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Archive for the tag “MS”

On the Horizon: The Future of MS Treatments

By Benjamin Segal, MD, as told to Kara Mayer Robinson

We’ve come a long way in treating MS — it’s been one of the biggest success stories in medicine. Over the last 20 years, there has been a revolution in drugs that change the course of the disease, particularly relapsing-remitting multiple sclerosis (RRMS).

Back when I was in training, we had no drugs that altered the prognosis of MS or prevented attacks. The only thing we had were steroids. We gave them to people during serious attacks to speed recovery. But we had nothing to lower someone’s chances of developing the disease. We also couldn’t stop future attacks, put off disability, or make it less serious.

Now there are more than 15 FDA-approved drugs that do just that. They include shots you can give yourself, pills, and intravenous infusions. But they differ in how effective they are and the side effects they have. And we don’t have a way to predict which patient will respond best to which drug.

The goal of MS specialists now is what we call “no disease activity.” This means no relapses, no new lesions, and no ongoing development of disability. For many patients, we can achieve that, especially those with RRMS.

There have also been changes in how we look at secondary progressive multiple sclerosis (SPMS). In the last several years, three drugs have been approved for both RRMS and SPMS. Before that, there were no drugs approved for SPMS, except one very potent chemotherapy that we don’t use anymore.

We now have evidence that early treatment, and particularly treatment with certain drugs, may delay the conversion of RRMS to SPMS. In some cases, patients don’t have gradual decline over the course of decades.

What’s on the Horizon

Many new therapies are being studied to advance MS treatment even more. Two important areas of study are how to promote repair in MS and how to treat progressive MS.

Remyelination and Repair

In people with MS, myelin is destroyed, which causes a lot of symptoms. Researchers are looking at different strategies to help the body form new myelin, the protective coating around nerves.

Some clinical trials target molecules that normally suppress the growth of myelin. Researchers are now looking at a protective or pro-regenerative part of the immune system that we can manipulate to protect damaged neurons and stimulate new fiber growth.

My group at the Ohio State University just published a paper about our discovery of an immune cell that rescues damaged nerve cells from dying. It also stimulates nerve fiber regrowth. It may not only stop further damage of the central nervous system, but it may also reverse damage and restore function.

Treating Secondary Progressive MS

We’ve made progress with SPMS medication, but there’s more to be done.

Data suggests three drugs recently approved for SPMS are somewhat effective in a subset of younger people who still have new inflammatory lesions. But they’re unlikely to help those who are further along with the disease. So the quest is to find treatments for those people.

A few pills being tested in trials show promise. One of them suppresses the immune cells that are normally found in the brain and spinal cord. It stops the body from activating them. In a recent phase II trial, it slowed the progress of disability in people with inactive, progressive MS.

Finding the Right Treatment for Each Person

Right now, we can’t predict which patient will respond best to which drug. But there are a lot of ongoing studies that predict which drug will be the most effective in a given individual.

Researchers are also looking for biomarkers to develop blood tests that may tell us if someone’s more likely to respond to one drug versus another.

Vitamin D, Antioxidants, and Gut Microbiome

Some studies show that very low levels of vitamin D raise your chances of developing MS. Now there are studies to see if boosting vitamin D levels with extra supplements may tamp down new attacks or new lesions for people who already have it.

There are also studies that look at the gut microbiome and if you can manage MS better by changing the bacteria in your gut.

It’s not conclusive yet, but researchers are looking at whether certain antioxidants may alter treatment or management of MS. One is called lipoic acid. A few studies suggest it may slow the loss of brain tissue in people with MS. There will likely be future studies that look at lipoic acid and other antioxidants in greater detail.

New Ways to Manage Symptoms

One of the most common and hard-to-manage symptoms of MS is fatigue. There are studies on pills and cognitive rehabilitation therapy to treat it. There’s also a lot of research into improved prosthetics and robotics to help patients with MS to function better.

Early, Aggressive Treatment

Now that we have highly potent drugs to treat MS, there’s a debate about whether it’s better to start early treatment with aggressive drugs or to start with lower-potency drugs and then step up (escalate) to more potent ones.

A recent study suggests that people treated with higher-potency drugs from the start are less likely to transition to SPMS years down the line. New studies that compare aggressive early treatment to escalation therapy may help us know more.

The Outlook

Right now, many of my patients with MS are living full lives. I’ve seen people who’ve been relapse-free for 2 decades with no new lesions. No one would know that they had MS.

This is a completely different situation from when I was a resident in training. Then, most people we saw went on to need assistance devices and had to stop working.

A cure is very difficult to predict. We’re more likely to find treatments that help relapsing-remitting disease and maybe completely stop the progress of the disease. A cure may take a little longer.

MS: Strangest Symptoms From Head to Toe

Extreme fatigue, clumsiness, weird prickly sensations, sluggish thinking, wonky vision — these are classic and common first symptoms of multiple sclerosis, or MS. But the expected stops here. Damage to the central nervous system, aka your brain and spinal cord, is what causes these symptoms. That’s a wide range of functions that affect many different people. So it can show up in some strange and varied ways. Watch this slide show (1 / 15).

https://www.webmd.com/multiple-sclerosis/ss/slideshow-unusual-symptoms-ms?ecd=wnl_mls_040921&ctr=wnl-mls-040921_leadCTA&mb=q80%2F%40kIeuyYKtyaYzOxdbc6RVoMqf%400VkpmvpK5yEEQ%3D

Top 7 benefits of having pets in our MS life

There is more to it than just the snuggles. Having pets in our lives has a wide range of benefits. They help us cope, lift us from feelings of loneliness and depression, and get us outside for a bit of sunshine and exercise.

1. Pets keep us company.

Living with a companion animal can help ease feelings of isolation. Having a buddy by your side can make such a big difference in minimizing the feelings of loneliness. Even if the conversation is only one way…

2. Pets can help us fight depression

Taking care of pets (walking them, grooming them, petting them, playing with them) takes you out of yourself and helps you feel better. Our pets’ love is unconditional so, good day or bad, they have a lot to give us. Well, that is unless your name is Hans who, when he doesn’t get the treats he persistently begs for in the morning, may not be spreading the love quite as far.

3. Pets give us a sense of support and pleasure

Our life with MS should focus more on the good parts, not the un-fun stuff, right? Having pets makes us feel good. They’re cute and they’re sweet and they’re funny and they’re snuggly. All good stuff that makes living with MS a bit more bearable.

4. Pets get us outside when we might not otherwise

When we walk Spot, we sometimes meet others along the way, stopping for conversation, watching dogs do the funny things they do. It’s a great social outlet. Plus, there’s the added benefit of soaking some of that sun vitamin!

5. Pets calm us and relieve our anxiety

This is a big one for me as I am slightly neurotic. Hans is chill so he keeps me chill, not an easy feat. Om.

6. Pets help us minimize stress

This is huge for us, as stress is often the culprit when our symptoms flare up.

7. Pets help us improve our physical fitness

After all, exercise is important for MSers and, taking your dog for short walks or tossing their favorite toy in the backyard, helps keep us moving. This includes basic stretching. I can’t tell you how many times Hans watches us at home, with keen interest and curiosity, as we stretch or do some yoga. Eventually, he gets right on the floor with us to do a bit of stretching himself. Kitty Yoga. Hilarious!

7 Lifestyle Changes to Help Slow MS Progression

MS is a lifelong disease. Your symptoms may gradually get worse as it progresses and parts of the brain and spinal cord get damaged. But a few simple lifestyle changes can help you stay mobile and have a good quality of life for a long time.

Stick With Your Treatment

There are more than a dozen medicines that doctors recommend to prevent relapses and slow MS. These treatments can help you feel better, but only if you take them.

Treatment Timeline

The goal with MS treatment is to prevent more trouble, says Randall Trudell, MD, an expert on this neurological disease. He says there are many effective medications from pills to infusions to help prevent relapses.

It can be hard to think about taking medications for many years to come. But the sooner you get on the right medicine routine and the longer you stick with it, the better you’ll control your disease.

Some people stop taking their medicine because they don’t think that it helps them or they have side effects. Talk to your doctor if that happens. They may be able to adjust your dose, switch you to a new drug, or help you manage any side effects you do have.

If you’ve stopped treatment because you can’t afford your medicine, check with the MS Society or the company that makes the drug. They may be able to help you cover the cost.

It’s also important to manage any other health problems you have. Heart disease, diabetes, lung disease, and depression can all make your MS progress more quickly. See your primary care doctor or a specialist to get diagnosed and treated.

Exercise

Years ago, doctors warned people with MS to avoid exercise because they thought it could make the disease worse. Today they know that the opposite is true.

Exercise strengthens the muscles that help you walk. It also eases fatigue, boosts mood, and improves quality of life in people with MS. There’s even some evidence that strength training might help slow MS damage in the brain.

An exercise program for MS includes 150 minutes of “aerobics” each week. These are activities that get your heart pumping, like walking or swimming. Work out at your own pace and level. Also stretch for at least 10 minutes each day to release tight muscles.

Use weights or resistance bands twice a week to strengthen your muscles. A physical therapist can show you how to do each exercise correctly to prevent injury.

Eat a Healthy Diet

A balanced diet is important for your health in general, but especially when you have a long-term disease like MS. Research shows that people with MS who eat a lot of fruits, vegetables, and whole grains have less disability and fewer symptoms like depression and fatigue than those who eat less of these healthy foods.

Limit processed foods and animal fats like red meat and butter. Get your fats from healthier sources such as fish, nuts, avocados, and olive oil.

Vitamin D

People who have higher levels of vitamin D in their blood are at lower risk of getting MS. Research is underway to see if there’s a link between vitamin D levels and curbing your relapses. 

You can get your daily vitamin D from foods like fatty fish and fortified milk. Your body also makes its own stores of this vitamin when your skin is in sunlight. A blood test can show whether you’re low in vitamin D. If so, a supplement will help boost your levels to where they need to be.

Get Restful Sleep

A lack of sleep may not make your MS progress, but it can certainly make you feel worse. It’s hard to fall asleep and stay asleep all night when you’re in pain, you feel depressed, or you have to get up to use the bathroom many times. Steroids and other medicines you take to control MS can also keep you awake.

Ask your doctor whether any of your MS medicines could be affecting your sleep. Treat pain and other symptoms that are getting in the way of a restful night’s sleep. Try to relax and let go of stress before bed with a warm bath, calming music, or a good book.

Don’t Smoke

Yet another reason not to smoke is that it can make your MS get worse, more quickly. Smoking also raises your chances of getting heart and lung diseases, which speed up MS progression.

It’s not easy to quit, especially if you’ve smoked for many years. But when you do kick the habit, you’ll start to see health benefits right away. Make a plan to quit, get support from your doctor and friends, and have medicines and other tools on hand to lessen the urge to smoke when it hits.

Get Vaccinated

Infections like the flu can make your MS relapse and your symptoms flare up. Get your flu vaccine each fall to avoid getting sick. If you take a disease-modifying drug for MS, don’t get the FluMist nasal spray because it’s a live vaccine. Since your immune system — the body’s defense against germs — is weaker from MS, the flu shot, which contains a dead form of the virus, is safer for you.

Ask your doctor whether you’re up to date on all the other vaccines you need to stay healthy.

From: WebMD

New advice for people with MS

Advice for people with MS

Current evidence shows that simply having MS does not make you more likely to develop COVID-19 or to become severely ill or die from the infection than the general population. However, the following groups of people with MS are more susceptible to having a severe case of COVID-19:

  • People with progressive MS
  • People with MS over the age of 60
  • Men with MS
  • Black people with MS and possibly South Asian people with MS
  • People with higher levels of disability (for example, an EDSS score of 6 or above, which relates to needing to use a walking stick)
  • People with MS and obesity, diabetes or diseases of the heart or lungs
  • People taking certain disease modifying therapies for their MS (see below)

All people with MS are advised to follow World Health Organization guidelines for reducing the risk of infection with COVID-19. People in the higher risk groups should pay particular attention to these measures. We recommend to:

  • Practice social distancing by keeping at least 1.5 metres* distance between yourself and others, to reduce your risk of infection when they cough, sneeze or speak. This is particularly important when indoors but applies to being outdoors as well.
  • Make wearing a mask a normal part of being around other people and ensure that you are using it correctly by following these instructions.
  • Avoid going to crowded places, especially indoors. Where this is not possible, ensure to wear a mask and practise social distancing.
  • Wash your hands frequently with soap and water or an alcohol-based hand rub (70% alcohol content is considered most effective).
  • Avoid touching your eyes, nose and mouth unless your hands are clean.
  • When coughing and sneezing, cover your mouth and nose with a flexed elbow or tissue.
  • Clean and disinfect surfaces frequently especially those which are regularly touched.
  • Talk to your healthcare provider about optimal care plans, through video consultations or in-person visits where needed. Visits to health clinics and hospitals should not be avoided if they are recommended based on your current health needs.
  • Stay active and try to take part in activities that will enhance your mental health and well-being. Physical exercise and social activities that can take place outside and with social distancing are encouraged.
  • Get the seasonal flu vaccination where it is available and encourage your family to do the same.

Caregivers and family members who live with, or regularly visit, a person with MS in one of the higher risk groups should also follow these recommendations to reduce the chance of bringing COVID-19 infection into the home.

* (National and international guidelines on physical distancing vary between at least 1 metre and 2 metres. People should consider their national guidance and be aware that these are minimum distances, longer being better.)

Advice regarding disease modifying therapies for MS

Many disease modifying therapies (DMTs) for MS work by suppressing or modifying the immune system. Some MS medications might increase the likelihood of developing complications from COVID-19 but this risk needs to be balanced with the risks of stopping or delaying treatment.

We recommend that people with MS currently taking DMTs continue with their treatment, unless advised to stop by their treating clinician.

People who develop symptoms of COVID-19 or test positive for the infection should discuss their MS therapies with their MS care provider or another healthcare professional who is familiar with their care.

Before starting on any new DMT or changing an existing DMT, people with MS should discuss with their healthcare professional which therapy is the best choice for their individual circumstances. This decision should consider the following information:

  • MS disease course and activity
  • The risks and benefits normally associated with different treatment options
  • Additional risks related to COVID-19, such as:
    • The presence of other factors for a more severe case of COVID-19, such as older age, obesity, pre-existing lung or cardiovascular disease, progressive MS, higher risk race/ethnicity etc, as listed above
    • The current and anticipated future COVID-19 risk in the local area
    • Risk of exposure to COVID-19 due to lifestyle, for example whether they are able to self-isolate or are working in a high-risk environment
    • Emerging evidence on the potential interaction between some treatments and COVID-19 severity

Evidence on the impact of DMTs on COVID-19 severity

Interferons and glatiramer acetate are unlikely to impact negatively on COVID-19 severity. There is some preliminary evidence that interferons may reduce the need for hospitalisation due to COVID-19.

The evidence available suggests that people with MS taking dimethyl fumarate, teriflunomide, fingolimod, siponimod and natalizumab do not have an increased risk of more severe COVID-19 symptoms.

There is some evidence that therapies that target CD20 – ocrelizumab and rituximab – may be linked to an increased chance of having a more severe form of COVID-19. However, these therapies should still be considered as an option for treating MS during the pandemic. People with MS who are taking them (or ofatumumab and ublituximab that work in the same way) should be particularly vigilant regarding the advice above to reduce their risk of infection.

More data on the use of alemtuzumab and cladribine during the COVID-19 pandemic are required to make any assessment of their safety. People with MS who are currently taking these therapies and are living in a community with a COVID-19 outbreak should discuss their current lymphocyte counts with their healthcare professional. (Lymphocytes are a type of white blood cell that helps protect the body from infection). If their counts are considered to be low they should isolate as much as possible to reduce their risk. Recommendations on delaying second or further doses of alemtuzumab, cladribine, ocrelizumab and rituximab due to the COVID-19 outbreak differ between countries. People who take these medications and are due for the next dose should consult their healthcare professional about the risks and benefits of postponing treatment. People are strongly encouraged not to stop treatment without the advice of their clinician

Am I Lazy or Is MS Actually to Blame?

By Matt Allen G · October 15, 2020

Most people living with multiple sclerosis have probably experienced the feeling that others think they are lazy. Or maybe they have flat out been accused! At the very least, I’m sure everyone has encountered at least one other person with MS who has shared this experience. It can be painful to feel like you’re being looked at as a human sloth due to your inability to “keep up” because if you have MS, you can’t help it. MS commonly causes people to not be able to do the things they once could. But lately, I’ve been catching myself wondering if I really am lazy.

Are people with MS lazy?

Why do people think we are lazy? Well, in my opinion, this is an easy question to answer. People tend to believe what they see. I think it’s human nature. With that in mind, what do we know about symptoms such as fatigue, spasticity, pain, or vertigo? They’re invisible. You can’t see them, which means the people around you only get to see you “lying around doing nothing.” They see the ‘what’ but not the ‘why.’

Making assumptions based on appearances

Since people usually accept the easiest explanation as the most likely explanation, you can see why they would jump to the conclusion that you’re just being lazy. I find this really frustrating, but I do understand it. I’m sure I’ve made similar assumptions based on appearances even when I know that you can’t judge a book by its cover. That’s just how our brains work. It’s up to us to catch ourselves in moments like this and seek the entire picture before reaching a conclusion.

Explaining that I’m not lazy

This all leads to one of the most challenging and irritating parts of everyday life with MS: trying to explain to people that there is something there, even though they can’t see it. It’s unfortunate, but this is a burden that falls on us – the ones living with this illness. It can be really hard to explain something that we ourselves don’t entirely understand. But I guess it’s just another responsibility that came with MS. Having to teach others around us about a disease we are often still learning about ourselves. Sometimes we succeed, but a lot of the time we don’t. That is one more thing in life with MS that we don’t have much control over.

But what if it’s not MS?

Despite everything I know, and despite the fact that I would tell anyone else saying what I’m about to say that they are wrong, I have caught myself wondering…am I? Am I lazy, or is it really just my MS? The thought comes from a small part of my brain, but it actually raises many questions for me. Questions like, “Why do I feel lazy?” “What am I doing to make myself feel lazy?” and “What can I do to stop feeling this guilt?”

Why couldn’t I get more done?

I’ve literally been having a hard time falling asleep at night because this question has really been weighing on me lately. I lie there thinking about everything I accomplished for the day and wondering why I couldn’t do more. Why I didn’t exercise. Contemplating how I might be able to get more done tomorrow. Listening to my inner-monologue debate, whether it’s a matter of how or if I can achieve more. Because maybe it really is just me? Perhaps I really am just lazy?

What I know and feel don’t always match

This is just one example of how MS can cause conflicting thoughts and emotions. I know I’m not lazy. I hate it when I’m not busy. I hate feeling like I wasted another day. I could never live a life of idle luxury without losing my mind. I know about and have felt the benefits of exercise, especially when I compare it to how I feel when I don’t.

At the same time, I often feel like I can’t keep up with my responsibilities in life. Sometimes I feel like the world is asking way too much of me, sometimes. So, at times I feel like I am lazy and subconsciously using my MS as an excuse. This all leads to the heavy feeling of guilt that’s been keeping me up at night. What I know and what I feel about my MS don’t always match.

Trying to make sense of how I feel

Turning back to my bedtime reflecting on the day and trying to make sense of the mess of thoughts and feelings I’ve been living with, the answer seems obvious. I’m currently not doing as much as I did even just six months ago. I’m not going on my morning walks, I’m not leaving the house to run errands, and I’m not exercising the way I should be. It would be easy to blame this on the pandemic, but that’s an excuse that can quickly be debunked with ease. The only blame I can actually attribute to that excuse is how it “shook up” my routine.

Getting back over the hump

Just because things are different and maybe even a little more complicated doesn’t mean they are impossible. I know I can still do most of those things – I’m specifically referring to exercise – even if they aren’t as easy or comfortable. But because I’m not? I’ve found myself back at the bottom of the hill you have to overcome to feel the positive benefits of exercise. I think if I can get back over that “hump,” I’ll start feeling less lazy and more productive because getting the amount of work and healthcare chores I’ve gotten done lately doesn’t seem to be helping.

Staying Healthy and Minimizing the Spread of COVID-19

The federal government and the CDC are proactively working to minimize the introduction and spread of this virus within the United States. More time is needed for researchers to gain a greater understanding of the specific virus (SARS-CoV-2) that causes this specific coronavirus (COVID-19), before a vaccine and treatments may be developed. Until these become available, the CDC explains that “Nonpharmaceutical Interventions” (NPIs) are actions that people and communities can take to help slow the spread of illnesses.

Also known as “community mitigation strategies,” and independent of medications and vaccines, examples of these types of actions include disinfecting surfaces, washing hands, staying home when sick, increasing the distance between people at public gatherings, canceling or postponing special events, and closing schools and/or businesses as needed. Avoiding travel to affected countries, as well as keeping a distance from anyone showing symptoms of the coronavirus, is also vital to minimizing the spread of the coronavirus.

Staying healthy and reducing one’s risk is another important factor. The CDC and MSAA recommend the following “healthy habits” for preventing the flu (and other illnesses):

Get a flu vaccine and help stop the spread of germs (if recommended by one’s doctor) *Please note that the current flu vaccine is NOT effective against COVID-19; it is only noted to otherwise help people remain in good health.

Continue taking a disease-modifying therapy (DMT) and do not make any changes to one’s treatment regimen, unless advised by one’s physician; consult a medical professional with any concerns

Take flu antivirals, if prescribed

Avoid close contact with people who are sick

Stay home when sick, but be sure to consult a medical professional

Individuals should cover their mouth and nose with a tissue when coughing or sneezing, or use the inside of their arm to avoid spreading germs

Washing hands often helps to protect people from germs; if soap and water are not available, an alcohol-based hand rub should be used

Avoid touching the eyes, nose, or mouth – an illness may be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth

Practice other good health habits, such as cleaning and disinfecting frequently touched surfaces at home, work, or school – especially when someone is ill; get plenty of sleep, be physically active, manage stress, drink plenty of fluids, and eat nutritious food

Anyone in close contact to someone with COVID-19 and who develops symptoms of COVID-19 should immediately call his or her healthcare provider to discuss symptoms and exposure

From: The Coronavirus and MS: What You Need to Know. The Motivator – Winter/Spring 2020

Making life easier in the kitchen

Chopped’ winner offers practical tips — and a recipe — for cooking with MS.

Chris Holland went from paralegal to restaurant chef and three-time winner of the cooking competition show “Chopped” in the span of about a decade. And he credits it all to multiple sclerosis.

Holland, who was diagnosed with MS in 2004, says his life “fell apart when I got sick.” But he put his life back together and, with encouragement from his wife, Marge, decided there was no better time to pursue his lifelong dream of becoming a chef. Today, he’s chef and part owner at DVine Bar in Rockland County, New York, where he specializes in what he likes to call “eclectic, weird fine-dining.” He concocts menu items that run the gamut from duck fat potato chips with cipollini onion crema to seared tuna and chanterelles.

“I love it there,” Holland says. “I have a great boss who really understands about my MS.”

Holland figures he applied to be on “Chopped” about 10 times before he got the call. Since then, he’s had an impressive run. He notched his third championship in November 2019, donating the $10,000 prize money to the National Multiple Sclerosis Society as a way to give back to an organization that he says has given so much to him and others. He’s also had a great response to his appearances on the show. He’s particularly happy when he hears from “the young people who were diagnosed. They say it’s so nice to see somebody who’s able to do something like I do.”

It’s not always easy. Standing for long hours in a hot kitchen, wielding knives and other cooking utensils while whipping up that cipollini crema can take its toll on somebody with MS. So, who better to offer a variety of practical tips for making life easier in the kitchen?

Here are chef Holland’s tips, along with a bonus recipe you can make while dreaming about being a “Chopped” chef yourself:

Get a Microplane grater
This grater is one of the most important tools in my kitchen and the best $15 you could ever spend. In addition to providing the delicious zest from a citrus fruit, it has other uses for the quick processing of ginger or garlic. Simply grate the ginger or garlic and avoid the tedious task of chopping these aromatics. You don’t even have to peel them.

Get some help from the supermarket
While I encourage everyone to cook your food rather than buy it, there is nothing wrong with using precooked foods for a head start. Rotisserie chickens are available in most supermarkets and are very affordable. Use them in anything that calls for cooked chicken as an ingredient and save those bones for a stock. Check the salad bar for ready-to-go ingredients that you can use in your own culinary creations.

Slow cookers are your friend
Slow cookers are a great way to stay out of a hot kitchen and avoid spending time on your feet. Many recipes call for 15–20 minutes of prep time, then set it and forget it. Just remember to start cooking early, as many recipes take hours to finish cooking. Slow cookers are also great for soups.

The microwave is not just for reheating coffee and for frozen dinners
This much-maligned kitchen tool does impressive work with vegetables. Hearty greens such as broccoli, green beans and carrots cook beautifully in a microwave. Just wash the vegetables (do not dry) and place them on a ceramic plate and cover with plastic wrap. Microwave on high for three minutes. Check for the desired doneness and add more time as needed. Season afterward with olive oil, lemon, and salt and pepper.

A salad doesn’t have to just be lettuce
A salad is an easy vehicle for incorporating foods beneficial to those living with MS, such as avocado, whole grains such as quinoa or chia seeds (high in fiber), fatty fish such as salmon, trout and tuna (omega 3s), walnuts (omega 3s), and lean proteins such as chicken, turkey and pork tenderloin.

Mediterranean chicken tacos

Cook Time: 15 minutes

Servings: 4

Ingredients:

1 small rotisserie chicken
3 cloves of fresh garlic (grated with a Microplane)
½ teaspoon dried oregano
½ teaspoon ground cumin
Pinch chili flakes (optional)
½ cup extra virgin olive oil plus 3 tablespoons
Juice of half a lemon
Zest of 1 lemon
1 English cucumber (diced)
½ red onion (diced)
2 tablespoons fresh dill (chopped)
1 tablespoon red wine vinegar
½ cup Greek yogurt
Salt and pepper
8 flour tortillas (6-inch)

Directions:

  1. Pull the meat off of the chicken and shred into a large bowl.
  2. In a medium sauté pan, heat the olive oil over medium heat. Check the heat by putting one piece of the diced onion into the pan. It should sizzle immediately upon hitting the oil.
  3. Once the oil is at the correct temperature, turn off the heat, and add the garlic, oregano, cumin and chili flakes. Stir the oil for one minute or until the pan stops sizzling.
  4. Add this oil mixture (reserving 3 tablespoons) along with the lemon juice to the shredded chicken. Season with salt and pepper to taste.
  5. In a separate bowl, add diced cucumber, diced red onion, reserved olive oil, chopped dill, red wine vinegar, and salt and pepper to taste.
  6. In a separate bowl, add Greek yogurt, lemon zest, and salt and pepper to taste.
  7. In a small sauté pan, toast flour tortillas.
  8. To assemble, spread one side of tortilla with the yogurt mixture. Top with chicken and the cucumber “salsa.”

For the leftovers, consider adding shredded mozzarella and making a Greek chicken quesadilla served with lemon yogurt and cucumber salsa.

From:  NMSS

Inside An MS Exacerbation

By Devin Garlit ·

Exacerbation, relapse, flare-up, attack: these are all names for the same thing with regard to Multiple Sclerosis. The general definition of this event is the occurrence of new or worsening of old symptoms lasting for more than 24 hours and taking place at least 30 days after a similar event. While this can be a standard occurrence for those with Multiple Sclerosis, not everyone actually understands what’s going during this period. Understanding what is happening during an exacerbation is critical for those with MS. With that in mind, I’ll do my best to help break it down as simply as I can.

What’s happening to the body during an MS exacerbation?

During one of these moments, the disease has caused your own immune system to attack your body. Specifically, your immune system begins to assault your central nervous system. Its weapon of choice? Inflammation (caused by various immune cells). This inflammation damages myelin, a fatty substance that surrounds and helps insulate our nerves. This insulating layer makes sure our nerves properly conduct the electrical signals that our brain sends to the other parts of our body (think of it as the plastic covering on an electrical wire). When this layer is damaged, those signals don’t move fast enough or at all, which is where we start to see our symptoms. Can’t lift your leg fast enough or at all? The myelin around a nerve between your brain and leg has been compromised and the signal isn’t traveling as efficiently as it should be. Not only does our immune system damage the myelin, but it also damages the cells needed to regrow it.

When the immune system attacks

These moments that we call exacerbations (or whichever term you like) are when the immune system is making its attack. It’s when the immune system has created a lot of inflammation in your central nervous system, and it’s damaging that myelin layer. Not only does this inflammation damage that protective coating, but it also has an effect on those signals that are traveling through that part of the central nervous system. We use steroids to fight exacerbations as they help to reduce this inflammation.

When a relapse is over: the aftermath

When an exacerbation is over, these damaged areas of myelin develop some scar tissue (that’s where we get the term sclerosis in multiple sclerosis, we are left with multiple scars; these scars are also referred to as plaques or lesions). Once all that inflammation is gone or significantly reduced, some of that myelin can regrow, but it never grows back completely or strong enough due to the scarring and because the cells needed to facilitate regrowth have been damaged. This regrowth, coupled with the reduction in inflammation, is why people can seem to bounce back after an exacerbation. They may even seem like they are completely well again. That’s why people often use the term “relapse,” because they seem to improve or go back to the way they were. This is a pattern that is extremely common in people diagnosed with the Relapsing-Remitting form of the disease. However, the more exacerbations you have, the more your ability to bounce back becomes hindered.

Accumulating damage over time

The more scars you have and the more cells that help regrow myelin are damaged, the less you are able to recover. In the past, maybe a damaged nerve could still get the brain’s signal where it needed to go, even if not the most efficiently (unless an outside influence temporarily triggered an issue). As more damage occurs over time though, the ability of that nerve to do its job, no matter the situation, becomes compromised. Basically, that’s how people with MS can worsen over time. That’s why doctors try to not only shorten the length of exacerbations through steroids but to minimize the overall number of them with disease-modifying drugs.

Survey on Complementary/Alternative Medicine Points to Increasing Use by People with MS

The use of complementary and alternative therapies – including vitamin/mineral supplements, mind-body therapies, diet, and exercise – is widespread in MS (81%), according to researchers from Oregon Health & Science University who report on a survey of 1,014 people with MS. It is also on the rise; the team compared these survey results to those of a similar survey conducted in 2001, and found that use of all therapies increased significantly. Respondents to the current survey were nine times more likely to speak with their neurologist about use of these therapies than in 2001.

Many complementary/alternative therapies are considered to be outside the realm of conventional medicine, although others, including vitamin D, exercise, acupuncture, and cooling strategies, for example, have established their role in comprehensive care through scientific study and clinical trials. The survey results highlight the need for  more research to determine the safety and effectiveness of specific complementary and alternative therapies, conclude the study authors. This study was partly funded by the National MS Society. Lead author Elizabeth Silbermann, MD, is funded by the Society’s Sylvia Lawry Fellowship, which trains individuals to conduct clinical research in MS.

Read more on the OHSU website

Read a scientific summary of the paper in MS and Related Disorders

Read more about complementary therapies and MS, including questions to ask when considering a complementary/alternative therapy

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