About the Paralyzed Veterans of America

Founded in 1946, PVA is the only congressionally chartered veterans service organization dedicated solely to individuals with spinal cord injury or diseases. PVA has 34 local chapters around the country and represents over 21,000 members. Approximately 20 percent of PVA members have MS. To serve them better, PVA has published a number of books on MS, promoted the development of MS Centers of Excellence within the Department of Veterans Affairs and engaged with other organizations in vigorous...

Addressing Cognitive Problems

LaRocca, PhD and Rosalind C. Kalb, PhD Multiple sclerosis (MS) is a disease that affects both the body and the mind. It causes damage to tissue in both the brain and the spinal cord. When it affects the brain, MS is highly likely to affect cognition. Cognition includes high-level functions carried out by the human brain, including comprehension and use of speech, visual perception and construction, calculation ability, attention (information processing), memory, and executive...

Adjusting to Changes in Sexual Function in MS

Foley, PhD and Audrey Sorgen, PhD Normal sexual function changes throughout one's lifetime, but having multiple sclerosis (MS) can profoundly affect an individual's sexual experience in a variety of ways. The most frequently reported change in men is diminished capacity to obtain or maintain an erection (impotence), while the most frequent change reported by women is partial or total loss of libido (sexual desire). Symptoms that can affect sexual activity include Bladder or bowel...

Bladder Management

Proper treatment of urinary dysfunction is probably the greatest factor in increasing the life expectancy of people with MS and in reducing the number of MS-related hos-pitalizations. In addition to interfering with daily activities, bladder infections and other urinary complications can cause serious illness. The good news is that bladder symptoms can be controlled and complications prevented with proper assessment and treatment. Understanding how the urinary system works will help you to make...

Caring For The Skin

Your skin should be inspected at least once a day and more frequently if you are less mobile. Areas over a bony prominence should be inspected for redness or deepening in color. Do not massage these areas Redness or deepening in color indicates increased blood flow, and the chance of damaging tiny blood vessels and tissue beneath is very high. If an area remains red for more than an hour, inform your physician or other healthcare professional. He or she will advise you on how to prevent any...

Chemical Name Methenamine methenameen

Brand Name Hiprex Mandelamine (U.S.) Hip-Rex Mandelamine (canada) Description Methenamine is an anti-infective medication that is used to help prevent infections of the urinary tract. it is usually prescribed on a long-term basis for individ uals with a history of repeated or chronic urinary tract infections. Before you start taking this medication, check your urine with phenaphthazine paper or another test to see if it is acidic. Your urine must be acidic (pH 5.5 or below) for this medicine to...

Common Symptoms Of Multiple Sclerosis

Virtually any aspect of neurologic function can be affected by MS, but some symptoms, such as optic neuritis in a young person, are characteristic. Optic neuritis usually results in partial loss of vision in one eye because of inflammatory demyelination of the optic nerve. Vision may be blurred, and colors may be difficult to distinguish. Eye movement may be uncomfortable. Double vision, another common symptom, is caused by plaques in the brainstem, the part of the brain directly above the...

Conclusion

Should you follow a special diet for MS When you evaluate the claims for dietary cures, be aware that the course of MS is somewhat unpredictable. Responses to particular foods and diets may be coincidental. Testimonials by individuals do not substitute for scientific research. Before adopting any diet plan, especially one that eliminates whole categories of food, consult your healthcare provider. See if there is any evidence to back the claim and be sure that the change you are considering will...

Coping And Stress Management

Coping is a broad term that encompasses several strategies, including stress management, counseling, psychotherapy, and use of psychotropic medication. Successful coping involves using whatever resources are at your disposal. The need for professional help may be indicated by a number of situations. For example, if your efforts to manage stress are foundering and you are feeling overwhelmed in spite of your best efforts, you probably need to consult a therapist. Likewise, if you are so...

Coping With Msrelated Changes In Sexual Response

Communicating with Healthcare Providers Some healthcare providers rarely bring up the subject of sexuality, perhaps because they feel uncomfortable with it, lack professional training in the area, or fear being overly intrusive. Most providers are willing to discuss sexuality, however, if you bring up the subject. You need to discuss changes in your sexual feelings and ask what treatments are available to enhance your sexuality. Communicate your concerns to your healthcare provider, including...

Fitness and Recreation

There is a belief among many experts in fitness and recreation that participating in physical activity is a close second in terms of its importance to eating and breathing. What would your life be like if you weren't able to participate in all sorts of leisure, fitness, and recreational activities In a society filled with many stressful events, the need to release by moving in any way, shape, or form that is comfortable and enjoyable to you is critical for maintaining overall balance in your...

Get Organized

MS makes the mind feel sort of slippery, because information that it used to store now seems to slip away. To counteract this feeling, you need to capture information in such a way that it cannot slip away and is organized for easy reference and retrieval. There are several ways to do this. Buy a journal. One of the simplest and most versatile ways is the familiar organizer book that many people use in their business and personal lives. Such a book can function as a sort of second brain by...

Hormonally Mediated Events

Many women with MS notice changes in their symptoms related to the menstrual cycle, such as a return of previously experienced problems. This relapse usually improves as the flow begins. If this is a sig nificant problem, controlling the menstrual cycle with a birth control pill may alleviate these symptoms you should consult your gynecologist. Women who are in their childbearing years and have MS should be in contact with their gynecologist when considering pregnancy. Prenatal and postnatal...

How Is Multiple Sclerosis Diagnosed

None of the symptoms described so far occurs only in MS. Strokes, tumors, or infections can cause the same disabilities when they affect the same areas of the brain and spinal cord. Therefore, the diagnosis of MS requires the exclusion of other neurologic diseases. Diagnosing MS was a greater problem in the past, before physicians could produce sophisticated images of the brain and spinal cord and test other aspects of neurologic function. In the past, the diagnosis of MS relied primarily on a...

Intermittent selfcatheterization ISC A

Procedure in which the person periodically inserts a catheter into the urinary opening to drain urine from the bladder. ISC is used in the management of bladder dysfunction to drain urine that remains after voiding, in order to prevent bladder distention, prevent kidney damage, and restore bladder function. Internuclear ophthalmoplegia A disturbance of coordinated eye movements in which the eye turned outward to look toward the side develops nystagmus (rapid, involuntary movements) while the...

June Halper Mscn Anp Faan

Some health issues affect all women and men, whether or not they have multiple sclerosis (MS), but are of particular concern when they may add to the symptoms or functional impairment brought about by a disabling condition. Therefore, health maintenance is extremely important in MS. Be aware that not all symptoms are related to MS. General healthcare should include regular general checkups by your primary care physician, with assessments appropriate for your age and current symptoms and...

Keep Your Teeth And Gums Healthy

Some medicines that are often prescribed for people with MS can cause dry mouth, which can cause increased risk of dental problems. Amantadine is one example. Baclofen also can cause dry mouth. Drink sips of water or calorie-free beverages to moisten the mouth or try sucking on sugar-free candy or chewing sugar-free gum. (Be aware that sweeteners, such as sorbitol, found in sugar-free gum and candies, can cause diarrhea ) Besides eating a healthy diet, the following things can help keep Brush...

Medicationinduced Injection Site Reactions

Recent studies have shown that disease modifying therapies alter the natural course of MS and slow the progression of disability. These medications are injectable either sub-cutaneously or intramuscularly. So while it is important to stay on treatment for as long as your health provider recommends it, it is important to take care of your skin. Some people who are using disease modifying therapies such as interferon beta-1b (Betaseron ), interferon beta-1a (Avonex , Rebif ), and glatiramer...

Pain Management Through Surgery

Severe spasticity in the lower extremities can be associated with pain. In these cases, benefit may be obtained from an intrathecal (within the spine) baclofen pump, which delivers tiny doses of baclofen directly into the spinal fluid by a surgically implanted pump. Morphine can also be delivered this way. Nerve blocks (injections of local anesthetic into the inflamed nerve) can also be used. The fifth cranial nerve (trigeminal nerve) controls sensory innervation of the face, sinuses, and...

Physical Fitness Physical Activity And Exercise

Physical fitness is the outcomes or traits that relate to the ability to perform physical activity. Physical activity is any bodily movement produced by skeletal muscle that results in caloric expenditure. Exercise is a subcategory of physical activity physical activity that is planned, structured, and repetitive. Exercise has been shown to be effective in improving physical fitness and quality of life. The purpose of an exercise or physical activity program is to improve overall health. In...

Physical Fitness

Physical fitness includes activities that will improve your strength, endurance, flexibility, and balance. It is divided into the following components cardiorespiratory endurance, which is the ability of your heart and lungs to transport oxygen through your body and is commonly referred to as aerobics-, muscular strength and endurance, which is the ability of your muscles to lift objects such as weights or groceries, and also helps you maintain good sitting posture if you use a wheelchair or...

Recreation And Leisure

Recreation and leisure activities are usually not done as regularly as fitness activities. Examples include taking a weekend ski trip, hiking, going for an occasional bike ride or walk, bowling, boating, and sleigh riding, among many others. Highlighted below are some enjoyable recreational activities that can be performed by individuals who have various levels of ability. Note that some recreational activities, such as swimming, if done regularly, can improve your fitness level and will most...

Skin Care

The skin is the largest and most visible organ, covering the entire body in a four-layer sheath. Like all organs, skin serves specific purposes that contribute to overall physical well-being. Limited ability, for example, to sense potential dangers to the skin or to turn or position oneself, can result in damage to the skin and cause it to break down. Proper skin care is essential to maintain function and prevent breakdown of this vital organ. An understanding of basic anatomy, skin functions,...

The Brain And Spinal Cord And Ms

Sexual response is controlled by emotional responses in concert with the central nervous system the brain, and the spinal cord. The brain is involved in many aspects of sexual functioning, including sexual desire, the perception of sexual stimuli and pleasure, movement, sensation, cognition, and attention. Throughout the sexual response cycle, sexual messages are communicated between the brain, spinal cord, and the genitals. Because MS can cause lesions along myelinated pathways, it is not...

Understanding Complementary or Alternative Treatments

Patricia Kennedy, RN, CNP, MSCN and Nancy J. Holland, EdD, RN, MSCN The terms alternative, complementary, or unconventional therapy cover a broad range of healing philosophies and approaches. Some approaches are consistent with the physiological principles of Western medicine, while others constitute independent healing systems. Some alternative therapies are far outside the realm of accepted medical theory and practice, while others fit within the traditional system. Conventional medicine has...

United Spinal Association formerly called Eastern Paralyzed Veterans Association

This organization's mission is to enhance the lives of all individuals with spinal cord injuries or diseases by ensuring quality health care, promoting research, and advocating for civil rights and independence. The organization continues to remain com mitted to veterans but has expanded services to all people with spinal cord injuries or diseases, MS being one of them. The United Spinal Association has programs to assist members to improve accessibility of their homes. It also publishes the MS...

What Are The Tests For Multiple Sclerosis

Magnetic Resonance Imaging (MRI) The most revolutionary advance in diagnosis of MS, as well as other diseases of the CNS, is imaging the brain and spinal cord by magnetic resonance. The MRI has revolu tionized the ability to diagnose MS, and it has emerged as a primary research tool as well (see Figure 1.5). MRI scanning determines the progression of the disease by measuring the size and number of both silent and active plaques. The technique is especially useful in clinical studies of new...

What Else May Be Important In Causing Multiple Sclerosis

The combination of unidentified genes, geographic location, and an abnormal immune response to myelin has led scientists to consider that MS may be caused by a virus. Some viruses can infect the CNS, including, in rare instances, viruses that cause common childhood diseases. Polio, a once-common scourge that has been virtually eradicated in industrialized nations, was, like MS, more common in temperate climates than in the tropics. One hypothesis is that paralytic polio does not develop in the...

Hope through Research

Progress in multiple sclerosis (MS) research is being made at a remarkable rate. Twenty years ago, very little was known about the regulation of the immune system, and before the approval of Betaseron in 1993, no therapy had ever proved capable of changing the underlying course of MS. Now five approved, disease-modifying drugs are available to treat individuals with Ms. But the work in Ms research is not over. scientists are closer than ever to understanding the underlying cause of Ms, and...

Other Types Of Exercise

Some exercises can improve balance. For example, you can use balance boards, Swiss balls, and variable surfaces to assist in balance training. However, balance problems are individual, and a balance training program should be designed by your healthcare professional to address your specific needs and maximize safety. A study evaluating a structured Awareness through Movement program to improve balance demonstrated improvements in balance, balance confidence, and self-efficacy. Yoga....

Public Benefit Programs

Living with a chronic condition like MS often involves financial help beyond personal resources. Although there is no replacement for personal wages and income, public benefit programs can serve a critical role. Adapting lists a number of public benefits worthy of investigation. Whether you consider Medicare, Medicaid, or veterans benefits, there will be a need to use the organization of your income and expenses, as mentioned above. Most public benefits are based on need, but you must be...

Food And Drug Interactions

While the prescription medicines you take are doing their jobs, they can sometimes cause unpleasant side effects. Some can affect your appetite and your sense of taste. Some can cause nausea and vomiting. Some can cause constipation. Others can cause diarrhea. Alcohol should be avoided when taking some medicines. Supplements, over-the-counter products, and herbs also can interact with medicines. Always consult with your healthcare provider when considering taking anything in addition to those...

Medications Commonly Used in Multiple Sclerosis

The information contained in these pages will help you to be more informed about the medications you are taking and therefore more able to discuss your questions and concerns with your physician. This information should never be used as a substitute for your own physician's instructions and recommendations. The following guidelines apply to the use of any and all the medications that you take Make sure that your physician knows your medical history, including all medical conditions for which...

Bowel Management

Gastrointestinal Tract Diagram Fill

Most people with MS had little reason to think about their bowel function prior to their diagnosis. Although some people with MS continue to function without difficulty, most experience constipation, a small number have bowel incontinence, and some have both constipation and loose stool. Recommendations for handling both types of problems follow. Causes of Constipation Constipation is defined as infrequent (less often than every 3 days) or incomplete bowel movement (when the stool is retained...

Aerobiccardiorespiratory Exercise

Aerobic exercise consists of rhythmic, large-muscle movements at moderate to high intensity. Activities such as walking, bicycling, swimming, cross country skiing, and stair stepping are considered aerobic exercise. Regular aerobic exercise reduces the risk of myocardial infarction, high blood pressure, excess body fat, resting heart rate, and lung function. In addition, aerobic exercise has been positively correlated with improvements in emotion and mood. A cardiorespiratory exercise...

Maintain A Healthy Weight

Achieving a healthy weight means eating Your current weight is the result of lifelong eating habits, heredity, and level of physical activity. Changing your weight is a matter of energy balance. Food energy is measured in calories. Carbohydrates, protein, fat, and alcohol are the sources of energy in foods. Fat is the most concentrated source of calories. If you are eating more calories than your body needs, regardless of the source, you will gain weight. If you are not getting enough calories,...

Is Multiple Sclerosis Inherited

Because people of similar ethnic or racial composition share certain inherited traits, genes may play an important role in MS. But MS is not a simple genetic disease that is, it is not due to a defective gene that causes the disease on its own. However, some individuals may inherit a cluster of genes that increases their susceptibility to the disease. Scientists are investigating genetic factors and how they contribute to the disease. We know that certain genes control some aspects of immune...

An Overview of Multiple Sclerosis

Partes Medusa

Guarnaccia, MD and John Booss, MD Multiple sclerosis (MS) is a disease of myelin, the insulating cover around the nerves of the central nervous system (CNS brain, optic nerves, and spinal cord) (see Figure 1.1), that becomes damaged in MS. MS most commonly begins in young adulthood and affects about twice as many women as men. Although its initial symptoms vary greatly, certain patterns are typical a previously healthy woman or less frequently, a man, 20 to 30 years old suddenly...

Chemical Name Docusate doekoosate

Brand Name Colace (U.S. and Canada) Generic Available Yes (U.S. and Canada) Description Docusate is an over-the-counter stool softener (emollient) that helps liquids to mix into dry, hardened stool, making the stool easier to pass. Laxatives are to be used to provide short-term relief only, unless otherwise directed by the nurse or physician who is helping you to manage your bowel symptoms. A regimen that includes a healthy diet containing roughage (whole grain breads and cereals, bran, fruit,...

Respiratory System

The respiratory system consists of the windpipe (trachea) bronchi (respiratory tree), which connects to the lungs diaphragm (the main muscle of breathing) and the intercostal muscles (the muscles between the ribs that are used for coughing and deep breathing) (see Figure 14.1). Protected by the breastbone, ribs, and spine, the lungs function primarily in breathing and filtering air. Air, which consists of nitrogen, oxygen, water, carbon dioxide, and other particles, enters through the nose and...

Exercise Options and Wellness Programs

Hicks, PhD Exercise is often the focal point of a comprehensive wellness program. Recent research projects have examined the effects of exercise and broader based wellness programs on people with multiple sclerosis (MS). Prior to this research, it was thought that exercise and wellness programs were either inappropriate or futile. It was thought that exercise may actually increase the disease process of MS. Wellness programs were thought to be either...

Chemical Name Imipramine imzprameen

Brand Name Tofranil (U.S. and Canada) Generic Available Yes (U.S. and Canada) Description Imipramine is a tricyclic anti-depressant used to treat mental depression. Its primary use in multiple sclerosis is to treat bladder symptoms, including urinary frequency and incontinence. Imipramine is also prescribed occasionally for the management of neurologic pain in MS. To lessen stomach upset, take this medication with food, even for a daily bedtime dose, unless your physician has told you to take...

Chemical Name Amantadine amantadeen

BrandName Symmetrel (U.S. and Canada) Description Amantadine is an antiviral medication used to prevent or treat certain influenza infections it is also given as an adjunct for the treatment of Parkinson's disease. It has been demonstrated that this medication, through some unknown mechanism, is sometimes effective in relieving fatigue in multiple sclerosis. The usual dosage for the management of fatigue in MS is 100 to 200 mg daily, taken in the earlier part of the day in order to avoid sleep...

Steroids

Corticosteroids are naturally occurring hormones in the human body. There are a variety of steroids including glucocorticoids, mineralcorticosteroids, androgens, and progestins. Of these, only the glucocorticoids are prescribed regularly to treat relapses in MS. Glucocorticoids occur naturally in the body as cortisone and hydrocortisone. These hormones are produced by a pair of organs called the adrenal glands, which are situated next to the kidneys. The adrenal glands are organized into two...

C07

Feel your breast in overlapping areas. Some research suggests that many women do breast self-examinations more thoroughhly when they use a pattern of up-and-down lines or strips. Other women feel more comfortable with another pattern. The important thing is to cover the entire breast and to pay special attention to the area between the breast and the underarm, including the underarm itself. Check the area above the breast, up to the collarbone and all the way over to your shoulder. Feel the...

Stress Demon Of The Modern

Many people believe that stress plays an important role either in precipitating the onset of multiple sclerosis (MS) or in triggering exacerbations. Anecdotes abound of people who had their first attack right after a major emotional trauma. Many studies have investigated this possible link, with mixed results. It is therefore unclear whether stress plays a major role in MS disease activity. Immune dysregulation seems to be the major culprit in MS. There is plenty of evidence, mainly from...

Chemical Name Bisacodyl bisaoedill

Brand Name Dulcolax tablet or suppository (U.S.) Bisacolax tablet or suppository (Canada) Generic Available Yes (U.S. and Canada) Description Bisacodyl is an over-the-counter stimulant laxative that can be used in either oral or suppository form. Stimulant laxatives encourage bowel movements by increasing the muscle contractions in the intestinal wall that propel the stool mass. Although stimulant laxatives are popular for self-treatment, they are more likely to cause side effects than other...

Chemical Name Interferon interfeeron beta1b

Brand Name Betaseron (U.S. and Canada) Generic Available No Description Betaseron is a medication manufactured by a biotechnological process from one of the naturally occurring interferons (a type of protein). In a clinical trial of 372 ambulatory patients with relapsing-remitting MS, those taking the currently recommended dose of the medication experienced fewer exacerbations, a longer time between exacerbations, and exacerbations that were generally less severe than those of patients taking a...

Chemical Name Meclizine meklizeen

Brand Name Antivert (U.S.) Bonamine Description Meclizine is used to prevent and treat nausea, vomiting, and dizziness. This drug adds to the effects of alcohol and other central nervous system depressants (e.g., antihistamines, sedatives, tranquilizers, prescriptions pain medications, seizure medications, muscle relaxants, and sleeping medications), possibly causing drowsiness. Be sure that your physician knows if you are taking these or any other medications. Meclizine may cause dryness of...

Chemical Name Sertraline sertraleen

Brand Name Zoloft (U.S. and Canada) Description Sertraline is used to treat mental depression and certain types of anxiety. This medication should always be taken at the same time in relation to meals and snacks to make sure that it is absorbed in the same way. Because sertraline may be given to different individuals at different times of the day, you and your physician should discuss what to do about any missed doses. It may take 4 to 6 weeks for you to feel the beneficial effects of this...

Multiple Sclerosis Functional Composite

(MSFC) A three-part, standardized, quantitative assessment instrument for use in clinical trials in MS, that was developed by the Task Force on Clinical Outcomes Assessment appointed by the National MS Society's Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. The three components of the MSFC measure leg function ambulation (Timed 25-Foot Walk), arm hand function (9-Hole Peg Test), and cognitive function (Paced Auditory Serial Addition Test PASAT ). Muscle tone A...

Chemical Name Pemoline pemohleen

Brand Name Cylert (U.S. and Canada) Description Pemoline is a mild central nervous system stimulant that has been used primarily to treat children with attention deficit hyperactivity disorder and adults with narcolepsy. It is used in multiple sclerosis to relieve certain types of fatigue. As directed by the Food and Drug Administration, Abbott Laboratories, the manufacturer of Cylert, has recommended evaluation of liver function prior to starting this medication, followed by biweekly liver...

Chemical Name Gabapentin gabapentin

Description Gabapentin is an antiepileptic used to control some types of seizures in epilepsy. it is used in multiple sclerosis to control dysesthesias pain caused by MS lesions and the pain caused by spasticity. Gabapentin may be taken with or without food. You must wait 2 hours after taking an antacid to take gabapentin. If gabapentin is taken 3 times a day, do not allow more than 12 hours to elapse between any 2 doses. If you miss a dose of this medication, take it as soon as possible....

Stretching And Flexibility

A regular stretching program is important to maintain optimal length of muscles and other soft tissue structures e.g., tendons, fascia, and connective tissue . If you have tightness in any areas, you increase your risk of injury or possible contractures secondary to abnormal shortening of the muscles or other soft tissue structures. Ultimately, such tightness reduces mobility, because of the decrease in range of motion, and makes you more prone to sprains and strains. Finally, a stretching...

Immunomodulators The Abcr Drugs

Perhaps the most effective treatments currently available today deal with the autoimmune component of MS and work by regulating aspects of the immune system. Avonex , Betaseron , Copaxone , and Rebif have been approved to modify the disease in relapsing forms of MS Betaseron has been FDA-approved for use in people who have SPMS. Avonex is being used for worsening MS in people presenting with a clinically isolated syndrome CIS one neurologic attack with MRI evidence of demyeli-nation. A fifth...

Chemical Name Mineral oil

Mineral oil is available in a variety of brands in the U.S. and Canada. Description Mineral oil is a lubricant laxative that is taken by mouth. It encourages bowel movements by coating the bowel and the stool with a waterproof film that helps to retain moisture in the stool. Laxatives are to be used to provide short-term relief only, unless otherwise directed by the nurse or physician who is helping you to manage your bowel symptoms. A regimen that includes a healthy diet containing roughage...