Wednesday, October 5, 2016
Ultra Low-Fat Vegan Diet Doesn't Slow Down MS
In addition to fighting MS with medication, patients may turn to diet, exercise, and alternative medicine to push back on the disease. Several studies have connected exercise to positive patient outcomes including reduced fatigue and improved cognitive function. But research exploring the effects of diet and nutrition on MS is less clear cut. A pioneer on the subject, Roy Swank, M.D., published several papers prior to 1991 discussing the benefits of a low-fat diet in MS patients before DMT were available. Modern day MS diet proponents may also observe subjective benefits of diet for MS patients, but research is difficult and expensive to conduct.
Read this post in its entirety:
Low-fat Vegan Diet May Reduce Fatigue But Doesn’t Slow Down MS
Wednesday, August 31, 2016
Caregiver Fatigue and MS
According to the Caregiver Action Network, there are 65 million family caregivers across the country. Nearly one-third of the adult population is providing an average of 20 hours of care per week. That’s an extensive, unpaid job, one that’s vital to protecting the health and safety of our loved ones, especially those with multiple sclerosis.
MS is a progressive disease that can cause significant physical disability and manifests with a broad range of symptoms, including weakness, sensory disturbance, bowel or bladder dysfunction, impaired mobility, and vision loss. As the abilities of a person living with MS gradually decline, caregivers must perform important functions to help those with MS stay more independent. Informal caregivers such as family members, friends, and neighbors help make it possible for people with MS to remain in their homes even as the need for personal assistance increases and physical and cognitive independence declines.
Caregivers have an important job, but may become highly burdened. Family caregiving, mostly unpaid, can cause emotional distress, isolation, feelings of abandonment, and economic difficulties. In contrast, however, caregiving can also strengthen relationships, improve coping skills, and encourage feelings of pride and accomplishment. Becoming a caregiver teaches you a lot about yourself and empathy.
Read this post in its entirety:
The Impact of Caregiver Fatigue in MS
Monday, October 19, 2015
Guided Imagery Reduces Depression and Fatigue in MS
In 2014, the American Academy of Neurology (AAN) released guidelines for the use of CAM in MS, classifying therapies into three groups: mind-body medicine, biologically-based practices, or manipulative and body-based practices. The National Center for Complementary and Alternative Medicine (NCCAM) defines mind-body therapies as those that integrate the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health; examples include meditation, yoga, tai chi, relaxation techniques, biofeedback, and hypnosis.
Guided Imagery (GI) is a traditional mind-body technique that is considered a form of hypnosis. The term ‘guided imagery’ can be found scattered throughout the literature examining the use of CAM therapies in MS. However, a systematic review of mind-body medicine used in MS identified only a single study (Maguire, 1996) that examined the use of GI in MS producing mixed or inconclusive results.
A recent small pilot study conducted at the University of California San Diego (UCSD) examined the effect of a novel guided imagery modality developed by a person living with MS as compared to guided journaling. This study measured the quality of life, fatigue, and depressed mood in 11 patients with MS over the course of 10 weeks. Participants were randomized to weekly 1-hour guided imagery sessions (n=6) or an at-home journaling program focusing on topics of gratitude or positive self-image (n=5).
Read this post in its entirety:
Guided Imagery May Reduce Depression and Fatigue in MS
Tuesday, October 6, 2015
Three Things My Doctor Got Right
And to confuse matters, it seemed like I was always one doctor’s visit ahead of my neurologist when it came to recognizing what I needed, such as occupational/physical therapy to rebuild strength in my left hand, a disabled parking placard to avoid becoming a walking hazard, and medication to combat spasticity.
Here was our routine: I would notice a subtle symptom or growing problem and mention it during an office visit. He would examine what could be detected and determine that it was not something to be concerned about. Something would happen between visits related to the original concern and I would dutifully report it. He would then prescribe or recommend whatever service or intervention it was that I originally thought I needed.
At the time, these delays were annoying, but it was a bit entertaining to feel as though I was always one step ahead of my doctor. In retrospect, I feel disappointed that perhaps my neurologist was not as responsive to my concerns as he should have been - a disappointing story which is shared repeatedly among patients in the MS community.
However, there are several things which my doctor got right in his advice and recommendations that I didn't fully appreciate at the time. Here are three of those pieces of wisdom.
Read this post in its entirety:
3 Things My Doctor Got Right
Wednesday, September 23, 2015
Five Hidden Symptoms of Multiple Sclerosis
Fatigue.
Fatigue is extremely common affecting 75 to 95 percent of people with MS. It can be one of the most troublesome symptoms regardless of one’s disease course or level of disability. The Social Security Administration recognizes fatigue as a significant cause of unemployment among people with MS. The first step in combating fatigue is working with your doctor to narrow down the cause.
Depression.
One study found that depression was the main factor affecting quality of life in MS patients, more so than disability status, fatigue, or reduced sleep quality. Depression can be caused by neurological damage associated with MS, but may also be caused by the emotional rollercoaster associated with difficult life challenges and the uncertainty of MS. Symptoms of depression may include sadness, irritability, loss of interest, sleeping too much or too little, weight loss or gain, fatigue, physical restlessness, impaired concentration, and thoughts of suicide or death. If you experience any of these symptoms, please talk to your healthcare provider.
Cognitive decline.
Cognitive issues can develop early on in the course of MS and impaired cognition can lead to a vicious cycle of frustration creating a negative impact on QoL. However, it is not always apparent whether cognitive decline is a result of depression, fatigue, neurological impairment, or a combination of factors. Patients should undergo neuropsychological evaluation so that appropriate treatment may be recommended and QoL may be protected.
Research shows that larger brain volume, cognitive reserve gained through life experience (such as years of education), and lifestyle choices (engaging in cognitive leisure activities such as reading) protect against disease-related cognitive impairment in MS patients.
Sexual (dys)function.
Sexual dysfunction, which affects up to 75 percent of women and 90 percent of men with MS, can be distressing for the patient and have a negative impact on family relationships. In fact, sexual dysfunction has been shown to have a greater detrimental effect on mental health aspects of health-related QoL in MS patients than the severity of physical disability. However, patients may be reluctant to discuss sexual dysfunction and doctors may not ask.
Reduced sleep quality.
Sleep disorders, including obstructive sleep apnea (OSA) and insomnia, are common in MS. Reduced sleep quality can lead to fatigue and depression and CPAP therapy can improve these symptoms in patients with sleep apnea. A recent study showed that sleep disorders can reduce QoL of MS patients, especially in areas related to energy and emotion. In patients with OSA, physical abilities can also be negatively affected. Due to the complex relationship between fatigue, depression, and sleep disorders in MS, it can be difficult to detect the root cause in traditional QoL questionnaires.
Read this post in its entirety:
Five Hidden Symptoms of MS
Friday, February 27, 2015
What Influences MS Fatigue?
- Factors that increase odds of fatigue
After controlling for level of disability and socio-demographic variables, increased risk of fatigue was associated with poor diet, being overweight or obesity (increased odds of fatigue by 1.7 and 2.9 times, respectively), and current or previous use of a disease-modifying therapy (increased odds by 1.5 times). Additional lifestyle factors that increase risk of fatigue include lower levels of physical activity, alcohol consumption, and fish consumption (less than once/week).
- Factors that reduce odds of fatigue
After controlling for level of disability and socio-demographic variables, reduced risk of fatigue was associated with exercise, high levels of physical activity, moderate alcohol use, healthy diet, frequent fish consumption (three or more times/week), supplementation with vitamin D, omega 3, and flaxseed oil, normal BMI, and never using a disease-modifying therapy. Persons with MS who exercised vigorously three times a week or undertook mild or moderate exercise seven days a week were almost three times less likely to experience fatigue.
- Factors with little influence on fatigue
Researchers founds that meditation, social support, and current smoking were not associated with clinically significant fatigue after adjusting for stable factors.
Read this post in its entirety:
Living with MS: Reduce Risk of Fatigue with Diet and Exercise
Tuesday, October 28, 2014
October 2014 Round-Up of MS News and Research
- Psychiatric disorders may precede MS diagnosis
- Non-drug therapies are more effective in combating MS-related fatigue
- Reasons why people with MS fall more frequently
- Other studies of interest
Hot Topics and MS Research News for October 2014
Wednesday, July 23, 2014
Rehabilitation is More Effective Against MS Fatigue
There seems to be no single cause of fatigue in MS, which means that there cannot be only one approach to managing fatigue. Neurologists will often prescribe medication or recommend rehabilitation (e.g., exercise, energy or fatigue self-management education, and cognitive behavioral therapy) for managing fatigue. But which approach is more effective?
A number of studies investigating the effects of MS fatigue management strategies exist in the research literature, but until recently there has not been a thorough review comparing the effectiveness of individual types of interventions. A new review summarizes the available research evaluating three types of fatigue management strategies (exercise, education, and medication) used to target MS fatigue. Researchers included 25 randomized controlled trials in the review, including 7 medication trials and 18 rehabilitation trials (10 exercise trials and 8 education trials), that involved 1499 people living with MS (Asano et al., 2014).
The goal of the review was to answer the following questions:
• How effective are exercise interventions for reducing the impact or severity of self-reported fatigue?
• How effective are educational programs for reducing the impact or severity of self-reported fatigue?
• How effective are commonly used fatigue medications for reducing the impact or severity of self-reported fatigue?
• Are MS fatigue rehabilitation interventions (i.e., exercise and educational programs) more effective than the common MS fatigue medications?
Read this post in its entirety:
Exercise, Education, or Medication: Which is Better for MS-Related Fatigue?
Thursday, May 15, 2014
Can Nutritional Deficiencies Cause MS Fatigue?
Fatigue and nutrient deficiencies
In the current study, only the nutrients, folate and magnesium, were associated with increased fatigue. Researchers found that lower dietary intake of magnesium and folate in MS patients is significantly correlated with higher Modified Fatigue Impact Scale (MFIS) scores, specifically the physical subscale. Fatigue scores were not significantly associated with vitamin D and calcium intake.
Daily dietary intakes of vitamin D, folate, calcium, and magnesium were significantly lower than DRI as well. In men, zinc was significantly lower but iron was higher than DRI. In women, iron intake was significantly below DRI levels. Researchers have previously demonstrated that low calcium and iron intake may be correlated with progression of MS (Ramsaransing 2009). In addition, deficiencies in vitamin D and magnesium have been implicated as risk factors for MS (Pennington 1997; Yasui 1992).
Fatigue and nutrient deficiencies
In the current study, only the nutrients, folate and magnesium, were associated with increased fatigue. Researchers found that lower dietary intake of magnesium and folate in MS patients is significantly correlated with higher Modified Fatigue Impact Scale (MFIS) scores, specifically the physical subscale. Fatigue scores were not significantly associated with vitamin D and calcium intake.
Fatigue and nutrient deficiencies
In the current study, only the nutrients, folate and magnesium, were associated with increased fatigue. Researchers found that lower dietary intake of magnesium and folate in MS patients is significantly correlated with higher Modified Fatigue Impact Scale (MFIS) scores, specifically the physical subscale. Fatigue scores were not significantly associated with vitamin D and calcium intake.
Fatigue and nutrient deficiencies
In the current study, only the nutrients, folate and magnesium, were associated with increased fatigue. Researchers found that lower dietary intake of magnesium and folate in MS patients is significantly correlated with higher Modified Fatigue Impact Scale (MFIS) scores, specifically the physical subscale. Fatigue scores were not significantly associated with vitamin D and calcium intake.
Read this post in its entirety:
Low Magnesium and Folate Intake Correlates with Multiple Sclerosis Fatigue, New Study Shows
Thursday, May 1, 2014
Carnival of MS Bloggers #155
I'm sorry is a phrase that is either really easy to say or really hard to say. Sometimes it is used lightly, and sometimes it is used in some pretty intense situations. In marriage and really in life in general, the art of saying I'm sorry and what it means is actually really complex.
The first words Josh said to me after his diagnosis were "I'm Sorry." I am pretty sure I looked at Josh like he was an idiot. Why was he apologizing? Who says they are sorry for being sick? Are you kidding me? Being diagnosed with MS is something that is totally out of a person's control. Thinking about it now, I'm sorry is a little bit ironic. The things I really need Josh to say I'm sorry for are things like...
- Sorry for leaving the toilet seat up, and the fact that you fall in the toilet at least once a week as a result of this.
- Sorry for never unpacking my bags after business trips.
- Sorry for falling asleep with a glass of red wine in my hand and waking up startled resulting in me drenching you with red wine at 3 in the morning. (True Story... Don't you feel sorry for me?)
- Sorry for being grouchy when I wake up.
- Sorry for leaving my work stuff scattered on the table.
- Sorry for leaving empty glasses on the nightstand.
On the MS front...
The eye washout has not completely gone away. Josh needs a steroid for his eyes to knock out the inflammation. Dr. Emily called in IV Infusion that can be done at home. Sounds dramatic, but it really isn't-just more of an inconvenience. Josh does an incredible amount of paperwork for his job. Really, I may never understand the amount of paperwork that he does. The IV is being done at home which works out really well for him so he doesn't have to stop work. Just another perk of having a home office. He has to do 3 consecutive days of the steroid. We are hoping to get them started today and finish on Saturday. I laughed and told him maybe he will have a cute little nurse come out to set it up:). It amazes me how far technology and medicine has come. The fact that he can do this from home and it not have an impact on his work is truly amazing.
Back to the "I'm Sorry's"...
Our wedding was FUN. Like, so fun I didn't want to leave. In fact, when we left the reception the first time, no one was outside to see us leave. We had to do a redo and tell the band to stop playing music so everyone would come outside to see us hop in the limo to start our happily ever after. Our friends and family celebrated (maybe celebrated a little too much:), but the main part of our wedding was our vows. When I took those vows, I signed up for MS. I signed on the dotted line when I signed our marriage certificate. Did I know it at the time? No. When you are young and in love, you feel invincible. All you can imagine are picket fences, babies, puppies, and rainbows. (At least as a girl I imagined this. I would be interested to see what Josh imagined:) Would I do it all again and sign up for MS? Yep. And guess what? I. AM. NOT. SORRY. And guess what else? I will NEVER be sorry.
I have been a runner in my lifetime. Some days I still feel like one, but most of the time I am happy to have the memorable experience of sustained motion. In 1999 a friend talked me into doing a "fun run" with her. She had just had her third child and wanted to get back in shape. She had been very involved in track during her college days and was really quite good, and fast.
I said yes, and over the next five years I ran in several events including four marathons and three triathlons. In 2004 I had a training accident which inadvertently led to an MRI revealing evidence of demyelinating disease. My next marathon had begun. It took another six years of head scratching before the diagnosis came. Oddly welcome. Nice to know the reason why, right?
Some questions though, do not have answers that feel satisfactory. And then there is the whole thing about not knowing what the future holds. All there really is to plant my feet on is what is in front of me right now. I am more than ok with that. Distance running is kind of the same. Being in the moment, being with myself is a big part of what I would try to do during a long run. Now the distances involve navigating the space between my CNS and my body, the emotions that surface with the myriad neurological sensations and the time it takes me to employ good old-fashioned self care. Running shoes are optional.
After transitioning to the autoimmune paleo and Wahls protocols, I definitely have had more good days than bad, as far as my MS fatigue. I have also learned to be more in tune with my energy levels, and therefore what I schedule for the week, making sure I rest if I need to, so I don't crash.
Having said all of that, there are days when I feel really good and I get caught up in the moment and push it too far. For example, last weekend, I started off my Saturday with a 1 hour vinyasa flow yoga class from yogaglo.com, then went for a walk with my daughter as she rode her scooter around our neighborhood and I ended up spending a couple hours in the afternoon out in my yard cleaning up the garden. I felt great and then it hit me, like somebody turned my switch to "off". I had just fixed dinner and then realized I was exhausted, and needed to lay down that minute. I basically ate dinner and went to bed and that was it for me. A couple months ago, I would have been down for the count the next day too, but I wasn't this time. I took it easy the next day, but I was still able to function, so I feel like I am making progress.
I believe that my body is slowly healing, and I am making peace with this new life, but sometimes this "MSness" can just sneak up on me...
This concludes the 155th edition of the Carnival. The next Carnival of MS Bloggers will be hosted here on June 5, 2014. Please remember to submit a post (via email) from your blog of which you are particularly proud, or which you simply want to share, by noon on Tuesday, June 3, 2014.
Photo Credit: Dawn - Pink Chick via Compfight cc
Tuesday, April 29, 2014
April 2014 Round-up of MS News and Research
A recent study shows that, for many individuals with MS, fatigue is associated with poor sleep quality. Fatigue is among the most common symptoms of MS, affecting up to 80% of those diagnosed with the disease. Several factors may contribute to the connection between poor sleep quality and fatigue. Increased levels of inflammatory cytokines or lesions in the brain may disrupt pathways involved with sleep and daytime alertness. Sleep apnea, which is common in people with MS, may also result in both fatigue and sleep disruption. The use of MS disease modifying therapies, particularly beta interferons, may contribute to both fatigue and sleep disturbance. Although depression was associated with both sleep disturbance and fatigue in this study, authors note that exclusion of patients with severe depression and the low incidence of depression in the study participants limits their ability to evaluate a possible connection.
Neuromuscular electrical stimulation cycling benefits people with advanced MS according to a recent study. Eight women with secondary progressive MS (SPMS) participated in a training program utilizing neuromuscular electrical stimulation (nMES) cycling that resulted in several real and perceived benefits. Electrodes are placed on the quadriceps, hamstrings, and gluteal muscles of each leg which allows persons with paralyzed legs to exercise on a stationary recumbent bicycle. The goal of this study was to investigate the feasibility of adapting nMES cycling to suit the needs of persons with MS. Adaptations included a slower pedaling cadence (at a speed of 10 revolutions/minute) which produces greater muscle forces and a slow, gradual increase in stimulation intensity (pulse amplitude) during the first 20 minutes of each exercise session as patients adjusted to the uncomfortable stimulation. Study outcomes included the stimulation intensity tolerated, thigh circumference changes, and power output and cardiorespiratory response during cycling.
Read this post in its entirety:
Hot Topics and MS Research News for April 2014
Thursday, April 3, 2014
Carnival of MS Bloggers #154
What I remember most about the first two years of MS is the hunger. I remember lying flat on my mattress, hungry. Close your eyes, go back to sleep.
I’m hungry.
I’m tired. No: I’m decimated. In this game of rock-paper-scissors, tired always wins out over hungry. I close my eyes. I drift in and out of sleep. Four hours pass. I wake up and think: I’m so hungry. Sleep. Eight hours. Still hungry. More sleep. Twelve hours. So fucking hungry. Knocked out again. Sixteen hours. Twenty hours. Sometimes twenty-four or more. Still hungry. Still fucking hungry.
Each time I awake I briefly contemplate getting up, foraging for something to eat. But the walk through the living room, past the bathroom, into the kitchen is long, and I am weak. The thought of opening the fridge or a cabinet, of microwaving something, is beyond me. And so I sleep.
I cry.
I remember crying because I was so fucking hungry but unable to get up and feed myself. I remember lying flat, limbs extended. Limp as a puppy, sobbing.
Sometimes I could make it to the fridge. I remember eating bread. Rolls. Holding onto the walls for support. Using my apartment as a walker.
I remember that when the disease hit it was nuclear. It obliterated me. I remember dreaming about 9/11 because my body identified with the collapse of those twin towers.
Whenever I was trying to do something difficult that required an extensive amount of concentration—like traverse an apartment, open a fridge, or take a piss—I would listen to my own breathing. To the silence.
I remember a stillness, a quietness that I’d almost never felt before and have almost never felt since (except on really bad days when, in class, I find myself again seeking out a wall to strategically hold onto in order to create the illusion that I’m not about to collapse–all of course while continuing to seamlessly deliver the day’s lecture on the present subjunctive, or vocabulary pertaining to zoo animals).
Crossing a street can be a victory. Taking a piss can be victory. I count my breaths. I listen.
I remember that for the longest time no human being touched me for any reason other than medical intervention. Nurses grasped my arms to insert needles or tie tourniquets. Doctors placed a firm hand on my back as I failed and failed and failed my Romberg’s test. Imaging techs gently guided my head into place for my 2 to 3 hour long MRI scans. The only touch I experienced was being strapped, tied, punctured, swabbed, infused, and physically manipulated. The worst is when they deliberately induce muscle spasms. I always beg for them not to deliberately induce muscle spasms. Please, please don’t do that thing. You know—that thing.
I remember having to do pulse steroids every single month for almost a year—along with thrice-weekly injections of Rebif—just to achieve something remotely like “remission.” The drugs demolished my immune system, leaving me with the blood cell counts of someone HIV+.
I remember being too weak to stand up after steroid infusions. Listen, I get 1,000mg of Solumedrol in 500ml of saline, — an assertion on my part which would inevitably cause the nurses to protest because “That’s more saline than normal. Why do you get so much saline?”
If you don’t give me 500ml of saline and infuse slowly over the course of 2 hours I will throw up.
“We usually infuse this in 30-40 minutes.”
Fine, then I’ll throw up.
“Fine. We’ll do it your way then.”
Fine.
They did it my way.
I remember leaving Brigham and Women’s at rush hour on a weekday and the #66 bus being jam-packed and me with a bandaged arm, glassy eyes, and an inability to stand and nobody—nobody—would offer me a seat. I remember sitting on the floor of the bus because I could not stand. I became stubborn in my willingness to sit down on floors, on the ground. Whenever I was out in public and became too fatigued to stand, I would simply sit down—wherever I was. Right there. Sit.
No, I don’t care who is looking. No, I don’t care what you think. I am sitting. Right now, right here, what I am doing is sitting, and I will get up when I am good and ready, and if you want to leave me here then go, fuck you, I don’t care.
I just need a minute. I just need an hour. A day. A few days. Just a week. A month. A couple of years, actually. Be right back.
Just need to get my bearings.
Just need this wall here. This is a good, solid wall. I love this wall. It’s not going anywhere, and I can lean on it. Holy shit: this wall is amazing. This wall is here for me. I love you, wall. Wall, I love you.
Whenever I would receive steroid infusions the only thing I could eat for days was Vietnamese food from Lês in Harvard Square. Pho chay, specifically.
I need limes from the grocery store. I need Vietnamese food and I need limes. I need, like, 40 limes. I need to get them before the steroid crash that’s coming in a few hours. Before it’s too late. I have to go, now, to the grocery store and buy like $40 worth of limes. Right now. Don’t bother me. I am on a mission. Don’t text me anymore because I need limes, OK? Goodbye. I need limes.
Steroids have a half-life of around 18-26 hours. If you’ve been infused with high doses for days in a row, your adrenal glands stop producing cortisol. Houston, this is a problem. I remember the crashes—the sweats, the muscle weakness, the inability to stand up (more so than usual), the bone pain.
This is why I need Vietnamese food and I need limes, and I need them now, before it’s too late.
I remember that I was left for dead for 2 years. Left for dead by everyone who was supposed to be there. Left for dead like an injured racehorse ready to be shot. I remember seriously weighing the hypothesis that perhaps I had already died and this was why I was being kept separate from the living. Why it seemed that no one could see me anymore. Why my ontological status seemed to have changed. I lay flat. Breathed. Waited. And sometimes, yes, I cried.
I’m doing the best I can. I may not be doing EVERYTHING I can, but it’s still enough.
I’ve been experiencing some additional MS symptoms lately. It’s completely understandable given I’m experiencing more stress than usual. Still, when healthy habits lead to feeling better it’s easy to blame myself for not living a perfect, healthy life when symptoms emerge.
When I was diagnosed with MS, I felt like my body had betrayed me and I could no longer trust it. I thought I was super healthy, and suddenly my body went numb. Doctors told me I had an incurable disease that I’d had for years.
In my research of how others coped with MS, I often heard people approach it as warriors fighting a daily battle against their disease. I can appreciate the analogy and it makes sense, but it never resonated with me. Fighting myself feels exhausting. And what am I fighting? I have a super active immune system that thinks the insulation on my nerves (myelin) is an invader and needs to be destroyed. My immune system is fantastic at destroying other invaders. It’s just confused with myelin some of the time. Bummer.
It occurred to me to think of my body as my buddy who is great at some things and sucks at others but I love her just the same. My body didn’t betray me. She is doing the best she can. She held up magnificently for a long time, and she continues to do amazing things. My neurologist says with my MRI scans he would expect me to have some disability. At this point I have symptoms I notice but no one else does. I think it’s awesome that my body has compensated to get the nerve messages to parts of my body blocked by lesions.
It’s taken me time to shift my thinking from feeling betrayed to trusting myself again. Now I think being healthy and having an incurable disease are not completely opposite ends of the spectrum. They can both be true in one body.
My body has been doing the best it can all my life. Some of my habits help it, and some challenge it. Some activities and foods don’t support optimal physical health, but they nurture my mental health and feed my soul. Sometimes I’m coping and sometimes I’m nurturing. I think stressing out about not doing more can be more harmful to my health than the occasional indulgence.
So I may not be doing everything I can, but I’m balancing all aspects of my health in order to lead a fulfilling, active and hopefully long life!
This concludes the 154th edition of the Carnival. The next Carnival of MS Bloggers will be hosted here on May 1, 2014. Please remember to submit a post (via email) from your blog of which you are particularly proud, or which you simply want to share, by noon on Tuesday, April 29, 2014.
Friday, August 31, 2012
Sleep Disorders and Chronic Illness
Sleep disorders may be under-diagnosed in both rheumatoid arthritis and multiple sclerosis, according to research. For information regarding sleep disorders, including sleep apnea, and their connection with RA and MS, please read the following posts I wrote this week for HealthCentral.
Read:
Sleep Apnea: Is RA Connected with Sleep Apnea? (Part One)
Sleep Apnea: How is it Diagnosed and Treated? (Part Two)
Multiple Sclerosis and Sleep Disorders: Do You Suffer Fatigue and Daytime Sleepiness? (Part Three)
Thursday, January 6, 2011
Carnival of MS Bloggers #79


For Hillel Panitch,
my primary MS doctor and the relentless researcher of MS,
who had stellar bedside manner and
who I really had to be talked into seeing by my eye doctor. In the end he became my first choice neuro doctor and I am very picky, being an "old neuro nurse".
I wrote this shortly after I found out he was gone.
I was sitting in the McDonalds parking lot,
Eating my lunch on the road where I work
(I still work full time, thanks Dr. P...)
Assessing clients
And helping them access personal care.
The clinic called and my heart always skips a beat when they call me
Back to my other reality....
This is YOUR life, not some other sufferer.
They wanted to invite me to a tribute to Dr Panitch.
I was on the “a” list.
I looked around, was there anyone looking at me?
Did anyone see? Hear?
I wanted to be polite, respectful,
I wanted to say, Yes.
My schedule flashing in my head.
How could I do that, I thought.
It is for the MS society.
The people who thought my MS story was too long and when I shortened it they said it wasn’t quite right.
But it is for Dr Panitch, I thought,
A lifetime achievement award.
No, I said, so plainly, No.
I am honored (and I was sincerely),
But I cannot do it.
I lived in two worlds,
The Neuro Nurse and the Neuro patient.
My friends, coworkers from 30 years ago would be there,
as health care professionals.
How would I fit in?
My world, a subset of both nurse and patient.
Hearing he is gone from our material world,
I am relieved I was not there,
That my memories can be of him standing in the hallway,
Trying to peek at my progress on his study meds,
Briefly making eye contact, I smiled at him,
Trying to say what he has done for me is appreciated.
He has bought me some time,
He has given me expensive cutting edge treatment I would have otherwise gone without,
He put his hand on my shoulder and said, “Don’t worry, we will take care of you.”
And
He meant every word.
The thing I love most about the internet is that it gives me the ability to communicate with people all over the planet.
That is really what the internet is all about, simple and straightforward communication and participation.
Nothing compares I think to the pleasure of "talking" to people every single day around the world and sharing our stories and information.
I get an opportunity to explain my opinions, viewpoints and share information which may be helpful to others.
My words are not changed by anyone, every post, with the occasional interesting article, has been written by me.
My blog welcomes comments which lets visitors tell me what they think of my posts and share their stories.
In the 4 years since I started blogging I have made many friendships and received and given alot of support.
I get a lot of positive feedback and comments which make my life so much better and stops me being isolated.
When I got my MS diagnosis on 19 July 2006, I started blogging the next month to receive and share information about MS and the difficulties of becoming handicapped.
This was also in order to make sense of what was happening to me, but also to communicate with other people with MS and without MS.
I believe that blogging has expanded my horizons and I have no doubt that the internet has saved my life.
It enables me to communicate with others around the world, even when I could not leave my bed for two years.
This was from August 2008, due to a pressure wound, this finally healed in August 2010 and I could sit in my wheelchair once again.
Since early 2009 I have been writing a blog post every single day, something that would have been unheard of 3 years ago.
I communicate regularly with people I have never, and sadly, will never meet, except online.
The internet has enabled me to communicate with others and be part of the world.
That is what the internet has done for me, it enables me to participate not just to consume, and despite my MS I can and do participate in the world.
It has helped me despite my severe disability caused by my MS to communicate, which has been and still is being a supportive and liberating experience for me.

The most important lesson learned is that I should not plan to have the same level of energy that I had before disability. Last year, there were too many times when I believed that I was normal and had the same energy level that I had before. So I filled up my schedule, made commitments, volunteered endlessly, and then crashed in confusion. "What happened?" I would whine. Then I would go to the doctor looking for yet another prescription, or try alternative therapies that friends said were successful for them.
But last year, I lost sight of my authentic self. I lost sight of the reason for my disability. This next year, I am going to ignore the cultural message that "You Can Do Anything You Set Your Mind To and Don't Let Anyone Tell You Otherwise." Bullpoop. I'm going to avoid going to lectures by people with MS who climb Mt. Everest or travel the world in 80 days. I am not using them as role models any more. I will be my own authority and not succumb to peer pressure.
This next year, I pledge to do less. I pledge to focus on a few fundamental activities, and to avoid saying 'yes' to everything. I pledge to give serious thoughts to my priorities. And I AM prepared to deal with the disappointments - mine and others.
Just thought you should know this now so that you will be prepared for a different year, too.
Happy New Year!
This concludes the 79th edition of the Carnival.
Thank you.
Comments for this post.
Friday, December 10, 2010
What does "normal" tired feel like?
On Sunday, I actually went out shopping for some Christmas items. I'm not sure how long we spent in the first store, but it was at the second store where I admitted (at one point) that my brain was tired and I couldn't think clearly. When asked if I wanted to go home, I said no. I wanted to rest (my mind) just a bit and make a decision. Rob was very patient with me and we ended up leaving much later, after I had make my decisions and purchases.
Monday, I participated on a phone "interview" helping someone with a project. It was really a very long conversation which I was surprised to see lasted more than an hour by the time we hung up. Of course, I had kids to teach later in the day.
Tuesday was a simple day, primarily about playing with one of the items I had purchased and then teaching.
Wednesday, I had to get up early (for me) for a 9am hair appointment. I knew that it would be a long one since we were planning to do some highlights and color (yes, I'm pushing back against the gray). I left there at 11am. Then, I went back to one of Sunday's stores to ask for a gift receipt for the item I had purchased. I should have thought to get it Sunday but wasn't thinking quite clearly at the time.
After getting the extra receipts, I went to another store to view a competing item to help me decide if I wanted to return the first item or not. Nope, I'm sticking with my first choice. Then I went to the nearby pet store to find some new toys for the kiddos. After that I needed to stop at the local music store to pick up some items I promised to look for and to find selections appropriate for this spring's solo festival for the horn students of varying levels of ability.
Anyways, I finally got home sometime before 2pm, needed to eat lunch and chill, and be ready to teach at 3:30pm. I was understandably tired after all of that. I felt "normal" tired, I thought.
Yesterday, I had to get up extra early to get downtown DC to Union Station to catch a train to New Jersey. We were making good time when disaster struck. An accident had shut down Constitution Ave. and thus blocked our route to the train station. After trying to figure out which metro station we were closest too, and what it would take to get to Union station from there, I decided to just get to the train station and take the next train (an hour later). It cost me more for the ticket but I got to the destination in time to scarf some lunch very quickly before I was needed.
Then in New Jersey, I participated in an event during which I seemed just as normal and active as anybody else. Nobody could see my diseases although I talked about them. I was the perfect example of the "but you look so good" syndrome. At 5:30pm I was sitting on the train to come back to DC. I think I walked in my front door at around 8:45pm.
I felt tired last night, but today I'm extra, crazy, must be the MS or RA, insane tired. It's the - I don't even want to get up to get something to drink although I'm really thirsty and probably dehydrated - tired. It's the - I can't walk a straight line or can hardly lift my legs high enough to climb the stairs - tired. It's the - how do people do this stuff and still function - kinda tired.
So I've completely forgotten what true "normal" tired feels like. But I guess the slight bonus to this is that my legs have a gentle tingling throughout which feels kinda soothing at this point. It kinda "feels" like white noise under the skin. Ahhhhh....
Tuesday, May 11, 2010
MS Spasticity and Fatigue haven't got a chance!!
The welcome dinner for the event did not take place until Sunday evening, but I boarded a plane Thursday to arrive Friday morning. The reason I traveled a couple of days early was to get adjusted to the time difference and to recover from the exhaustion of travel. Plus I wanted to see just a bit of the area.
An ‘overnight’ flight sounds like a great way to sleep on the way over; however, leaving at 6pm from the US and arriving at 8am (in a time zone which is 6 hours ahead of home) is like waking up around 1am on the plane to eat ‘breakfast’ and begin a full day ahead. I don’t know about you, but I don’t exactly function well on only a few hours of sleep (assuming I was even able to fall asleep and stay asleep on the plane).
Read this post in its entirety:
Taking MS On the Road: International Travel, Spasticity, and Hot Baths
Personal note: I was extremely fortunate to be able to find a way to deal with these MS-related issues. Not everybody is so lucky all of the time. Perhaps due to sheer will or the new medication I'm using (Rituxan), who knows, but I seem to have fully recovered from the trip without much residual effect.
I am very ready for next week's Rituxan infusion since my RA has started to act up again and my joints are feeling the effects. I've become a cranky RA person again. I'm told that some patients report even greater benefit after the 2nd and 3rd rounds of medication. That would be awesome, and maybe I will achieve as close to remission as is possible with my rheumatoid arthritis. That would be very cool.
Next week I've got another story related to my recent trip. This one, however, involves a bathroom, soaked underwear, and going commando. You can probably figure this one out ahead of time. ;)
Monday, March 16, 2009
Provigil and Me
In How to Manage of MS-Related Fatigue, pharmacological and non-pharmacological strategies to combat fatigue were discussed. MS fatigue is not the same as simply being tired, or muscles which are fatigued after a good work-out, or the desire to sleep in on a Saturday morning. MS fatigue can be debilitating and interfere with daily functioning.
Even before I was diagnosed with multiple sclerosis, I was T.I.R.E.D.!!!! After diagnosis it got worse, to the point where I needed to take 2-3 naps daily just to make it through. So I mentioned this to my neurologist who gave me some samples of a medication to try. Those samples were for Provigil, a prescription medication used to improve wakefulness in adults who experience excessive sleepiness due to one of the following diagnosed sleep disorders: obstructive sleep apnea, shift work sleep disorder, or narcolepsy.
Read this post in its entirety:
Taking Provigil for MS-Related Fatigue
Saturday, March 14, 2009
Management of MS-Related Fatigue
Fatigue was recently defined by the Fatigue Management Panel of the Multiple Sclerosis Council on Clinical Practice Guidelines as:
A subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities.
RECOMMENDATIONS
Based on clinical experience and careful review of the medical literature and research findings pertaining to MS-related fatigue, the Medical Advisory Board of the National MS Society makes the following recommendations:
* Because of the complexity of MS-related fatigue, the first step in effective treatment is to identify the cause(s) of the fatigue (e.g., any combination of factors, including co-existing medical illnesses, side effects of medications, depression, disrupted sleep, and fatigue caused by the MS itself.
* Once the source(s) of the fatigue have been identified, the treatment of MS-related fatigue is approached in a step-wise fashion in order to address all contributing factors.
The treatment of fatigue should include TWO major steps:
1. Management and elimination of any secondary causes of fatigue
2. Treatment of primary MS fatigue
Read this post in its entirety:
How to Manage MS-Related Fatigue
Wednesday, August 6, 2008
I'z Sleepy
Thursday, July 10, 2008
Pharma Wants You to Walk Faster and Easier for $10,000
On May 21, I was contacted by Jeff Macdonald, communications director at Acorda Therapeutics, Inc., a company which is developing treatments for multiple sclerosis and other neurological disorders. They have a product for which they will be seeking FDA approval early next year. Jeff thought that you and I would be interested in learning about milestones in their clinical development. We even talked on the phone just after Memorial Day to discuss Fampridine-SR.
On June 2, Acorda released the following press release regarding positive results from the second of two Phase III trials of a drug called Fampridine-SR in the treatment of MS. As any MSer with very slight obsessive-compulsive tendencies, I felt compelled to do some research before blindly presenting you with Acorda's information. I don't know about you, but I like to know more than what is summarized in a press release. Included is personal commentary, not in italics.
Much of what I found is presented in these recent posts:
- What is 4-Aminopyridine?
- 4-AP, Fampridine-SR, and Spinal Cord Injury
- 4-AP, Fampridine-SR, and Multiple Sclerosis
- The Bioentrepreneur and Fampridine
Hawthorne, NY, June 2, 2008 - Acorda Therapeutics, Inc. (NASDAQ: ACOR) today announced positive results from its second Phase 3 clinical trial of Fampridine-SR (MS-F204) on walking ability in people with multiple sclerosis (MS). A significantly greater proportion of people taking Fampridine-SR in the trial had a consistent improvement in walking speed compared to people taking placebo (42.9% vs. 9.3%), as measured by the Timed 25-Foot Walk (p less than 0.001). Consistent improvement in walking speed was the primary endpoint of the study as outlined in the Special Protocol Assessment (SPA) with the U.S. Food and Drug Administration (FDA).The number of patients taking Fampridine-SR in this trial was 120, according to the study design description below. But 42.9% of 120 patients total 51.5 patients. Perhaps it is 42.9% of 119 patients, being 51 patients, who became responders in this trial with consistent improvement in walking speed.
“With the success of this trial, we have achieved a critical milestone for Fampridine-SR. We have now completed two successful Phase 3 trials demonstrating improved walking ability in people with MS,” said Ron Cohen, M.D., President and CEO of Acorda Therapeutics. “We believe that, subject to FDA review, the results of our two Phase 3 trials are adequate to support an NDA. We expect to submit this application in the first quarter of 2009 and plan to request priority review.”I don't know too much about the FDA approval process, but I doubt that Fampridine-SR will hit the market before 2010. According to a Reuters article, Fampridine-SR "might cost between $5000 to $10,000 per year." When I spoke with Jeff Macdonald in May, he could not offer any guidance on the expected cost. He said that they (Acorda) were focused simply on getting FDA approval right now. I also asked him about any plans for a patient assistance program. He answered that with approval they expect that insurance will reimburse the cost. Arghh! Why is that always the cop-out answer when the cost of medication is called into question? I have insurance and there's no way it would cover this drug, just as it doesn't cover the cost of Copaxone.
The study’s only prospectively defined secondary outcome measure, leg strength, showed a statistically significant increase in the Fampridine-SR Timed Walk responders compared to placebo (p = 0.028). There was a small improvement in leg strength for Fampridine-SR Timed Walk non-responders compared to placebo that was not statistically significant.Between 1997 and 2002, Dr. Goodman was instrumental in conducting a number of studies which focused on how best to measure impairment and changes in impairment levels. A study published in 2002 concluded that a 20% change in qualitative functional measurement can be considered a reliable threshold to indicate true change in function for an individual. What this means is that variation in walking speed of the Timed 25-Foot Walk up to 20% could be considered within acceptable fluctuations of ability without indicating a true change in function. So the average increase in walking speed of 24.7% does not impress me as greatly as Acorda would probably hope.
Additional measures in this study were consistent with the results of the first Phase 3 Fampridine-SR trial. The average increase in walking speed over eight weeks of treatment compared to baseline was 24.7 percent for the Fampridine-SR Timed Walk responders compared to 7.7 percent for the placebo group. The 12-Item Walking Scale (MSWS-12), a self-rated assessment of walking disability, was improved in Timed Walk responders compared to nonresponders. Also, an increased response rate on the Timed 25-Foot Walk was seen across all four types of MS. The Company intends to present comprehensive data from this trial at an upcoming medical meeting.
“Difficulties with walking are among the most pervasive and debilitating problems faced by people with MS. Walking disability affects their ability to accomplish daily tasks and limits their independence,” said Andrew Goodman, M.D., Director of the Multiple Sclerosis Center at the University of Rochester. “Because there are currently no therapies indicated to improve walking impairment in MS, clinicians are limited in their ability to address this aspect of the disease. The results of this study indicate that Fampridine-SR could represent an important new way to treat people with MS.”I do not disagree with Dr. Goodman's characterization that difficulties in walking do impact a patient's ability to accomplish tasks with ease. In fact, difficulties with spastic leg muscles causes me trouble. However, I find the statement regarding "no therapies indicated to improve walking impairment in MS" to be promotional in nature. For me, a prescription of the muscle relaxant, Baclofen, has tremendously improved my ease of walking and costs much less than Fampridne-SR will.
Study DesignSo if the estimated cost of MS is greater than $47,000 per patient per year, why not go ahead and increase the cost 21% by adding yet another drug into the mix? However I believe the NMSS estimate is inaccurate. Here's why I believe that to be the case based on my experience and research.
The double-blind, placebo-controlled trial was designed to evaluate the safety and efficacy of Fampridine-SR in improving walking ability in people with MS. The primary endpoint of the study was response on the Timed 25-Foot Walk. A Fampridine-SR Timed Walk responder was defined as a study participant whose walking speed was faster at a majority of the four on-drug visits than any speed measured during the five off-drug visits. The trial, which enrolled 240 individuals at 39 MS centers in the United States and Canada, recruited patients between 18 and 70 years old with a definite diagnosis of MS and some degree of walking disability. Subjects were randomized to treatment with Fampridine-SR (n=120), at a dose of 10mg twice a day, or placebo (n=119), and the study was open to people with all four major types of MS: primary-progressive, secondary-progressive, relapsing-remitting and progressive-relapsing. Participants were permitted to remain on a stable regimen of their current medications, including immunomodulators.
Safety Statement
In this study, adverse events were generally mild to moderate and largely consistent with the safety profile observed in previous studies of Fampridine-SR in people with MS. The most common adverse events reported in the Fampridine-SR treatment group compared to the placebo group included: urinary tract infection (17.5% vs. 8.4%), falls (11.7% vs. 16.8%), insomnia (10.0% vs. 1.7%), headache (9.2% vs. 0.8%), asthenia (8.3% vs. 4.2%), dizziness (8.3% vs. 0.8%), nausea (8.3% vs. 0.8%), back pain (5.8% vs. 2.5%), balance disorder (5.8% vs. 1.7%), upper respiratory tract infection (5.8% vs. 6.7%), arthralgia (5.0% vs. 4.2%), nasopharyngitis (5.0% vs. 4.2%) and paraesthesia (5.0% vs. 1.7%).
There were three serious adverse events (SAEs) that led to discontinuation: two in the placebo group and one in the Fampridine-SR group. In the placebo group, one participant experienced a possible complex partial seizure and another experienced a combination of chest tightness and gastric reflux. Both of these events were judged by investigators, who were blinded at the time, to be possibly related to treatment. In the Fampridine-SR group, one participant had a patellar fracture, which was judged not to be treatment related. In addition, one participant treated with Fampridine-SR experienced an episode of syncope (fainting) one day after completing the treatment phase of the study. This was judged to be possibly related to treatment, but the participant was not discontinued from the trial. Follow-up assessment by the clinical investigators determined that these SAEs resolved completely with no residual effects. No deaths occurred during the study.
As of June 2, 2008, the total exposure in our MS studies to Fampridine-SR at 10mg twice a day, including both double-blind and open-label studies, is approximately 1,100 patient years. The incidence of seizures in these studies at the 10mg dose has been within the rates reported for placebo-treated groups in long-term controlled studies of immunomodulator drugs in MS patients. These rates have ranged up to two percent of patients in a two-year study, or one seizure per 100 patient years. The overall incidence of seizure appears to be dose-related.
About MS
Multiple sclerosis is a chronic, usually progressive disease in which the immune system attacks and degrades the function of nerve fibers in the brain and spinal cord. Over 400,000 Americans have MS, and someone is newly diagnosed with MS every hour in the United States. Most are between the ages of 20 and 50, and women are affected two to three times as much as men. Worldwide, MS may affect 2.5 million individuals.
According to the National Multiple Sclerosis Society (NMSS), the direct costs of medical care for MS patients in the United States exceed $6 billion annually. Additionally, a NMSS analysis estimated the total cost of MS, including medical and non-medical care, production losses, and informal care, at more than $47,000 per U.S. patient per year. Complications from MS may make it harder for people to work and may interfere with their ability to perform common daily activities.
- $25,000 Copaxone
- $01,360 Gabapentin
- $00,840 Baclofen
- $00,184 Sertraline
- $03,540 Provigil
- $00,088 Annual Neurological Exam ($237 billed)
- $03,500 Insurance Premiums
- $06,000 Cost of relapse-related medical care ($10,500 billed)
- $02,000 Loss of earnings during relapse
- $10,000 Loss of earnings by cutting back hours due to fatigue
- $00,500 Cost of Membership to County RecCenter with Pool
- $00,500 Cost of Yoga Classes at County RecCenter
Being disgusted with the above - Priceless
For most people with MS, the disease slowly progresses with a series of unpredictable flare-ups, also called relapses. But for some, the progression of the disease is rapid. Each relapse tends to lead to increasing disabilities such as walking impairment, muscle weakness or speech or vision impairments. Approximately 85 percent of people with MS experience some form of walking impairment. Within 15 years of an MS diagnosis, 50 percent of patients often require assistance walking and, in later stages, up to a third of patients are unable to walk.
About Fampridine-SR
Fampridine-SR is a sustained-release tablet formulation of the investigational drug fampridine (4-aminopyridine or 4-AP). In laboratory studies, fampridine has been found to improve impulse conduction in nerve fibers in which the insulating layer, called myelin, has been damaged. Fampridine-SR is being developed by Acorda Therapeutics and manufactured by Elan Corporation plc.
Fampridine-SR and MS
A nerve cell has one extension, called an axon, which it uses to communicate via electrical signals to other nerve cells. All but the smallest axons have a special covering of a fatty substance called myelin that acts as insulation to preserve and speed these nerve signals, much like the insulating cover of an electrical cord helps preserve the transmission of electricity.
In MS, the myelin becomes damaged and the axon cannot effectively transmit electrical impulses. Specifically, the damaged myelin exposes channels in the membrane of the axon, which allow potassium ions to leak from the axon, dissipating the electrical current. In published studies, fampridine has been shown to block these exposed channels and help the electrical signals to pass through areas of damage.
Loss of Mobility Found to Impact Quality of Life and Emotional and Financial Health of Most People Living with Multiple Sclerosis
Two new complementary surveys provide groundbreaking data on the impact of walking impairment on people living with multiple sclerosis, revealing challenges related to quality of life, family relationships, independence, work, financial security and other areas.
"Among the many important conclusions we can draw from these studies is that they indicate we must educate more people with MS and care partners about the impact of mobility loss and the options now available to address mobility challenges," said Dr. Nicholas LaRocca, vice president, health care delivery and policy research, National MS Society."Many people do not realize the extent to which symptoms such as fatigue can affect people living with MS. Physical fatigue is a very common symptom of MS that can also affect mobility and balance. This study clearly demonstrates that it is essential to assess the impact of multiple symptoms in MS in order to develop effective educational programs and treatment strategies," observed Dr. LaRocca.
"These surveys provide important new insights about how walking disability affects the quality of life of people with MS, their families and other care partners. Examining walking disability from different perspectives can help provide a better understanding of its prevalence and impact. These findings, coupled with previous research on aspects of walking impairment such as the use of assistive devices, highlight the need to continue to develop new treatment options," said Andrew Blight, Ph.D., chief scientific officer of Acorda Therapeutics."As someone who has lived with MS for over two decades now, I see that people with MS are living fuller and more active lives than ever before, but we clearly have a long way to go. For me, MS and especially mobility issues have had a direct impact on my ability to work and the cost of my care. These surveys shed new light on the challenges that thousands of us with MS are experiencing every day," said Mimi Mosher, a patient advocate from Mechanicsville, VA, and a person living with MS who uses both a scooter and a wheelchair.
Finally, check out the non-branded outreach program which Acorda initiated this spring to coincide with the many MS Walks around the country.
I write because I can. I research because I must. I share for me and you. I hope for a cure as much as others do. I expect some MSers will derive benefit from Fampridine-SR and others will not. I know that I will not be able to afford it, even with the insurance I have now. I sincerely hope that it might give folks like Diane in Seattle a new level of functioning. But the more this drug is hyped, the less faith I have that it...well, I simply become less enthusiastic. Just my personal opinion.
So there it is folks. These five posts regarding 4-AP, Fampridine and Acorda Therapeutics are all I've got. I trust that you've found them informative.



