Category Archives: Multiple Sclerosis Diagnosis

Where and How to get Your MS Information

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                                                  “Tips and Cautions”

The upside of the internet and social media is that mounds of information about MS are available immediately with the stroke of a few keys and searches. Folks need as much knowledge that they can get to help them understand and handle this complicated disease.

The downside of the net–besides being overwhelming–is that one has to be very careful with the validity of the source and information of what is read. I read discussions between MSers on Facebook, other social media, and MS Association sites and am concerned by how much info is misleading, incorrect, and cause for fear. Bad information causes bad decisions.

1. Understand which treatments/drugs help symptom improvement.

While it is gratifying that DMTs (Disease-Modifying Therapies) are reducing relapses for many MSers, participants in some discussions talk about how their symptoms improved when they were taking a certain DMT.

This is not true. Here is what one MS specialist-neurologist stated:

“The disease modifying medications do not directly help with symptoms in MS. these medications are to delay disability, slow progression and some can have improvements on MRIs. I can tell you that I have seen people in my clinic that had been doing well for years and so didn’t start any medications. But, then they had an attack that hit them quite hard. Then they wanted to go on a medication, “to get better. I told them that the medications are to keep from getting worse and not to make one better.”(see Source #1 below)

Now, there ARE drugs to directly and successfully treat symptoms (e.g. depression, bladder incontinence…), and relapses (e.g. steroids). These often improve symptoms and help a patient feel better, but not alter the disease course or direction of the disease itself.

2. No treatment exists today that will stop the disease activity/progression and damage completely, or reverses it. (see Source #2 below)

Recently, I followed a discussion on FB about stem cell treatments that miraculously accomplished this for them.  Most of the participants that had the procedure were diagnosed within the past two-three years. These participates probably did not know their personal pattern of relapses; it’s not uncommon to lose one’s sight or have impaired mobility for a long stretch of time in their initial relapses. Their recovery was more likely due to the relapse being over and they’re being back into remission with little residual, which is very common in the early years of the disease.

Furthermore, it takes a while for a patient to understand their own case of MS and how their body responds to a variety of things—both medicinal and non-medicinal. Nowadays, it is even more difficult since a newly-diagnosed person during their first couple of years are receiving DMTs and drugs for relapses and symptoms all at the same time. What is doing what?

3. Be careful with reading statistics, study results, etc.

I worked a number of years in my professional jobs doing financial analyses and market research. One of the things I know from that experience is that conclusions of studies can be misleading by what numbers are used and how numbers are presented. I’ve become quite the cynic about this.

For example, one might read “according this study, 50% of patients using XYZ showed a 38% reduction in…” How many people were used in the study, what were their characteristics, how long did they take XYZ, what were their side effects, who did the study, etc. You have to dig deeper, be cautious, use common sense and talk to your professionals when you hear something of interest and want to pursue it (like trying a new medication).

How would you feel if you discovered that a study was based on eight people?

4. When gathering information, consider the following:

• Use common sense and logic.
• If something sounds too good to be true, it probably is.
• Listen to your gut, not what you want to hear.
• There is no cure, and if something says you will be cured, throw it away. You can manage MS and even control it in many ways, but there is no cure yet.

5. What are good Sources of Information?

MS associations and Pharmas are good sources of information that can be trusted for acquiring basic MS knowledge about the disease itself, the symptoms, current research/events that are happening, and treatments that are available. They also can be helpful in providing programs and forums for people dealing with MS to get together and interact.

Where to use caution?

• When listening/reading information that MS associations, Pharmas, and neurologists present statistical information about study/treatment results. They all recommend DMTs as the first line of defense, and one has to be careful of taking this information at face value. Re-read #3 above, and know that numbers/statistics can be arranged to project just about anything. Dig deeper into what you are told. You may be surprised.

For example, a current starting point to get specific data on DMT’s is Source #2 below. And read closely. On Page 13, the colleagues point out that 50% of persons diagnosed will have “benign MS”. People with benign MS will have an Expanded Disability Status Score (EDSS)<3 after 10 years.  After 20 years they found while 51% remained benign, 21% had progressed to EDSS >6 and 23% had converted to SPMS.

The point? Stats like these could help a patient weigh their options more carefully.

• A standard line of advice is “consult with your doctor.” Do you trust your doctor? How experienced is your doctor with MS? Does your doctor listen to you and talk with you, respect your questions and doubts? If the answer is no to any of these, it’s a red flag. Remember that doctors get kickbacks, and truthfully are limited to prescribing drugs and giving referrals. Get second and even third opinions.

• Social media sites are wonderful for sharing information and feelings with other peers, but remember that two-thirds of effective communication is through body language. There is no eye contact, no voice to hear, etc. that can make judgment of people difficult. Learn the background of the people you engage with. If reading an MS blog, make sure it is a credible, respected and experienced person that is doing the writing.

Here is a link to my Resources/Links page on my website that is quite comprehensive, not overwhelming, and judged by many to be trusted http://debbiems.com/links-resources_271.html . (You can check out my background, experience and credentials in other sections of my site.)

(Sources)
#1 The NPR Diane Rehm Show (9/24/2012) aired “Diagnosing, Treating and Living with MS.” A panel of experts—neurologists/MS Specialists including a doctor who has MS—answered audience questions about diagnosing, treating and living with multiple sclerosis.

#2 The Use of Disease-Modifying Therapies in Multiple Sclerosis: Principles and Current Evidence http://bit.ly/1oEnTqY  September, 2012

www.DebbieMS.com
Author/MS Counselor/Living with MS

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

The Truth about MS and Wheelchairs

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“My Personal Insights”

If you asked anyone “What do you think of when you hear the term MS?” the answer usually includes “wheelchairs.”

When my first relapse happened back in 1980, a picture of a person with MS in a wheelchair was always shown, even by the MS Society. Perhaps it was to help with fundraising, or perhaps it was to a way to draw attention to a disease that was not usually heard of.

Whatever the case, it did create a picture of “this is MS” and the huge fear of living a life in a wheelchair. That vision still exists today, despite the advances in awareness and research that have occurred. Despite the reality that MS involves many other neurological symptoms in addition to a life in a wheelchair.

I know much about this because I am one of those MSers who ended up in a wheelchair. And I want to speak up about MS and wheelchairs to try to correct that picture and reduce that fear for anyone dealing with MS.

1. Over a lifetime, only 20-25% end up in a wheelchair. That was the statistic in 1980, and it probably is less today due to the development of the disease-modifying drugs that have been available since the mid-90’s.

I have many friends who have had MS over 30 years, and I am the one of a few who is in a wheelchair permanently. Now, of course many patients use walkers or canes since MS and mobility problems usually go hand-in-hand, but few are not hunched over paralyzed, completely debilitated in a wheelchair.

2. A person can have a quality life living in a wheelchair, though admittedly the limitations it causes can be frustrating. Again, I know.

I manage my MS well and despite having lived permanently in a wheelchair these past thirteen years, I have had a happy life. I travel, swim, volunteer, take care of many household responsibilities… And the other MSers I know who are in my position would agree their lives are full and active.

Having MS certainly is not a cakewalk, but it certainly isn’t the end of the world either. There are far worse things in life. Plus, I must add that there are other MS symptoms that can be difficult, such as vision loss and overwhelming fatigue. However, so many of these symptoms can be successfully managed to minimize their interfering effects.

3. Wheelchairs should be viewed as a friend, not the enemy. So, you ask, what the heck does THAT mean? I’ll explain.

At many MS events and online, I see and hear people with mobility issues struggling with trying to walk without a walking aid, or one that is not suitable for them. Part of it is due to vanity, or part of it is a desire to not “give in” to MS.

• Is vanity worth the risk of falling down and getting hurt? In truth, I purposely started using a wheelchair full-time even though I could walk with a walker for 15-30 steps. The years on steroids, the osteoporosis, and my age put me at great risk for breaking an arm or leg. Instead, I used the swimming pool to walk and exercise safely.

• Before I went into the chair permanently, I used a power chair on a part-time basis around the house and scooters that were available in stores for customers. It is a tremendous help in reducing fatigue and getting more things done. This was a great morale booster. In addition, the pain from overused muscles and poor posture was lessoned substantially.

I wasn’t giving into my MS at all. There are many persons with MS that will use a scooter or wheelchair because of fatigue, weakness, balance problems, or to assist with conserving energy.

4. The majority of people with MS do not become severely disabled. Three out of four people who have MS remain able to walk, though many will need an aid, such as a cane or crutches.*

Before I decided to post this article, I talked to a couple of good friends of mine to ask them about the content of this article. They, like me, are the “Ol’ MS Vets”, i.e. who have lived with MS for decades and also have been involved with the MS community for the same amount of time. We know this disease because we have lived with it and been continuously involved with its research. 

We are a reliable resource you can trust.

www.DebbieMS.com
Author/MS Counselor/Living with MS

*Note: This statistic is listed in many reputable resources. The Nat’l MS Society used to use this percentage until several years ago, but changed it to 35% based on some study. I question their revision, as well as the study, because with the numerous DMDs that have been/are available, the percentage of MSers in wheelchairs permanently should have declined, not increased.

Diagnosing Multiple Sclerosis

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      “What’s going on?—I’m so scared!”

February 5, 2013

Diagnosing multiple sclerosis is difficult. Being tested and waiting for a diagnosis is grueling for both the patient and their families. Even in this day and age, the process can take months, or even years in some cases. The stress of the testing, office visits and waiting can send someone over the edge.

I often see online posts about this subject, with an added comment like “I’m scared to death…” This always upsets me because someone or some article is not doing the job of explaining an MS diagnosis in an easy-to-understand manner.

Diagnosing Multiple Sclerosis

It takes a long time to get a diagnosis because it is a process of elimination, to rule out other neurological disorders that could be causing the same type of symptoms.

The process begins with a clinical office evaluation, whereby many things can be initially noted, like your history. There are indicators that a good neurologist will check out—such as the Babinski sign (if the bottom of the foot is scraped and the big toe goes up, not down, it is an indication of a neurological disorder.) Other examples? Hyper reflexes, discoloration of the optic nerve in the eye indicating inflammation/optic neuritis, signs of imbalance or incoordination when walking…

Next come the numerous tests—MRI’s, spinal taps, EVR’s, etc to look for things such as tumors; many neurological disorders have symptoms that mimic multiple sclerosis like Lyme disease or fibromyalgia. Note: The MRI is a powerful tool, but a neurologist will not only use that particular test for an MS diagnosis as many people like to assume. Why? Because lesions may not show if an MRI is done only on the brain; an MRI should be done on the spinal cord as well to check if lesions are there. Also, sometimes spots on the MRI may look like lesions, but they may be due to another reason.

The term “multiple” in multiple sclerosis is important. Why? Multiple symptoms in multiple parts of the nervous system have to occur over multiple periods of time. My first relapse lasted ten months—I had both sensory and motor disturbances in my left arm and left leg. Mysteriously, all symptoms went away except for a slight residual in my left arm. I didn’t have my second relapse until over two years later. That time I went partially blind and I was wetting the bed. When I went back to the neurologist, I was diagnosed immediately! Bingo!—a multiple occurrence in addition to the multiple symptoms in multiple parts of my body.

Finally, a neurologist will most often not give a definite diagnosis until they are definite that it is MS.

In the meantime, what should you do while going through this evaluation and waiting game? Try to stay as healthy as possible. Take all measures you can to sleep, eat, reduce stress and keep your resistance up so that you don’t get a cold or virus. And know that having multiple sclerosis is not a death sentence or that you will end up in a wheelchair. Read on…

A Multiple Sclerosis Diagnosis

Getting an MS diagnosis is extremely frightening. I went through it thirty-two years ago myself, and over the years I have talked to so many people about this as a trained, MS-peer counselor. The fear of the unknown is overwhelming.

Sadly, there are many misconceptions about MS that create a lot of fear. So for starters, here are some facts to clear up some common ones:

• No, MS is not fatal (though in past decades people died from complications of it such as urinary tract problems that led to kidney failure…)

• Although there is no cure, there are treatments available to help symptoms and to slow the relapses/progression of MS.

• It is not congenital (people do not directly inherit MS, though they now know that there is a genetic factor involved.)

• It is not contagious.

• Not everyone ends up in a wheelchair—in the 1980’s the estimate was 1 in 4 (25%). Today, statistics are on your side for a better future prognosis, especially with the new treatments available now and the tremendous research that is happening.

So what should a person do initially when he/she receives a MS diagnosis? These are my recommendations:

Gain as much knowledge and support from the right places. I suggest starting with the National MS Society and other National MS Associations in the beginning. But, there is so much information and so many other resources available it can become overwhelming, confusing and perhaps create more fear. Take baby steps when gathering information.

Your best source of comfort and information will be from another person who has MS, a peer. However, be selective with whom you talk to and use good judgment. Some unknown people online can cause confusion, be uninformed, misleading, and negative.

Make sure you have a good neurologist who treats many others with MS or is a MS specialist. You need to trust your doctor and feel comfortable with him/her. Also, make sure that any other specialists that you may need to see (e.g. physical therapist, urologist, etc.) understand MS and have dealt with MS patients.

Don’t freak out if you don’t get on a treatment right away–it takes time to figure out the right thing to take/do, and waiting won’t severely impact your course, for better or for worse. Keep a journal. You will start to see patterns and learn how your body acts and reacts. An easy way to do this is to use a 12-month calendar, with large blocks to jot brief notes in. It is helpful to see patterns when you are looking at a whole month at one time and easier to reference.

Remember that staying healthy is essential–getting illness/infections could trigger a relapse. MS is an autoimmune disorder; therefore the immune system is not working properly. When you get sick, you may be twice as sick and it may take twice as long to recover as compared to a “normal” person. Relapses usually result in some residual (damage). It’s a must to keep your resistance up—food, sleep, stress management…

Finally, there ARE many things a person can do to manage their MS! The biggest mistake someone with MS can do is nothing, or expecting a shot or a pill to fix everything. There is no magic pill or shot yet that you can take to make it all go away. It takes work, discipline, dedication, attitude, and the common sense to take care of yourself. MS is still a lifetime illness. Until there is a cure for multiple sclerosis, the goal is to stay healthy, prevent new attacks, and prevent disability.

I am a MS survivor as are so many others! Check out my website for more information.

www.DebbieMS.com