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Suggest Treatment For Secondary Progressive MS

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Posted on Mon, 9 Mar 2015
Question: They say I have Secondary Progressive MS. What can I expect to happen? How and fast does it progress? Should I start looking for nursing care? I think I've had it nearly my whole life. Had a really bad episode in my early 50s. In late 50s became unable to do much of anything but take care of myself and sleep. I'm 68. My medical treatments have been delayed due to long term illness of family members, Doctor passed, no insurance for a long time.
doctor
Answered by Dr. Naval Mendiratta (1 hour later)
Brief Answer:
progression of multiple sclerosis

Detailed Answer:
Good evening.

Thank you for writing on health care magic

Well secondary progressive multiple sclerosis tends to overlap remitting relapsing at course when it slowly starts progressing. But it is hard to predict how fast and what all the symptoms it will cause. The most common predictor for multiple sclerosis is the number of episodes and the system involved initially. For example optic neuritis is a sign of a good prognosis.

To exactly tell you how the disease will behave, it will be helpful if you could tell me what were the initial symptoms you experienced?

2. Number of episodes per year or number of episodes you have had till now

3. MRI findings would be helpful as well

4. Current medications you are taking for multiple sclerosis?

5. The most severe episode you had like a paralysis or loss of vision which recovered eventually?

Since already 18 years have passed it makes it less likely that it may cause major central nervous system involvement.

But do let me know these queries. Would be useful in predicting the disease response.

Regards
Dr naval
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Naval Mendiratta (35 hours later)
20 years ago I had a severe episode where I became partially paralyzed. I became so weak I had to use special braces and a walker. I tried so hard to move that I fractured my pelvis. Sometimes I had to crawl on the floor to use the bathroom I wasn't strong enough to pull the covers up over me in the middle of the night. Couldn't make a fist. It took me a couple of hours to put my clothes on. I had to change from pantyhose to short, soft socks. My reflexes were exaggerated and slow. Before that I was hyper. Moved really fast to do things.I still use a cane once in a while.I have a hard time swallowing and choke easily. If I take my dogs for a walk I use a dog stroller so that I can push it and keep my balance.The 1st Doctor gave me ? Depa? shots. They helped temporarily. My second Doctor at UM prescribed oral predisone for me. I responded very quickly. It took me another 2 years to come out of it. I never regained my prior strength and had fatigue. Then my hubby went into the hospital and passed after a year. I became so fatigued that I could hardly do anything. Although I did not become paralyzed. I slept nearly 24-7 for 10 years. I do not sleep as much as what I did but I am now very weak and fatigued with pain. I also have inflammatory Arthritis. My NAB test is positive but low. A lot of my burning and tingling,etc. is controlled with Lyrica. When I become tired I become very wobbly. .I do things like keep my legs crossed when I go to stand. I become jerky, espec. arms and hands when tired. It was controlled with Xanax and Inderal for years. It isn't working as well as what it used to. My blood pressure goes way up sometimes. It started in my eyes. Bright lights. I had to wear sunglasses indoors. Gave me bad headaches. My eyes seem to have imporoved a lot but I still have blurry vision.When I was younger I became very fatigued and weak. I had to rest a lot. Then all of a sudden I would come out of it and be normal. As I have aged the normal seems to be a memory. I have not been diagnosed formally yet. But my Ruhmey who was also my Mother's Doctor gave me the Lab report of NAB and told me to hang on to it. She moved on to another job .Then a 10 year series of family deaths 13 happened. I tried my best to care for my parents and sister but had a really hard time an wasn't able to do much.The number of episodes I had when younger I don't know.It seemed as though I would get really run down and fatigued. Then I would wake up and feel normal for no reason at all. I do know that as a Nurse's Aide I gradually became weaker and weaker until unable to do the job. I then became a Teacher but had to have a special kind of desk for my students and myself so that I could sit in a position where they surrounded me. They had to retrieve a lot of heavier things for me like books. I would just drop them. They'd just drop out of my arms because they were too heavy. I have had problems with my bowel control for 15 years. I couldn't hold it and it would just let loose. Chewing gum would cause muscle cramps. It seems as though my upper arms are a lot stronger then my lower arms and hands. I could go on and on. Slurred words where my family thought I must be high. Ice cream or ice cubes seems to make my mouth freeze and I'm not able to talk. I''ve never met a person with that problem. I seem to have like absent seizures at times when I first get up or am really tired. Like if it is hot out doors. I stare and am aware of things around me. Sometimes when I stare it seems as though I am focusing on what I am staring at and . I can't explain what I experience but I am fine afterwards. I started on the Inderal and Xanax because of severe tremors. I also take nifidine, Effexor, Syn Thyroid, Lyrica. That's it. Can't stand the feeling in my legs and toes without the Lyrica. I get like a bad headache in one ear and eye on my left side. I can't sleep when that is acting up.I used to get like bad electrical shocks in my limbs and electrical feelings - it feels like a little upside down v of a shock in limbs. My dentures used to feel to heavy for my mouth and I had a hard time talking because of it.I don't leave the house much or socialize because of the embarrassing things and fatigue. Especially if I am outdoors during the summer. at the lake with me kids. I just get too tired and don't feel good. Not very good company at all. Or if I am it is only for short bursts. I had high ESR, c- protein and other high inflammatories. But I also have a positive NAB. I have low thyroid. I have a hard time carrying a conversation. I forget or don't know the words I want to use. Although I am able to write. I don't understand that. I used to and still trip and fall a lot. It used to be common for me to fall down the basement stairs. mowing the lawn I have fallen for no reason. It scares me.
doctor
Answered by Dr. Naval Mendiratta (17 hours later)
Brief Answer:
Could be Secondary Progressive Multiple Sclerosis

Detailed Answer:
Good evening

Sorry for the delayed reply. Had got stuck up with family issues

Well you have had a rough course throughout. I read through the history but what I could not get is: You said you haven’t been formally diagnosed as Multiple Sclerosis. If you could throw some light on it that would be great. Cause if you have been diagnosed as Multiple Sclerosis, then there are many good treatment options available. Prednisolone is one drug for the acute stage, but now they have plenty of Biological Drugs available which help control the disease like Natalizumab. So I would like to clarify on this aspect regarding your diagnosis and if it is MS, then you should be on some treatment.

Secondly, the symptoms you are experiencing now are more of Fibromyalgia ones with lot of fatigue, forgetfullness, irritability. Never the less, it can still be a part of Multiple Sclerosis as well.

Also, I feel you need to include Vitamin D supplements in your diet. It will help your fatigue as well and plays a very important role in Multiple Sclerosis.

If you could mail me your results that would be good, I can go through it once. Also, if it is Really MS we need to put you on treatment for it ,so we can curtail it. And you need to ask your rheumatologist to start you on Duloxetine/Amitryptilline for the other symptoms. It will definitely help you.

Do let me know for more queries

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Naval Mendiratta (22 hours later)
I will mail you my test results as they come in.
My NAB - low
Vit.D - Low
Muscle inflammation is High
Fatigue- sleep - 10- 24 hours at a time.
Weakness- Physical Therapist told me I am a very weak person.
Inflammatory tests high
Thyroid - low
Tremors- intentional- moderate to severe- including head.
body jerks - need Xanax to stop
Pain in left ear and left eye - not able to sleep on that side when it is acting up.
slurred speech
lack of bowel control at times
bladder infections
Staring off into space when 1st get up or tired.
Heat makes me sick, staring and tired . Mostly tired.
buzzing, tingling, whooshing sounds in head.
looking up and too left with eyes is painful and makes my head shake.
head shakes with tremors
electric like shocks back, arms, legs
Total exhaustation of my limbs - pain with it. Can't use them for a while. happens a lot when driving car.
Total Body numbness at times.
Feeling light headed or dizzy
Feeling light headed? I don't know how to explain it. Strange.


doctor
Answered by Dr. Naval Mendiratta (24 hours later)
Brief Answer:
multiple sclerosis likely

Detailed Answer:
Good evening

Sorry for the delayed reply. Had my emergency shift going on.

I have gone through your symptoms list. A lot of them can fit into multiple sclerosis/fibromyalgia and Vitamin D Defeciency. I feel we need to plan the course of action for you as your quality of life is getting compromised.

I do see the main problem you are having is a lot of fatigue. The fatigue in Multiple Sclerosis is mostly after exertion and gets relieved with rest. You seem to be experiencing it. I feel you should consult your Neurologist once and ask him if there is Muliple Sclerosis, why arent you being treated for it. Loss of bowel and bladder control along with Uthoff symptoms( Worsening on Heat) can very well be a part of it. As you don't have any paralysis or loss of vision, you will benefit from low dose of steroids along with another medication which they feel appropriate for you.

Secondly start Replenishing your Vitamin D. It can help alleviate the fatigue component and relieve the muscle aches and body pain.

Thirdly, as i had mentioned before you will need some mood stabilizing drugs as well. All this long course of illness is making you more depress and we need to get you out if it primarly.

You should seek an appointment at the earliest with your neurologist and get these issues sorted out. You will feel much better once the treatment commences and it will definately improve your quality of life.

Hope the information was useful. Do let me know for more queries. Would be happy to help out.

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Naval Mendiratta (47 hours later)
You have just described what I go through.
I get really wobbly and weak.
left eye and ear pain where I Can't sleep on that side.
My eye pains started in both eyes. Couldn't be near light and bad headaches. Opthlamologist said he didn't know what it was after checking me several times. flunked the shrimer test with 0-4 moisture. Severe pain. That was 20 years ago. It has improved a lot over the years. XXXXXXX test positive, NAB positive - low- homogenous, with low white cells years later.
C- Reactive high.
Alpha 2 near high by .01 point.
Deep tendon reflexes 2-3+.
High ESR.WEStergren 35
Generalized muscle weakness
no erosive arthritis
co2 - low
Lymph - low
confusion
hematemesis
inflammatory arthritis
GGT -high
alkaline phosphatase
sed. rate-35
crp-2.2

Did not meet criteria for - Lupus,
rheumatoid arthritis, or a connective tissue disease.
no fibro points.
vision loss and blurring
hyperreflexia
pain in joints and
d muscles

























;;;


doctor
Answered by Dr. Naval Mendiratta (14 hours later)
Brief Answer:
? Multiple Sclerosis

Detailed Answer:
Good evening

Thank you for your reply

I have gone through your reports. I still feel you need to sort out with your neurologist here if it is really multiple sclerosis. You dont fit with SLE or Rheumatoid at all. There are no symptoms of joint pains/oral ulcers/rash/hair fall and the tests are not suggestive of it as well.

I would suggest you to follow the advise i mentioned earlier.I feel it will really help your cause and improve the quality of your life as well.

Do let me know for more queries

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Naval Mendiratta (9 days later)
Thank you very much. I will get in touch with you at a later date.
doctor
Answered by Dr. Naval Mendiratta (5 hours later)
Brief Answer:
?/multiple sclerosis

Detailed Answer:
Good evening.

Oh yes feel free to buzz whenever you want..I am glad if I could be of some help

Regards
Dr naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Answered by
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Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 754 Questions

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Suggest Treatment For Secondary Progressive MS

Brief Answer: progression of multiple sclerosis Detailed Answer: Good evening. Thank you for writing on health care magic Well secondary progressive multiple sclerosis tends to overlap remitting relapsing at course when it slowly starts progressing. But it is hard to predict how fast and what all the symptoms it will cause. The most common predictor for multiple sclerosis is the number of episodes and the system involved initially. For example optic neuritis is a sign of a good prognosis. To exactly tell you how the disease will behave, it will be helpful if you could tell me what were the initial symptoms you experienced? 2. Number of episodes per year or number of episodes you have had till now 3. MRI findings would be helpful as well 4. Current medications you are taking for multiple sclerosis? 5. The most severe episode you had like a paralysis or loss of vision which recovered eventually? Since already 18 years have passed it makes it less likely that it may cause major central nervous system involvement. But do let me know these queries. Would be useful in predicting the disease response. Regards Dr naval