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Thursday, August 12, 2010
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.
Wednesday, August 11, 2010
Understanding factors that increase your risk of multiple sclerosis and what — if anything — you can do about them.
There are a number of key factors that seem to be related to developing multiple sclerosis. They include:
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.
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.
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.
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.
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Tuesday, August 10, 2010
Walking (Gait), Balance, & Coordination Problems
Dizziness and Vertigo
Less Common Symptoms
These symptoms also occur in MS, but much less frequently.
Respiration / Breathing Problems
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
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.
Source - National MS Society
Monday, August 9, 2010
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
Fertility, Conception, and Sexually Transmitted Diseases
Source: National MS Society