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Thursday, August 12, 2010

Multiple Sclerosis - Your Own Private Hiroshima

Written by Marc Stecker - The Wheelchair Kamikaze


Sixty-five years ago this weekend, atomic bombs were dropped on the Japanese cities of Hiroshima and Nagasaki. At 8:16 AM on August 6, 1945, a bomb nicknamed "Little Boy" exploded over Hiroshima, leading to the eventual death of 120,000 human beings. Three days later, a bomb called "Fat Man" wreaked similar havoc upon Nagasaki. Though the destructive effects of the atomic bombs were limited to the confines of those two cities, they ushered mankind into a frightening new age, and for the residents of planet Earth, things would never be the same again.

Those of us who have received a diagnosis of Multiple Sclerosis, or any other potentially devastating illness, have suffered through our own very personal versions of Hiroshima. Not to minimize the horrific effects of the atom bomb, which literally vaporized tens of thousands of human beings and created never before imagined levels of destruction on the ground, being given a serious diagnosis has an A-bomb effect on the life and emotions the patient hearing the news. There is the blast-like shock of the sudden confirmation that something has gone terribly wrong with your body, the firestorm of searing fear about what an abruptly uncertain future might hold, and the unknown implications of the long-term effects of the illness, much like the silent but lethal radiation that plagued the survivors of the initial atomic attacks.

Similar to the residents of Hiroshima, who lived in a city that had somehow been spared the horrors of a war that had thus far kept its distance but of which they were nevertheless acutely aware (the city had been left untouched by the Allies so that a pristine target would be available for the first A-bomb), many MS patients suspect that their bodies are betraying them long before being given an actual diagnosis. Most MS patients, myself included, experience strange physical symptoms for years before the disease finally outs itself enough to be picked up by medical diagnostics.



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The Psychological Impact of Multiple Sclerosis

Information provided by Lisa Booth Hoffman

Do you have Multiple Sclerosis and find yourself depressed because of the challenges it presents? You are not alone. Up to half of all people who suffer from Multiple Sclerosis also show signs of being depressed, or having psychological problems, at some point during their illness. MS is a chronic and disabling disease which attacks the central nervous system, or CNS, which is made up of the brain, optic nerves and spinal cord. Symptoms have a wide range, from numbness in limbs to paralysis or loss of vision. The drugs used to treat it, such as steroids and interferon, are powerful and can have side effects. 

The result of the amount of stress suffering from MS puts on an individual, and possibly the drugs taken to relieve the symptoms, is often psychological problems. The signs that someone may be depressed are sadness, loss of energy, feeling worthless/hopeless, loss of interest in activities they previously enjoyed, irritability, increased need to sleep, change in appetite causing weight loss or gain, decreased sex drive, thoughts of suicide and more. When these symptoms begin to interfere with your normal life or you, or someone you know, begins to contemplate suicide, help should be sought.

If you or someone you know have been, or may be suffering from psychological problems as a result of Multiple Sclerosis, it should not be ignored. Amy Sullivan, Psych. D is an associate staff member in the Mellen Center at the Cleveland. She completed her undergraduate degree at St. Bonaventure University in St Bonaventure, NY, held an internship at the University of Cincinnati Medical Center/ University Hospital, and received her doctorate from Argosy University in Atlanta, GA. She then completed her fellowship at the Cleveland Clinic in health psychology and pain management. She will be available during our free online chat to answer your questions regarding this topic. 

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Wednesday, August 11, 2010

Can You Prevent Multiple Sclerosis?

Information provided to me by Jane Schlossman


Understanding factors that increase your risk of multiple sclerosis and what — if anything — you can do about them.


Medically reviewed by Cynthia Haines, MD


Can multiple sclerosis be prevented? Based upon what experts know about MS, evidence seems to indicate that the answer is no — or at least not yet. One reason why effective prevention measures have yet to be developed is that the cause of multiple sclerosis is still not fully understood. Scientists believe that a combination of factors, both genetic and environmental, contribute to the development of multiple sclerosis. Unfortunately, because not enough is known about the specifics of these factors, it is difficult to give concrete advice about how to prevent MS.
Understanding Factors Involved in Multiple Sclerosis: Reducing Your Risk
There are a number of key factors that seem to be related to developing multiple sclerosis. They include:
Genetics
Hereditary propensities that come from your family appear to be a factor in multiple sclerosis risk. Tanuja Chitnis, MD, assistant professor of neurology and director of the Partners Pediatric MS Center at Massachusetts General Hospital for Children, says that in studies of identical twins, about 25 percent of people who have an identical twin with multiple sclerosis end up developing MS themselves. Dr. Chitnis also says that the incidence of MS in the general population is 1 in 100,000 people, compared with a 3 to 5 percent incidence in people with a first-degree relative with MS (a sibling, parent, or child). Although you can't change the family you're born into, eventually experts hope to learn enough about what causes MS to be able to tell people with a family history of MS what they can do to decrease their risk of developing the condition.
Viruses
The Epstein-Barr virus (EBV), a member of the herpes family of viruses, has been linked to MS, but has not conclusively been identified as a cause of multiple sclerosis. EBV is extremely common; the U.S. Centers for Disease Control and Prevention (CDC) reports that 95 percent of people in the United States between the ages of 35 and 40 have had this virus at some point in their lives. In children, it looks just like the common cold; in adolescents, it can develop into mononucleosis.
It is impossible to entirely avoid exposure to a virus this widespread without completely withdrawing from society. However, avoiding contact with people who are sick and washing your hands frequently during cold and flu season and after time spent on planes and other forms of public transportation are general illness prevention techniques that help. And while avoiding viral infections now may or may not protect you against developing multiple sclerosis in the future, staying healthy can certainly contribute to your quality of life in the short term.
Geography
According to the Partners Multiple Sclerosis Center, multiple sclerosis has a higher incidence in North America, southern parts of Australia, and northern Europe, suggesting that the farther you live from the equator, the greater your risk for developing multiple sclerosis.
Does that mean you should pack up and move to a warmer climate? Not necessarily. The link between vitamin D, known as the sunshine vitamin, and MS could explain why areas closest to the equator typically have the lowest rates of multiple sclerosis. Research indicates that vitamin D, which the human body generates in response to sunlight, may play some role in protecting against MS. It has yet to be determined whether taking a vitamin D supplement might carry the same benefit as exposure to sunlight appears to do. If you already take vitamin D supplements, you can be confident in the benefits that experts do know about; Vitamin D helps boost immune system function and may aide the body in absorbing calcium.
Diet
According to Chitnis, the biggest diet-related factor in the possible prevention of multiple sclerosis is vitamin D. Higher levels of vitamin D, which is added to milk and some cereal products, have been linked to a lower risk of MS in several studies.
Still, other dietary factors have also been linked to a lower risk

Continue Reading by Clicking Here

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Tuesday, August 10, 2010

Describing MS and Symptoms of the Disease

In multiple sclerosis , damage to the myelin in the central nervous system (CNS), and to the nerve fibers themselves, interferes with the transmission of nerve signals between the brain and spinal cord and other parts of the body. This disruption of nerve signals produces the primary symptoms of MS, which vary depending on where the damage has occurred.
Over the course of the disease, some symptoms will come and go, while others may be more lasting.

Symptoms

Most Common Symptoms
Some symptoms of MS are much more common than others.
Fatigue
Numbness
Walking (Gait), Balance, & Coordination Problems
Bladder Dysfunction
Bowel Dysfunction
Vision Problems
Dizziness and Vertigo
Sexual Dysfunction
Pain
Cognitive Function
Emotional Changes
Depression
Spasticity


Less Common Symptoms
These symptoms also occur in MS, but much less frequently.
Speech Disorders
Swallowing Problems
Headache
Hearing Loss
Seizures
Tremor
Respiration / Breathing Problems
Itching
TO READ ABOUT each of these SYMPTOMS CLICK this link to be
 redirected to the National MS Society website

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Multiple Sclerosis :Bladder Dysfunction, Symptoms and Complications

Bladder dysfunction, which occurs in at least 80% of people with MS, can usually be managed quite successfully. Treatment strategies for bladder management include dietary and fluid management, medications, and intermittent or continual catheterization (inserting a thin tube into the bladder to remove urine).


Bladder dysfunction occurs when MS lesions block or delay transmission of nerve signals in areas of the central nervous system that control the bladder and urinary sphincter. The sphincter is the muscle surrounding the opening of the bladder, that controls the storage and outflow of urine. It is this muscle that gives people voluntary control over urination.
Symptoms and Complications


Symptoms of bladder dysfunction can include:
Frequency and/or urgency of urination
Hesitancy in starting urination
Frequent nighttime urination (known as nocturia)
Incontinence (the inability to hold in urine)


These symptoms can be caused by a “spastic” bladder that is unable to hold the normal amount of urine, or by a bladder that does not empty properly and retains some urine in it. Retaining urine can lead to complications such as repeated infections or kidney damage.


Left untreated, bladder dysfunction also could cause emotional and personal hygiene problems that can interfere with normal activities of living and socialization. It is therefore important to seek appropriate medical evaluation and treatment early, so that the cause of the bladder symptoms can be determined and treated, and complications avoided.


Source: National MS Society

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Bowel Dysfunction and MS / Guidelines for Bowel Regularity

Constipation is a particular concern among people living with MS,as is loss of control of the bowels. Diarrhea and other problems of the stomach and bowels also can occur.


Causes of constipation include insufficient fluid intake, reduced physical activity and mobility, and decreased or slowed “motility” (movement of food through the intestinal tract). Certain medications, such as antidepressants or drugs used to control bladder symptoms, might also cause constipation. Loss of bowel control in MS could be neurologic in origin or related to constipation, and it should be evaluated by a physician or nurse.


Bowel dysfunction can cause a great deal of discomfort and humiliation, and could aggravate other MS symptoms such as spasticity or bladder dysfunction. A healthcare provider can help establish an effective bowel management program. Occasionally, it might be necessary to consult a gastroenterologist, a physician specializing in the stomach and bowel.
Guidelines for Bowel Regularity


Bowel regularity generally can be maintained by following a few simple guidelines:

  • Drink adequate amounts of fluids—at least 48 ounces or 6 to 8 glasses of fluids daily.
  • Include plenty of fiber in the diet. Fiber can be obtained from fresh fruits and vegetables, whole grain breads and cereals, and dietary additives such as powdered psyllium preparations.
  • Use stool softeners as recommended by your physician.
  • Establish a regular time and schedule for emptying the bowels. Wait no more than two to three days between bowel movements. Enemas, suppositories, and laxatives can be used in moderation to facilitate a bowel movement. 
  • Continuous or regular use of laxatives is generally not recommended.


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    Monday, August 9, 2010

    Spasticity and Multiple Sclerosis

    Spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms (sustained muscle contractions or sudden movements). It is one of the more common symptoms of MS. Spasticity may be as mild as the feeling of tightness of muscles or may be so severe as to produce painful, uncontrollable spasms of extremities, usually of the legs. Spasticity may also produce feelings of pain or tightness in and around joints, and can cause low back pain. Although spasticity can occur in any limb, it is much more common in the legs.

    There are two types of severe MS-related spasticity:
    In flexor spasticity, mostly involving the hamstrings (muscles on the back of the upper leg), and hip flexors (muscles at the top of the upper thigh), the hips and knees are bent and difficult to straighten.
    In extensor spasticity, involving the quadriceps and adductors (muscles on the front and inside of the upper leg), the hips and knees remain straight with the legs very close together or crossed over at the ankles.


    Spasticity may be aggravated by sudden movements or position changes, extremes of temperature, humidity, or infections, and can even be triggered by tight clothing.
    Treatment with Exercise and Medication


    There are a number of therapeutic approaches to the management of spasticity. Because spasticity varies so much from person to person, it must be treated on an individual basis and demands a true partnership between the person with MS, physician, nurse, physical therapist, and occupational therapist. Treatment begins with the physician recommending ways to relieve the symptoms, including exercise, medication, changes in daily activities, or combinations of these methods. The physician will track the progress and make referrals to other health professionals such as occupational and physical therapists.

    Daily stretching and other exercises are often effective in helping to relieve spasticity.
    If drugs are also needed, there are two major antispasticity drugs that have good safety records. Neither, however, can cure spasticity or improve muscle coordination or strength.


    Baclofen, the most commonly used drug, is a muscle relaxant that works on nerves in the spinal cord. Common side effects are drowsiness and a feeling of muscle weakness. It can be administered orally or by an implanted pump (intrathecal baclofen). Intrathecal baclofen is used for severe spasticity that cannot be managed with oral medication.
    Tizanidine (Zanaflex®) works quickly to calm spasms and relax tightened muscles. Although it doesn't produce muscle weakness, it often causes sedation and a dry mouth. In some patients, it may lower blood pressure.

    Other, less commonly-used drugs, include:
    Diazepam (Valium®) —not a "first choice" drug for spasticity because it is sedating and has a potential to create dependence. However, its effects last longer with each dose than baclofen, and physicians may prescribe small doses of Valium® at bedtime to relieve spasms that interfere with sleep.
    Dantrolene (Dantrium®) —generally used only if other drugs have not been effective. It can produce serious side effects including liver damage and blood abnormalities.
    Phenol, a nerve block agent
    Botulinum toxin (Botox®) injections—have been shown to be effective in relieving spasticity in individual muscles for up to three months.
    Clonidine—still considered experimental


    Treatment Helps Prevent Complications

    Left untreated, spasticity can lead to serious complications, including contractures (frozen or immobilized joints) and pressure sores. Since these complications also act as spasticity triggers, they can set off a dangerous escalation of symptoms. Treatment of spasticity and muscle tightness by medication and physical and occupational therapy is needed to prevent painful and disabling contractures in the hips, knees, ankles, shoulders, and elbows. Surgical measures are considered for those rare cases of spasticity that defy all other treatments.

    Spasticity Can Provide Some Benefit for People with Significant Weakness


    Some degree of spasticity can also provide benefit, particularly for people who experience significant leg weakness. The spasticity gives their legs some rigidity, making it easier for them to stand, transfer, or walk. The goal of treatment for these individuals is to relieve the spasticity sufficiently to ensure comfort and prevent complications, without taking away the rigidity they need to function.

    Review article source


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    Therapies Are Available to Treat Sexual Problems of MS

    There are a variety of therapies to treat sexual dysfunction. 
    For men, erectile dysfunction may be addressed through use of the oral medications Viagra® (sildenafil), Levitra® (vardenafil), and Cialis® (tadalafil); injectable medications such as papaverineand phentolamine that increase blood flow in the penis; the MUSE® system which involves inserting a small suppository into the penis; inflatable devices; and implants.
    For women, vaginal dryness can be relieved by using liquid or jellied, water-soluble personal lubricants, which can be purchased over-the-counter. It is a common mistake to use too little of these products. Specialists advise using them generously. Petroleum jelly (Vaseline®) should not be used because it is not water-soluble and may cause infection.
    Both men and women with MS and their partners can benefit from instruction in alternative means of sexual stimulation, such as the use of a vibrator, to overcome slow arousal and impaired sensation. Abnormal sensations and spasms can often be controlled through use of medication. Techniques such as intermittent catheterization or medication can control urinary leakage during intercourse.

    Fertility, Conception, and Sexually Transmitted Diseases

    MS does not affect the basic fertility of either men or women, although sexual problems may interfere with the ability of a man with MS to father a baby. "Dry orgasms," that impair fertility, have been reported by men with MS in several studies. These problems have been successfully treated with medication or through techniques to harvest sperm for insemination. Men who are concerned about fertility issues should consult a urologist experienced in this area.
    Women and men with MS are also advised that they must make the same decisions and take the same precautions regarding birth control and sexually transmitted diseases as anyone else.

    Emotional Issues

    The emotional factors relating to changes in sexual function are quite complex. They may involve loss of self-esteem, depression, anxiety, anger, and/or the stress of living with a chronic illness. Counseling by a mental health professional or trained sexual therapist can address both physiologic and psychological issues. This therapy should involve both partners.

    Source: National MS Society

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