Thursday, April 2, 2020

Impact of Comorbidity and Multiple Sclerosis

Living with one chronic disease, such as multiple sclerosis, can be challenging. Living with more than one chronic disease can make diagnosis and treatment difficult. Living with comorbidity can lead to disability, lower quality of life, delayed diagnosis, increased hospitalization, and increased risk of death for people living with MS.

Some comorbid conditions may be symptoms of MS, such as depression or anxiety, but others are unrelated to MS. Common comorbidities in multiple sclerosis include depression, anxiety, high cholesterol, high blood pressure, gastrointestinal disease, thyroid disease, and chronic lung disease. The subject of comorbidity is a personal one as I actively manage three of these comorbidities in addition to MS.

Mental health and MS

Mood disorders, such as depression, anxiety, and bipolar disorder, are more common in people with MS than in the general population. The prevalence of depression ranges from 36 to 54 percent in people with MS, according to the National MS Society, compared to 16 percent in the general population. Anxiety disorders affect approximately 36 percent with MS while bipolar disorder affects between 6.5 and 13 percent. These estimates are somewhat higher than what was found in a 2015 worldwide literature review and significantly higher than results of a 2018 retrospective analysis of claims data for patients living in the United States. 

Feelings of anxiety or depression may be symptoms of MS, might signal a relapse, or might relate to conditions that were diagnosed before MS. No matter the cause of these symptoms, it is important to discuss what’s going on with your doctors. Mental health conditions can go undiagnosed or untreated. 

Many neurologists are willing to prescription medication for a mood disorder, but others may refer you to a specialist instead. I have worked with a licensed clinical social worker (LCSW) to learn how to deal with various challenges I face related to mental health while medication prescribed by my neurologist helps to alleviate symptoms. 

Cardiovascular disease and MS

In the United States, the most common comorbidities in people with MS, based on claims data from 2006 to 2014, are high cholesterol and high blood pressure which affect between 26 to 30 percent of people with MS. Researchers found that claims for high cholesterol and high blood pressure were 39 and 25 percent, respectively, more likely among male patients compared with female patients with MS. However this contradicts results from a previous study that found hypertension, heart failure, and coronary heart disease were significantly less common in people with MS. 

Treatment of cardiovascular comorbidity is particularly important for people with MS as researchers have determined that high blood pressure and heart disease contribute to advanced brain atrophy and vascular comorbidity is associated with increased risk of disability progression. 

Lifestyle changes can help reduce the risk of heart disease. If you smoke, stop. Exercise and healthy eating can help to control high blood pressure. To lower cholesterol levels, eat a diet high in fiber, but low in cholesterol, saturated fat, and refined sugar. Stay active, increase physical activity, and maintain a healthy weight. If lifestyle changes alone are not enough, your doctor may prescribe medication to help control risk factors for heart disease.

Gastrointestinal disease and MS

In the US claims study mentioned above, gastrointestinal (GI) disease comorbidities were found in the claims of 18 to 21 percent of patients with MS. In general, these diseases were more common among women than men. The gastrointestinal diseases included were celiac disease, constipation, Crohn’s disease, diarrhea, dysphagia (difficulty swallowing), gastroesophageal reflux disease (GERD), irritable bowel syndrome, and ulcerative colitis. 

Several of these GI conditions double as symptoms of MS. If you experience any difficulties with bowel dysfunction, constipation, diarrhea, trouble swallowing, GERD, or other GI symptoms, please talk to your neurologist. You may be referred to a gastroenterologist for evaluation. While there is no single MS diet, some people with MS report that they feel better when they limit sugar and grains from their diet.

Thyroid disease and MS

Thyroid disease comorbidity was documented in 13 to 17 percent of the medical records for MS patients in the US claims database study. A prior systematic review estimated the overall prevalence of thyroid disease comorbidity in MS patients at 6.44 percent, ranging from 0 percent to 16 percent depending upon the specific condition. Examples of thyroid diseases included in the analysis were hypothyroidism, hyperthyroidism, Hashimoto’s thyroiditis, and Grave’s disease. 

Although thyroid disease has been identified as one of the more common comorbidities in people diagnosed with MS, the prevalence of thyroid disease prevalence of thyroid disease in people with MS is similar to that of the general population. Since one MS disease-modifying therapy, Lemtrada (alemtuzumab), is associated with thyroid disease, periodic thyroid function tests are required.

Impact of comorbidity on MS

Living with comorbidity, or having more than one health condition to manage, negatively impacts a person with MS in several ways. It can lead to greater physical disability and quality of life. The person with MS may have more symptoms to deal with which can complicate treatment decisions. Increased risk of death is the ultimate reason to try to reduce comorbidity in people with MS.

What can you do?

If you are coping with MS and one or more additional health conditions, it’s vitally important to seek proper medical treatment and to make healthy lifestyle choices. The choices you can make to improve your chances of living well with MS are very similar to the healthy actions suggested to reduce cardiovascular disease. 

Healthy steps you can take include:
  • Stay physically active and move your body as you can
  • Stay mentally and socially active as well
  • Stop smoking
  • Limit alcohol consumption
  • Focus on eating proper nutrition
  • Eliminate vitamin deficiencies
  • Maintain a healthy weight
    Stay hydrated
  • Get adequate sleep
  • Reduce stress 
  • Take time for yourself 
  • Seek routine medical care to stay on top of your health
(originally published on in 2018)

Wednesday, March 28, 2018

An Interview with Body Builder David Lyons

Competitive bodybuilding is one way that David Lyons conquers multiple sclerosis (MS). Diagnosed with MS in 2006, David is motivated to educate and inspire people living with the disease to focus on fitness and nutrition and to develop a mindset that anything is possible.

In 2012, with his wife Kendra Lyons, R.N., David founded the MS Fitness Challenge (MSFC) charity to help bring his message worldwide. David has received the Milestone Award from the National MS Society, and in 2015, he was presented the Health Advocate Lifetime Achievement Award by Arnold Schwarzenegger.

He’s also the author of “David’s Goliath: Winning the Battle Against All Odds” (2013) and “Everyday Health and Fitness with Multiple Sclerosis: Achieve Your Physical Wellness While Working with Limited Mobility” (2017). He’s working on a new show called “Pumped: The Muscle Hustle” with Lou Ferrigno.

He spoke with HealthCentral about his experience.

HealthCentral (HC): What were the initial symptoms that led to your diagnosis?

David Lyons: MS caught me off guard in the gym. Initially I experienced severe pain, numbness, tingling, and lack of coordination in my left arm while working out. Within a few weeks, the symptoms radiated throughout my body and moved into my legs. I became bedridden for months during the pre-diagnosis and diagnosis stage. When I was finally hospitalized, I was almost paralyzed from the chest down.

HC: What did you most fear when you learned of your diagnosis?

David: After a five-day stay in the hospital, the symptoms were still so severe that I felt I could not continue as a bodybuilder, or might not step foot in a gym again. The neurologists said that MS would quickly make me wheelchair bound due to the tremendous nerve damage I experienced during that initial attack. I began to fear that would become my reality. Twelve years later and almost 60 years old, I’m still not using a wheelchair.

Read this post in its entirety:

Building Your Fitness Future With MS: An Interview with David Lyons

Wednesday, March 21, 2018

How to Reduce the Pain of Injections

Self-injectable medications

Several of the medications used to treat multiple sclerosis are injectable drugs. The requirements for storage and administration differ for each drug, but here are some universal tips that will help reduce the pain of the injections. Please note that if you have questions or difficulties with a specific drug, call the drug company’s helpline or ask your own MS nurse for help.

Room temperature medication

Medications which must be kept in the refrigerator for storage are often much less painful upon injection when at room temperature. Before injecting, remove one pre-filled syringe from the refrigerator and leave the syringe out for at least 30 minutes before using. Or alternatively, while still in the wrapper, hold it in your armpit to bring it to body temperature.

Read this post in its entirety:

7 Tips To Reduce the Pain of Injections

Wednesday, March 14, 2018

What is Spinal MS?

Maybe you have heard the term “Spinal MS.” What is that? I thought MS could be relapsing, primary progressive, secondary progressive, or “benign.”

The lesions caused by multiple sclerosis can occur anywhere within the central nervous system, which includes the brain, the spinal cord, and the optic nerves. Approximately 55-75 percent of patients with MS will have spinal cord lesions at some time during the course of their disease. If a patient does have lesions in the spinal cord, he/she may be said to have Spinal MS.

A smaller number of MS patients, approximately 20 percent, may have only spinal lesions and not brain lesions. I am an example of one of those 20 percent of MS patients who only have spinal lesions.

Symptoms of Spinal MS

Spinal MS occurs more commonly with lesions in the cervical spine (the neck area) in approximately 67 percent of cases. Lesions in this area often affect the corticospinal tract. Neurological signs which indicate lesions in the corticospinal tract include the Babinski Sign and the Hoffmann Sign. Additional indicators of lesions in the upper spine include the l’Hermittes phenomenon and the Romberg Sign. At one time or another, I have shown each of these signs of neurological involvement/interference due to MS lesions.

Although the location of lesions do not always closely correlate to areas of clinical disability, there are cause/effect patterns which do emerge. Patients with spinal cord lesions are more likely to develop bladder dysfunction (e.g., urinary urgency or hesitancy, partial retention of urine, mild urinary incontinence), bowel dysfunction (e.g., constipation or urgency), and sexual dysfunction (e.g., erectile dysfunction or impotence in men, genital anesthesia or numbness in women, pain with intercourse for either sex). Complete loss of bladder and bowel control may be lost in more advanced cases of MS.

Spinal cord lesions can also lead to sensory and motor deficits, including dysesthesias, spasticity, limb weakness, ataxia or other gait disturbances.

Read this post in its entirety:

What is Spinal MS?

Wednesday, March 7, 2018

Common Multiple Sclerosis Symptoms

Multiple sclerosis is a disease of the central nervous system (CNS) with symptoms that can affect almost anything from head to toes. The disease is so variable that no two people with MS are likely to have exactly the same combination of symptoms. As MS symptoms mimic dozens of other conditions, it is also important to consider that this list is not exclusive to MS.

Here are 50 of the most common MS symptoms:

Sensory problems

  • Abnormal sensations (dysesthesias)
  • Numbness, tingling, burning, or tightness
  • Pins and needles
  • Severe itchiness (pruritus)
  • Hypersensitivity to touch
  • Pain - acute or chronic, mild to severe
  • Loss of proprioception (sense of body position in space)
  • Inability to detect vibrations
  • Impaired sense of taste or smell
  • Trigeminal neuralgia - stabbing pain in the face
  • L’Hermitte’s sign - electrical shock-like sensation running down the spine and into the limbs when you bend your neck forward or backward
  • The MS hug

Motor problems

  • Loss of strength or muscle weakness
  • Loss of muscle tone (hypotonicity) or increased muscle tone (hypertonicity)
  • Spasticity - continuously contracted muscles and/or muscle spasms
  • Myoclonus - sudden involuntary muscle contractions
  • Tremor
  • Foot drop
  • Problems walking, impaired gait, or mobility problems
  • Paralysis
  • Loss of balance
  • Loss of coordination (ataxia)
For more MS symptoms, read this post in its entirety:

Top 50 MS Symptoms

Wednesday, February 28, 2018

Marcus Gunn Syndrome and Multiple Sclerosis

One test which my neurologist, ophthalmologist, and primary care doctor each conduct during every office visit is the “swinging flashlight test.” You know the one. The doctor asks you to look ahead then shines a penlight first toward one eye, then the other, alternating quickly to observe your pupils’ response to light.

I strangely enjoy this test because I know that my pupils will show something unique. Something which proves that I have damage to my optic nerve. My pupils show a Relative Afferent Pupillary Defect (RAPD) or Marcus Gunn Sign.

What does the doctor look for during the “swinging light test”?

The pupils (the black centers of the eyes which dilate or constrict in response to light) are inspected for size, equality, and regularity. Did you know that the pupils will constrict or dilate when you look at objects far or near? They do, which is kinda cool.

More importantly, each pupil should constrict quickly and equally during exposure to direct light and to light directed at the other pupil (the consensual light reflex). Using the swinging light test, the doctor can test and observe the pupillary response to consensual light in order to determine if there is a defect present.

Normally, the pupil constriction does not change as the light is swung from eye to eye. When the light is moved quickly from eye to eye, both pupils should hold their degree of constriction.

What is a Relative Afferent Pupillary Defect?

The Afferent Pupillary Defect (APD) or Relative Afferent Pupillary Defect (RAPD) is an abnormal and unequal response in the pupils of the eyes when exposed to light. It basically demonstrates that one optic nerve transmits a different message to the brain than the other one. Testing for RAPD is a good way to implicate or rule out optic nerve damage such as is caused by optic neuritis.

My temporarily blinding case of optic neuritis in 2000 left my right eye impaired. It doesn’t register light in the same way as my left eye as the optic nerve has permanent damage. When the doctor shines the light in my left eye (the “good” eye), both pupils will constrict. This is normal. When the doctor quickly moves the light to my right eye (the “bad” eye), my pupils begin to dilate since the brain thinks that less light is coming in. This shows that there is damage to the corresponding optic nerve.

Read this post in its entirety:

MS Signs and Symptoms: What is Marcus Gunn Syndrome?