography. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis #spinalinjury Here is My Question:
What is the incidence of patients having both MS and Type 1 DM? If MS flares develop in a person in this circumstance- how do you go about treatment- as IV steroid use is very difficult to manage. I have had multiple consults with MS Specialists over the years and there does not seem to be an understanding of how to manage with steroids. I have been told if you have an insulin pump/cgm- we would just administer the IV steroid in the office. An insulin pump cannot handle controlling glucose levels on IV steroids. The lack of understanding on treatment of T1DM with MS is frightening. Answer: There is not an increased world-wide co-occurrence of Type I diabetes and MS despite similarities in environmental and genetic risk factors and immune pathogenesis. Perhaps one reason is that common genetic susceptibility risk factors differ between the two disorders. It is true that management of MS relapses can be difficult in people with both type I and type II diabetes because of the effect of steroids on glycemic control. The best approach is to use high active DMTs to dramatically lower the risk of relapses, make sure worsening function is not caused by an infection and, if so, treat appropriately, use only short courses (3 days) of high dose corticosteroids (500 to 1000 mg per day equivalent methylprednisolone dose), avoid tapering prednisone courses following the high dose treatment, and frequent blood sugar checks with sliding scale insulin coverage. In practice we usually admit people for 3 days during their steroid treatment to monitor and control blood sugars. Hope this helps. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis #diabetes #diabetesandmultiplesclerosis Here is My Question:
Very unusual symptoms following my third infusion of Ocrevus. Feel like limbs are swelling. Answer: If your legs are not actually swelling, then you are experiencing a common sensory illusion (macrosomia) frequently reported by people with MS. It is akin to the sensation that occurs when the dentist numbs your mouth with lidocaine and your lip feels swollen. If your legs are actually swollen this could be dependent edema or another problem. For this contact your PCP. Hope this information helps Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #legswelling #multiplesclerosis #Ocrevus Here is My Question:
Can you donate blood if your are taking Kesimpta injections for MS? What about if you are on pain medication? Answer: You cannot donate blood when taking monoclonal antibody therapies. I doubt they allow you to donate if you are taking controlled substances Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #kesimpta #blooddonation #multiplesclerosis Here is My Question:
I have a new lesion that is listed as possible encepholomalacia in the thalamus that is new from last MRI 7 months ago. Is this from MS? Answer: This could be from MS or another process. Without knowing your case or seeing your images it is not possible to answer your question. Revere P (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’ve had numbness in my limbs for the last 6 years, but since last one month it has increased, and I've been using a walker since last one year. Please help & tell me any remedy. Answer: It sounds like you need to see a neurologist to start. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #MS #multiplesclerosis Here is My Question:
When do I need to take action to come off Ocrevus if it’s not working and I’m deteriorating at much more aggressive rate since I’ve gone on Ocrevus. What are my next options then? Answer: When to stop Ocrevus depends on several factors including your age, disease type, disability level, prior treatments and complications while taking Ocrevus. You would benefit from an evaluation by an MS specialist to help you with this decision. If it helps, I typically encourage my patients to set specific goals before initiating a treatment. This makes it easier to determine when it is time to stop treatment or consider another treatment. Many of the options after treatment with Ocrevus include participation in various ongoing clinical trials. Your MS specialist can tell you how to find out about clinical trials in your area for patients with your disease characteristics. Good luck Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #Ocrevus Here is My Question:
Can Kesimpta cause hair loss? Answer: Ofatumumab (Kesimpta) is not associated with hair loss. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #Kesimpta Here is My Question:
How to decrease blood levels of JCV? Answer: I believe you are asking how to decrease your JCV index level ( a blood test to determine antibodies directed against the JC virus), if you are positive. There is no reliable method for decreasing your JCV index level. Several studies suggest that treatment with B cell and T cell depleting agents (e.g., rituximab, ocrelizumab, ofatumumab and alemtuzumab) can decrease the value of your JCV index and treatment with natalizumab and fingolimod can increase the value of your JCV index. The significance of these associations is unclear currently. Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #JCVindex Here is My Question:
I have long standing Type 1 diabetes and MS. How to I determine the etiology of my foot cramps between MS vs periperal neuropathy? I have had foot cramping in years past, but it resolved- it is now more consistently present. I usually get routine MRI’s done year.y- which have shown no change. I am an RN and knowing how to differentiate the symptoms is important to me. Answer: PS Foot cramping is common in both diabetics and people with MS. See my last response Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego Here is My Question:
Hello (again)- I just submitted a question regarding T1D and MS symptoms of foot cramping/numbness. I forgot to add that I have had T1D for 49 years- with reasonable glucose control- I wear a pump/cgm. The MS was formally diagnosed 10 years ago, but I may have actually had it starting since the age of 18. I am now almost 60. Only took Tecfidera briefly as it caused hypoglycemia. No changes on MRIs done yearly and to this point no severe disabling- only intermittent numbness/pain/fatigue. I am wondering how best to have work up done to evaluate MS vs T1D neuropathy vs sacral lumbar issue...Thanks so much for your insights. Answer: It should be fairly easy to differentiate MS related sensory symptoms from diabetic neuropathy or lumbosacral polyradiculopathies (Lumbar canal stenosis, for instance). Remember, Multiple Sclerosis does not affect the peripheral nervous system which is the source of symptoms in people with either diabetic neuropathy or lumbosacral nerve root compression or injury. Peripheral nerve disease or injury can be evaluated with nerve conduction studies and electromyography, a procedure commonly performed by neurologists specializing in neuromuscular disease. The next step would be to see this type of specialist. Good luck Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego #multiplesclerosis #lumbosacral |
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