Multiple sclerosis (MS) is a progressive, degenerative disorder of the central nervous system (CNS), including the brain, the optic nerve, and the spinal cord. It is characterized by may areas of inflammation and scarring of the myelin sheaths in the brain and spinal cord. These are wrappings, composed of a fatty substance, that insulate the nerve fibers throughout the body. Sclerosis means hardening of tissue; multiple simply indicates many regions of tissue hardening. It seems that the body's immune system malfunctions and produces antibodies that attack the myelin sheaths. Consequently, the sheaths are damaged, and the damaged areas develop scarring that leads to either distorted communication or lack of communication between the nerve endings. This may produce a multiplicity of symptoms, from slurred speech to vision problems to loss of mobility.
At least 380,000-400,000 people in the United States have multiple sclerosis.
The underlying cause of MS is not known, but it is widely believed to be an autoimmune disease in which white blood cells attack the myelin sheaths as if they were a foreign substance. Stress and malnutrition, whether from poor absorption or poor diet, often precede the onset of the disease. Some experts suspect that an as yet unidentified virus may be involved. Heredity may also be a factor. Another theory is that this condition may be caused by food intolerances or allergies, especially allergies to dairy products and gluten.
Chemical poisoning of the nervous system by pesticides, industrial chemicals, and heavy metals may also play a part in the development of MS. Environmental toxins can cause disturbances in the body's normal metabolic pathways that result in damage to the nerves' protective myelin sheaths. Even substances that are not necessarily toxic to everyone can be a problem for susceptible individuals. Toxins such as those produced by bacteria and fungi in the body have been known to produce symptoms like those of MS.
Many experts suspect that mercury poisoning is behind many cases of MS. Mercury has been shown to bind to the DNA of cells and cell membranes, causing cellular distortion and inhibited cell function. The installation of mercury amalgam dental fillings (the chief source of mercury exposure for most people in the United States) has been known to produce symptoms indistinguishable from those of multiple sclerosis in some people. Further, the levels of mercury in people with MS have been found to be an average of 7 times higher than those in healthy people.
Finally, diet may play a role in the development of MS. This is suggested by the fact that MS is fairly common in the United States and Europe and almost unheard of in some other countries, such as Japan, Korea, and China. The consumption of saturated fats, cholesterol, and alcohol, so common in the Western countries, leads to the production of a hormone-like substance called prostaglandin 2 (PG2), which promotes the inflammatory response and worsens symptoms of MS. People in Asian countries typically consume much less fat than people in North America and northern Europe do. Their diets are also rich in marine foods, seeds, and fruit oils, which are high in essential fatty acids, including omega-3 essential fatty acids, which have an inhibitory effect on the inflammatory response.
MS is usually diagnosed between the ages of 25 and 40. Women are affected nearly twice as often as men are. MS is rarely diagnosed in children and in people over 60 years of age. In the United States, MS occurs much more often in states north of the 37th parallel (an imaginary line stretching approximately from Newport News, Virginia to Santa Cruz, California) than in other parts of the country.
CAUSE OF SYMPTOMS
Demyelination, or deterioration of the protective sheath that surrounds nerve fibers, can occur in any part of the brain or spinal cord. The symptoms that people with MS experience depend on the affected area. Demyelination in the nerves that send messages to the muscles causes problems with movement (motor symptoms), while demyelination along the nerves that carry sensory messages to the brain causes disturbances in sensation.
TYPES OF SYMPTOMS
It is helpful to divide the symptoms into three categories: primary, secondary, and tertiary.
- Primary symptoms are a direct result of the demyelination process. This impairs the transmission of electrical signals to muscles (to allow them to move appropriately) and the organs of the body (allowing them to perform normal functions.) The symptoms include: weakness, tremors, tingling, numbness, loss of balance, vision impairment, paralysis, and bladder or bowel problems. Medication, rehabilitation, and other treatments can help keep many of these symptoms under control.
- Secondary symptoms result from primary symptoms. For example, paralysis (a primary symptom) can lead to bedsores (pressure sores) and bladder or urinary incontinence problems can cause frequent, recurring urinary tract infections. These symptoms can be treated, but the ideal goal is to avoid them by treating the primary symptoms.
- Tertiary symptoms are the social, psychological, and vocational complications associated with the primary and secondary symptoms. Depression, for example, is a common problem among people with MS.
Multiple sclerosis follows a varied and unpredictable course. In many people, the disease starts with a single symptom, followed by months or even years without any progression of symptoms. In others, the symptoms become worse within weeks or months.
It is important to understand that although a wide range of symptoms can occur, a given individual may experience only some of the symptoms and never have others. Some symptoms may occur once, resolve, and never return. Because MS is such an individual disease, it is not helpful to compare yourself with other people who have MS.
Symptoms vary from individual to individual, depending on which portion of portions of the nervous system are most affected. In the earlier stages, the primary symptoms may include:
MOST COMMON MS SYMPTOMS
- Fatigue. This is the most common symptom of MS. It is typically present in the mid afternoon and may consist of increased muscle weakness, mental fatigue, sleepiness, or drowsiness.
- A feeling of tingling and/or numbness, especially in the hands and feet. Many people with MS experience abnormal sensations such as "pins and needles," numbness, itching, burning, stabbing, or tearing pains. Fortunately, most of these symptoms, while aggravating, are not life-threatening or debilitating and can be managed or treated.
- Loss of balance and/or coordination.
- Weakness in one or more limbs.
- Difficulty walking. Gait disturbances are amongst the most common symptoms of MS. Mostly this problem is related to muscle weakness and/or spasticity, but having balance problems or numbness in your feet can also make walking difficult.
- Eye problems such as blurred or double vision. Vision problems are relatively common in people with MS. In fact, one vision problem, optic neuritis, occurs in 55% of people with the condition. Most vision problems do not lead to blindness.
- Episodes of dizziness. Many people with MS complain of feeling "off balance" or lightheaded. Occasionally they may experience the feeling that they or their surroundings are spinning; this is called vertigo. These symptoms are caused by damage in the complex nerve pathways that coordinate vision and other inputs into the brain that are needed to maintain balance.
LESS COMMON SYMPTOMS AND THOSE THAT MAY APPEAR AS THE DISEASE PROGRESSES
- Slurred speech & swallowing problems. People with MS often have swallowing difficulties. In many cases, they are associated with speech problems as well. They are caused by damaged nerves that normally aid in performing these tasks.
- Sudden onset of paralysis.
- Lack of coordination.
- Cognitive difficulties, changes in thinking or perception. Problems with thinking occur in about half of people with MS. For most, this means slowed thinking, decreased concentration, or decreased memory. Approximately 10 percent of people with the disease have severe impairment that significantly impairs their ability to carry out tasks of daily living.
- Extreme fatigue.
- Muscular stiffness.
- Muscle spasms. Muscle spasms are a common and often debilitating symptom of MS. Spasticity usually affects the muscles of the legs and arms, and may interfere with a persons ability to move those muscles freely.
- Tremors. Fairly common in people with MS, tremors can be debilitating and difficult to treat.
- Sensitivity to heat. Heat sensitivity (the appearance or worsening of symptoms when exposed to heat, like a hot shower) occurs in most people with MS.
- Bowel and bladder dysfunction.
Secondary symptoms, which are problems that arise because of the primary symptoms rather than because of the underlying illness itself, may include:
- Bone loss.
- Muscle wasting.
- Sexual dysfunction.
- Urinary tract infections (UTIs).
- Weak respiration or breathing problems.
Many of these secondary conditions occur as a result of decreased mobility if the disease progresses.
The disease typically follows a pattern of periodic flare-ups, called exacerbations, followed by periods in which symptoms diminish or even disappear called remissions. MS is variable in its rate of progression. It can be relatively benign, with only a few minor attacks spread over decades, or it can be rapidly and completely disabling. Most commonly, it progresses slowly, disappearing for periods of time but returning intermittently; often in progressively more severe attacks.
Risk factors These factors may increase your risk of developing multiple sclerosis:
- Heredity. Multiple sclerosis is more common in people of Northern European descent. There also appears to be a genetic component to the condition, although the risk to children of people affected by MS is less than 5 percent over their lifetime. Researchers suspect that the tendency to develop multiple sclerosis is inherited, but the disease manifests only when environmental triggers are present.
- Environmental factors. Environmental factors have some influence on multiple sclerosis. Many viruses and bacteria have been suspected of causing MS, most recently the Epstein-Barr virus, known also for causing infectious mononucleosis. Some studies have suggested that developing infection at a critical period of exposure may lead to conditions conducive to the development of MS a decade or more later.
- Geographical factors. Multiple sclerosis is more common in countries with temperate climates, including Europe, southern Canada, northern United States, and southeastern Australia. The reason is unknown.
DIAGNOSIS & TREATMENT
DIAGNOSIS & HEALTH EXAM
Diagnosing MS is not a simple task, so the illness often goes undiagnosed for some time. Early diagnosis is important, since treatment can slow the disease. There is no single test that is proof-positive for diagnosing multiple sclerosis. Although there are accepted criteria for making a diagnosis, this system is imperfect.
ACCEPTED DIAGNOSTIC CRITERIA
- Onset usually occurs between 20 and 50 years of age.
- Symptoms and signs indicating disease of the brain or spinal cord.
- Evidence of two or more lesions upon examination by MRI scan.
- Objective evidence of disease of the brain or spinal cord on practitioner's examination.
- Two or more episodes lasting at least 24 hours and occurring at least one month apart.
- No other explanation for the symptoms
Health professionals diagnose the disease when damage typical of MS has occurred to more than one area of the brain or spinal cord at more than one point in time. This means that you have had at least two episodes of signs and symptoms that could be caused by MS, such as weakness or clumsiness, vision problems, tingling or numbness, or balance problems that a neurologist can verify. Each episode must have lasted at least 24 hours, and the episodes should have occurred at least 1 month apart.
DISORDERS THAT MIMIC MS
Since diagnosing MS can be a difficult task, a neurologist who specializes in treating MS should evaluate your symptoms. As many as 10 percent of people diagnosed with MS actually have a condition that mimics MS. Examples of other conditions that can be mistaken for MS include:
- Inflammation in the blood vessels.
- Multiple strokes.
- Vitamin Deficiency.
- Brain infection.
- Stress related disorders can sometimes lead to a misdiagnosis of MS.
An accurate diagnosis is based on a person's medical history and a neurological examination using several types of tests to examine the function of the brain and spinal cord. The interviewing skills of the practitioner is important when trying to uncover information and to properly evaluate the signs and symptoms of a malfunctioning brain and/or spinal cord.
In additions to a complete examination and medical history, blood samples may be analyzed in a laboratory to rule out conditions that mimic (imitate) multiple sclerosis. However, MS cannot be detected in the blood. A group of specialized diagnostic procedures are helpful, though not always necessary, to accurately diagnose MS. Neurological tests that can be used to detect the disease include:
- Magnetic Resonance Imaging (MRI): Widespread use of MRI has revolutionized the ability to diagnose multiple sclerosis. It is an imaging technique used to look for signs of plaques or lesions, which are disease-related changes in the brain or spinal cord. More than 90 percent of people suspected of having MS have these changes detected by using MRI and is considered the best test to view the changes caused by MS. The MRI produces very clear pictures of the human body without the use of x-rays. It uses a large magnet, radio waves and a computer to produce these images. The precise image produced by MRI gives the neurologist clear evidence of scar tissue in the deep parts of the brain or spinal cord that is characteristic of MS. MRI can often detect damaged areas in the brain or spinal cord that would be missed by other imaging techniques such as a CAT scan. However, abnormal spots on the brain MRI can be caused by other conditions, so before making a diagnosis your neurologist will consider all information including your symptoms and scan results. Similar lesions can be seen in elderly people or people with migraine headaches or high blood pressure. Also, a normal MRI does not absolutely rule out a diagnosis of MS. About 5 percent of patients who are confirmed to have MS on the basis of other criteria, do not have lesions in the brain on MRI, thus a "negative" scan does not completely rule out MS. These people may have lesions in the spinal cord or may have lesions that cannot be detected by MRI. Although they are not widely needed, sometimes someone with MS will get repeat scans to determine how fast the disease is progressing.
The MRI examination poses no risk to the average person if appropriate safety guidelines are followed. Many people who have had heart surgery and people with the following medical devices can be safely examined with MRI:
- Artificial joints.
- Many cardiac valve replacements (check with your health care provider).
- Disconnected medication pumps.
- Vena cava filters.
- Brain shunt tubes for hydrocephalus.
Since the MRI is a flat bed encircled by a magnetic tube, some conditions may make an MRI examination inadvisable. Inform your health care provider if you have any of the following conditions:
- Heart pacemaker.
- Cerebral aneurysm clip (metal clip on a blood vessel in the brain).
- Implanted insulin pump (for treatment of diabetes), narcotics pump (for pain medication), or implanted nerve stimulators ("TENS") for back pain.
- Metal in the eye or eye socket.
- Cochlear (ear) implant for hearing impairment.
- Implanted spine stabilization rods.
- Severe lung disease (such as tracheomalacia or bronchopulmonary dysplasia).
- Gastroesophageal reflux (a common disease that causes heartburn).
- Weigh more than 300 pounds.
- Not able to lie on back for 30 to 60 minutes.
- Claustrophobia (fear of closed or narrow spaces).
Allow two hours for your MRI exam. In most cases, the procedure takes 40 to 80 minutes; during that time, several dozen images may be taken. Personal items such as your watch, wallet (including any credit cards with magnetic strips that can be erased by the magnet) and jewelry should be left at home if possible or removed prior to the MRI scan. Secured lockers are available to store personal possessions. If you use a metal cane, a cane with a metal rod inside it, or a walker for mobilization, these will have to be left outside the MRI room. You may be asked to wear a hospital gown during the MRI scan. As the MRI scan begins, you will hear the equipment making a muffled thumping sound that will last for several minutes. Other than that sound, you should experience no unusual sensations during the scanning. Certain MRI exams require an injection of a contrast material. This helps identify certain anatomic structures on the scan images. Feel free to ask questions and tell the technologist or health care provider if you have any concerns. After the exam, your health care provider will discuss the test results with you. Generally, you can resume your usual activities immediately.
- Lumbar Puncture (Spinal Pap): Your brain and spinal cord are bathed in spinal fluid. A spinal tap, also called a lumbar puncture, is a procedure that removes fluid from your spinal canal. Tests on this fluid may help your health care provider diagnose disorders of the brain and spinal cord, including multiple sclerosis. The fluid, called cerebrospinal fluid (CSF), contains glucose (sugar), proteins, and other substances that are also found in the blood. Analysis of the fluid includes looking at the number and types of white blood cells (infection fighting cells), the level of glucose, the types and levels of various proteins (especially immune system proteins called antibodies or immunoglobulins), and testing for bacteria, fungus, or other abnormal cells. A spinal tap that reveals a large number of immunoglobulins (antibodies) as well as oligoclonal bands (the pattern of immunoglobulins on a more specific test) or certain proteins that are the breakdown products of myelin is suggestive of MS. These findings indicate an abnormal autoimmune response within the brain and spinal cord, meaning that the body is attacking itself. Over 90 percent of people with MS have oligoclonal bands in their CSF. While increased immunoglobulin in the CSF and oligoclonal bands are seen in many other brain and spinal cord conditions, their presence is often useful in helping to establish a diagnosis of MS. However, a "negative" spinal tap does not rule out MS or other diseases. An abnormal autoimmune response in CSF is found in a number of other diseases, so the test is not specific for MS. Conversely, some 5 to 10 percent of people with MS never show these CSF abnormalities. Therefore, analysis of the CSF by itself cannot confirm or rule out a diagnosis of MS. It must be part of the total clinical picture that takes into account other diagnostic procedures such as evoked potentials and magnetic resonance imaging. Performing a spinal tap to examine the cerebrospinal fluid may be helpful in diagnosing MS in some people, but it is no longer considered necessary in all instances. Experienced specialists will be able to determine if you need this test to confirm a suspected diagnosis of MS, particularly if your history and examination suggest the presence of the disease. Abnormalities that may appear in the cerebrospinal fluid can be very helpful in establishing a diagnosis but, like other tests, spinal taps are not foolproof in diagnosing MS.
No preparation is needed unless your health care provider gives you special instructions. Discuss with your health care provider about stopping the use of alcohol, aspirin products, and anticoagulants prior to the test. If you are allergic to latex or any medications, tell your health care provider. You will be asked to lie on your side with your knees drawn as close to the chest as possible or to sit with your arms and head resting on a table. Your skin around your spine will be cleansed and covered. You will be given a local anesthetic to numb the area. A long, thin hollow needle is then inserted in your low back between two bones in the lower spine and into the space where the CSF is. The spinal canal is penetrated and fluid is collected. One to two tablespoonfuls of fluid are withdrawn. The spinal cord is never touched. After the fluid is collected and the needle is removed, you will be asked to lie on your back or stomach for a few hours. Your blood will be drawn and sent to the lab with the spinal fluid. You may feel some pain or discomfort involved with this procedure if the needle brushes against nervous system tissue. Fortunately the procedure does not take very long to perform.
After the test your health care provider may recommend that you lie down for several hours to prevent a spinal headache. If you develop a headache, lie down as much as possible and drink plenty of fluids. Avoid strenuous or vigorous exercise for a day or so following the spinal tap. The test is safe; however, as with most tests, there are risks. These include:
- Headache. Approximately 10 percent of people develop a spinal headache (one that worsens when sitting or standing).
- Infection. The risk of infection is extremely low.
- Bloody tap. Occasionally a small blood vessel is pierced during the procedure, causing a "bloody tap." No treatment is needed.
Warning: Call your health care provider immediately if you notice any unusual drainage, including bloody discharge, pain symptoms worsen.
Evoked potentials are electrical tests used to help determine if MS has affected a person's nerve pathways. Evoked potential tests measure electrical activity in certain areas of the brain in response to stimulation of certain groups of nerves. These tests are often used to assist in the diagnosis of MS because they can indicate problems along the pathways of certain nerves that are too subtle to be noticed or found on a health care provider's exam. Problems along the nerve pathways are a direct result of the disease. The demyelination causes the nerve impulses to be slowed, garbled, or halted altogether. These tests are very helpful in confirming whether MS has affected the visual, auditory, or sensory pathways. These tests are done by placing wires on the scalp to test the brain's response to certain types of stimulation, such as watching a pattern on a video screen, hearing a series of clicks, or receiving electrical impulses in your arm or leg. There are three main types of evoked potential tests:
- Visual Evoked Potential (VEP) Test: You sit in front of a screen on which an alternating checkerboard pattern is displayed. This is done to assess the connection between the retina and the visual area of the brain.
- Brainstem Audio Evoked Potential (BAEP) Test: You hear a series of clicks in each ear. Which may help to detect lesions in the brain.
- Sensory Evoked Potentials (SEP) Test: Short electrical impulses are administered to an arm or leg and Motor Evoked Potential (MEP) Electrodiagnostic Tests may be used to detect lesions along motor pathways (those that produce movement) of the central nervous system and to measure the rate at which nerve impulses travel (this may be slower than normal in people with MS). The MEP test is not commonly used to diagnose MS.
While evoked potentials are used to help diagnose MS, other conditions can also produce abnormal test results, so the tests are not specific for MS. To accurately diagnose MS, the information the tests provide needs to be considered along with other laboratory and clinical information.
Evoked potentials are recorded by placing wires with stimulators on the scalp over the areas of the brain. It usually takes about two hours to do all three types of evoked potentials. A neurologist or neurophysiologist with special training in these tests will interpret the results. Evoked potential testing is harmless and painless.
The diagnosis of multiple sclerosis can be a lengthy process. Upon hearing the diagnosis, a patient may feel a mixture of emotions, including denial, fear, relief, optimism, or hope. For some people, a diagnosis after months or years of symptoms is a relief, but for others it may be shocking. Even when a diagnosis of MS is made, the uncertainty is not over. The patient have some concerns about the unknown elements of the disease, its course and its impact. This is completely understandable since the course of MS is unpredictable and not knowing how the disease will affect an individual over the long term is probably the most difficult factor a patient has to deal with. Sharing thoughts and emotions with others can help a person with MS to cope with the diagnosis. Keep in mind that MS affects everyone differently so what one person with MS experiences may not be what you or someone else will experience.
There is no known cure for multiple sclerosis at this time, but treatment can relieve worsening of symptoms.
CLINICALLY ISOLATED SYNDROME
A "clinically isolated syndrome" or CIS is thought of as the "first attack" of multiple sclerosis. It is a single clinical event that points to demyelination (the loss of the protective substance in the brain or spinal cord that insulates nerve endings). An example of CIS is an attack of optic neuritis in one eye, or an episode of numbness on one side, would count as a clinically isolated syndrome.
A CIS is usually unaccompanied by any other clinical sign or symptom. You may imagine many other possible explanations for your numb right arm or vision problems with a CIS occurrence. But if your health care provider rules out other syndromes and also finds certain abnormalities in your brain MRI, a CIS should spur you to talk to your health care provider about treatment with an MS drug.
MS PROGRESSION, REMISSION & RELAPSE
The course of multiple sclerosis varies for each person. Because of this uncertainty, health care providers often tell their patients that they "probably" or "possibly" have MS. Your diagnosis is based on the combination of problems, patterns of recurrence, which systems are impaired and your test results. There is no way to predict how each person's condition will progress. It often takes years before a health care provider can be certain of an MS diagnosis and have some idea on how the disease will progress.
There are four courses that MS takes:
- Relapsing-Remitting MS: Characterized by unpredictable acute attacks, called "exacerbations," with worsening of symptoms followed by full, partial or no recovery of some function. These attacks appear to evolve over several days to weeks. Recovery from an attack takes weeks sometimes months. The disease does not worsen in the periods between the attacks. This pattern usually occurs early in the course of MS in most people.
- Primary-Progressive MS: Characterized by a gradual but steady progression of disability, without any obvious relapses and remissions. This form of disease occurs in just 15 percent of all people with MS, but it is the most common type of MS in people who develop the disease after the age of 40.
- Secondary-Progressive MS: Initially begins with a relapsing-remitting course, but later evolves into progressive disease. The progressive part of the disease may begin shortly after the onset of MS, or it may occur years or decades later.
- Progressive-Relapsing MS: This is the least common form of the disease and is characterized by a steady progression in disability with acute attacks that may or may not be followed by some recovery. People with progressive relapsing MS initially appear to have primary progressive MS.
Most people with MS are diagnosed between the ages of 20 and 40, but the unpredictable physical and emotional effects of the disease continue throughout the person's life.
TRUE EXACERBATION (RELAPSE)
A true exacerbation of MS is caused by an area of inflammation (swelling) in the nerves of the brain and spinal cord system followed by something called demyelination, which is the destruction of myelin. The myelin is the fatty sheath that surrounds and protects the nerve fibers.
Demyelination results in the formation of an abnormal area called a plaque within the brain and/or spinal cord. A plaque causes the nerve impulses to be slowed, distorted, or halted, producing the symptoms of MS. One example of an exacerbation of MS would be the development of optic neuritis, an inflammation of the optic nerve (which is in the back of the eye) that impairs vision.
An exacerbation of MS may be mild and not cause a noticeable impairment in functioning or may significantly interfere with a person's daily life. Exacerbations usually last from several days to several weeks, although they may extend into months.
Exacerbations or relapses of MS are often treated with medications called corticosteroids. These drugs reduce inflammation. It is generally accepted that taking corticosteroids for a short amount of time will shorten an exacerbation and/or reduce the severity.
Sometimes an increase in symptoms has nothing to do with the underlying MS, but is caused by factors such as fever, infection or hot weather that can temporarily aggravate MS. This is referred to as a pseudo-exacerbation. For example, some people report a worsening of their symptoms during or after periods of intense stress.
A remission does not mean that all the symptoms of MS disappear, but rather that a person with MS mostly returns to the way they were before the last exacerbation or relapse began.
MULTIPLE SCLEROSIS PAIN DESCRIPTION & TREATMENT
Most people associate multiple sclerosis with symptoms of weakness and motor problems, but not pain. Even as recently as 10 to 20 years ago, there was a saying that MS causes all kinds of trouble but does not cause pain. But in a national survey of more than 7,000 MS patients, 70 percent of them had experienced some kind of pain, and at least 50 percent were experiencing some kind of pain at the time of the survey.
The National Multiple Sclerosis Society reports that almost half of all people with MS are troubled by chronic pain. MS pain differs from the kind of pain you might get with a headache, a joint injury, or muscle strain. The pain is often more diffuse, affecting several areas of the body at a time. It often changes over time, getting worse or better for no apparent reason. It tends to fluctuate and MS sufferers often find the pain hard to describe. It is sometimes described as like a toothache, other times like a burning pain, and sometimes as a very intense sensation of pressure. It is very distressing for people with MS because they have a hard time explaining their pain experience.
The cause of this complex, baffling and often debilitating pain as an illusion created by the nervous system. Under normal conditions, the nervous system sends pain signals as a warning phenomenon when something harmful happens to the body. It is a natural defense mechanism telling us to avoid whatever is causing the pain. However, when a person has MS, the nerves are too active and they send pain signals without a good reason, meaning that they are sending a pain message when they should not be.
TYPES OF PAIN EXPERIENCED
Some of the most common types of pain experienced by multiple sclerosis patients include:
- Acute MS pain. These come on suddenly and may go away suddenly. They are often intense but can be brief in duration. The description of these acute pain syndromes are sometimes referred to as burning, tingling, shooting, or stabbing.
- Trigeminal neuralgia or "tic doloureux." A stabbing pain in the face that can be brought on by almost any facial movement, such as chewing, yawning, sneezing, or washing your face. People with MS typically confuse it with dental pain. Most people can get sudden attacks of pain that can be triggered by touch, chewing, or even brushing the teeth.
- Lhermitte's sign. A brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward.
- Burning, aching, or "girdling" around the body. This is called dysesthesia by health care practitioners.
- There are also some types of pain related to MS that are described as being chronic in nature. These types of pain last for more than a month and include pain from spasticity that can lead to muscle cramps, tight and aching joints, and back or musculoskeletal pain. These chronic pain syndromes can often be relieved by anti-inflammatory drugs, massage, and physical therapy.
For the most part, however, acute MS pain can not be effectively treated with aspirin, ibuprofen, or other common OTC pain reliever medications or treatments. Because most MS pain originates in the central nervous system, it makes it a lot more difficult to control than joint or muscle pain. Often the treatment of choice is one of a range of anticonvulsant medications, such as Neurontin and Tegretol. Health care providers are not quite sure how they work - either for pain or for seizures. The FDA has not officially approved these anticonvulsants for the treatment of pain so practitioners are using them "off-label". As an example, Neurontin is prescribed five times more often for pain than for seizures. According to practitioners, in the vast majority of patients, these medications do work. However, there is a problem in that most of them can make people sleepy, groggy, or fatigued, and MS patients already have a lot of fatigue.
Most pain in MS can be treated. There are more than half a dozen of these anticonvulsants, and they all have a slightly different mechanism of action and different side effects. The side effects of these drugs can also include low blood pressure, possible seizures, and dry mouth. They can also cause some weight gain. Some drugs are so similar to each other that if one drug in the class fails, another is unlikely to work. That is not the case with these drugs. The drug chosen for patient to use depends on the side effects associated with it. Finding the right anticonvulsant is all about trial and error. A patient is started at the lowest possible dose of one medication and increase it until the person feels comfortable or until side effects are not tolerable. If one medication does not work, a practitioner will try another. It is a process that can take a long time, but it is the only way practitioners can find the right drug for the patient.
TREATMENT & PAIN RESEARCH
Unfortunately, some patients still have not found the right drug and the right dosage to control their pain. It is estimated that about 1 to 2 percent of patients have extremely refractory pain that's very hard to manage and MS experts are still looking for options for treating these individuals.
One possibility being considered is Botox. The anti-wrinkle injections popular with Park Avenue socialites have shown promise in helping to control some types of MS pain. Botox, which acts locally to temporarily paralyze a nerve or muscle, has been used for years at some multiple sclerosis clinics to manage spasticity and bladder problems. These clinics found that it also seemed to have an effect on pain. It is far from being a known treatment for pain in MS at this point, but it is being considered. Three medical centers will soon be starting a small study involving about 40 patients with MS to assess whether Botox can indeed relieve the stabbing pain of trigeminal neuralgia. There are no systemic side effects with Botox, only mild local facial weakness. The biggest drawback is that a practitioner can only inject it in a limited area, so even if they do find that it is effective against MS pain, Botox will certainly not replace any of the medications practitioners currently have. But it may be used in very specific conditions like trigeminal neuralgia.
Another study has recently begun looking at a very different approach to MS pain: hypnosis. It is well known that there is a 'gating' mechanism in the higher cognitive parts of the brain to let signals come through to the consciousness. There can be all kinds of things that can happen in the pain fibers in the spinal cord, but it has to get through to the brain cortex before it is felt as pain. With hypnosis, practitioners hope to block or at least reduce the interpretation of that stimulus as a painful stimulus. It looks promising so far, and obviously it does not have the problem of medication side effects.
MAKING DECISIONS ABOUT MS MEDICATIONS & DRUG THERAPY
Medications cannot cure MS at this time. They do not stop disease activity or progression, and they do not reverse nervous system damage that has already occurred. However, medications may reduce relapses and delay disability in many people with relapsing forms of MS. Studies have shown that:
- For people with relapsing-remitting MS, interferon beta (Avonex, Rebif, or Betaseron) can reduce the severity of relapses, and decrease their frequency by about one-third. They may also delay disability in some people, and decrease the occurrence of new areas of damage (lesions).
- Glatiramer acetate (Copaxone) can make relapses less severe. It can also decrease their frequency by about one-third, like the interferon beta drugs. But less is known about the effect on MS lesions or on the development of disability. Doctors often use glatiramer acetate in milder cases of MS.
- Mitoxantrone (Novantrone) can also slow disease progression and decrease relapse rates in people with relapsing-remitting and secondary progressive MS, but with a greater chance of side effects.
- Natalizumab (Tysabri) can decrease relapse rates in people with relapsing-remitting MS. It can also decrease the chance that a person with MS will be permanently disabled. Natalizumab (Tysabri) is typically used when other medicines for MS do not work or if the side effects of another medicine for MS are severe. This is because it may cause a serious and life-threatening disease called PML. Natalizumab is tightly controlled because of this possible side effect.
Early treatment, beginning as soon as relapsing MS is diagnosed, seems to be most effective and is recommended by the National Multiple Sclerosis Society. The National MS Society also says that treatment with medicine may be considered after the first attack in some people who are at a high risk for MS (before MS is definitely diagnosed). The decision about whether to take medications for MS takes into account your personal feelings and the medical facts.
DECIDING WHETHER TO TAKE MEDICATIONS TO TREAT MS
Reasons To Take Disease-Modifying Medications Reasons Not To Take Disease-Modifying Medications Experts recommend treatment as soon as MS is diagnosed, because early treatment may result in fewer and less severe relapses and may delay damage to your central nervous system; waiting may be harmful. Most people will have repeated attacks of symptoms. These treatments are the only ones proven to reduce the frequency and severity of attacks (relapses) and to delay disability. Side effects from the medications frequently stop in many people after 2 to 3 months of treatment. Many people get used to injecting themselves with medication. Insurance may cover most or all of the cost of medication. Even when symptoms are mild, permanent damage may occur. Consider any other reasons you might want to take medications for MS. It's hard to predict who will respond well to medication. A few people may have an initial episode of symptoms and then not have another for months or years. A small number of people have only mild symptoms and do well without medication. Some of the medications can have significant side effects, including flu-like symptoms and depression, that may be debilitating for some people. These medications require you to give yourself a shot one or more times a week. Treatment can cost up to $15,000 a year, and not everyone has insurance that will pay for medication. Medication may become less effective after several years of use. Most medications are not recommended around the time of conception or when you are pregnant or breast-feeding. Consider any other reasons you might not want to take medications for MS.
Medications can help ease MS attacks and possibly slow the disease. Physical therapy and other treatments help control symptoms and improve your quality of life. Your decision about whether to treat multiple sclerosis (MS) with medications-called disease-modifying therapy-will depend largely on your health care provider's recommendations and your own views about the benefits and drawbacks of treatment. Disease-modifying means treatment to delay, change, or interrupt the natural course or progression of a disease. Consider the following when making your decision:
- The National Multiple Sclerosis Society and most neurologists usually recommend starting treatment with either interferon beta or glatiramer acetate when MS is diagnosed. Most experts now agree that permanent damage to the nervous system may occur early on, even while your symptoms are still quite mild. Early treatment may help prevent or delay this damage. The National MS Society also says that treatment with medicine may be considered after the first attack in some people who are at a high risk for MS (before MS is definitely diagnosed).
- Mitoxantrone (Novantrone) is considered when other treatments fail to control symptoms or progression of the disease. Natalizumab (Tysabri) is recommended when other medicines for MS do not work or if the side effects of another medicine for MS are severe.
- MS is unpredictable. Health care providers cannot know with certainty whether you will progress to a more severe form of the disease. A small number of people with MS have only mild disease and do well without treatment, but most get worse over time.
- Interferon beta, glatiramer acetate, or natalizumab can reduce the frequency and severity of attacks of relapsing-remitting MS and may reduce or delay disability. However, doctors cannot predict whether the medications will work for you.
- Disease-modifying medications for MS may have significant side effects. The side effects are different for each medicine. Some may cause flu-like symptoms such as fever, chills, fatigue, and muscle aches. Others may cause allergic reactions to the shot, infections (some can be serious), headaches, tiredness, and joint pain. One medication can even damage your heart (mitoxantrone). Another may cause a serious and life-threatening disease called PML. This medicine (natalizumab) is tightly controlled because of this side effect.
- These medications are expensive; your cost will depend on your insurance coverage. However, some foundations and other organizations pay for MS treatment for those who cannot afford it; financial costs alone should not keep you from considering treatment.
- Not much is known about the safety of using disease-modifying therapy during pregnancy or breast-feeding. If you are pregnant, planning on becoming pregnant soon, or breast-feeding, talk to your health care provider or midwife.
A number of drugs have been shown to slow the progression of MS in some people. These are called the disease modifying drugs. They include:
- Avonex (interferon beta-1a)
- Betaseron (interferon beta-1b)
- Copaxone (glatiramer acetate)
- Novantrone (mitoxantrone)
- Rebif (interferon beta-1a)
- Tysabri (natalizumab)
All of these drugs work by suppressing, or altering, the activity of the body's immune system. Thus, these therapies are based on the theory that MS is, at least in part, a result of an abnormal response of the body's immune system that causes it to attack the myelin surrounding nerves. These medications do not cure MS, but they do reduce the frequency and severity of attacks and the development of new brain lesions. In addition, they slow down the progression of MS, reducing future disability. These drugs can improve the quality of life for many people with MS. Therefore, most health care providers suggest that treatment with one of these drugs be started in most people as soon as a diagnosis of relapsing-remitting MS has been made. The decision concerning whether or when to begin treatment with one of these medications is best made by you and your health care provider. Factors that should be considered include potential side effects, benefits, frequency, method of medication delivery, and your personal concerns, priorities and lifestyle. The most important goal is to find a treatment you can use comfortably and consistently. Each pharmaceutical company offers customer support and may also provide some financial assistance for qualifying individuals without prescription drug coverage.
COMMON DRUGS USED FOR MULTIPLE SCLEROSIS THERAPY
INTERFERON DRUG THERAPY (DISEASE MODIFYING DRUGS)
Interferons are a group of immune system proteins (alpha, beta, and gamma) produced by the body. They act in different ways to control the activity of the immune system. They also have antiviral properties. (Remember that another theory regarding relapses in people who already have MS is that they may be triggered by viruses.) So far, experts have found that interferon beta is effective in treating multiple sclerosis (MS).
There are three forms of interferon beta on the market in the U.S.: Avonex, Betaseron and Rebif. These interferon beta drugs are very similar to the interferon beta naturally produced in the body.
SIDE EFFECTS OF INTERFERON DRUGS
- Flu-like symptoms (fatigue, chills, fever, muscle aches and sweating during initial weeks of treatment. Therefore it's recommended that the injection be taken at bedtime. Taking Tylenol or Advil or Motrin before each injection and during the 24 hours after the injection may help relieve the symptoms.
- Reactions at the site of injection (swelling, redness, discoloration and pain). Contact your health care provider if the injection site becomes hardened. Do not inject into that site.
- Interferon drugs can cause ongoing sadness, anxiety, irritability, guilt, poor concentration, confusion and difficulties sleeping or eating. These symptoms should be reported to a health care professional immediately.
- Women who are pregnant or breastfeeding or trying to become pregnant should not use interferon drugs; birth control measures should be used.
- People with a history of depression should be closely monitored and interferon drugs can worsen depression symptoms.
- These drugs can affect the functioning of the liver. Avonex has been linked to severe liver injury, and liver failure in a few patients taking the drug. Therefore your health care provider will perform regular blood tests to be sure the liver is functioning normally.
- Interferon drugs can affect the blood cells and thyroid gland function as well. Therefore, your health care provider will perform regular blood testing to follow this.
AVONEX (INTERFERON BETA-1A)
Avonex (interferon beta-1a) is used and FDA approved for treatment of relapsing forms of MS, and to treat after an initial episode of inflammation. It is administered by intramuscular (into the muscle) injection weekly. Avonex is shown to reduce exacerbations of MS and reduce the size of brain lesions and delay the time to a second MS exacerbation by treating the initial demyelinating event if seen on MRI (along with symptoms). Demyelination is the destruction of myelin, which is the fatty sheath that surrounds and protects the nerve fibers. It has also been shown to reduce progression of MS disability, if started in the early stages of the disease. Common side effects include mild flu-like symptoms.
Support Program: MS Active Source 1-800-456-2255
REBIF (INTERFERON BETA-1A)
Rebif (interferon beta-1a) is used and FDA approved to treat relapsing forms of MS. The drug has been shown to reduce relapse rate, and reduce the active lesion on MRI and delay the progression of disability. It is also shown to delay the progression of disability if started early in the course of the disease. The drug is given 3 times weekly, subcutaneously (between the fat layer under the skin). Common side effects are mild flu-like symptoms.
Support Program: MS LifeLines 1-877-447-3243
BETASERON (INTERERON BETA-1B)
Betaseron (interferon beta-1b) is used and FDA approved for the treatment of relapsing forms of MS. It has bee shown to reduce the number of MS exacerbations, reduce the severity of exacerbations and extend the time between exacerbations. Additionally, the drug stabilizes the size of brain lesions. The drug is administered as an subcutaneous (between the fat layer under the skin) injection every other day. Common side effects are mild flu-like symptoms.
Support Program: MS Pathways 1-800-788-1467
COPAXONE (GLATIRAMER ACETATE)
Copaxone (glatiramer acetate) is used for the treatment of relapsing-remitting MS. It is administered as a subcutaneous (under the skin) injection daily. Common side effects are possible reaction at the injection site.
Support Program: Shared Solutions 1-800-887-8100
Novantrone (mitoxantrone) is a drug treatment of rapidly worsening relapsing-remitting MS and for progressive-relapsing or secondary-progressive forms of MS. It is administered intravenously (by vein) once every 3 months or 4 times a year. Maximum dose is 8-12 doses. Common side effects include nausea, hair thinning, and decreased white blood cells count.
Support Program: MS LifeLines 1-877-447-3243
MONOCLONAL ANTIBODY THERAPY - TYSABRI MEDICATION
In February 2005, the makers of Tysabri voluntarily withdrew sales of the drug after three patients in the drug's clinical trials developed a serious brain infection called progressive multifocal leukoencephalopathy (PML), which usually leads to death or severe disability. On June 5, 2006, the FDA allowed the drug Tysabri back on the market after there were no additional cases of PML in a clinical trial that was resumed in February 2006 and on re-examination of patients from the previous clinical trials. The drug's return to the market will include a risk-minimization program with mandatory patient registration and periodic follow-up to identify any possible cases of PML as soon as possible.
Tysabri is a new drug used to treat multiple sclerosis (MS). Tysabri is unique among MS drugs in that it works by blocking the effects of white blood cells, which are believed to be harmful to the nervous system (brain, spinal cord, and nerves) and may create the damaging effects of MS. Tysabri, a monoclonal antibody, binds to white blood cells and prevents them from entering the brain and spinal cord. Tysabri is the first monoclonal antibody approved for the treatment of MS.
Tysabri can be prescribed to treat patients who have relapsing forms of MS. The drug reduces the frequency of MS attacks. In a study comparing Tysabri with a placebo (sugar pill), Tysabri reduced the average yearly relapse rate by 66 percent. In addition, patients taking Tysabri had fewer new brain lesions.
Tysabri is given intravenously (through a vein) over the course of an hour every four weeks in a practitioner's office.
The most common side effects of Tysabri therapy are:
- Allergic reactions.
- Gall bladder disorders.
- Joint pain.
- Menstrual problems.
It is important that patients are observed for one hour after each infusion in case an allergic reaction develops. As is the case with all medications, it is important to weigh the risks and benefits carefully. Talk to your health care provider to determine if this treatment is right for you.
IV STEROID THERAPY FOR INFLAMMATION
Medications such as Solu-Medrol and Decadron are potent steroids that ease inflammation and are often used to treat an acute attack of multiple sclerosis. During an acute attack of multiple sclerosis (also called exacerbations or relapses) there is a distinct increase in the severity of symptoms. The onset of the attack may take several days or weeks. New symptoms may appear, or your existing symptoms (such as numbness, tingling, slurred speech, or blurred vision) may flare up or worsen. When attacks occur, you may receive Solu-Medrol or Decadron at a treatment center each day for one to five days, depending on your treatment plan.
Plan to be at the medical center for about one hour on the day(s) of your treatment. You may receive blood tests before the treatment to monitor your complete blood count, sodium, and potassium levels. You will have your blood pressure and pulse checked before and after the treatment. The medication is given by intravenous drip for 30 to 45 minutes or injected directly into a vein. After the treatment, you can return to your normal daily activities, including driving.
Patients generally receive a one- to five-day course of intravenous treatment. Following the intravenous treatments, you will be asked to take an oral form of a steroid called prednisone. You will be given a written schedule of when and how often to take the medication. You may also be given a prescription for a medication to reduce stomach irritation.
SIDE EFFECTS FROM IV STEROID TREATMENT
Not everyone experiences side effects from IV steroid treatment, but the most common are:
- Stomach irritation, such as indigestion and heartburn.
- Increased energy.
- Rapid heartbeat.
- Flushing of the face, neck or chest.
- Feeling warm or cool.
- Retaining fluid (avoid table salt and salty foods).
- Mood changes (euphoria, irritability, nervousness, restlessness) or mood swings.
- Metallic taste in the mouth.
Long-term side effects of steroids may include:
- Bone-thinning osteoporosis.
- Stomach ulcers.
- Weight gain.
Since steroid use can increase your risk of developing osteoporosis, it is beneficial to include more dairy products and/or other calcium-rich foods into your diet while on this therapy. You can also talk with your health care provider about calcium supplements with vitamin D.
Insurance coverage for this treatment varies greatly, depending on individual insurance plans, but it is usually covered.
IMMUNE SUPPRESSORS - CYTOXAN
Cytoxan is a therapy that may be given to people with multiple sclerosis. It works by suppressing the immune system. It's given to people with MS because MS is thought to be the result of an abnormally active and misdirected, immune system. Cytoxan can keep your white blood cells from attacking your central nervous system, thereby slowing MS disease activity. The medication is administered directly into a vein by way of an intravenous (IV) drip. Unfortunately, Cytoxan can produce serious side effects. Your neurologist will discuss the potential benefits and risks with you and your family. If you have any concerns or questions, discuss them with your health care team.
SIDE EFFECTS OF CYTOXAN THERAPY
- Hair thinning and hair loss.
- Low white blood cell count.
To control nausea associated with Cytoxan therapy, your doctor will probably give you either Zofran or Reglan. Side effects may include:
- Diarrhea or constipation.
- Dry mouth.
- Tired feeling.
You will need to go to your treatment center a few days before your treatment begins for pre-treatment testing, including:
Note: You are responsible for getting your blood work according to your health care provider's specifications.
- Blood tests, a urine test (urinalysis), and an electrocardiogram (ECG).
- Having your weight and height measured.
- Learning about pre-treatment medication to control nausea.
- Be sure to wear comfortable, warm clothes when you come for treatments and bring something to pass time, such as a book.
Expect to be at the treatment center for about 3 to 4 hours each day. The nurse will check your blood pressure and pulse before and after treatment. During treatment, you will usually be given a combination of Cytoxan and other medications, which may include Solu-Medrol (an anti-inflammatory that eases inflammation), Zofran (anti-nausea medicine) and/or Reglan (anti-nausea medicine), and intravenous fluid through an IV drip.
Because Cytoxan suppresses your immune system, the body's system for fighting illness, you will be prone to infection after treatment. Because of this, you will need to avoid contact with people who are sick, especially the first 12-14 days after the treatment. Notify your practitioner if you experience extreme weakness, severe nausea, or vomiting.
Insurance coverage varies greatly, depending on individual insurance plans. Cytoxan is usually covered; however, it is best to check with your insurance company before treatment begins. If you have any other questions, please address them with your healthcare team.
IMMUNE SUPPRESSOR DRUGS - IMURAN THERAPY
Imuran is an immune system-suppressing drug. That means that it can theoretically halt the attack of the immune system on your nerves. The drug can be used to slow the progression of MS in people who are not responding well to other treatments. Imuran may also be used with other disease-modifying therapies, such as Avonex, to boost their effect. Imuran is generally taken orally, in the form of tablets. Your white blood cell count and your weight will determine the dose that is prescribed. The starting dose is low and is slowly increased. Imuran is generally taken once or twice a day. It is available in 50 mg tablets, which may be easily broken in half if necessary. Your prescription label tells you how much to take at each dose and how often to take it. Follow these instructions carefully and ask your pharmacist or health care provider to explain any instructions that you do not understand. It is important that you take this medication regularly as prescribed; do not stop taking it and do not take more or less of the medication than is prescribed.
Some mild nausea often occurs when you start taking Imuran. This discomfort is expected and will go away as your body gets used to the medication. If you have extreme nausea with vomiting, contact your health care provider. While you are taking this medication, you may be asked to have regular blood tests (such as blood cell counts and liver function tests) to evaluate the medication's effectiveness and to monitor your response to the medication.
Keep all appointments with your health care provider and the laboratory. Your health care provider may reduce or even stop Imuran when you are being treated for certain infections. This allows your body to effectively fight the infection.
Be sure that you always have enough medication on hand. Check your supply before holidays or other occasions when you may be unable to fill your prescription.
Do not have any vaccinations without your health care provider's approval.
Take precautions to avoid infection while taking this medication. Avoid anyone who may have an infection and report any signs of infection to your health care provider.
SIDE EFFECTS ASSOCIATED WITH IMURAN THERAPY
- Increased stomach irritation.
- Nausea and vomiting.
- Changes in hair color and texture along with hair loss. These changes are usually temporary.
- Loss of appetite.
- Blood in the urine or stool.
- Unusual bruising.
- Development of mouth sores and ulcers.
- Liver damage.
- Increased risk of infection. Because Imuran is an immunosuppressive medication, it can lower the number of white blood cells in your blood, increasing the chance of infection.
It is important to remember that not everyone experiences all of these side effects. This medication is generally well-tolerated. Even though some of the side effects could be very serious, remember that precautions will be taken to detect these side effects and treat them before they become harmful. If you forget to take a dose, take it as soon as you remember and then continue to follow your regular dosing schedule.
- Store this medication at room temperature.
- DO NOT store this medication in direct heat or light.
- DO NOT store this medication in the bathroom, near the kitchen sink or in other damp places. Heat or moisture may cause it to break down.
- Keep this medication in the container it came in, tightly sealed.
- Do not keep outdated medicine.
- Keep this and other medications out of the reach of children.
Call your health care provider right away if you have any of these warning signs of infection:
- Fever over 100°F (38°C).
- Sweats or chills.
- Skin rash.
- Pain, tenderness, redness or swelling.
- Wound or cut that will not heal.
- Red, warm, or draining sore.
- Sore throat, scratchy throat or pain when swallowing.
- Sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones.
- Persistent, dry or moist cough that lasts more than two days.
- White patches in your mouth or on your tongue.
- Nausea, vomiting or diarrhea.
- Flu-like symptoms (chills, aches, headache or fatigue) or generally feeling "lousy."
- Trouble urinating: pain or burning, constant urge, or frequent urination.
- Bloody, cloudy, or foul-smelling urine.
- If you have any other symptoms that cause concern.
MUSCLE RELAXING THERAPY - INTRATHECAL BACLOFEN PUMP THERAPY
Baclofen is a medication commonly used to decrease spasticity related to multiple sclerosis, spinal cord injuries, or other neurological diseases. Spasticity is a muscle problem characterized by tight or stiff muscles that may interfere with voluntary muscle movements. Normally muscles receive electrical signals via nerves to contract and relax. Spasticity is caused by an imbalance of electrical signals coming from the spinal cord through the nerves to the muscle. This imbalance causes the muscle to become hyperactive, resulting in involuntary spasms. Baclofen works by restoring the normal balance and reducing muscle hyperactivity. In this way, it allows for more normal muscle movements.
Baclofen can be taken orally as a pill or delivered directly into an area of the spine called the intrathecal space. The intrathecal space contains the cerebrospinal fluid (the fluid surrounding the spinal cord and nerve roots). Often MS patients receive intrathecal baclofen because oral baclofen causes unpleasant side effects, such as confusion, weakness, and sleepiness. But intrathecal baclofen delivers the drug right to the target site in the spinal cord. Since the medication does not circulate throughout the body, only tiny doses are required to be effective. Therefore, side effects are minimal.
SIDE EFFECTS OF MEDICATION
DESCRIPTION OF THE INTRATHECAL BACLOFEN PUMP SYSTEM
The intrathecal baclofen pump system is the way practitioners give the drug directly into the spinal fluid. The system consists of a catheter (a small, flexible tube) and a pump. The pump is a round metal disc, about one inch thick and three inches in diameter and is surgically placed under the skin of the abdomen near the waistline. The pump stores and releases prescribed amounts of medicine through the catheter. With a programmable pump, a tiny motor moves the medication from the pump reservoir through the catheter. Using an external programmer, your treatment team can make adjustments in the dose, rate, and timing of the medication. People with the pump must return to their health care provider's office for pump refills and medication adjustments, typically every 1-3 months. The pump is taken out and replaced at the end of the battery's life span (which is usually 5 to 7 years).
Anyone who has spasticity that is not responsive to oral treatment is a candidate. If you are considering intrathecal baclofen therapy, you will generally meet with a treatment team that may include a practitioner specialized in rehabilitation (physiatrist), a physical therapist, an occupational therapist, a nurse, and a social worker. All of these professionals work as a team to provide a comprehensive evaluation of your spasticity symptoms and to establish a treatment plan adapted to your personal needs.
- Efficiently reduces spasticity and involuntary spasms, promoting a more active lifestyle, better sleep, and reduced need for oral medications.
- Continuously delivers baclofen in small doses directly to the spinal fluid, increasing the therapeutic benefits and causing fewer and less severe side effects than the oral medication.
- Can be individually adjusted to allow infusion rates that vary over a 24-hour period.
- Can be turned off when it is not needed.
- Reduces or eliminates pain and discomfort from spasms and spasticity.
DISADVANTAGES, COMPLICATIONS & ADVERSE REACTIONS
There are certain risks that must be considered with any surgery. These risks include:
- Bladder control can be altered, causing loss of urine unexpectedly.
- Pump malfunction: If the pump malfunctions, it may deliver too much medicine at once. In that instance, you will develop symptoms such as drowsiness, dizziness, weakness, insomnia (difficulty falling and/or staying asleep), lightheadedness, nausea, constipation, vomiting, loose muscles, trouble with vision, coma, respiratory depression, seizures, dry mouth, double vision, decreased concentration, diarrhea, or delayed responsiveness. Should this occur, go to the nearest Emergency Department immediately. A health care practitioner can give you a drug called physostigmine to counteract baclofen.
- Kinked catheter: If the catheter becomes "kinked," surgery may be necessary to replace the catheter.
If your treatment team recommends the baclofen pump system after your evaluation, you will have a trial of the therapy to test the potential effectiveness of the medication. During the medication trial, baclofen is injected into the spinal canal (using a small needle) and the treatment team assesses its effectiveness over 2-4 hours. If your muscles do not relax during the first trial, a larger dose may be given on a later date to determine its effectiveness. If you experience positive results with the intrathecal medication you can decide with your health care provider and family members if you should have a baclofen pump system implanted during a surgical procedure.
MUSCLE-RELAXING THERAPY - BOTOX
Botulinum toxin, called botox for short, is a muscle-relaxing medication used to decrease spasticity related to multiple sclerosis and other neurological conditions. Botulinum toxin is derived from the bacterium Clostridium Botulinum and is in a class of drugs called neurotoxins. There are two types of botulinum toxin available for therapeutic use:
- Botulinum Toxin Type A (Botox®)
- Botulinum Toxin Type B (Myobloc®)
Your health care provider will decide which type of botulinum toxin is more appropriate for you. The FDA, despite the drug's effectiveness, has not yet approved the use of botox to treat MS-related spasticity.
Spasticity refers to a wide range of involuntary muscle contractions that result in muscle spasms or stiffness. Spasticity interferes with voluntary muscle movement and usually involves the muscles of the legs and/or arms. Spasticity may vary, based on many factors, including infections, stress, pain, temperature, position and time of the day. Over time, severe spasticity may cause decreased range of motion in the affected limbs. Spasticity is the result of an imbalance in the central nervous system, caused by a trauma or disease in the brain and/or spinal cord. This imbalance causes hyperactive muscle stretch reflexes, which result in involuntary contractions and increased muscle tone. Some health care practitioners believe that an increased sensitivity in the parts of the muscles that are responsible for contracting (tightening), relaxing and stretching the muscles contribute to spasticity.
BOTOX FOR TREATING MUSCLE SPASTICITY
Normally, the brain sends electrical messages to the muscles so that they can contract and move. This message is transmitted to the muscle by a substance called acetylcholine. Botulinum toxin works to block the release of acetylcholine; therefore the muscle does not receive the message to contract. Botulinum toxin is given as an intramuscular injection (in the muscle). Your health care provider will determine the muscle(s) in need of treatment. If the muscles to be injected are small or difficult to reach, it may be necessary to send short electric impulses, or to record electric signals from the muscles, to ensure that the appropriate muscles are receiving the injected medication. A very fine needle is used for the injection. Some people report minor and temporary discomfort from the injection. The medication does not sting or cause irritation after it has been injected. You can expect the appointment to last from 1 to 2 hours. The effects of the medication begin to appear from one to two weeks after the injection. The muscles injected should then relax.
ADVANTAGES OF BOTOX
- Improvement of discomfort related to spasticity symptoms.
- In some cases, improved ability to use the affected part of the body.
- The medication is effective for two to six months, depending on the individual.
DISADVANTAGES OF BOTOX
- The benefit of botulinum toxin is limited to the injected muscles. Therefore, botulinum toxin may not be a good choice of treatment when many muscles are involved or when the spastic muscles are large.
- The effect of the injections is temporary. Therefore, injections must be repeated over time to maintain the beneficial effects. Injections are not repeated more often than every 3 months to minimize the risk of developing antibodies to the botulinum toxin (see below).
SIDE EFFECTS OF BOTOX
- Temporary weakness of the injected muscle and weakness in some nearby muscles.
- Brief flu-like symptoms (these may develop one week after the injections and usually only last for about one day).
- There is a slight chance that you may develop antibodies to botulinum toxin. Antibodies to botulinum toxin cause the botulinum toxin to be less effective. If this occurs, switching to the other type of toxin (for example, from type A to type B) may be helpful. To minimize the risk of developing antibodies, specific guidelines are followed to restrict the frequency of injections and the dose of medication that is injected.
A health care provider will perform a complete evaluation to determine if you are eligible to receive botulinum toxin therapy. Insurance coverage varies greatly, depending on individual insurance plans. Check with your insurance company before treatment begins.
CONTACT YOUR HEALTH CARE PROVIDER:
- If you think that the medication is not working (please wait at least 2 weeks after the injection).
- If you are experiencing side effects that you think may be related to botulinum toxin.
- When the effects of the medication wear off.
You will be examined during frequent follow-up appointments to determine if the treatment is working properly. Typically, you will be re-evaluated every 3 to 6 months to determine if it is appropriate to repeat the injections.
For more information about Botox®, please call 1-800-44-BOTOX or visit the website at www.botox.com.
TREMOR TREATMENT SURGERY - DEEP BRAIN STIMULATION (DBS)
Deep brain stimulation (DBS) is a variation of an old surgery that may be used to treat tremors in people with conditions such as multiple sclerosis, Parkinson's disease, and essential tremor. In the 1960s, surgery was used to destroy a small area deep in the brain called the thalamus (thalamotomy) or another part of the brain called the globus pallidus (pallidotomy).
These surgeries are still done today, although less frequently because of the availability of deep brain stimulation. These surgeries carry significant risks: both thalamotomy and pallidotomy require purposeful destruction of the brain. If the surgeon is off by even a fraction of an inch, the surgery may not be effective and severe complications such as paralysis, loss of vision or loss of speech can result.
Deep brain stimulation is a way to inactivate parts of the brain without purposefully destroying the brain. Therefore, the risks are much lower. In deep brain stimulation, an electrode is placed with the tip of the electrode in the thalamus (for tremor and multiple sclerosis) or in the globus pallidus or subthalamic nucleus (for Parkinson's disease).
The electrode for deep brain stimulation is left in the brain. It is connected by a wire to a pacemaker-like device that is implanted under the skin over the chest. The pacemaker-like device generates the electrical shocks.
Deep brain stimulation offers many advantages. The electrical stimulation is adjustable, whereas surgical destruction is not. The electrode has four metal contacts that can be used in many different combinations. Even if one electrode contact is not in the exact location, it is likely that one of the others or some combination of the electrical contacts will be closer to the proper target. As the patient's response to surgery changes over time, the stimulation can be adjusted without requiring a repeat operation.
Another significant advantage of deep brain stimulation relates to future treatments. Destructive surgery, such as thalamotomy or pallidotomy, may reduce the patient's potential to benefit from future therapies. With deep brain stimulation, the stimulator could be turned off if other therapies were to be tried.
The main purpose of deep brain stimulation for people with multiple sclerosis is to control the tremor related to the disease. In the case of multiple sclerosis, other problems such as loss of vision, sensation, or strength are not helped by deep brain stimulation. However, electrical stimulation does not cure multiple sclerosis nor does it prevent the disease from getting worse; it helps to relieve the symptom of tremor related to MS.
Deep brain stimulation is not experimental. The FDA has approved DBS to treat Parkinson's disease, essential tremor and dystonia. Dystonia is a type of movement disorder characterized by abnormal postures and twisting motions. The FDA has not specifically approved deep brain stimulation of the thalamus to treat multiple sclerosis. However, this does not mean that the treatment is experimental or that it would not be covered by insurance. There are many examples of treatments that are used every day and are standard and accepted but that have not been approved by the FDA.
There are many important issues to be addressed when considering deep brain stimulation. These issues should be discussed with a movement disorders expert or a specially trained neurologist. Before considering surgery, you should have tried medication first. Surgery should not be undertaken if medications are able to control your symptoms. However, surgery should be considered if you do not achieve satisfactory control through medications. If you are unsure if DBS is right for you, consult a movement disorders expert or a neurologist who has experience with movement disorders.
The surgery should be performed in a center where there is a team of experts to care for you. This means neurologists and neurosurgeons who have experience and specialized training in doing these types of surgeries.
Another thing to consider when deciding where to go for the surgery is to find out how the target (that is the thalamus) is localized. Different centers may perform the surgeries in different ways. It is clear that the chances of benefit and the risks of complications are directly related to how close the electrode is to the correct target.
LIVING WITH MULTIPLE SCLEROSIS
When you have a brief illness like bronchitis or the flu, you know you will be feeling better and functioning normally within a week or so. A chronic illness, like multiple sclerosis, is different. It may never go away and can disrupt your lifestyle in many ways. But, by keeping a positive attitude, you should be better able to cope with the changes.
MS should not define who you are. You are the same person you were before you were diagnosed. However, you just have a heavier load to bear. The best thing you can do is to learn how to make your life better. Here are some tips:
- Get help if you need it. The most important step you can take is to seek help as soon as you feel less able to cope. Taking action early will enable you to understand and deal with the many effects of MS. Learning to manage stress will help you maintain a positive physical, emotional, and spiritual outlook on life. A mental health care provider can design a treatment plan to meet your specific needs. Strategies can be designed to help you regain a sense of control over your life and improve your quality of life. At times, if depression is present, medications may be ordered to help lift your mood.
- Find a support group. Support groups can be a very useful sharing experience. They provide an environment where you can learn new ways of dealing with your illness. You may want to share approaches you have discovered with others. You will also gain strength in knowing that you are not facing hardships alone.
- Consider counseling. Sometimes people have problems that are better addressed in a one-on-one atmosphere. By participating in individual counseling, you may be able to more effectively express sensitive or private feelings you have about your illness and its impact on your life and relationships.
- Take care of yourself. Eat healthy, exercise, learn techniques to help you deal with stress better, and get enough rest.
- Keep a diary. Write down your experiences, symptoms, and feelings. Not only will this be a valuable tool for your doctor, but it will also help you learn to express yourself.
- Take control. There is often such a sense of uncertainty with MS that it may help to take control of the things in your life that you can control. You should also consider some of your life-planning issues, such as finances, work, adapting your home, and other practical issues. Be proactive in your health, get educated, and ask questions.
- Get enough rest. Fatigue is a common symptom of multiple sclerosis, and getting your rest may make you feel less tired.
- Exercise. Regular aerobic exercise may offer some benefits if you have mild to moderate MS. Benefits include improved strength, muscle tone, balance and coordination, and help with depression. Swimming is a good option for people with MS who are bothered by heat.
- Be careful with heat. Extreme heat may cause extreme muscle weakness. Although some people with multiple sclerosis are not bothered by heat and may enjoy warm baths and showers, be very careful before exposing yourself to extreme heat until you know how you will react. Do not get into a hot tub or sauna unless there is someone nearby who can pull you out if necessary. If you do experience heat-related worsening of signs or symptoms, cooling down for a few hours usually will return you to your normal state.
- Cool down. Many people with multiple sclerosis experience heat-related worsening of MS symptoms. If you live in a hot and humid area and these conditions worsen your MS, try to stay in cool and dry areas as much as possible. consider having air conditioning in your home. A home air conditioner may be tax-deductible for some people with MS. Discuss it with your health care provider. Since tepid heat or high humidity can make many people with MS experience a temporary worsening of their symptoms. cool baths also may provide some relief. Health care providers believe that this occurs because heat causes nerves (whose myelin covering has been destroyed from MS) to conduct electrical signals even less efficiently. It is important to remember that while climate may worsen the symptoms of MS, climate changes do not produce more actual nerve damage. The adverse effects of temperature and humidity are generally temporary.
- Avoid extreme cold. For reasons that are not well understood, extremely cold temperatures and changes in temperature can also cause MS symptoms, usually spasticity, to flare.
- Eat a well-balanced diet. Eating a healthy, well-balanced diet can help keep your immune system strong. See Nutrition further down on this page for dietary and supplemental suggestions.
MS SPEECH & SWALLOWING DIFFICULTIES
People with MS often have swallowing difficulties. In many cases, they are associated with speech problems as well. Like other symptoms of MS, if you are experiencing swallowing or speech difficulties, it is because you have an area of damaged nerves that normally aid in performing these tasks. Locating the damaged areas responsible for the speech problem is often difficult. Many areas in the brain, especially the brainstem, control speech patterns. These damaged areas (lesions) in different parts of the brain can cause several types of changes in normal speech patterns. They range from mild difficulties to severe problems that make it difficult to speak and be understood. Symptoms of swallowing problems include:
- Coughing or choking when eating.
- Feeling like food is lodged in the throat.
- Unexplained recurrent lung infections (pneumonia).
- Otherwise unexplained malnutrition or dehydration.
When swallowing difficulties are present, food or liquids that you eat may be inhaled into the trachea (windpipe) instead of going down the esophagus and into the stomach. Once in the lungs, the inhaled food or liquids can cause pneumonia or abscesses. Because the food or drink is not reaching the stomach, a person may also be at risk for malnutrition or dehydration.
Initially, your health care provider will ask you many questions about the nature of your problem and perform a physical exam, paying attention to the function of your tongue and swallowing muscles. Occasionally, your health care provider may recommend that you get a test called a modified barium swallow. This is a special imaging procedure where you drink or eat contrast material of different consistencies (solid, thick liquid, and thin liquids) after which a machine takes pictures tracing the path of the contrast material. Thus the precise location and manner of the swallowing problem can be identified.
A speech therapist (or speech and language pathologist) usually treats swallowing problems. Treatment typically consists of changes in diet, positioning of the head, exercises, or stimulation designed to improve swallowing. In very severe cases that do not respond to these measures, feeding tubes may be inserted directly into the stomach to provide the necessary fluids and nutrition. Some tips that may make swallowing easier:
- Sit upright at a 90-degree angle, tilt your head slightly forward, and/or remain sitting or standing upright for 45 to 60 minutes after eating a meal.
- Minimize distractions in the area where you eat. Stay focused on the tasks of eating and drinking. Do not talk with food in your mouth.
- Eat slowly. Cut your food into small pieces and chew it thoroughly. Do not try to eat more than 1/2 teaspoon of your food at a time.
- You may need to swallow two or three times per bite or sip. If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before taking a breath. Repeat if necessary.
- Concentrate on swallowing frequently. It may help to alternate a bite of food with a sip of liquid. If you have difficulty sucking liquid all the way up a straw, cut the straw down so that there is less distance for the liquid to travel.
- Change the temperature and texture of liquids (make the liquids colder, try carbonated beverages).
- Drink plenty of fluids. Periodically suck on Popsicles, ice chips, lemon ice, or lemon-flavored water to increase saliva, which will increase swallowing frequency.
- If chewing is difficult or tiring, minimize (or eliminate) foods that require chewing, and eat more soft foods. Puree your foods in a blender.
- If thin liquids cause you to cough, use a liquid thickener. You can also substitute thin liquids with thicker liquid choices such as nectars for juices and cream soups for plain broths.
- When taking medication or dietary supplements, crush your pills or open capsules and mix them with applesauce or pudding. Ask your pharmacist for recommendations on which pills should not be crushed and which medications or supplements can be purchased in a liquid form.
One pattern of speech that is commonly associated with MS is called "scanning" speech. This type of speech produces speech in which the normal "melody" or speech pattern is disrupted, with abnormally long pauses between words or individual syllables of words. People with MS may also slur words. This is usually the result of weak tongue, lip, and mouth muscles. Other speech problems include explosive dysarthrias, or nasal speech, which sounds as though the person has a cold or nasal obstruction. A speech/language pathologist or speech/language therapist help people with MS improve speech patterns, enunciation, and oral communication in general. If a person with MS becomes unable to speak, there are many assistive devices available. These range from alphabet cards to hand-held communicators that print out a tape to computers that respond to eye blinks.
CONTROLLING YOUR SLEEP DISORDERS
Sleep problems, or disorders, are conditions that prevent a person from getting restful sleep and as a result, cause daytime sleepiness. There are about 80 different types of sleep disorders and about 70 million Americans suffer from them. The inability to fall asleep or to stay asleep, called insomnia, is the most common sleep disorder. Many people with multiple sclerosis complain of insomnia or broken sleep patterns, yet sleep problems are not a result of the disease itself. They occur because of secondary factors such as stress, spasticity, inactivity, or depression that people with MS often have. People with MS often have trouble staying asleep because of spasticity, especially in the legs, and an increased need to go to the bathroom at night. Talk to your health care provider about what is keeping you up at night. There may be medications he or she can prescribe to improve the problem.
One of the most important ways to ensure a good night's sleep is to create a consistent bedtime routine. Here are some tips to get you sleeping soundly:
- Relax in the evening before going to bed. Try to not rehash the day's problems or worry about tomorrow's schedule. Consider using relaxing techniques, such as meditation and/or breathing exercises to help you de-stress.
- Go to bed when you are tired. Try to be consistent about the time you go to bed.
- Prepare yourself for bed by wearing comfortable nightclothes, adjust your bed pillows in a comfortable position, turn off the lights, adjust the temperature in your bedroom, and position yourself comfortably in your bed. If you do not fall asleep after 10-15 minutes - get up! Do not lie in bed and watch the clock or count the cracks in the wall. Find something to do that is relaxing to you, such as putting together a puzzle, reading, or writing a letter to a friend. Rather than watching TV, which is a passive activity, do something active so that natural tiredness can build up. Remember your bed is only for sleeping. Any of the above activities should be done out of bed. Return to the bed only when you feel tired.
- Do not nap during the day.
- Do not consume caffeine within 4-6 hours of bedtime.
- Do not smoke or use nicotine products close to bedtime or during the night.
- Do not drink alcoholic beverages within 4-6 hours of bedtime.
- If running to the bathroom is keeping you up at night, reduce fluid intake in the evening. It is still important to drink the recommended amount of fluids during the day. Also go to the bathroom immediately before you go to bed.
- Do not go to bed hungry or soon after a heavy meal. If you are hungry, eat a light snack or drink a glass of warm milk or a cup of warm, relaxing herbal tea, such as chamomile tea.
- Exercise regularly, preferably during the day. Avoid vigorous exercise 3 hours before bedtime.
- Set your alarm to wake up at the same time every day, even on days when you are off work and on the weekends.
If these suggestions do not help or if sleep disturbances are interfering with your daily activities, talk to your health care provider who can help you determine what is causing your sleep problems. Your health care provider can also refer you to a sleep specialist, if necessary.
MS-RELATED BLADDER CONTROL PROBLEMS
Bladder control problems occur in at least 80 percent of people with MS. Because MS interrupts or slows the transmission of signals to and from the brain, the electrical impulses to the muscles that are involved in emptying the bladder can become disrupted. These problems can seem overwhelming, and often embarrassing. But, there are steps you can take to manage bladder control problems.
MOST COMMON TYPES OF BLADDER CONTROL PROBLEMS
Urinary Urgency. People with this problem feel the need to urinate frequently and urgently. The small "tickle" and feeling of pressure that help us recognize the right time to head to the restroom is very intense. When urinary urgency takes place, the signals that coordinate urination are disrupted and you experience this uncontrollable urge to urinate which can cause incontinence.
Incontinence. This is the loss of bladder control. Sometimes MS will disrupt the nerve signals sent to the body parts that control urine movement allowing urine to be expelled involuntarily.
Nocturia. People with nocturia must awake frequently during the night to go to the bathroom. There are a number of causes for this type of incontinence, but persons with MS may experience nocturia due to the interruption of brain impulses that travel up and down the spine to coordinate urination.
Urinary Hesitancy. This refers to difficulty initiating urination. With multiple sclerosis, this problem may be caused by interruption of brain impulses that control that part of the urination process.
UNTREATED BLADDER CONTROL CONCERNS
If left untreated, bladder control problems can cause other health concerns, including:
- Repeated urinary and bladder infections or kidney damage.
- Personal hygiene problems.
- Interfering with normal activity and leading to isolation.
URINARY CONTROL TREATMENTS
Treatment of urinary control problems is individualized. Many times a health care provider who specializes in treating incontinence, called a urologist, will be involved in your care. Your health care provider may recommend one or more of the following:
- Dietary changes to minimize incontinence.
- Behavioral changes.
- Mechanical aids to help control the flow of urine.
- Intermittent or continual catheterization (inserting a thin tube through the urethra and into the bladder to remove urine).
Dietary Changes: Dietary changes you can try that may help to reduce urinary control problems include:
- Reduce the amount of fluids you drink if you drink more than 2 quarts (1.89 L) daily.
- Reduce or eliminate caffeine-containing drinks, such as coffee, tea, and soda, from your diet.
- Do not drink more than one alcoholic drink per day.
Behavioral Changes: Behavioral treatments used to control urinary control problems include:
- Bladder Training: Bladder training (also called bladder retraining) is used to treat motor urge incontinence (uncontrollable bladder contractions that force urine out of the bladder). Bladder training attempts to increase the time interval between urinating. A voiding schedule is established, and the person is trained to resist the first urge to urinate and refrain from urinating until the scheduled time. The interval between scheduled bathroom visits is increased until the person can refrain from urinating (remain continent) for several hours.
- Timed Voiding: Timed voiding (also called habit training) is used to treat functional incontinence. Functional incontinence occurs when something makes it hard for a person to reach or use a bathroom in time to urinate, such as a disability. In timed voiding, the person follows a schedule consisting of set times to urinate. The schedule is determined by the person's own habits and does not attempt to increase the time between urinating or to teach the person to resist the urge to urinate.
- Prompted Voiding: Prompted voiding is also used to treat functional incontinence. It trains a caregiver to prompt the incontinent person to urinate. The intention is to decrease the chance of accidents by making the person aware of the need to urinate periodically. Prompted voiding is usually used in combination with timed voiding for people who are insufficiently aware of their bodily functions.
- Kegel Exercises: These exercises help strengthen the pelvic floor muscles, which play a role in bladder control. Your doctor can specify how to perform this exercise.
MoonDragon's ObGyn Procedures: Kegel Exercises
Absorbent Devices: Absorbent products are items that absorb urine, such as mini-shields that attach to underwear or plastic-backed diapers. Most commercially available items are disposable (such as Depends or Attends), although some people with urinary incontinence may use absorbent cloths that can be washed and reused. Absorbent products may be used to manage any form of incontinence.
Medications: For many types of urinary incontinence, including motor urge incontinence, medication treatment may be prescribed if behavioral methods do not work. Medication treatment is often used in combination with behavioral changes. For motor urge incontinence (uncontrollable bladder contractions that force urine out of the bladder), the following medications may be used:
- Ditropan XL.
Mechanical Aids: Mechanical aids may be used to treat bladder control problems associated with MS. These include:
- Catheters: A thin, flexible, hollow tube (catheter) can be inserted through the urethra (the tube through which urine leaves the body) into the bladder to drain urine. Several different types of catheters are available.
- Urethral Insert: A thin, flexible solid tube can be inserted into the urethra to block the flow of leaking urine.
- External Urethral Barrier: A self-adhesive patch can be placed over the opening from which urine leaves the body.
Surgery: Surgery may be used to treat some types of urinary incontinence, but it is used only as a last resort when other treatments have failed.
MoonDragon's Health & Wellness: Bed Wetting
MoonDragon's ObGyn Information: Incontinence - Stress
MoonDragon's ObGyn Information: Incontinence - Urge
MS-RELATED BOWEL PROBLEMS
Because MS interrupts or slows the transmission of signals to and from the brain, the electrical impulses to the muscles that are involved in emptying your bowel can become disrupted. Constipation, bowel incontinence (loss of bowel control), and diarrhea are problems that affect people with MS.
Constipation is characterized by infrequent bowel movements (usually fewer than two bowel movements per week), or by frequent straining to void fecal matter. Constipation is very common among people with MS. In general, poor diet (including consuming less than 20 grams of fiber per day), lack of physical activity, and depression all affect the digestive system. Medications and supplements may also contribute to constipation. With MS, constipation may be caused by an interruption of impulses to the brain that signal the need for a bowel movement. MS may also prevent pelvic floor muscles from relaxing. These muscles are used to help void fecal matter. Also, MS may block the natural increase in activity of the colon following meals.
MoonDragon's ObGyn Information: Constipation
Bowel incontinence is the loss of voluntary bowel control. A person suffering from bowel incontinence may not be able to reach the bathroom fast enough. The most common causes include long-term constipation, severe diarrhea, stress, hemorrhoids, nerve or muscle damage, and overuse of laxatives.
Diarrhea is frequent, loose, or watery stools. It is sometimes the result of allergies or sensitivity to spicy foods or dairy products, contaminated water or food, a change in activity level, or viral, bacterial, and parasitic infections. Diarrhea can also be the signal of another problem. If it becomes frequent or continual, see your health care provider. In some cases, your health care provider may recommend that you see a specialist in treating bowel problems (gastroenterologist).
MoonDragon's Health & Wellness: Diarrhea
MAINTAINING REGULAR BOWEL MOVEMENTS
To maintain regular bowel movements try these suggestions:
- Increase your fluid intake. Try to drink 6-8 glasses of water daily. If you are having MS-related urinary problems it may be tempting to cut back on your fluid intake, but this makes constipation worse. Lack of water may harden the stool, making it more difficult to pass. And increased pressure from the stool on parts of the urinary system may actually increase bladder problems. Drink something hot as the first beverage in the morning, such as hot water or hot apple cider or drink 1/2 to 1 cup of prune juice in the morning to stimulate a bowel movement.
- Increase your fiber intake. Eating plenty of fresh fruits and vegetables and whole grain breads and cereals is the best way to increase the amount of fiber you eat. Add 2 to 4 tablespoons of unprocessed wheat bran to foods and drink plenty of liquids (liquids help bran to be effective). Try bran sprinkled over hot or cold cereal, casseroles or mixed with applesauce, pancake batter, pudding, muffin batter, milk shakes, or cookie dough. Your health care provider may also recommend that you take a fiber supplement such as Metamucil.
- Try to maintain regularity. Establish a regular time for emptying the bowels. Plan trips to the bathroom immediately after meals since eating is a natural stimulus for having a bowl movement. Try to wait no more than 2-3 days between bowel movements.
- Exercise. Regular activity such as walking helps normalize bowel function.
- Use stool softeners. Only do this under the direction of your health care provider. Non-medicated glycerine suppositories can be of help if you are having problems passing stool.
- Drink 8 or more cups of liquids per day. Add 1 to 2 cups of liquids to the daily 8 cups for every episode of loose, watery stool you have to replace losses. Try water, lemonade or fruit-flavored drinks, fruit or vegetable juice, broth, milk, or cream soup.
- Discuss with your health care provider or dietitian about increasing or decreasing the amount of fiber you eat.
- Eat soft foods that contain large amounts of liquid, such as sherbet, yogurt, and pudding.
- Ask your health care provider whether adjusting your medications might help relieve the diarrhea, but do not change your medications without first talking to your practitioner.
- Do not take over-the-counter (non-prescription) drugs for diarrhea without talking to your health care provider.
CONTROLLING MS-RELATED MUSCLE SPASMS
Many people with MS experience spasticity, or muscle stiffness and spasms. It usually affects the muscles of the legs and arms, and may interfere with the ability to move those muscles freely. Spasticity can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, especially at night. It can feel like a muscle tightening or it can cause severe pain. Spasticity can also produce feelings of pain or tightness in and around joints and can cause low back pain. The intensity may vary depending on your position, posture, and state of relaxation.
Spasticity is the result of an imbalance in the electrical signals coming from the brain and spinal cord, often caused by damage to these areas from by MS. This imbalance causes hyperactive muscle stretch reflexes, which result in involuntary contractions of the muscle, and increased muscle tension. Spasticity may be aggravated by extremes of temperature, humidity, or infections. It can even be triggered by tight clothing.
To diagnose spasticity your health care provider will first evaluate your medical history, including what medications you have taken and whether there is a history of neurological or muscular disorders in your family. To confirm the diagnosis, several tests can be performed to evaluate your arm and leg movements, muscular activity, passive and active range of motion, and ability to perform self-care activities.
Spasticity can be treated using physical therapy, medications, surgery or any combination of these treatments. Your health care provider(s) will consider the severity of your condition, your overall health, and the following factors when prescribing an appropriate treatment plan:
- Is the spasticity affecting function or independence?
- Is the spasticity painful?
- What treatment options have already been tried, and how did they work?
- What are the costs of the possible treatments?
- What are the limitations and side effects of the treatment?
- Will the benefits outweigh the risks?
- How Does Physical and Occupational Therapy Help Spasticity?
A basic physical therapy stretching program is the first step in treating spasticity. A daily regimen of stretching can lengthen muscles to help decrease spasticity. An occupational therapist may prescribe splinting, casting, and bracing techniques to maintain range of motion and flexibility. If physical and occupational therapy do not adequately control the spasticity, medications may be added to the treatment plan.
Common medications used to treat spasticity include the muscle relaxants baclofen and Zanaflex. Another drug that might be used to treat spasticity is Valium, which is often helpful when taken at night to relieve spasms that interfere with sleep. If medications taken orally are not effective, a pump can be surgically implanted to deliver the medication (such as the baclofen pump). Botulinum toxin (or Botox) can also be injected locally into the affected area to relax the muscles.
When other treatments fail, rhizotomy and tendon release are two surgical procedures used to treat spasticity. Rhizotomy involves surgically cutting away part of the spinal nerve. It is performed to relieve pain or decrease muscle tension. Tendon release, also called a tenotomy, may be performed to help reduce the frequency or magnitude of the spasticity, depending on the age of the patient. The surgery involves cutting severely contracted tendons away from the muscles to which they are attached. Tendon release may need to be repeated. These surgeries are usually only done in extreme cases that do not respond to other treatments.
PHYSICAL THERAPY FOR MS
The symptoms of multiple sclerosis (MS) can affect your ability to move around. You may be experiencing tightness, pain, and weakness, especially in the muscles and joints. Physical therapy may help. Physical therapy cannot cure the primary symptoms of MS (such as weakness, tremors, tingling, numbness, loss of balance, vision impairment, paralysis, and bladder or bowel dysfunction), but therapy can enable you to compensate for the changes brought about by MS. These "compensatory treatments," as they are called, include learning about new movement techniques, strategies, and equipment. Physical therapy can also be very helpful at lessening and even stopping secondary symptoms of MS. A physical therapist can teach you exercises to strengthen and loosen muscles. Many of these exercises can be performed at home. The goal of physical therapy is to improve your independence and quality of life by improving movement and function and relieving pain. Physical therapy can help with:
- Balance problems.
- Lack of coordination.
Many hospitals offer outpatient physical therapy services. However, you may need to get a practitioners's order to be seen in physical therapy. If you feel you can benefit from physical therapy, ask your health care provider for a referral. Treatments in physical therapy often can be completed in one to three office visits. The first appointment includes an evaluation and recommendations for exercises. The following appointments check your progress and review and expand your home program. Most hospitals can provide additional sessions of outpatient physical therapy if a physical therapist is needed to attain an expected improvement in function.
A physical therapist can make recommendations for physical therapy at home, at an outpatient facility, or at a nursing or rehabilitation facility. Many physical therapists can perform functional capacity evaluations to provide more information for disability claims based on physical performance. This functional capacity evaluation can be useful when the Social Security office denies disability to a person who is unable to work for an eight-hour day.
MS-RELATED OCCUPATIONAL THERAPY
Occupational therapy can help people with multiple sclerosis stay active in daily life. By improving skills, teaching alternative ways to complete tasks, or introducing handy equipment, an occupational therapist can help people with MS perform everyday activities with greater ease and satisfaction. Occupational therapy can be quite beneficial when symptoms of multiple sclerosis are hindering you from:
- Being productive at home, work, or school.
- Having fun, such as enjoying pastimes and finding new ways to spend time.
- Performing self-care measures, such as dressing, bathing, grooming, and eating.
Occupational therapy generally provides assessment, treatment, and recommendations in the following areas:
- Arm and hand therapy.
- Handwriting aids.
- Home modification information.
- Driver evaluation and vehicle modification information.
- Cooking and homemaking adaptations.
- Eating and dinnerware adaptations.
- Computer modifications.
- Workplace or work equipment modifications.
- Leisure skill development.
- Manual or electric wheelchair use.
- Bathtub and toilet equipment use.
- Dressing and grooming aids.
Ask your healthcare provider for a referral to an occupational therapist. Insurance companies will usually pay for occupational therapy if your health care provider refers you to one.
MS & EXERCISE
Exercise can help ease the symptoms of multiple sclerosis, but it is important to take certain precautions if you want your exercise program to be successful. The most important thing to remember is to not overdo it. You may have heard the mottos "stretch till it hurts" or "feel the burn," but those approaches are counterproductive for people with MS. If you overdo it you can end up straining an already compromised muscular system, increasing pain and causing your body and mind to become over-stressed, overworked, and overtired. Check with your health care provider before beginning any exercise program. He or she may make recommendations about:
- The types of exercise best suited to you and those which you should avoid.
- The intensity of the workout (how hard you should be working).
- The duration of your workout and any physical limitations.
Referrals to other professionals, such as a physical therapist, who can help create a personal exercise program that meets your needs. The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Some tips for safe exercise include:
- Always warm up before beginning your exercise routine and cool down at the end.
- If you plan to workout for 30 minutes, start with 10-minute workout sessions and work your way up.
- Workout in a safe environment; avoid slippery floors, poor lighting, throw rugs, and other potential tripping hazards. If you have difficulty balancing, exercise within reach of a grab bar or rail.
- If at any time you feel sick or you begin to hurt, STOP.
- Select an activity that you enjoy and have fun. Water aerobics, swimming, tai chi, and yoga are examples of exercises that often work well for people with MS.
Some people with MS are sensitive to heat, which means they notice that their symptoms either reappear or become worse when their body heat rises. This will happen when you exercise. Here are some tips to avoid overheating:
- Do not exercise during the hot time of the day (10 a.m. to 2 p.m.). Try to exercise in the morning or evening if you are exercising outside.
- Drink plenty of cool fluids.
- Become aware of your body. If you notice any symptoms that you did not have before you began exercising, then slow down or stop exercising until you cool down.
- Swimming and water aerobics are good exercise options to keep you cool while exercising. Also, make sure that there are non-slip floors in the locker room and around the pool.
MS & PROPER NUTRITION
Healthy eating is important for everyone, but it is particularly important if you have a chronic illness, such as multiple sclerosis. Good nutrition, especially adequate calories and protein, helps maintain your body's store of protein, provide energy, heal wounds, and fight infection. Some basic nutritional guidelines for people with MS include:
- Eat a variety of foods from each food group.
- Maintain your weight through a proper balance of exercise and food.
- Choose foods low in saturated fat and cholesterol, unless otherwise directed by your healthcare provider.
- Try to limit how much sugar you eat.
- Moderate your use of salt.
- If you choose to drink alcoholic beverages, do not consume more than one or two beverages per day. (Always consult with your health care provider about alcohol consumption.)
- Drink eight 8-ounce glasses of water per day.
- Limit caffeine consumption.
See Nutrition and Nutritional Supplements further down on this page for more information about maintaining a healthy diet and a good immune system.
MANAGING STRESS WITH MS
The prolonged stress of living with a chronic illness, like multiple sclerosis, can lead to frustration, anger, hopelessness, and depression. People with MS are especially at risk of becoming depressed. And, for good reason since people with MS face many stressors. To better cope with the disease, it is important to learn how to manage stress. The first step is to recognize when you are stressed and then you can take steps to reduce your stress. Your body sends out emotional, physical and behavioral warning signs of stress. The stress-related warning signs include:
- Emotional warning signs include anger, an inability to concentrate, unproductive worry, sadness, and frequent mood swings.
- Physical warning signs include stooped posture, sweaty palms, chronic fatigue, and weight gain or loss.
- Behavioral warning signs include overreacting, acting on impulse, using alcohol or drugs, and withdrawing from relationships.
Reducing stress is important. Here are some suggestions:
- Keep a positive attitude.
- Accept that there are events that you cannot control.
- Be assertive instead of aggressive. Assert your feelings, opinions, or beliefs instead of becoming angry, combative, or passive.
- Learn relaxation techniques (see below).
- Exercise regularly. Your body can fight stress better when it is fit. But, talk to your health care provider before starting an exercise program.
- Eat well-balanced meals.
- Rest and sleep. Your body needs time to recover from stressful events.
- Do not rely on alcohol or drugs to reduce stress.
There are a number of exercises that you can do to relax. These exercises include breathing, muscle and mind relaxation, and relaxation to music. Some methods are given below that you can try:
- First, be sure that you have a quiet location that is free of distractions. Find a comfortable body position and sit or recline on a chair or sofa. Find a good state of mind and try to block out worries and distracting thoughts.
- Two-minute relaxation: Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Loosen up these areas. Let go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice. (Stop any movements that cause pain!) Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly.
- Mind relaxation: Close your eyes. Breathe normally through your nose. As you exhale, silently say to yourself the word "one," a short word such as "peaceful," or a short phrase such as "I feel quiet." Continue for 10 minutes. If your mind wanders, gently remind yourself to think about your breathing and your chosen word or phrase. Let your breathing become slow and steady.
- Deep-breathing relaxation: Imagine a spot just below your navel. Breathe into that spot and fill your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow breath out, you should feel more relaxed.
MoonDragon's Health Therapy: Relaxation Techniques
MoonDragon's Health Therapy: Meditation Techniques
MoonDragon's Health Therapy: Pain Control Techniques
MoonDragon's ObGyn Information: Stress
MoonDragon's Health Therapy: Stress Links
MS & FAMILY RELATIONSHIPS
A chronic and unpredictable disease, such as multiple sclerosis, has significant impact not only on you but also on your loved ones. You are not the only one who suffers. Your partner and children must also cope with the disease and the changes it may bring. If you have little or no physical disability, your family life may not change at all. But, there may be times when you will need to change your family activities, choosing ones that are less physically demanding and time-consuming. The most important thing to do is to communicate openly about your emotions and about issues related to MS. It is especially important for you to explain to your loved ones how MS affects you. Some symptoms of MS are not apparent to others, and family members depend on you to tell them when a problem occurs.
Often children are worried about you and fear you will become disabled or will die. Frustration may arise when you are unable to keep up with them or to make commitments the way other parents can. Some children may also feel ashamed and embarrassed to go out in public with a parent who requires assistance with a cane or uses a wheelchair. The best way to handle these concerns is to talk about them. Ask your children questions about what they are thinking. Try to alleviate some of their concerns. Talking openly with your children about multiple sclerosis helps relieve their anxiety about your health. Children of all ages are very intuitive and know when something is different or has changed. Talking with your child opens the lines of communication and helps to reduce fear and stress. When parents are reluctant to talk to their children about the disease, kids misinterpret silence as an indication that the situation is so bad that it cannot be discussed. Parents who can talk with their children about MS convey a message of trust, confidence, and strength. When responding to questions or concerns, take into consideration your child's age and maturity level, and don't overwhelm them with information they cannot understand. If you have more than one child, it may be helpful to talk to them individually so that you can tailor your discussion to their level of understanding. You may want to ask them how they would like to learn about MS, such as reading a book alone or with you, watching a video, or going with you to a health care provider's visit. All of the following emotions are normal reactions to a parent's diagnosis:
These emotions may lead to changes in behavior for your child. Here are some signs to watch for:
- Increased concern with their own body and wellness.
- Difficulty maintaining close friendships.
- Higher anxiety and stress.
- False maturity ("growing up too quickly").
- Behaving badly in public.
- Lying to friends about the parent's illness.
- Regressive behavior (acting younger).
- Temper tantrums.
- Waiting until parents are tired at the end of day to ask for things (such as help with homework).
- Poor performance in school.
- Nightmares, bed-wetting, and trouble falling asleep.
Beyond these behaviors, which in moderation are considered normal, your child may have additional difficulty coping with your illness. In some cases, you may want to seek professional help. Some warning signs of unhealthy behavior are:
- Severe or chronic behavior problems.
- Problems with sleeping and nightmares consistently for over a month.
- Loss of appetite or sudden increase of appetite.
- Loss of interest in schoolwork and extracurricular activities.
- Persistent mood swings and changes in personality.
Common questions adults and children have about MS include:
1. If you have MS, does that mean I will get it? Unlikely. MS is not passed directly from parents to children, although it is possible for more than one family member to have MS. MS is not considered a fatal, contagious or directly inherited disease, although there may be a familial predisposition of MS. Prevalence in families of individuals with MS is somewhat higher than in the general population.
2. Will your symptoms get worse? Everyone's experience with MS is different. A person's MS can get better, worse, or stay the same. Most people with MS usually get around without assistance; however, there may be a time when you will need some type of assistance. Approximately 25 percent of people with MS will need a wheelchair. There may be a time when you would need to use some type of other walking aide like a cane or walker.
3. Why is there no cure? The cause of MS is still not known. Unfortunately, there is not a cure for multiple sclerosis, but there are many drugs that may slow down the progression of the disease. There are also many treatments available that can help a person with MS manage their symptoms and live a productive and fulfilling life. Scientists need to discover the cause first and then they can work on developing a cure. Choosing to begin therapy can be a difficult decision to make; learning about your treatment options and discussing them with your doctor is the first step in deciding what treatment to begin. Some other factors to consider are effectiveness, side effects, your current lifestyle, and how the therapy is given.
Other things you can do to help your children include finding someone else your child can talk to about your illness. Remember that you are not alone. You do not have to be the only person your child talks to about MS. Developing a trusting relationship with a friend or family member can be both helpful and healthy for children. Share how you are feeling, both physically and emotionally. Talk to your child. Do not be afraid to start the conversation. Children appreciate it when you open the door. Conduct open and honest discussions. Keep the door open. Children are not always ready to talk. Let your child know that you will be available if he or she has something to discuss. Allow your child to feel whatever emotion he or she is experiencing. Help your child to manage his or her emotions. Do not try to change what he or she is feeling. Include your child in family decisions. Whether you are assigning household chores or going to the hospital for treatment, it is important to involve your child in all of your decisions. It will give your child a sense of control and belonging. Seek professional help if you need it. There are many counselors and support groups that can help your family adjust to the changes that are occurring.
Other things you can do for yourself and those people around you in your life:
- Explain MS to those around you, including your children, extended family, friends, and co-workers.
- Set realistic expectations and goals.
- Get help, not only emotionally but also physically. If you are having trouble fulfilling certain tasks, ask for assistance.
- Explore financial resources.
- Find new activities that allow you, your spouse, and your family to spend time together.
- Identify new ways to be intimate with your spouse if you are having emotional or physical difficulties with sexual activity.
- Work closely with your healthcare team and stay educated about your illness.
- Reassure each family member of his or her importance.
MS & YOUR CAREER
Maintaining a career and a satisfying work life is as important to someone with multiple sclerosis as to anyone. But if you have MS, finding work that matches your skills, interests, and abilities can be especially challenging. State government agencies and healthcare facilities offer vocational rehabilitation services and evaluation to help you find the right job or help you keep an existing one. Vocational evaluation and rehabilitation can help you find a job that matches your skills and abilities. Vocational evaluation tests your transferable skills to assess your aptitudes, vocational interests, and strengths and limitations. This evaluation also measures your general abilities and specific needs and interests. OASYS, a computer database of thousands of jobs, is sometimes used to match jobs with your past work history and current physical and mental capabilities. Part of vocational rehabilitation is career exploration, which introduces you to the many resources available for making career choices. You can:
- Review labor market data.
- Clarify your aptitudes and abilities.
- Research career interests.
- Identify occupational preferences.
- Define vocational goals.
A vocational rehabilitation counselor provides support and guidance throughout the decision-making process. Individual and group counseling helps you cope with issues related to returning to work, including:
- Adjustment to disability.
- Fear of injury or change.
- Clarification of functional limitations.
- Factors affecting motivation and benefits of working.
- Employer and worker expectations.
- Resume and cover letter writing and job interviewing.
- Job accommodations (American Disabilities Act).
To determine if your workspace is safe, a counselor can observe you at work while performing specific job duties to determine if you can safely perform a job. The counselor may then recommend modifying job duties or the work site to improve safety. For those with severe disabilities, job coaching is often performed with support from community agencies. Some workers require assistance on the job to learn procedures, organize and prioritize tasks, and meet productivity standards. A job coach works closely with the worker to set up job duties in an effective way, based on the worker's overall vocational strengths and limitations.
MS & SEXUAL INTIMACY
It is not surprising that many people with multiple sclerosis report a decline in sexual desire. What with the fatigue, muscle spasms, and bladder control problems, who would want to think about sex? But, there are steps that can be taken to improve sexual function and intimacy, despite MS. Changes in sexual function can occur as a result of the neurologic and psychological affects of MS.
Neurologic Affects: Sexual arousal begins in the central nervous system, as the brain sends messages to the sexual organs along the nerve pathway in the spinal cord. MS-related changes to these nerve pathways can directly or indirectly impair sexual functioning. For example, the following symptoms can occur as a direct result of myelin breakdown in the spinal cord or brain:
- Decreased sex drive.
- Altered genital sensations (numbness, pain, increased sensitivity).
- Difficulty or inability to maintain erection.
- Decreased vaginal lubrication.
- Decreased vaginal muscle tone.
- Ejaculation difficulty.
- Problems having an orgasm.
The following symptoms can arise as a consequence of MS physical changes or treatments:
- Fatigue can suppress sexual desire.
- Spasticity can interfere with sexual positioning or cause pain.
- Sensory changes can make physical contact uncomfortable.
Psychological: A loss of interest in sexual contact or intimacy may arise as a result of psychological or social issues, such as:
- Performance anxiety.
- Changes in self-image or body image as a result of disability.
To improve intimacy and sexual relations, talk with your partner. The most important way of dealing with sexual difficulties is to discuss your feelings with your loved one. When MS begins affecting your sexual desire, talk to your partner. Confiding in your partner deepens intimacy and may help resolve concerns relating to sexual intimacy.
MS & MAKING CHANGES IN YOUR HOME ENVIRONMENT
Because daily activities, including leisure activities, can cause fatigue more quickly in people with multiple sclerosis, it is important to modify your activity levels. And, because MS can make moving around difficult, making certain changes to your home environment may help conserve energy and increase independence. An occupational therapist or rehabilitation specialist can recommend a variety of devices that are designed to make home care and daily activities more comfortable. Some examples include:
- Built-up utensils.
- Grab bars.
- Reaching and grabbing devices.
- Electric beds or mattresses.
- Sliding boards.
Along with appropriate medications, exercise, and other management techniques, this equipment can help you maintain your activity and safety levels. The following is a list of the most common change recommendations that can assist you in dressing, bathing, using the toilet, general hygiene and self-care activities, eating and drinking, working in the kitchen, cleaning, and shopping. Not all of these recommendations may benefit your personal situation. Your occupational therapist or rehabilitation specialist can help determine which of these recommendations are best for you.
- Get dressed while sitting in a chair that has arm rests. This will help you keep your balance.
- Roll from side to side to get pants over your hips. You can do this while sitting in a chair or lying down on your bed.
- Wear clothes that are loose-fitting and have elastic waistbands.
- Choose wrap-around clothing instead of the pull-over type. Also choose clothing that opens in the front, not the back.
- Wear clothing with large, flat buttons or use Velcro closures.
- Use a buttonhook to button clothing.
- If you have shoulder weakness, use a dressing stick to get your coat or shirt on and off.
- Use a zipper with a large pull or attach a leather loop on the end of the zipper to zip pants or jackets.
- Use devices such as a sock aid and a long-handled shoehorn for additional assistance.
- Install grab bars inside and outside the bathtub or shower.
- Use a bathtub transfer bench or a shower chair with back support.
- Put extended lever handles on faucets to make them easier to turn.
- Put a non-skid mat in the bathtub.
- Use a handheld hose for showering and bathing.
- Use a long-handled sponge or scrubbing brush.
- Use soap-on-a-rope, bath mitts, or sponges with soap inside, or a soft soap applicator instead of bar soap.
- Use lukewarm water; very hot water can cause fatigue and aggravate your symptoms.
- Sew straps on towels to make them easier to hold while drying.
- Place a towel on the floor outside the tub to dry your feet so you do not slip.
- Put a towel on the back of your chair and rub your back against it to dry. Or use a terry cloth robe instead of a towel to dry off.
USING THE TOILET, GENERAL HYGIENE & SELF-CARE
- Use an elevated toilet seat with armrests (a raised seat with armrests can be placed over a regular toilet) and/or safety rails or grab bars near the toilet to assist standing from a low surface. Do not use towel racks or bathroom tissue holders to help you stand.
- Consider using a bedside commode.
- Put extended lever handles on faucets to make them easier to turn.
- Use hairbrushes and combs with built-up handles or handles with finger loops.
- Use toothbrushes with built-up handles or use an electric toothbrush.
EATING & DRINKING
- Rest your elbows on the table to provide more motion at your wrist and hand. Use wrist supports.
- Sit with your knees and hips bent at a 90-degree angle in a straight-back chair.
- Use specialized utensils with built-up, lightweight handles, such as large handled spoons and forks, or use a "spork" (a spoon and fork in one). Use a rocker knife for cutting food.
- Use a non-skid mat (made out of a material called Dycem) to stabilize objects on the table.
- Use a plate guard or plate with a raised lip to prevent food from spilling.
- Use a long straw with a non-spill cup or use a plastic mug with a large handle.
WORKING IN THE KITCHEN
- Have at least one counter workspace that has been lowered so that you can reach it from a sitting position.
- Use a jar opener for tightly sealed containers.
- Do not close jar lids or containers too tightly once they have been opened.
- Use an extended lever to assist with lift-tab cans.
- Use pans with a wide base that cannot be knocked over easily or a pot stabilizer.
- Use a food processor for vegetable cutting and peeling.
- Use plastic containers to avoid breakage.
- Use a non-skid mat to stabilize bowls and plates.
- Store food and beverages (such as milk or juice) in small, easy-to-manage containers.
- Place utensils, pots, pans, and measuring cups on a pegboard or in an accessible cupboard instead of in lower cupboards, which require bending. Sit when getting things out of lower cupboards.
- Use a spike board to stabilize vegetables, fruit, and potatoes so you have both hands free to peel or chop them.
- Use two hands to pour liquids.
- Use a wheeled utility cart to move food and dishes instead of trying to carry them.
- Use scissors to open cellophane packages. Use a box top opener to open boxes.
- Use electrical appliances whenever possible, such as a microwave and electric can opener.
- Use long handles on sponge mops, cleaning brushes, dustpans, brooms, or window washers.
- Sit to fold laundry, wash dishes, iron clothes, use the sweeper, mop the floor, or plug in appliances at low outlets. Adapt counters so that you can reach them from your wheelchair or from a sitting position.
- Call ahead to make sure the store has the item you need.
- Call ahead to reserve a wheelchair or tri-wheel cart if you are not planning to bring your own.
- Call a taxi or ask a friend or family member to drive you.
OTHER USEFUL TIPS
- For writing, use special grips for pens and pencils and wrist supports.
- Always keep emergency numbers in an accessible location; consider having them preset on your phone.
- Use telephones with oversized buttons.
- To avoid slipping or tripping, remove throw rugs.
- Make your environment as comfortable and sensory-pleasing as possible. Use soothing colors to decorate, use scented candles or potpourri in fragrances that relax you. Keep photos and music around that lift your spirit.
- If you find you would like company during the day, consider a pet such as a bird, a fish, or a cat.
- If you are concerned about daily care, consult with your health care provider or other patient services about arranging visiting nurses, cleaning services, or personal care services in your home.
- Surround yourself with beauty such as plants or flowers to help keep your spirits up.
- Make sure the temperature and climate in your home are suitable to your sensitivities. The more comfortable and uplifting your environment is, the more positive your attitude will be!
By maintaining a high quality of life and a positive attitude, living with MS can be more manageable.
MS & ASSISTIVE DEVICES
There are a variety of assistive devices that can help you manage the symptoms of multiple sclerosis (MS). An assistive device is a tool or product that makes a certain function easier to perform. An occupational or physical therapist can prescribe these devices. Below find a list of assistive devices and equipment that are available.
Orthotics: Orthotics are light-weight inserts worn inside the shoes that can be used to increase stability and decrease fatigue. Orthotics can help with spasticity in the foot and can help brace the foot. Leg Braces: Weakness of the leg muscles may make it more difficult to maneuver on stairs, rise from a chair or walk. An ankle-foot brace can stabilize the ankle when there is weakness in the foot muscles. This brace fits into an ordinary shoe and prevents the toes from dragging. If muscle weakness occurs in the neck, a neck brace may be recommended to make you more comfortable. Canes: A cane may be the most useful tool when one leg is weaker than the other, or when you have mild problems with balance. Here are some guidelines for cane use:
- The cane should be held on the stronger side of the body while the weight is shifted away from the weaker side.
- A quad cane (or four-legged cane) provides more stability than a standard cane.
Walkers: Walkers may be more appropriate when there is significant leg weakness. They can also provide support for maintaining balance. Wheels or platforms may be added to the walker if necessary. Wheelchairs or Scooters: Wheelchairs or three-wheeled scooters may provide more independence. Wheelchairs are usually recommended when a person experiences excessive fatigue, unsteadiness, or occasional falls.
RESOURCES FOR ASSISTIVE DEVICES & EQUIPMENT
ABLEDATA 8630 Fenton Street, Suite 930
Silver Spring, MD 20910
1-800-227-0216 (Voice) or (301) 608-8912 (TTY)
HOLISTIC & NUTRITIONAL RECOMMENDATIONS
MS & ALTERNATIVE-COMPLEMENTARY THERAPY
The term alternative therapy, in general, is used to describe any non-conventional medical treatment or intervention that may be used in place of conventional medical drugs, therapy or surgery. Some therapies have not been "scientifically" researched or "medically approved" by conventional means but may have a long standing history of use (such as massage, acupuncture, homeopathy, and traditional Chinese medicine [TCM]). However, alternative therapies can also be used as a complementary therapy in addition to conventional medical treatment. Alternative therapy encompasses a variety of disciplines that range from diet and exercise to mental conditioning to lifestyle changes. Examples include acupuncture, yoga, aromatherapy, relaxation, herbal remedies, and massage. An example of a complementary therapy would be using nutrition and weekly massages in addition to MS drug treatment.
Holistic means treating not only the disease or illness (primarily treating the symptoms and not necessarily the cause) but also the entire body including the mental, emotional as well as the physical concerns. Holistic therapies do not isolate one body part from another but treat the whole person. Not all non-conventional therapies are supported by conventional medical health care providers. If you want to use holistic approaches in your MS therapy, either with or without drug therapy, you can include holistic practitioners in your circle of health practitioners. These can be homeopathic, naturopathic, massage, acupuncture, mind-body therapists and so forth. Whatever approaches you find to help you manage your condition and the symptoms will be beneficial. Do not be afraid to try different approaches and different practitioners until you find what works for you. Nutritional therapy and a good sound nutritional diet is important for anyone interested in maintaining good health, a strong immune system and a positive approach to health problems. It is the groundwork to health.
SOME HOLISTIC THERAPIES THAT CAN HELP WITH MS
Positive Attitude. Having a positive outlook cannot cure MS, but it can reduce your stress and help you feel better and help you to fight depression, anger, frustration and other symptoms associated with the disease. Regular meditation and relaxation can help with stress and "finding your center and balance".
Exercise. Exercises, such as tai chi and yoga can lower your stress, help you to be more relaxed, and increase your energy, balance, and flexibility. As with any exercise program, check with your health care provider before getting started, especially if you have a sedentary lifestyle.
Diet. It is important for people with MS to follow a healthy, well-balanced diet. Ask your health care provider what diet is right for you. You may want to consult with a nutritionist with experience in dealing with MS patients and their problems.
Massage. Many people with MS receive regular massage therapy to help relax and reduce stress and depression, which can exacerbate the disease. There is no evidence that massage changes the course of the disease. It is usually safe for people with MS to receive a massage, but if you have bone-thinning osteoporosis (usually as a result of your treatments) massage may be dangerous. Discuss massage therapy with your health care provider before receiving massage therapy.
Acupuncture. Some people with MS report that acupuncture provides some relief of symptoms such as pain, muscle spasms, or bladder control problems. Acupuncture has been used and recognized as a treatment for pain in many disorders. Consult with a qualified acupuncturist about benefits associated with MS. Also, keep in mind that there are always risks when a procedure involves puncturing the body with needles as is done with acupuncture. The main risk is infection. Unless sterile techniques are used, acupuncture could transmit hepatitis or HIV. Today acupuncturists are well educated about sterile techniques and most use disposable, one-use acupuncture needles for therapy.
Nutrition & Diet. It is important for people with MS to maintain a healthy, well-balanced diet to keep them as healthy as possible. Discuss any dietary concerns you may have with your health care provider or nutritionist.
Marijuana. The use of marijuana to treat any illness remains highly controversial. Some people with MS claim that smoking marijuana helps relieve spasticity and other MS-related symptoms. Marijuana has been used for glaucoma for many years. However, there is little evidence to date that marijuana really works. Research is ongoing to answer this important question. Until more is known, most conventional health care providers do not recommend the use (or overuse) of marijuana to treat MS as the drug is associated with serious long-term side effects such as heart attack or memory loss in some individuals. However, keep in mind, many of the conventional drugs used in treatment can also have some serious side effects in certain individuals. Discuss options with your health care provider(s), both conventional and non-conventional.
Evening primrose oil (linoleic acid). Linoleic acid is also found in sunflower seeds and safflower oil. There is some evidence that taking an oral supplement of linoleic acid may slightly improve MS symptoms.
MAKING A DECISION ABOUT TREATMENTS
Whether you decide to use conventional drug therapy and possible surgery or other conventional approaches to your treatment or decide to go the holistic route and use non-conventional therapies or combine the two approaches, there are some things you should always keep in mind for all treatments:
- What is the treatment?
- What does it involve?
- How does it work?
- Why does it work?
- Are there any risks?
- What are the side effects?
- Is it effective? (Not all therapies, conventional or non-conventional will work for everyone.)
- How much does it cost? (Will your insurance pay for the therapy or will it be "out of pocket"?)
Once you answer these questions, weigh your options and decide whether the benefits outweigh the risks. Whatever way you decide, make sure your health and your money are protected. Here are some tips.
- Do not take the claim at face value. Contact reliable organizations and discuss the therapy. Talk to others in a support group, your family, and friends. Although they may not always be supportive, they can help you make an educated, objective decision.
- Discuss the therapy with your health care provider (both conventional and non-conventional). Make sure your health care provider knows what therapy you are considering so he or she can discuss possible interactions or side effects with your current treatment. Your health care provider can also provide you with information on other patients who may have tried the same therapy.
- Talk to others who have used the therapy. Ask them what their experiences have been. Do not go solely on testimonials from the care provider or product manufacturer. Track down your own references and get their opinions.
- Research provider's background. Contact the Better Business Bureau and thoroughly research the background of the therapy provider. Determine how long they have been providing this therapy, what credentials they have, and what their philosophy of treatment is. This is important for conventional practitioners as well as non-conventional practitioners. Just because they have M.D. behind their name, does not necessarily mean they know what they are doing and are good clinicians or have had much experience with MS patients and their treatment. Conventional treatment methods are often more invasive (such as a spinal tap or surgery) than non-conventional therapies and carry the risks involved with it. Make sure your practitioner knows and has had extensive experience with whatever procedure you decide on. Do not be afraid to ask about their qualifications and experience.
- Avoid providers who refuse or are reluctant to work with your other health care providers (whether conventional or non-conventional). Be sure that the provider is willing to refer patients to a conventional health care provider when necessary and vice versa. There needs to be a willingness for all practitioners involved in your care to work together and provide supportive care as a health team.
- Make sure you know the total cost of the treatment up front. Many therapies, medicines, experimental drugs or procedures, and alternative treatments may not be covered by your health insurance. If you do not have health insurance and must pay out of your own wallet, it is important to know all expenses, both for conventional and non-conventional treatment.
BE AWARE AND INFORMED
watch out for any drug, product, or provider that are promoted through telemarketers, direct mailings, infomercials, ads disguised as valid news articles, or ads in the back of magazines, whether conventional or non-conventional. If a provider or product claims to be a "cure" for MS or makes other outrageous claims, be cautious. Be wary if the product is only being offered through one manufacturer. Research alternatives and generics that may be available. Make sure all of the active ingredients are listed in a product or drug. Do not trust "secret formulas" or any product that will not list active and inert ingredients. Be sure to read any data or research information regarding side effects, contraindications, overdose, and any other concerns with regards to any product or drug or any ingredient in the product. Keep in mind that testimonials are only given by those who are satisfied with the product, so beware, especially if the terms "paid endorsement" are used. Also, be cautious if testimonials are given by people who are only listed by initials, locations, or first names. Do your research and protect your health no matter what treatment you decide to use. Always be an informed consumer, especially when it comes to your health care.
There is no known cure for this disease, but the supplement and dietary programs outlined below can have been shown to be helpful. Long-term sufferers of MS may not benefit as much, but younger people who are just starting to exhibit symptoms may find that the correct supplements slow or even stop the progression of the disease. The recommendations given below are general. For more specific, individualized nutritional guidance, consult with a practitioner or nutritionist knowledgeable about MS and nutritional therapy.
A strong immune system may help to prevent multiple sclerosis by helping the body avoid infection, which often precedes the onset of this disease.
MoonDragon's Health & Wellness: Immune Disorders & Weakened Immune System
While the effects of MS on pregnancy seem to be minimal, slightly more flare-ups occur during the 6 months following childbirth.
Gluten intolerance may make a person more susceptible to MS.
MoonDragon's Health & Wellness: Celiac Disease
Recent studies point to a possible link between MS and candida infection. A significant proportion of people with MS show evidence of imbalanced bowel flora, which is characteristic of candidiasis. Further chronic fatigue is a symptom of candidiasis, and it is also one of the most common complaints of people with multiple sclerosis. Treatments to reduce candida activity have been found to reduce the fatigue experienced by many people with MS.
MoonDragon's ObGyn Information: Chronic Fatigue Syndrome
MoonDragon's ObGyn Information: Candida
The symptoms of Lyme disease may mimic those of multiple sclerosis.
MoonDragon's Health & Wellness: Lyme Disease
Chlamydia pneumoniae, a very common type of bacteria, has been cited as a possible cause of MS. In an article in the July 1999 issue of Annals of Neurology, researchers reported that C. pneumoniae were found in all MS patients in their study group. (It may be that this was a result of MS, not a cause.) Chlamydia pneumoniae is a species of chlamydia bacteria that infects humans and is a major cause of pneumonia. It is not the same organism which causes the well known sexually transmitted disease (C. trachomatis).
One recent study concentrated on the ability of hypericin, a chemical found naturally in St. John's Wort, to destroy viruses and cancer cells when exposed to light. Hypericin has shown promise as a disease-fighting agent and research is continuing.
Some people with MS have experienced relief of symptoms by using honeybee venom. Bee venom apparently acts as an anti-inflammatory and immune system stimulant. A bee venom cream can be used for topical applications. Bee venom has been used to treat arthritis symptoms.
ApiTherpy.org: MS & Other Neurological Conditions
ApiHealth.com: VENZ Bee Venom Cream Product
ApiHealth.com: Bee Venom Products
Herbal Remedies: Manuka Honey & Bee Venom, Actiflex, GMO-Free, 8 oz.
Although it is considered controversial by many health care providers in the United States, hyperbaric oxygen therapy has been used with success for people with multiple sclerosis in some other countries.
MoonDragon's Health Therapy: Hyperbaric Oxygen Therapy (HBOT)
There are 3 drugs that health care providers sometimes prescribe to treat MS: Interferon-Beta-1a and -1b (Avonex and Betaseron, respectively) and glatiramer acetate (Copaxone, also known as copolymer-1). Possible side effects include flu-like symptoms and depression. Vitamin C promotes the production of natural interferon in the body.
Oral corticosteroids, such as prednisone (Deltasone and others), are often used to hasten remission and to reduce the severity of the attacks. Giving cortisone intravenously for a short period (five days) eliminates the side effects that come with the use of oral medication. The same drugs now used by transplant patients to keep their bodies from rejecting donated organs can be used to control symptoms. These immunosuppressant drugs are not without side effects, however. People who take them commonly experience nausea, vomiting, and hair loss, and they run a greater risk of cancer as well.
There are many drugs that health care providers prescribe to treat the accompanying conditions of MS. Always ask you health care provider about all available medications, and especially about possible side effects, so that you can make informed decisions about which, if any, to take.
According to the New Jersey College of Medicine, x-ray irradiation to the lymph glands and the spleen may halt the progress of MS in some cases. However, radiation exposure depresses the immune system.
Because there are so many conditions that can occur over time with MS - including bowel and bladder problems, chronic fatigue, depression, headaches, impotence, pain, problems with vision and hearing loss, seizures, urinary tract infections, and vertigo - it is advisable to read the information that cover these individual conditions. Consult the link below for these pages to review.
MoonDragon's Health & Wellness Index
Eat only organically grown foods with no chemical treatments or additives, including eggs, fruits, gluten-free grains, raw nuts and seeds, vegetables, and cold-pressed vegetable oils. The best diet for people with this disorder is totally vegetarian.
Eat plenty of raw sprouts and alfalfa, plus foods that contain lactic acid, such as sauerkraut and dill pickles. also good are"green drinks" that contain plenty of chlorophyll.
MoonDragon's Nutrition Therapy: Juicing & Green Drinks
Eat plenty of dark green leafy vegetables. These are good sources of vitamin K.
Drink at least 10 8-ounces glasses of quality water each day to prevent toxic buildup in the muscles.
Do not consume any alcohol, barley, chocolate, coffee, dairy products, fried foods, highly seasoned foods, meat, oats, refined foods, rye, salt, spices, sugar, tobacco, wheat, or processed, canned, or frozen foods.
Take a fiber supplement. Fiber is important for avoiding constipation. Periodically take warm cleansing enemas with the juice of a fresh lemon. A clean colon is important for keeping toxic waste from interfering with muscle function.
MoonDragon's Health Therapy: Enemas
MoonDragon's Health Therapy: Lemon Juice Enema
Never consume saturated fats, processed oils, oils that have been subjected to heat (either in processing or in cooking), or oils that have been stored without refrigeration.
Mountain Rose Herbs: Vegetable & Carrier Oils
Vegetable and carrier oils have a plethora of fine uses which include acting as a carrier for therapeutic applications, as an excellent addition to your culinary creations, as a lathering agent for soap, and a binding medium for cosmetics. It is hard to imagine where we would be with our creations, if it were not for the goodness and substance that pure oil provides. At Mountain Rose Herbs we are committed to providing you the most magnificent vegetable oils that are unsurpassed in color, depth, consistency, essential fatty acids and key nutrients. Since 1987 we have become the leading supplier of exquisite quality bulk oils known for the full bodied aroma and color, and we have firm procedures in place to ensure you that each oil is screened, analyzed and sampled by our quality control department. All of this is done to protect the very qualities that make the line of oils offered by Mountain Rose Herbs, some of the finest. Every vegetable oil we offer is extracted through expeller or cold pressed methods. We do not employ the use of solvent, hexane or alcohol extraction, and we do not stock oils that have been processed through heat intensive hydraulic extraction. These methods produce relatively unhealthy oils that lack in the qualities we require.
Have yourself tested for possible food allergies. It is believed that food allergies are a major factor in the development and progression of multiple sclerosis. Unfortunately, all too often the allergies are not discovered until irreversible nerve damage has occurred. Early detection is therefore vital. Eliminating offending foods from your diet may slow down the progression of the disease and help you to avoid further damage.
MoonDragon's Health & Wellness: Allergies
Avoid stress and anxiety. Attacks of MS are often precipitated by a trauma or a period of emotional distress.
MoonDragon's ObGyn Information: Stress
MoonDragon's Health & Wellness: Anxiety Disorders
MoonDragon's Health Therapy: Relaxation
MoonDragon's Health Therapy: Stress Links
Avoid exposure to heat, such as hot baths, showers, sunbathing, and overly warm surroundings, and avoid becoming overheated when working or exercising. Avoid exhaustion and viral infections. All of these may trigger an attack or worsen symptoms.
Get periodic massages and regular exercise, and keep mentally active. These are extremely valuable in maintaining muscle function and bringing about remission of symptoms. However, exercises that may increase body temperature can decrease the function of the nerves involved and make symptoms worse. Swimming is the best activity. Doing other exercises in cool water is good as well because body temperature is kept lower and the body's weight is supported by the water. Stretching exercises help to prevent muscle contractures. Physical therapy is often needed.
MoonDragon's Health Therapy: Massage
When an exacerbation begins, take at least two days of complete bed rest. This can often stop a mild attack.
Educate yourself and your family about the disease and seek out sources of emotional support. For names and addresses of organizations that can help, see the following links.
National MS Society (www.nationalmssociety.org)
MS Society free telephone numbers:
UK: 0808 800 8000
US: 1-800-Fight MS (1-800-344-4867)
Australia: 1 800 CURE MS (1 800 2873 67)
New Zealand: 0800 2 HELP MS (0800 2435 767)
Multiple Sclerosis Foundation
About Multiple Sclerosis
The Multiple Sclerosis Association of America (MSAA)
Multiple Sclerosis.com: Real Heal, Real Hope
Multiple Sclerosis Treatment & MS Symptoms - Connecting with MS Community
Alfalfa is a good source of vitamin K and other nutrients. It can be taken in liquid or tablet form.
Herbal Remedies: Alfalfa Supplements & Products
Burdock, Dandelion, Echinacea, Goldenseal, Pau D'Arco, Red Clover, St. John's Wort, Sarsaparilla, and Yarrow are effective detoxifiers. Caution: Do not take Goldenseal internally on a daily basis for more than one week at a time, do not use it during pregnancy, and use it with caution if you are allergic to ragweed.
Herbal Remedies: Burdock Supplements & Products
Herbal Remedies: Dandelion Supplements & Products
Herbal Remedies: Echinacea Supplements & Products
Herbal Remedies: Goldenseal Supplements & Products
Herbal Remedies: Pau D'Arco Extract, Incan LaPacho, 100% Natural Herbal, 4 fl. oz.
Herbal Remedies: Pau D'Arco Tea, Incan LaPacho, 48 Tea Bags
Herbal Remedies: Pau D'Arco Supplements & Products
Herbal Remedies: St. John's Wort Supplements & Products
Herbal Remedies: Sarsaparilla Supplements & Products
Herbal Remedies: Yarrow Supplements & Products
Cordyceps is a Chinese herb that improves memory, helps you assimilate nutrients more efficiently, and increases energy.
Herbal Remedies: Cordyceps Cs-4, 400 mg, 90 VCaps
Herbal Remedies: Cordyceps, Standardized 10% Cordycepic Acid, Nature's Way, 60 VCaps
Herbal Remedies: Cordyceps Supplements & Products
Lobelia, Skullcap, and Valerian root relax the nervous system. Taken at bedtime, they aid in preventing insomnia. Lobelia is good for daytime use also. Caution: Do not take lobelia internally on an ongoing basis.
Herbal Remedies: Lobelia Supplements & Products
Herbal Remedies: Skullcap Supplements & Products
Herbal Remedies: Valerian Root Supplements & Products
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose. See Cold Supplements & Products for more helpful recommendations.
NUTRIENTS Supplement Suggested Dosage Comments Very Important Coenzyme Q-10 90 mg daily. Needed for improved circulation and tissue oxygenation. Strengthens the immune system.
CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps,
CoQ10, Now Foods, 400 mg, 60 Softgels
Coenzyme A As directed on label. Supports the immune system's detoxification of many dangerous substances. Can ease depression and fatigue, increase energy, process fats, remove toxins from the body, and boost the immune system.
Pantethine (Coenzyme A Precursor), Highly Active Form of Vitamin B-5, 300 mg, NOW Foods, 60 Softgels,
Methylsulfonylmethane (MSM) As directed on label. Helps to keep cell walls permeable, allowing water and nutrients to freely flow into the cells and allowing wastes and toxins to properly flow out. With vitamin C, is used by the body to build healthy new cells.
Pure MSM (Methylsulfonylmethane), 500 mg, 250 Caps
Gamma-Linolenic Acid (GLA) As directed on label, 3 times daily, with meals. An essential fatty acid needed to control symptoms. Deficiency is common in people with MS. Or
Essential Fatty Acids
(Flaxseed Oil, Primrose Oil, Omega-3 Complex)
As directed on label, 3 times daily, with meals. If GLA is not available, use one of these supplements for essential fatty acids.
Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 SoftGels,
Total Omega, Complete Omega 3,6 & 9, Barlean's, 16 fl. oz.,
Total Omega, Complete Omega 3,6 & 9, Barlean's, 90 Softgels,
Barlean's Primrose Oil, With Gamma Linolenic Acid (GLA), 1300 mg, 120 SoftGels,
Evening Primrose Oil, Rich In Gamma Linolenic Acid (GLA), NOW Foods, 100% Pure, 4 fl. oz.,
Essential Fatty Acids For Baby & Children, Organic, 8 fl oz.,
Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.,
Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps
Garlic (Kyolic) 2 capsules 3 times daily, with meals. Acts as a natural antibiotic and immunity boosting enhancer. An excellent source of sulfur.
Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.,
Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps,
Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels,
Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs,
Every Day Garlic Supplement, Kwai, 30 Tabs,
Garlic Tincture, 100% Organic, 2 fl. oz.,
Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps,
Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz.,
Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps,
Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 Caps
Oxy-5000 Forte As directed on label. A potent nutritional antioxidant formula. Vitamin B Complex 100 mg 3 times daily. (Amounts of individual vitamins in a complex will vary.) Aids immune system function and maintains healthy nerves. Use hypoallergenic formulas for all the B vitamins.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
Vitamin B-6 (Pyridoxine)
50 mg 3 times daily. Promotes red blood cell production; aids the nervous system and immune function. Deficiency may cause MS in susceptible persons. Vitamin B-6 is an active participant in many chemical reactions of proteins and amino acids. It aids in the normal function of the brain, promotes red blood cell formation, produces energy, and acts as a coenzyme in carbohydrate, protein and fat metabolism. Vitamin B-6 helps normalize the homocysteine levels in your body and promotes nerve and muscle function. Vitamin B-6 is found in avocados, bananas, beef liver, chicken, fortified cereals, ground beef, ham, hazelnuts, lentils, potatoes, salmon, shrimp, soybeans, sunflower seeds, tuna, and wheat germ.
Vitamin B-6 (Pyridoxine), 100 mg, 100 Caps
1,000 mcg twice daily. Aids in cellular longevity and helps to prevent more damage by maintaining the protective myelin sheaths. Use a lozenge or sublingual form.
Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.,
Vitamin B-12, Nature's Way, 2000 mcg, 100 Sublingual Lozenges,
Vitamin B-12 Liquid Supplement, 50 mcg, With Vitamin B-9 (Folic Acid), 400 mcg, 1 oz.
Vitamin B-12, California Natural, 1000 mcg, 60 Tabs,
Vitamin B-12 LipoSpray, NOW Foods, 2 fl. oz.
Choline & Inositol As directed on label. To stimulate the central nervous system and aid in protecting the myelin sheaths from damage.
Choline Supplement, 100% Natural, Nature's Way, 500 mg, 100 Tabs,
Inositol (Vitamin B-8), 100% Natural, Pure Crystalline, Nature's Way, 500 mg, 100 Caps,
Choline & Inositol, 100% Natural, Nature's Way, 250 mg / 250 mg, 100 Caps,
As directed on label or 1 teaspoon twice daily, on an empty stomach. Helps to detoxify harmful substances, enhances absorption of nutrients, and aids digestion. Use a powdered non-dairy form.
Acidophilus Supplement Powder, Non Dairy, 3 oz. Bulk,
Acidophilus, 3 Billion, NOW Foods, 90 Tabs,
Lactobacillus Acidophilus Supplement, Non Dairy, 100 Caps,
Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.,
LifeStart from Natren
As directed on label.
As directed on label.
For adults. Replaces "friendly" bacteria and acts as an antibiotic.
For infants and children.
1/4 teaspoon twice daily, on an empty stomach. A combination of the branched chained amino acids Valine, Isoleucine & Leucine, which aid in use of nutrients by the muscles. See Amino Acids for more information. Plus
500 mg twice daily, on an empty stomach. Aids in supporting the myelin sheaths.
L-Glycine Powder, Free Form, Vegetarian, 1 lb.
Calcium 2,000-3,000 mg daily. Deficiency may create a predisposition to developing MS. Some medications used in the treatment of MS may cause a decrease in bone calcium resulting in osteoporosis. Necessary for bone strength and health.
Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.,
Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.,
Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 Gelcaps
1,000-1,500 mg daily. Essential for normal cell function and division. Needed for calcium absorption and proper muscular coordination.
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.,
Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 Caps
Creatine As directed on label. Do not take with fruit juice, as this combination produces creatinine, which is difficult for the kidneys to process. Do not exceed the recommended dose. May help counteract muscle depletion. Should be used in combination with a balanced diet.
Creatine Overload, Creatine Supplement Powder, Hi-Tech, 1200 g,
Creatine Monohydrate, Pharmaceutical Grade, NOW Foods, 750 mg, 120 Caps,
Micronized Creatine Monohydrate Powder, NOW Foods, Vegetarian, 21.2 oz.,
Creatine Monohydrate, NOW Foods, 1500 mg, 100 Tabs,
Free-Form Amino Acid Complex 1/4 teaspoon 3 times daily or as directed on label, between meals. Helps to maintain good absorption of nutrients needed for proper brain function. Supplies needed protein in a form that is rapidly absorbed and assimilated. Use a sublingual form.
Amino 1000 Complete, NOW Foods, 120 Caps,
Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs
Grape Seed Extract As directed on label. Grape Seed Extract is one of the most potent antioxidants and anti-inflammatory; protects the cells.
Grape Seed (Grapeseed) (Vitus vinifera), 100% Pure, NOW Foods, 16 fl. oz.
As directed on label 3 times daily with meals.
As directed on label.
For proper breakdown of foods. Inflazyme forte helps to reduce inflammation and aid digestion.
MetabolicZyme (Hypoallergenic), Allergy Research Group / Nutricology, 900 Tabs,
Plant Enzymes, NOW Foods, Vegetarian, 120 VCaps,
Enzymes, All Complete, 250 mg, 90 Caps,
Pancreatin 4X, NOW Foods, 500 mg, 100 Caps
Raw Glandular Complex As directed on label for each glandular. Stimulates glandular function, especially the thymus (site of T lymphocyte production). See Gland Therapy.
Immuno-Gland Plex, Organic Glandular (Hypoallergenic), Allergy Research Group/Nutricology, 60 Caps,
Nicotinamide Adenine Dinucleotide (NADH) As directed on label. Important in the creation and transfer of chemical energy, especially during breathing.
Source Naturals ENADAlert ENADA, NADH Supplement, 5.0 mg, 30 Tabs,
NAD (Niacin), NOW Foods, 25 mg, 60 Lozenges,
As directed on label. To detoxify the body of parasites. Potassium 300-1,000 mg daily. Needed for normal muscle function.
Potassium Ionic Mineral Supplement, Fully Absorbable, 340 +/- ppm, 16 fl. oz.,
Potassium Chelate, 100% Natural, Nature's Way, 99 mg, 100 Caps,
Potassium Chloride Powder, NOW Foods, Vegetarian, 8 oz.
Raw Thymus Glandular 500 mg twice daily. Enhances immune function of the thymus (site of T lymphocyte production). See Gland Therapy.
Thymus Organic Glandular (Hypoallergenic), Allergy Research Group/Nutricology, 75 Caps
Selenium 150-300 mcg daily. An antioxidant and immune system stimulant.
Selenium Supplement, Yeast Free, NOW Foods, 200 mcg, 180 Caps,
Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.,
Ionic Selenium, Trace Minerals, 300 mcg, 2 fl. oz.,
Selenium, 100% Natural, Nature's way, 200 mcg, 100 Caps
7-Keto-DHEA As directed on label. Slows overall body deterioration. Enhances fat loss and lean muscle mass development. Preferable to ordinary DHEA because it is not converted to sex hormones in the body.
7-Keto DHEA, Metabolite of DHEA, NOW Foods, 25 mg, 90 Caps
Ultra Osteo Synergy
As directed on label. To provide nutritional support for bone renewal. Vitamin A 25,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. Important antioxidants. Use emulsion forms for easier assimilation.
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels
As directed on label. An antioxidant and precursor of vitamin A. Antioxidant and free radical scavengers.
Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels,
Multi-Carotene Antioxidant, Nature's Way, 60 Softgels
Vitamin C With Bioflavonoids 3,000-5,000 mg daily. Promotes production of the antiviral protein interferon in the body. Also an antioxidant and immune stimulant. Use a buffered ascorbic acid or an esterified form such as Ester-C with Bioflavonoids.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 Tabs
Vitamin D-3 800 IU daily. Aids in calcium absorption.
Vitamin D, NOW Foods, 2000 IU, 120 SoftGels,
Vitamin D, NOW Foods, 1000 IU, 180 SoftGels,
Dry Vitamin D, Nature's Way, 100% Natural, 400 IU, 100 Caps
Vitamin E 200 IU daily or 400 IU every other day. Important for circulation, destroys free radicals, and protects the nervous system. Use d-alpha-tocopherol form. Emulsion for is recommended for easier assimilation and greater safety at high doses.
Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
200 mcg 2 times daily
As directed on label.
Contains a balance of essential minerals plus chlorophyll, which cleanses the blood. Helps to prevent nausea and vomiting. See more Alfalfa information under Herbs above.
Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps,
Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.,
Alfalfa, NOW Foods, 650 mg, 500 Tabs,
Alfalfa Tincture, 2 fl. oz.,
Chlorophyll With Alfalfa Powder, 100 mg, NOW Foods, 90 Caps,
Helpful Brewer's Yeast Start with 1/4 teaspoon daily and slowly increase to 2 teaspoons daily. A good source of B vitamins. Improves blood sugar metabolism when taken with chromium. Aids in lowering cholesterol and improving HDL/LDL ration.
Brewer's Yeast, Debittered, NOW Foods, 1 lb.,
Brewer's Yeast, NOW Foods, 650 mg, 200 Tabs
Chromium Picolinate As directed on label. Helps to build and maintain muscle mass. Useful if muscle atrophy exists. Works with Brewer's Yeast to improve blood sugar metabolism.
Chromium Picolinate, NOW Foods, 200 mcg, 100 Caps,
Ionic Chromium Supplement, Trace Minerals, 550 mcg, 2 fl. oz.,
Chromium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
Fresh Wheatgrass Juice
Such as Kyo-Green from Wakunaga
As directed on label or 1 teaspoon in liquid 3 times daily. A good source of organic chlorophyll, live enzymes, vitamins and minerals plus amino acids and important nutrients. Wheatgrass is used to for the treatment of cancer in many cancer clinics.
Wheat Grass Powder, Organic, 10 oz.,
Wheat Grass Powder, Single Serving Packets, 15 Packets,
1 tablespoon 3 times daily, before meals.
1,200 mg 3 times daily, with meals.
Protects the cells. Needed for normal brain function.
Lecithin Vegetarian Granules, NOW Foods, 97% Phosphatides, Identity Preserved Non-GE, 1 lb,
Lecithin Liquid, NOW Foods, Vegetarian, 16 fl. oz.,
Lecithin Concentrate, Nature's Way, 400 mg, 100 SoftGels
Manganese 5-10 mg daily. Take separately from calcium. An important mineral often deficient in people with MS.
Manganese Ionic Mineral Supplement, Fully Absorbable, 30 +/- ppm, 16 fl. oz.,
Multi-Vitamin & Mineral Complex As directed on label. All nutrients are needed in balance for healing, normal cellular function and repair and for immune response. Needed for all enzyme systems in the body and to supply needed nutrients. Use high potency formula.
Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 32 fl. oz. (98% Bio-Available for Absorption), Damage Control Master Formula, High Potency, Multi-Vitamin & Mineral, 60 Packets (30 Day Supply)
Phosphorus 900 mg daily. Needed for transfer of energy within cells.
MULTIPLE SCLEROSIS (MS) SUPPLEMENTS & PRODUCTS
Information, products and supplements for multiple sclerosis (MS), an immune system disorder that causes the body's own antibodies to attack the myelin sheath in the brain and the spinal cord, causing inflammation and scarring.
Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps
Nature's Way Alfa-Max Alfalfa Extract capsules is a 10x extract of fresh green Alfalfa leaves.
Alive! Whole Food Energizer Multi-Vitamin & Mineral With Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tabs
No other supplement contains more life-giving nutrients than Nature's Way Alive Multi-Vitamin. Alive Multi-Vitamin is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.
Antioxidant Formula, Antioxidant Supplement, All Natural, Nature's Way, 100 Tabs
Nature's Way Antioxidant Formula supplement is 100% natural.
Ashwagandha Root Tincture, 100% Organic, 2 fl. oz.
Ashwagandha root is said to improve physical energy, strengthen immunity and increase sexual activity.
Broad Spectrum Formula Enzyme Active Food Enzyme Supplement, Nature's Way, 275 mg, 90 Caps
A Food Enzyme supplement supports the modern diet. It helps to restore food enzymes lost in processing and cooking.
Cat's Claw Bark, Nature's Way, 485 mg, 100 Caps
Cat's Claw Bark is a traditional tonic herb for well being, Cat's Claw was historically used by the indigenous people of South America to stimulate the immune system in a variety of serious ailments.
Cat's Claw Bark (Uncaria Tomentosa) Powder, 4 oz. Bulk
Cat's Claw Bark (Uncaria Tomentosa) was reputed to be a super drug in the Andean region of South America. It has a long history of indigenous use for arthritis and rheumatism as well as other types of inflammation associated with various stomach disorders and ulcers where it was clinically shown to be effective.
Cat's Claw Bark Tea Spice System Builder, Regular, Loose Leaf, 8 oz.
Reduces inflammation in arthritis, protects the body from harmful substances, supports the body while undergoing cancer treatments, helps to boost the immune system.
Cat's Claw Extract, Standardized, Nature's Way, 335 mg, 60 Caps
Nature's Way Cat's Claw extract, also known as Una de Gato is derived from the bark of plants wild-harvested in Peru and Brazil.
Choline & Inositol, 100% Natural, Nature's Way, 250 mg / 250 mg, 100 Caps
Nature's Way Choline Inositol is 100 percent natural crystalline Inositol and choline bound to tartaric acid for superior absorption.
Colon & Liver Cleanser, Truman's CAC Tea, Loose Leaf, 1/2 lb.
Use of this cleansing tea has many additional benefits: improves overall digestion; strengthens the immunity; helps to prevent cancer; makes the skin more emollient and flexible: clears the eyes; and provides an overall tonic effect on the body.
Colostrum Nature's Gift To The Immune System, Revised & Updated, By Beth Ley, Ph.D.
Colostrum offers help for: auto-immunity (Arthritis, Multiple Sclerosis, Allergies, Asthma) immune deficiency, Cancer, Inflammation, etc. plus offers Growth Factors to benefit Athletes and Body Builders (speeds tissue healing).
CoQ10, All Natural, Hypoallergenic, Nature's Way, 60 mg, 60 Softgels
CoQ10 is vital for cellular energy production and is a powerful antioxidant and free radical scavenger.
Coral Calcium (Okinawa) Plus Magnesium & Vitamin D, 100% Natural, NOW Foods, 500 mg, 100 VCaps
Okinawa Coral Calcium Plus with Magnesium, Vitamin D and 70 other trace minerals provides essential minerals, restores body alkalinity, supports the immune system, and is bio available for better absorption.
Enzymes & Enzyme Therapy, How To Jump-Start Your Way To Lifelong Good Health, By Anthony J. Cichoke, D.C., Abram Hoffer, M.D.
Updated edition, enzyme authority Cichoke expands on his 5-Step Jump-Start Plus Enzyme Program.
Flax Seed Oil Super, Cold Pressed, 100% Organic, (20%) Lignan, Nature's Way, 16 fl. oz.
Super Lignan Flax Seed Oil is a rich, vegetarian source of omega-3 and omega-6 essential fatty acids beneficial for many ailments.
Flax Seed, Whole, Certified Organic, 1 lb. Bulk
Flax Seeds are an important source of polyunsaturated fatty acids, including Omega-3, plus Magnesium, Zinc and dietary fiber. Flax oil from flax seeds is the richest known source of linolenic acid.
Kombucha Miracle Fungus, Kombucha Tea Benefits, By Harald Tietze, Paperback
One time best seller, Kombucha Miracle Fungus is all about synergy and Kombucha Tea Benefit's it is an easy read for those interested in the synergy Kombucha offers or Kombucha benefit's.
Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps
Lactobacillus Acidophilus Supplement taken as a dietary supplement may help to detoxify and to rebuild a balanced intestinal flora.
Lecithin Concentrate, Nature's Way, 400 mg, 100 Softgels
Nature's Way Lecithin Supplement is 100% natural from soy oil and it contains no artificial ingredients or preservatives.
Manganese Ionic Mineral Supplement, Fully Absorbable, 30 +/- ppm, 16 fl. oz.
WaterOz Ionic Manganese is a pure liquid Manganese supplement. Manganese, also called the "brain mineral," is important in the utilization of all mental facilities/functions.
Manuka Honey & Bee Venom, Antiflex, GMO Free, 8 oz.
Manuka Honey & Bee Venom, Actiflex, GMO Free has been used to enhance the immune systems battle against Arthritis & MS. Combined Pure Organic Manuka Honey and Bee Venom direct from New Zealand.
MSM Supplement (Methylsulfonylmethane), 1000 mg, 120 Caps Plus Free 4 oz. Lotion
Buy MSM Supplement caps and get a 4 oz Lotion free, MSM supplement plays a beneficial role in connective tissue and joint flexibility, immune health, arthritis, osteoporosis, rheumatoid arthritis, inflammation, pain, hair, skin, nails, athletic injuries, acne, wrinkles and allergies.
Nerves Formula Tincture, 2 fl. oz.
The Nerves Formula was created to help calm and soothe the nerves. Can also help arteriosclerosis / atherosclerosis, arthritis, auto-immune diseases.
Nerves & Tension Tincture, 2 fl. oz.
To soothe the nervous system, which may help reduce stress and benefit Hyperactivity/Hyperkinetic, Mental Fatigue, Migraine Headache, Muscular Problems (aches, pain & spasms), Nervous Disorders, Neuralgia, Palsy, Parkinson's Disease, Schizophrenia, Spasms, Stress, and Tension among other things.
Odorless Garlic Supplement, NOW Foods, 50 mg, 250 Softgels
Odorless Garlic supplement is extracted from Allum sativum and is a specially made Japanese product. Our Odorless Garlic yields high amounts of Scordiin, a unique sulfur compound which may be responsible for many of garlic's renowned benefits.
Ola Loa Vitamin Energy Supplement, Powder Drink Mix, Orange Repair, 30 Packets
Ola Loa is the most extensive vitamin and mineral supplement available in a great tasting effervescent energy drink.
Planetary Herbals Myelin Sheath Support, 820 mg, 90 Tabs
Planetary Herbals Myelin Sheath Support is a comprehensive botanical preparation, designed to support the fat-like insulating sheath (myelin) that surrounds certain nerve tissues.
SAM-e With B Vitamin Cofactors, Vegetarian, Enteric Coated, NOW Foods, 200 mg, 60 Tabs
Important for the production of glutathione, this powerful free radical scavenger defends the body from toxic agents and is necessary for liver detoxification.
Samento (Uncaria Tomentosa), Extra Strength (100 Times More Effective Than Regular Cat's Claw), 0.5% POA, 600 mg, 30 Caps
Samento is beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.
Samento (Uncaria Tomentosa), Liquid Extract, 0.5% POA, 1 fl. oz.
Beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.
Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Selenium is pure liquid Selenium supplement. Selenium promotes normal body growth, enhances fertility, encourages tissue elasticity and is a potent antioxidant that naturally reduces the retention of toxic metals in the body. Selenium is crucial for the proper functioning of the heart muscle and there is evidence that it can help the body fight cancer.
Sulfur Ionic Mineral Supplement, Fully Absorbable, 500 +/- ppm, 16 fl. oz.
WaterOz Ionic Sulfur is a pure liquid Sulfur supplement. increases blood circulation, reduces back pain, relieves migraine headaches, promotes muscle healing, scavenges free radicals, beautifies the skin, relieves allergies to food, controls acidity in stomach ulcers, is important for carbohydrate metabolism and speeds wound healing.
The Cure For All Advanced Cancers Book, By Dr. Hulda Regehr Clark
According to the Author, Cancer Can Now Be Cured, not only the early stages, but also advanced cancer, stages four and five, including imminent death.
Vitamin B-50 Complex With B-2 Coenzyme, 100% Natural, 330 mg, 100 Caps
B Vitamins, as found in a Vitamin B Complex, are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.
What You Need To Know About Multiple Sclerosis, Muscular Dystrophy & ALS, By Kurt W. Donsbach
This book, What You Need to Know About Multiple Sclerosis, Muscular Dystrophy & ALS, will help you understand the physiology of MS, MD and ALS, learn how to assist the body with nutrition and how to apply proper dietary habits for specific conditions.
Yeast Connection & Women's Health, By William Crook, M.D. & Hyla Cass, M.D.
Covering vaginitis, migraines, multiple sclerosis, depression, and more, this book is a completely revised and updated version of Dr. Crook's classic The Yeast Connection And The Woman.
Yeast Connection Handbook, By William Crook, M.D.
This easy-to-follow Yeast Connection Handbook brings readers the latest information about yeast related disorders and how to overcome them.
You Can Heal Your Life, By Louise L. Hay, Dave Braun
Hay believes we make ourselves ill by having thoughts of self-hatred. She includes a directory of ailments and emotional causes for each with a corresponding affirmation to help overcome the illness.
Herbal Remedies: Multiple Sclerosis (MS) Information, Symptoms & Causes
Herbal Remedies: Multiple Sclerosis (MS) Information
Herbal Remedies: Multiple Sclerosis (MS) Supplements & Products
NOTIFY YOUR HEALTH CARE PROVIDER IF...
EARLY WARNING SIGNS OF MS
You should notify your health care provider if you have any of the signs and symptoms associated with MS. Also check with your health care provider if you have any signs or symptoms that may not be associated but that are of concern to you. You may not have MS, but because of the non-specific nature of this disease, it is best to let a qualified professional make that determination.
Several of the symptoms of MS may send you to a hospital's emergency department.
If you experience visual changes and painful eye movements, visit the nearest emergency department. You could have optic neuritis, one of the most common early signs of MS. If you can be treated with corticosteroid medication shortly after optic neuritis develops, the course of the disease may be altered.
If you have changes in personality, sudden loss of strength in the arms and legs, or respiratory difficulty, you should go to the emergency department for evaluation. These symptoms are common with MS, but they can also be signs of other serious diseases, such as stroke, infection, or chemical imbalances.
For a full list of available products from Mountain Rose Herbs, click on banner below:
HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.
Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.
HERBS, OILS, & SUPPLIES
MoonDragon's Health & Wellness: Manufacturers & Distributors
Mountain Rose Bulk Herbs
Mountain Rose Herbs, Bulk Herbs A
Mountain Rose Herbs, Bulk Herbs B
Mountain Rose Herbs, Bulk Herbs C
Mountain Rose Herbs, Bulk Herbs D
Mountain Rose Herbs, Bulk Herbs E
Mountain Rose Herbs, Bulk Herbs F
Mountain Rose Herbs, Bulk Herbs G
Mountain Rose Herbs, Bulk Herbs H
Mountain Rose Herbs, Bulk Herbs I
Mountain Rose Herbs, Bulk Herbs J
Mountain Rose Herbs, Bulk Herbs K
Mountain Rose Herbs, Bulk Herbs L
Mountain Rose Herbs, Bulk Herbs M
Mountain Rose Herbs, Bulk Herbs N
Mountain Rose Herbs, Bulk Herbs O
Mountain Rose Herbs, Bulk Herbs P
Mountain Rose Herbs, Bulk Herbs R
Mountain Rose Herbs, Bulk Herbs S
Mountain Rose Herbs, Bulk Herbs T
Mountain Rose Herbs, Bulk Herbs U
Mountain Rose Herbs, Bulk Herbs V
Mountain Rose Herbs, Bulk Herbs W
Mountain Rose Herbs, Bulk Herbs Y
Mountain Rose Aromatherapy Oils
Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
Mountain Rose Herbs.com: Order Online
Accessories & Tools
Aroma Sprays and Flower Waters
Body and Bath
Bottles, Jars & Containers
Green & Black Teas
Herbal Salves & Balms
Herbs for Pets
Incense, Resins and Candles
Medicinal Herb Seeds
Tea Brewing Supplies
Click Here To Visit Herbal Remedies Product Page
A Source For Medicinal & Ritual Herbs & Supplies
Aphrodisiacs Aromatherapy Bath & Body Care Bulk Herbs By The Pound Capsules, Tablets & Extracts Chinese Herbals Electronics Extracts First Aid Products Food Products, Mixes, Seeds, Snacks & More! Hair Care Products & Supplies Herbs & Oils, Kilo & Ton Hydroponics & Gardening Kava Products Kitchen & Housewares Mushrooms Musical Instruments Oral Care & Dental Products PC & IT - Computer Supplies & Assessories Skin Care, Cosmetics, & Gift Sets Smokes, Seeds, Cacti Spices, Salts, Sweeteners, & Seasonings Sports, Toys & Games Sweets, Candy, Chips & Snacks Stimulants Sedatives Teas & Coffees
Shaman Shop Home Page
MoonDragon's Nutrition Information Index
MoonDragon's Health & Wellness: Nutrition Basics Index
MoonDragon's Health & Wellness: Therapy Index
MoonDragon's Nutrition Therapy Index
MoonDragon's Alternative Health Information Index
MoonDragon's Aromatherapy Information Index
MoonDragon's Health & Wellness Index
MoonDragon's ObGyn Information Index by Subject Order
MoonDragon's ObGyn Information Index by Alphabetical Order
MoonDragon's Main Indexlisting
MoonDragon's Home Page