Tuesday, July 28, 2015

What is Better: Endurance Training or Resistance Training?

Physical activity is an important part of staying healthy. Not only do we, as people living with MS, need to maximize cardiovascular health, we also need to maintain muscle strength and flexibility. However, multiple sclerosis is often associated with reduced physical fitness and lower quality of life.

Before I began riding the exercise bike regularly last fall, I would get winded much more easily. My heart and lungs were not functioning at their full capacity and I realized that I needed to do something about it. Although I really started riding the bike to improve my osteoarthritic knees, doing so helped me to get my heart pumping and to work up a sweat.

Over these past several months, I’ve noticed that both my strength and endurance have improved. I definitely feel better, physically and mentally.

Endurance training vs resistance training
Both options are good! People with MS are able to improve their physical fitness, including aerobic capacity and muscle strength, with either a combination of endurance and resistance training or endurance training alone, according to a recent study. Both forms of exercise used in the study reduced fatigue and improved quality of life for MS patients, especially in the areas of general health, mental health, vitality, and social functioning.

Trial participants (n=60; 44 female, 16 male) were randomized into one of two groups: the combined workout group (CWG) or the endurance workout group (EWG). MS patients completed a physician-supervised training program that lasted three months and consisted of two moderate-intensity training sessions per week, each of which was 40 minutes long. The CWG group exercised 20 minutes on a bicycle ergometer, followed by 20 minutes of resistance training. The EWG group focused on endurance exercise for the full 40 minutes. Twenty-three patients dropped out of the trial due to lack of time, long distance to training location, new workplace, or exacerbation.

Read this post in its entirety:
Which Type of Exercise is Better for People with MS?

(photo credit: pippalou)

Thursday, July 23, 2015

29 Things About My Life With MS

What’s it like for YOU to live with MS?

One of the most important principles behind MS storytelling is sharing. Through that sharing, we work to increase awareness and understanding, which helps to decrease stigma.
Memes are popular around the internet, so I thought that I’d like to adapt one for our MS community. I invite you to participate by sharing your own answers. If you’d like to share your own answers to these questions here, you can copy / paste my responses and replace the answers with your own responses.
Here are the questions and my answers:
  1. My current diagnosis is: relapsing-remitting multiple sclerosis.
  2. I was diagnosed in: 2005.
  3. My symptoms include: numbness, spasticity, visual disturbances, heat sensitivity, anxiety, fatigue, weakness.
  4. My comorbid conditions include: rheumatoid arthritis, hypothyroidism, and depression.
  5. I take: a number of medications for comorbidities, including a monoclonal antibody therapy prescribed for RA.
  6. My first MS attack was: blinding optic neuritis in 2000.
  7. My strangest MS symptom has been: the feeling that cotton fuzz is on my face, especially around my left eye, when I’m beginning to feel rundown.
  8. My biggest MS symptom/relapse triggers are: heat! The heat and humidity of summer totally wrecks my ability to function normally.
  9. I know an MS attack is coming on when: a myriad of symptoms seem to whisper, “hi, I’m back; remember me?” and won’t go away.
  10. The most frustrating thing about having MS is: not being able to do as much, physically and musically, as I used to.
Read this post in its entirety:
29 Things About My Life with MS

Tuesday, July 21, 2015

How common is musculoskeletal pain in MS?

How common is musculoskeletal pain in MS?

A recent study investigated the severity and prevalence of musculoskeletal pain in MS patients in the Mazandaran Province of north Iran. Among 115 participants (76.5 percent female; mean age 30.4±5.8 years; mean disease duration 26.3±24.3 months), 87.8 percent were experiencing pain at the time of the study.

Lower limb pain, especially in the knees, is most common.

The most common locations for musculoskeletal pain reported were the knee (in 55.7 percent of study participants), wrist (43.5 percent), and neck (41.7 percent). In the 12 months prior to the study, significant numbers of the participants experienced chronic upper limb pain (60.9 percent), lower limb pain (64.3 percent), and backache (46.1 percent).

Upper back and neck pain are common in early stages of the disease.

MS patients reported mild to moderate pain, with more than half (53.9 percent) reporting that musculoskeletal pain had interfered with daily functioning, at least for a time. Upper back and neck pain were more common in patients who’d had MS for a shorter period of time, while knee pain was more common in patients with MS for a longer period of time.

Five times more women with MS have upper back pain.

Women experienced higher prevalence of shoulder, upper back, and ankle pain. The risk of upper back pain was 5.16 times higher in women than men, while ankle pain was 2.19 times higher. There was no significant gender difference in neck, wrist, back, hip, or knee pain.

Read this post in its entirety:
Majority of MS Patients Report Knee Pain

(photo credit: aleks)

(photo credit: aleks)
(photo credit: aleks)

Monday, July 20, 2015

Tecfidera and PML

A second case of progressive multifocal leukoencephalopathy (PML) has been reported in an MS patient taking Tecfidera (delayed-release dimethyl fumarate), an oral disease-modifying therapy approved to treat relapsing forms of multiple sclerosis.
Biogen reported the case to the Food and Drug Administration (FDA); however, details of the report are not available on the Drugs@FDA website nor on Biogen’s company website.
This case will not likely require any change to the prescription label. The FDA had already updated the Tecfidera label in December 2014 to warn of the risk of PML, following the death of a 54-year old woman with MS who had participated in the DEFINE clinical trial and experienced severe lymphopenia for 3.5 years.
Reports of the earlier case of PML, as well as another fatal case in a patient using a compounded version of dimethyl fumarate for the treatment of psoriasis, were published in an April edition of The New England Journal of Medicine. Surprisingly, the patient with psoriasis who died in August 2014 did not have two of the known risk factors for PML: severe lymphopenia and exposure to immunosuppressive therapy.
Biogen spokesperson Catherine Falcetti told MedPageToday that this most recent case of Tecfidera-related PML involved a patient diagnosed with primary progressive MS who had prolonged severe lymphopenia. Decreased lymphocyte counts (i.e., lymphopenia) is a known side effect of dimethyl fumarate, indicating a lowered immune system.

Read this post in its entirety:
Tecfidera Linked to PML Once Again

Thursday, July 16, 2015

Treatment for MS-Related Itching

Pruritus in MS can be tricky to treat. If the itching is mild, treatment is usually unnecessary and the symptom often goes away on its own. If the itching is severe, prolonged, or disrupts your daily life, talk to your doctor about possible treatments.

Since itchiness associated with MS is neurologic in origin, cortisone cream and other topical treatments are rarely helpful. There are some medications, however, which may be useful in diminishing the itch, including anticonvulsants (e.g. gabapentin, carbamazepine, phenytoin), antidepressants (e.g. amitriptyline, paroxetine, mirtazapine), and the antihistamine hydroxyzine (Atarax).

It is tempting to scratch the itch, but resist the urge because scratching may actually increase the feeling of itchiness. Scratching too hard can also cause problems such as broken or damaged skin that bleeds or becomes infected. And if the skin is itchy, but also numb, then you might cause a lot of damage before you realize it.

Instead, you may want to experiment with applying ice or cold packs to temporarily relieve the itching. Cold seems to override the itchiness and “confuse” the already mixed up nerve signals. Never apply ice directly to skin (always wrap in a towel or washcloth) and never leave ice on one area for more than 15-20 minutes at a time.

Read this post in its entirety:
How Can I Fix This Crazy MS Itchiness?

(photo credit: "Ice Sculpture" by Andy Rogers is licensed under CC BY-SA 2.0

See also: Itchiness as an MS Symptom

Itchiness as an MS Symptom

When pruritus occurs as a symptom of multiple sclerosis, it is similar to other neurologic sensations - pins and needles, burning, stabbing, or tearing pain - known as dysesthesias. The itching with MS is often paroxysmal (coming on suddenly with great intensity) but temporary in nature and lasting anywhere from a couple of seconds to minutes. It can even seem to get worse the more you scratch.

Heat triggers pruritus for some people with MS and for others, it seems to be related to movement or tactile stimulation. For some reason, the itching often occurs at night with an intensity that has the power to wake you up from sleep.

Other causes of MS-related itching may include temporary skin irritation following injections, allergic reaction to medication, or side-effect of medication. In clinical trials, one of the common side effects of the oral medication dimethyl fumarate (Tecfidera) was flushing, followed by the sensation of heat or itching.

Read this post in its entirety:
MS Signs vs Symptoms: What is Pruritus?

(Photo credit: "Scratching her head" by Tambako is licensed under CC BY-ND 2.0

See also: Treatment for MS-Related Itching

Thursday, July 9, 2015

Monday, July 6, 2015

Talking to Your Doctor About Family Planning and MS Drugs

Some of the newer MS medications are contraindicated with pregnancy, including drugs that must be stopped for a period of time before a patient attempts to become pregnant, such as Aubagio or Gilenya. However, approximately half of all pregnancies are unintended, whether mistimed, unplanned, or unwanted, according to the CDC. So it is important to do some planning in advance to prepare yourself for the unexpected.

Talking to Your Doctor

Neurologists have much area to cover in a brief period of time during appointments. Family planning and reproduction are topics that likely do not rank in the top ten things to discuss with your MS doctor.

My neurologist may have asked once, ten years ago, whether starting a family was something I needed to discuss. Currently, my rheumatologist asks during each appointment whether my husband and I plan to have children and whether we are using consistent birth control as one of my medications is known to cause birth defects and miscarriages. It doesn’t matter that I’m almost 47 years old, my doctor still asks.

In addition to discussing symptoms and disability, please talk to your doctor about issues related to sexual activity, pregnancy, medication use, contraception, and family planning. Listed below are medications (included in the HealthCentral article), commonly used with MS patients, which have been categorized as carrying some level of risk to an unborn fetus. Research other medications on websites such as drugs.com.

If the topic of pregnancy, family planning, and MS medications is one which concerns you, please take time during your next doctor’s visit to discuss these concerns. If you do become pregnant while taking one of these medications, you can contact patient pregnancy registry programs to report drug exposure.

Read this post in its entirety:
Drugs to Take (And Not to Take) When Pregnant with MS