Managing relapses | MS Trust

If you’re going through a relapse, it’s important to bear in mind that it will usually settle down of its own accord. It’s likely that you will feel unwell and more tired than usual while you’re recovering from your relapse. This can have an impact both at home and at work.

Home life

You might find you’re not able to do all the household tasks that you’d normally undertake. Try to be kind to yourself and keep within your limits while you’re recovering. Consider asking for some help from family and friends while you’re recovering – perhaps help with the shopping, washing up or collecting children from school could make all the difference. Asking for help can be one of the hardest things to do but the chances are that your family and friends really want to help and perhaps just aren’t sure what they should offer to do – so talk to them!

If you need additional support, talk to your MS nurse. If you are struggling more than usual it may be possible to arrange some social services support, just to help in the short-term. Organisations such as Home Start may also be able to help you cope with family life.

Work

You may need to reduce your working hours or take time off work while you’re recovering.

Taking time off work isn’t easy or always possible and some people with MS have no alternative but to continue to work during a relapse, which can be difficult. If this is the case, it may help to let your manager or supervisor know that you’re having a relapse. It may be possible to arrange for you to work from home, temporarily reduce your hours, take some flexi-time or have longer or more flexible breaks during your working day depending on your needs. Under the Equality Act, if you’ve been diagnosed with MS you’re entitled to ask your employer to make reasonable adjustments to help you remain in work.

If you’ve had to stop working for a period of time, it’s a good idea to stay in regular contact with your manager or supervisor rather than just sending in the required paperwork. Keeping people informed will give you the opportunity to talk things through and discuss the best solution for everyone. When you’re planning your return to work, it may be helpful to request a phased return, slowly building up the number of hours/days that you work over a period of time. 

More information about working with MS

Feeling emotional

Relapses can take you by surprise and the symptoms can be difficult to deal with. This can trigger reactions such as anger that this has happened to you at this particular time, or you may feel that you should’ve been able to avoid the relapse. You might also have concerns about what the future holds for you or be concerned about the impact that MS will have on your relationships or your work. It’s normal to feel emotional, depressed or worried in this situation but try to remember that these feelings won’t last forever. If they do become overwhelming, you could make an appointment to discuss your concerns with your GP or MS nurse.

If you are finding it hard to sleep well, you may find it more difficult to deal with everyday situations which wouldn’t usually be a problem.

Some medications, including steroids, can also have an impact on your emotions.

Relapses could also have an impact on people close to you. Your family and friends may experience a range of emotions such as anxiety, guilt or anger. Being aware that they may have these feelings during a relapse, and that it’s a completely normal reaction, can help all of you to manage.

Thinking processes affected

Because a relapse is often stressful, many people can feel distracted and a bit overwhelmed and may have problems thinking through complex tasks. These thinking problems are fairly common during a relapse but should become less of an issue as you recover.

During some relapses, you may have more obvious problems with thinking. You may find that your speed of thinking is slower and that you have trouble concentrating. If these symptoms have come on quite suddenly, it’s possible your relapse is directly affecting your thinking processes – this is called a cognitive relapse.

These symptoms will usually settle down. If they interfere with your ability to do important tasks, an occupational therapist or neuropsychologist can work with you to develop strategies to help you manage. You’ll find all sorts of tips and tricks to help with cognitive symptoms on the MS Trust website Staying Smart.

Relapsing-Remitting Multiple Sclerosis | Johns Hopkins Medicine

What is relapsing-remitting multiple sclerosis?

In multiple sclerosis (MS), the central nervous system, which includes the brain and spinal cord, becomes damaged. MS causes the immune system to attack the myelin, which is the insulation protecting the nerves. The nerves themselves can also be damaged. When myelin or the nerves become damaged, nerves cannot properly pass along their signals. The damaging process forms scar tissue called sclerosis, which gives the disease its name of multiple sclerosis.

Different types of MS affect people in different ways. One type is called relapsing-remitting MS. With this type, you have flare-ups of the disease, or relapses. Between these flare-ups, you have periods of recovery, or remissions.

Most people diagnosed with MS start off with the relapsing-remitting type. In most cases, the course of the disease changes after a few decades and is then likely to become steadily worse.

MS most often develops in people in their 20s and 30s. Women are twice as likely to have MS as men.

What causes relapsing-remitting MS?

Multiple sclerosis occurs when your body’s immune system attacks the central nervous system, damaging the myelin that protects nerve fibers. Experts believe that environmental factors trigger the disease in people whose genetics make them susceptible to MS.

Who is at risk for MS?

• Scientists think MS may be caused by an infection that lays dormant in the body such as Epstein-Barr Virus (the virus that causes infectious mononucleosis)

• Scientists also think there may be a genetic susceptibility for some people

• Cigarette smoking appears to increase risk

What are the symptoms of relapsing-remitting MS?

These are often the earliest symptoms of MS:

• Trouble seeing

• Sensitivity to heat

• Numbness, especially in the feet

• Weakness

• Fatigue

• Difficulty thinking clearly

• Depression

• Needing to urinate urgently

• Trouble with balance

• Lack of coordination

Relapsing-remitting MS is marked by relapses that last at least 24 hours. During a relapse, symptoms get worse. A relapse will be followed by a remission. During a remission, symptoms partly or completely go away.

How is relapsing-remitting MS diagnosed?

Healthcare providers use many tests to help diagnose MS. Your healthcare provider will ask you questions about your symptoms. It’s important to rule out other diseases that can cause similar symptoms.

Your healthcare provider will also check to see how well your vision, your sense of balance, and other functions are working. You will need an MRI scan of your brain and spine. This may find areas of damage in your brain or spinal cord that suggest you may have MS.

Another possible test measures what’s called visual evoked potentials. Painless electrodes placed on your scalp measure how your brain responds to things you see.

Your healthcare provider may want to check your blood for other signs of disease. He or she may also order a test called a spinal tap (also called a lumbar puncture) to look at a sample of your spinal fluid.

How is relapsing-remitting MS treated?

MS is not considered curable, but different types of medicine are available to decrease inflammation and slow down the progression of the disease. These medicines include:

• Beta-interferon

• Glatiramer acetate

• Monoclonal antibodies

• Dimethyl fumarate

• Fingolimod

Other medicines can be prescribed to treat:

• Muscle spasms

• Urge to urinate

• Depression

• Erectile dysfunction

• Fatigue

Your healthcare provider may also suggest steroids to reduce symptoms during flare-ups. If steroids are not effective your healthcare provider may recommend plasmapheresis, a blood cleansing procedure.

What are the complications of relapsing-remitting MS?

In most cases, relapsing-remitting MS is mild, although you may need to use a cane or other mobility device. In some cases, the disease is severe and causes the inability to care for yourself. Seldom does it cause death.

Living with relapsing-remitting MS

If you have relapsing-remitting MS, you can take steps to manage your condition.

• Physical therapy may help relieve muscle spasms.

• Eat a diet low in saturated fat and trans-fat. Eat more foods with healthy omega-3 fatty acids because these nutrients are believed to fight inflammation.

• Talk with a counselor to help with depression.

• Avoid situations that cause you to become overheated.

• Avoid smoking.

• Get a moderate amount of exercise and enough sleep.

Key points about relapsing-remitting MS

• Multiple sclerosis affects young people in their 20’s and 30’s.

• MS affects the way your muscles and eyes work.

• Although there is no cure, medicines can help you manage your symptoms.

• Adopting a healthy life-style can also help you manage your disease.

• Avoiding overheating or other triggers can prevent flares of MS.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.

What is it and how to cope

Multiple sclerosis is a condition that results in nerve damage. People with multiple sclerosis sometimes experience exacerbations where old symptoms get worse or new ones develop.

In multiple sclerosis (MS), a person experiences an abnormal immune response. The body attacks the protective covering around the nerve fibers, disrupting communications from the brain.

This can potentially cause permanent nerve damage and disability.

Estimates vary as to how many people MS affects. The National Institutes for Neurological Diseases and Stroke (NINDS) estimate that 250,000–350,000 people in the U.S. have MS, but they note that it is difficult to know the exact number. The National Multiple Sclerosis Society put the number closer to 1 million.

In this article, we look at the different types of MS exacerbations or relapses and how to recognize and manage them.

Share on PinterestMS exacerbations can be debilitating, but preparing for them can help preserve quality of life.

Knowing when an exacerbation or relapse is taking place is critical, as receiving treatment early on can help reduce the impact of an exacerbation on everyday living.

A new MS exacerbation would have the following criteria:

• Previous symptoms have become more severe, or new symptoms have started growing evident.
• Symptoms have persisted for longer than 24 hours. More commonly, symptoms last for weeks or even months.
• A period of 30 days must have passed since the start of the previous relapse.
• A healthcare professional has ruled out other possible causes for flare-ups, including infections, heat, and stress.

Certain flare-ups of symptoms can occur for a variety of reasons, but these typically resolve without active treatment and would not qualify as exacerbations.

Examples include:

• Symptoms getting worse in high or low temperatures that resolve after moderate temperature resumes.
• Daily fluctuations in symptoms that may vary without reason, or might occur due to fatigue or stress.
• A mild bout of infection that makes symptoms worse without triggering a full relapse, such as a stomach bug.

Common relapse symptoms

The most common symptoms of MS that occur during a relapse include:

• balance, coordination, and dizziness issues
• fatigue
• vision problems
• bladder weakness
• leg or arm weakness
• numb sensations
• pins and needles
• reduction in mobility
• memory and concentration issues

Some relapses are mild and do not severely impede on daily functioning. Others will require hospitalization.

Triggers

Share on PinterestCertain vaccines, such as those containing live pathogens, might trigger MS exacerbations in people who have the disease.

Possible triggers of an MS exacerbation can include:

• Infection: Viral, bacterial, and fungal infections may trigger an MS exacerbation. People with MS may wish to take steps to reduce their risk of infection, such as avoiding people with colds.
• Vaccinations: Certain vaccines may have links to triggering an MS relapse. Doctors do not recommend some vaccines for people with MS, such as those shots that contain live pathogens, including the vaccines for shingles and yellow fever.
• Childbirth: Exacerbations might occur during the time just after childbirth in some women who have MS. Breastfeeding may offer some protection, however.
• Vitamin D deficiency: Low levels of vitamin D can contribute to the risk of MS exacerbations. People with MS should regularly monitor vitamin D levels and boost them when appropriate.

Common symptoms of MS can include:

• limb numbness or weakness
• pain
• tingling or itching
• tremors, unsteadiness, or coordination problems
• partial or complete loss of vision
• double vision
• headache
• breathing or swallowing difficulties
• slurring of speech
• tiredness
• dizziness
• bowel and bladder problems
• sexual problems
• emotional disturbances, such as depression and mood swings
• changes in thinking and concentration
• seizures
• hearing loss

During exacerbations, these will start to flare or get worse. Depending on the type of MS, these will either recover during a remission period or become permanent.

Exacerbations work differently in each type of MS.

Clinically isolated syndrome

Clinically isolated syndrome (CIS) is the first episode of central nervous system inflammation and damage to the protective coating of nerve cells. It produces symptoms that last for at least 24 hours.

People with CIS sometimes develop brain lesions typical of people with MS. These lesions usually suggest a higher risk of developing relapsing-remitting MS (RRMS). Brain lesions are scars, and they usually show up on MRI scans.

Not all people with CIS develop MS. However, since 2017, diagnostic criteria have indicated specific findings on an MRI that suggest earlier damage in a different location in the brain, as well as active inflammation in a region that is not causing the episode of symptoms.

People who have CIS without these brain lesions have a lower risk of developing MS. High-risk CIS patients who receive early treatment may experience a delay in developing MS.

Relapsing-remitting multiple sclerosis

People who have a diagnosis of RRMS will often experience exacerbations. These have a clear start and end point. Symptoms will recover either partially or fully outside of these attacks.

Sometimes all symptoms improve, but specific symptoms may persist and become permanent during other times.

During remission, MS will not often progress. These periods of recovery might last for months or years. Relapses will often lead to changes in MRI results as new brain lesions occur.

RRMS is the most common type of MS, making up 85 percent of initial diagnoses for MS.

Primary progressive MS

Primary progressive MS, or PPMS, is an escalating type of MS that gets worse from the start of any symptoms without any early remissions or relapse. Symptoms may go through periods of not being active or not progressing, but they do not get better.

Exacerbations do not often occur in PPMS, as the symptoms get worse without remission.

Around 15 percent of people with MS have the PPMS form of the condition.

Secondary progressive MS

This form of MS, which specialists abbreviate to SPMS, is a progressive condition.

It usually starts with a period of RRMS that later develops into a type in which brain and nerve function become gradually worse without periods of remission. People are more likely to experience exacerbation during this initial episode of RRMS.

Every person’s experience with RRMS, PPMS, and SPMS will be different, with varying symptoms escalating at different rates.

No single test can diagnose MS. Doctors use many different tests to rule out other causes of a person’s symptoms.

Symptoms must meet specific criteria for a doctor to make a diagnosis of MS. The National Multiple Sclerosis Society define the criteria as:

• at least two separate areas of damage in the central nervous system
• evidence that the above damage occurred at least one month apart
• the ruling out of all other possible causes

Some of the tests that doctors may use to help identify MS include:

• MRI scanning
• spinal tap to obtain spinal fluid samples
• evoked potentials, or measurements of the brain’s electrical activity response to nerve stimulation
• certain blood serum tests

Share on PinterestYour employer should make adjustments to the workspace to accommodate developing MS symptoms.

People experiencing an exacerbation might find that they need to make adjustments in their personal lives to allow for a relapse to pass as comfortably as possible.

These include:

Home life and chores: Less mobility and fatigue can reduce a person’s ability to complete all their usual tasks around the home. Ask friends or family for help with daily chores and tasks. Alternatively, short-term home care can provide support.

Emotional impact: An MS relapse can take a toll on emotional well-being. Exacerbations might occur without warning, causing frustration, anger, and anxiety about the future and leading to similar feelings in the people around the individual with MS.

Relapses can lead to concerns about work and relationships, as well as sleep issues due to medications and physical pain.

Know that the feelings during an exacerbation are not forever and will become easier once symptoms pass or improve.

Work: When possible and necessary, during a relapse, take time off work. If this is not possible, then an individual can talk to their manager about working fewer hours or having a more flexible arrangement.

Cognitive difficulties: During an exacerbation, thoughts might be slower and concentration difficult.

These effects might be due to the stress of a relapse being overwhelming but can also be a direct effect of the exacerbation. Doctors refer to this as a cognitive relapse.

While these symptoms will often pass, people may wish to seek support from an occupational therapist or neuropsychologist. They will be able to help the individual manage the cognitive effects of an MS exacerbation.

The following actions might also help a person prepare for the effects of an exacerbation:

• Keeping track of daily MS symptoms plus physical or cognitive changes in a symptom log.
• Having a dedicated emergency contact to call if a relapse occurs, and a contingency plan in case they do not respond.
• Developing a support network, having a list of people who can assist with more difficult tasks, and opening a dialogue about needing help at times.
• Knowing the sick leave and return-to-work policy for your employer, or the benefits to which self-employed people are entitled if they cannot work for health reasons.
• Having a supply of everyday essentials, including milk and food with long expiry dates, toiletries, and easy meals.

People may or may not need treatment for exacerbations, as most mild symptoms, such as fatigue, may resolve without intervention.

In more severe cases, medications that doctors use to treat exacerbations include high-dose oral and intravenous (IV) methylprednisolone. Methylprednisolone is a steroid that can help reduce inflammation.

Another option for treating MS exacerbations is plasmapheresis, or a plasma exchange. During this therapy, the medical team separates plasma from the blood cells, mixes it with a water-soluble protein called albumin, and introduces it back into the body.

People with MS should speak to their healthcare team, and gauge the best treatment approach for their MS exacerbations. Physical rehabilitation programs may also provide benefit.

Treatment for MS

No full cure for MS currently exists. However, a range of treatments can help recovery during relapses, slow the progression of the disease, and help manage symptoms.

Treatment of MS includes the use of medications, rehabilitation, and complementary and alternative therapies.

The United States Food and Drug Administration (FDA) have approved several medications for treating the various forms of MS.

Medications for injection include:

• interferon beta-1a (Avonex, Rebif)
• interferon beta-1b (Betaseron, Extavia)
• glatiramer acetate (Copaxone)
• glatiramer acetate, a generic equivalent of Copaxone 20 milligram dose (Glatopa)
• peginterferon beta-1a (Plegridy)

Oral medications include:

• teriflunomide (Aubagio)
• fingolimod (Gilenya)
• dimethyl fumarate (Tecfidera)
• siponimod (Mayzent)
• cladribine (Mavenclad)

Infused medications include:

• alemtuzumab (Lemtrada)
• mitoxantrone (Novantrone)
• natalizumab (Tysabri)

Various treatment options are available for the different symptoms of MS. Doctors will customize treatment, depending on the specific symptoms that the individual with MS is experiencing.

A person with MS can include rehabilitative interventions in their treatment plan to help with everyday tasks. These services typically include physical, occupational, vocational, and cognitive therapies, as well as speech-language pathology services.

In addition to mainstream MS treatment, some people may find complementary alternative therapies useful. These include the use of acupuncture, diet modification, massage, exercise, yoga, meditation, and stress management.

The American Academy of Neurology advise that medical marijuana might also help treat some symptoms of MS-related pain and muscle problems.

Multiple Sclerosis (MS): Symptoms, Diagnosis & Treatments

What is multiple sclerosis?

Multiple sclerosis (MS) is a central nervous system disorder-that is, it affects the brain and spinal cord and spares the nerves and muscles that leave the spinal cord. MS is an inflammatory disorder in which infection-fighting white blood cells enter the nervous system and cause injury. It is a demyelinating disorder because the myelin sheath that protects nerves is stripped off during inflammation. When this happens, the nerves cannot conduct electricity as well as they should, causing various symptoms. Symptoms may be the type that come and go over time (relapsing-remitting MS) or progress over time (progressive MS). MS can happen to just about anyone and is long-term.

How is MS diagnosed?

Multiple sclerosis is often difficult to diagnose because there is no single test or finding on an exam that makes the diagnosis and because the disorder varies from person to person. In most cases, there is a history of neurological symptoms that come and go over years. The neurological exam may show changes that suggest problems with the spinal cord or brain.

The magnetic resonance imaging (MRI) may show areas of abnormality that suggest MS, though the MRI in and of itself does not make the diagnosis. Spinal fluid testing may show that the immune system is active in and around the brain and spinal cord, supporting the diagnosis. Evoked potentials may assist in diagnosis. All of these need to be put together by the physician to determine if MS is the actual diagnosis. Even when all the tests are done, some people cannot be diagnosed for years after the beginning of symptoms.

What are some early symptoms of MS?

MS varies from person to person so there is no ‘standard’ set of symptoms for MS. However, we know that common symptoms of MS include:

• Numbness or tingling in various parts of the body
• Walking difficulties
• Weakness of one or more body part
• Fatigue
• Visual blurring, and occasionally, double vision
• Dizziness
• Lhermitte’s phenomenon, a symptom in which people feel electrical tingling or shocks down their back, arms, or legs when they bend their neck forwards
• Urinary symptoms, such as hesitancy when trying to urinate, or a feeling of urgency (when you have to go, you have to go)

There is no way to predict which symptoms one person might develop.

What is demyelination?

In MS, patients develop various areas in the brain and spinal cord where the myelin is stripped off of the nerves. These areas are called plaques or sometimes lesions. When the myelin is off, the electrical conduction of these nerves is altered. It is like getting a fuzzy signal on a television set. This event may affect any aspect of central nervous system functioning, causing symptoms. The symptoms may vary over time depending on how extensive the demyelination is and on factors such as fatigue and heat.

What do we know about multiple sclerosis?

There has been widespread research about MS over the past 50 years. We do not know the cause of MS, but do know that it is an inflammatory disorder of the central nervous system that occurs in people with a tendency to such a problem. We know that about 350,000 people in the United States have MS, about 1 in 1,000 people. We know that it is more common further north and south of the equator. Although we are still unsure exactly why this is. Females tend to get MS about three times as often as males, a rate similar to other immune diseases. MS is more common in Caucasians, but can occur in other populations. It is not contagious, nor is it infectious.

Did I do anything to bring on the MS or make it worse?

As far as we know there are no activities that specifically cause MS or make it worse. People with MS may not tolerate heat as well as they used to and may need to avoid particularly hot or humid situations. There is evidence that having infections makes having an exacerbation of MS more likely. There does not appear to be a link to trauma. However, emotional stress has been linked to a worsening of MS symptoms. Having MS is not the fault of people who have it; it can happen to anyone.

Is there anything new that we know about MS?

Multiple sclerosis is being studied actively in many research institutions around the world, and new knowledge is being added constantly. For example, we now know that even with early MS, the nerve fibers themselves (the axons) are affected more than we knew before. We know from MRI studies that new lesions (abnormal areas in the brain or spinal cord) occur about 5 to10 times as often as people with MS have new symptoms; that is, much of the disease occurs ‘under the radar scope’. We know that myelin repair occurs in the central nervous system all the time. Some groups feel there are different types of immune or pathological processes going on that we call MS, and perhaps MS may be many different disorders that we have lumped together.

Do any other diseases look like MS?

When neurologists evaluate MS they are also considering other diagnoses. While MS is the most likely cause of typical white matter changes and symptoms in an otherwise healthy young person, there are some other diseases that we consider and occasionally diagnose. These include a vitamin B12 deficiency that can cause an MS-like illness, and rarely, lupus, which may have symptoms that suggest MS. The MRI is very useful in ruling out many other disorders that could be confused with MS, and the blood tests and spinal fluid may also be helpful in diagnosing other diseases.

What does magnetic resonance imaging show in MS?

Magnetic resonance imaging has become the single most useful test for the diagnosis of MS; MRI is sensitive to brain changes which are seen in MS. Classically, the MRI shows lesions in the white matter deep in the brain near the fluid spaces of the brain (the ventricles). The test may also show changes in the cortex or near the cortex. MRI can also show changes in the brainstem and in the spinal cord.

There may be a loss of brain or spinal cord volume, a change which is called atrophy. Neurologists will occasionally use gadolinium, a heavy metal dye, to look at the brain more carefully. In a lesion that is active (a new plaque), this dye will leak out into the brain and show abnormalities. It is not clear how useful repeated MRIs are for following MS. However, many neurologists will repeat an MRI about a year after starting treatment for MS, or when there are unexplained changes in the patient’s course that make it important to take another look. In MS, the MRI may not make the diagnosis, as sometimes the changes are not specific for MS. Other times the appearance may be characteristic of MS.

What are evoked potentials, and what are they used for?

Evoked potentials are tests where different sets of nerves are stimulated, and the activity of the brain, spinal cord, or nerves is measured electrically. Visual evoked potentials are done by flashing a checkerboard image in front of the patient and recording the brain’s response at the back of the head. Auditory evoked responses are stimulated with a clicking noise in the ears, recording the brain’s response. Somatosensory evoked responses are recorded after stimulation of the nerves usually in the arms or legs and are a measure of the nerve activity coming up the nerves and into the spinal cord. In MS, these tests may be normal but may show changes such as slower electricity conduction along the nerve pathways. In MS, visual evoked potentials are the most useful as they may show evidence of injury to the optic nerve not suspected clinically.

What is the lumbar puncture (spinal tap) for?

The lumbar puncture helps to show signs of inflammation and immune system activity in and around the brain and spinal cord. The test is really the only direct measure of immune activity that we can use clinically. In people with MS, there may be an increase in white blood cells and antibody formation in the spinal fluid. There may be ‘oligoclonal’ bands, which are a measure of immune activity found in MS but also in other immune disorders. Spinal fluid helps to diagnose other diseases such as Lyme disease and lymphomas of the nervous system. Not everyone needs a lumbar puncture, but it can be very useful.

Are there different types of MS?

MS varies from patient to patient so that each individual has their own set of symptoms, problems, and their own course. There are people who have MS so mildly that they never even know that they have it. Of course, there are also others that have it severely. It is really a spectrum that ranges from mild to severe. An international panel of experts developed a classification of MS in 1999 that most neurologists use today:

• Relapsing-remitting: Patients have attacks of symptoms/signs, with or without recovery, but between attacks have no interval worsening.
• Secondary progressive: This is often after a few years of relapsing-remitting MS. The pattern changes from a relapsing pattern to progressive in between attacks, usually with fewer attacks.
• Primary progressive: This involves a gradual onset from the beginning and no attacks.
• Progressive relapsing: This is a rare form, and begins with a progressive course, while later developing attacks.
• Fulminant: This is a rare form, and is very severe, rapidly progressive MS.

Is there such a thing as benign MS?

The term, “benign MS,” is not part of the international classification. It is used when people have had MS for many years without developing significant measurable disability. Recent studies have shown that it cannot be predicted early in the disease and so the term can only really be used retrospectively, after people have done very well with MS for many years.

What is an attack?

An MS attack is also known as a ‘relapse’, an ‘exacerbation,’ or a ’bout’ of MS. All of these terms mean the same thing–usually a worsening of MS symptoms or new MS symptoms lasting more than 48 hours and not due to infection or fever. An attack may be mild or severe; it may or may not correlate with MRI changes, though neurologists do not usually perform MRI imaging as part of an attack evaluation. Many patients have a daily variation of their symptoms; this is not an attack. Similarly, some patients may develop transient symptoms lasting only seconds such as twitching in an arm or a leg. This is also not an attack. Attacks are one marker of disease activity.

What is the prognosis (outlook) for MS?

Most people think that MS is a rapidly disabling disorder. This is not true for most people with MS. A recent study of people with MS in the Olmstead county area near the Mayo clinic showed that most people did well even without treatment. An older study showed that after 25 years without treatment most people were still able to walk. However, only a small percentage of people followed for years do not show some measurable signs of MS on examination.

Will the medications for MS make me feel better?

There are now 16 FDA-approved medications to control the course of MS, all for the treatment of relapsing-remitting MS. There are currently no FDA approved medications for the treatment of progressive MS. In general, the medications do not ‘make you feel better,’ but do reduce MS activity. People treated for MS are less likely to develop new attacks, have fewer new MRI changes, and tend not to progress as much as those on no treatment. So, while the medications may not make people feel better in the present, they do help prevent people from feeling worse in the future.

What is spasticity?

Spasticity is an increased muscle tension and tightness that may interfere with useful movements. It is often present when people have had MS for a few years, and tends to happen more often in the legs than in the rest of the body. Phasic spasms are rapid movements of limbs that occur suddenly, such as sudden flexing of a leg. Tonic spasms are a tightening of limbs in place. Spasticity may be painful and may interfere with walking, transferring, and sitting; in general, this is when spasticity is treated. While patients with spasticity may be weak, the two are not the same, and strength may be preserved in someone with spasticity.

Do people with MS get pain?

In the past, physicians thought that MS did not cause pain. However, recent studies have shown that up to one-third of people with MS will have pain related to their MS at some time during the course of their disease. This pain comes in a variety of forms, including trigeminal neuralgia, a syndrome involving sharp, stabbing pain in the side of the face or the jaw. It may come and go for days, weeks, or even longer. Medication may help with this. Some people develop back or neck pain, similar to the pain that many other people get. Some patients may get burning or tingling pain in the legs, arms, or body which may stay or come and go. Pain is part of MS and should be treated appropriately.

Do people with MS get bladder problems?

Some people with MS will have problems with bladder function due to injury to the nerves that tell the bladder and the sphincters what to do and to the nerves that help the bladder sense when it is full. The most common symptom of bladder problems in MS is urgency, a feeling that “when you have to go, you have to go.” Sometimes people find that it is hard to start going, for the urine to flow. Some people cannot tell when they have to go, or may have accidents (incontinence).

Many of these symptoms can be treated either with medication or with approaches such as self-catheterization, which allows the bladder to be emptied whenever it needs to be. People with MS and bladder problems are at a higher risk of urinary tract infections. Bladder problems in MS may range from being a nuisance to being a major problem that needs to be addressed.

Is fatigue part of MS?

Fatigue, a sensation of being tired all the time, is very common in MS. Most patients with MS feel tired more than they used to, despite getting sleep at night. While fatigue in MS can be due to a lack of sleep or poor sleep, it is often just one of the symptoms of MS. It may be due to activation of the immune system, like fighting off an infection. It may be due to having to work harder to re-route information in the brain because of the MS. In any case, it can be treated. Taking naps helps with afternoon fatigue.

Regular exercise actually improves fatigue symptoms. Avoiding very heavy meals may help. Making sure that night-time sleep is good is also useful. There are medications that have been shown to be helpful in MS-related fatigue.

Part I: Understanding Progression in MS

Background Information

Multiple sclerosis (MS) is a disease of the central nervous system (CNS). The CNS consists of the brain, optic nerves, and spinal cord. With MS, areas of the CNS become inflamed, damaging the protective covering (myelin) that surrounds and insulates the nerves (axons). In addition to the myelin, over time, the axons and nerve cells (neurons) within the CNS may also become damaged. This damage is referred to as neurodegeneration.

The damage to the protective covering and also to the nerves disrupts the smooth flow of nerve impulses. As a result, messages from the brain and spinal cord going to other parts of the body may be delayed and have trouble reaching their destination – causing the symptoms of MS. Described later in this booklet, these symptoms can include a wide variety of physical, emotional, and cognitive changes.

Areas of inflammation and damage are known as lesions, which are viewed on magnetic resonance imaging (MRI) scans. The changes in size, number, and location of these lesions may determine the type and severity of symptoms. While individuals with relapsing forms of MS are believed to experience more inflammation than those with progressive forms of MS, lesions still occur for individuals with all forms of MS. However, the lesions in progressive forms of MS may be less active and expand more slowly.

Shown above is an illustration of two nerve cells. The normal one on the left has a healthy nerve fiber, or axon, protected by myelin (insulation covering the nerve), and is able to transmit signals at a very fast speed – similar to electricity traveling along an electrical cord. The MS nerve cell on the right shows damage to the myelin, and as a result, signals do not travel well along the nerve.

Types of MS

MS affects each person differently. For many years, the most common types of MS had been classified as:

• relapsing-remitting MS (RRMS)
• primary-progressive MS (PPMS)
• secondary-progressive MS (SPMS)
• progressive-relapsing MS (PRMS)

However, these classifications are changing, and some experts are now grouping relapsing-remitting MS (RRMS) and secondary-progressive MS (SPMS) together, as a continuum of the same disease. These are now frequently referred to as “relapsing forms of MS.” Additionally, progressive-relapsing MS (PRMS) and primary-progressive MS (PPMS) have also been grouped together. These are now frequently referred to as “progressive forms of MS.”

Initially, most people with MS experience symptom flare-ups, which are also known as relapses, exacerbations, or attacks. When someone experiences a relapse, he or she may be having new symptoms or an increase in existing symptoms. These usually persist for a short period of time, from a few days to a few months. Afterward, the symptoms greatly improve or remit completely, and these individuals may remain symptom-free for periods of months or years. This type of MS is known as relapsing-remitting MS (RRMS). Approximately 80 to 85 percent of MS patients are initially diagnosed with this form of the disease.

Over time, RRMS may advance to secondary-progressive MS (SPMS). This form of MS does not have the dramatic variations in symptoms that RRMS does, but rather has a slow, steady progression – with or without relapses. If relapses do occur, they usually do not fully remit.

Without treatment, approximately half of individuals with RRMS convert to SPMS within 10 years. However, with the introduction of long-term disease-modifying therapies (DMTs), fewer individuals advance to this latter form of the disease. Since 1993, and as of mid-2017, a total of 15 DMTs have been approved by the FDA and are available through prescription. All of these approved medications are aimed at slowing disease activity and delaying progression in MS.

Individuals who are not initially diagnosed with RRMS may be experiencing a more steady progression of the disease from the onset. Approximately 10 percent of the MS population is diagnosed with primary-progressive MS (PPMS), where individuals experience a steady worsening of symptoms from the start, and do not have periodic relapses and remissions.

Approximately 5 percent of patients are initially diagnosed with progressive-relapsing MS (PRMS). This type of MS steadily worsens from the onset, but symptom flare-ups – with or without remissions – are also present.

The Pathogenesis of MS Progression

All forms of MS share an underlying pathogenesis, which refers to the origin of a disease and its development. The pathogenesis of MS includes:

• inflammation – this is an autoimmune attack where an individual’s own white blood cells cause damage to his or her own neurons within the brain and spinal cord
• demyelination – this is damage to the myelin covering around nerves, caused by inflammation
• axonal degeneration – this is the shrinking, atrophy, and death of neurons
• remyelination – this is the body’s own attempt to repair damaged myelin, although this repair is often incomplete
• glial scar formation – this results in multiple scars within the brain and spinal cord at sites of damage from MS

Research has shown that individuals with progressive forms of MS have predominantly neurodegeneration and less inflammation. This is in comparison to relapsing-remitting MS, where inflammation is the predominant driver of the disease with less neurodegeneration occurring early in the disease process.

Multiple Sclerosis Pathophysiology

Particularly with relapsing forms of MS, inflammation is greatly involved with the initial disease process. This causes damage to the myelin – the protective covering of the nerves in the central nervous system – and eventually damage to the nerves as well. As time progresses and fewer relapses are experienced, the disease involves increasingly less inflammation and more neurodegeneration, which is the breakdown or cell death of nerve cells.

The Measures and Assessment of Progression

► Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) has revolutionized the ability to efficiently diagnose MS, track new inflammatory-disease activity – through the discovery of new T2 bright spots and/or new gadolinium-enhancing lesions (these are areas of disease activity with inflammation) – as well as monitor an individual’s response to MS disease-modifying therapies. Currently, an MRI scan provides the best biomarker for evidence of MS progression. MRI measures that most closely correlate to progression include:

• accelerated brain atrophy, which refers to faster brain shrinkage
• development of T1 hypointensities, also referred to as “black holes,” which indicate more neurodegeneration versus inflammation

Readers should note that many of the current MS therapies have been shown to decrease the accumulation of bright spots and black holes as viewed on an MRI, along with slowing atrophy rates. MS specialists encourage people with MS to review their MRI scans with their providers and to ask about these two types of disease measures.

Important note: MSAA may be able to help cover MRI costs through its MRI Access Fund program (certain income limits apply). To learn more, please visit mymsaa.org/mri or call (800) 532-7667, extension 120.

► The EDSS and Neurologic Exam

Kurtzke’s Expanded Disability Status Scale (EDSS) is the oldest and most widely accepted measure of MS disability. The EDSS ranges from 0 to 10 in half-point increments, where 0 is a normal examination, 3.0 is moderate disability, 6.0 is where the person needs assistance to walk, and higher numbers refer to greater disability, largely in terms of mobility.

View Larger ImageShown above are features from Kurtzke’s Expanded Disability Status Scale (EDSS). Frequently used for clinical evaluation and research study assessments, it mainly focuses on mobility when determining a score.

A trained MS clinician assigns a functional score to a patient in eight neurologic systems: pyramidal (referring to the motor system, with weakness and spasticity), cerebellar, brainstem, sensory, bladder and bowel, vision, cerebral, and “other.” These are all based on a standard neurologic examination. The EDSS is frequently criticized for being insensitive to small changes, being heavily dependent on mobility, not capturing cognitive impairment, being subjective in some assessments (rating scores can vary), and for not capturing the full range of disabilities.

► The Multiple Sclerosis Functional Composite

The Multiple Sclerosis Functional Composite (MSFC) is another clinical tool that assesses MS disability. Unlike the EDSS that is based on a standard neurological examination, the MSFC assesses disability using three “functional” tests. It summarizes the scores of the following:

• a timed 25-foot walk evaluating ambulation
• the nine-hole peg test evaluating arm function
• the paced auditory serial addition test evaluating cognition

The goal of this system is to capture information on key functional measures affected by MS, specifically leg, arm, and cognitive function. The MSFC is often used in connection with the EDSS in MS clinical trials. Many aspects of the MSFC, such as the timed 25-foot walk, are routinely monitored in MS clinics as well.

The Natural Progression of MS

Approximately one in every 750 individuals in the United States has MS. The natural progression of MS has changed over time. Early studies showed that the median time from onset of PPMS to needing a device (such as a cane) to assist with walking was 10 years, while more contemporary studies show that this has increased to 15 years. Another study showed that 25 percent of people with PPMS still did not require a cane after more than 25 years. Although difficult, individuals with MS should not compare their disease course with those of others, as every individual is different.

Risk factors for disease progression have been identified, but their interplay is complex. Early onset of disease and female gender are favorable factors associated with a better prognosis in terms of one’s long-term course of MS. For instance, individuals who were young at the onset of their MS have been shown to take a longer amount of time before their MS progresses to the point of needing a device to assist with walking, which is a score of 6.0 on the EDSS.

Relapses can still occur in people with progressive MS. Individuals with secondaryprogressive MS can have an occasional relapse, which is a new neurologic symptom that lasts more than 24 hours, in the absence of fever or infection. This occasional relapse is superimposed on progressive disease, characterized by a gradual decline.

For example, an individual with SPMS may notice worsening balance and walking issues over several years, and then notice over the course of hours to days, they have developed blurry vision in one eye and pain with eye movements. He or she may then be diagnosed with an MS relapse of optic neuritis, in addition to having a gradual decline in neurologic function over the course of years. This is different from RRMS, as individuals with RRMS only experience neurologic worsening in the setting of a relapse.

Criteria for Diagnosis and Description Modifiers

The word “progressive” has historically carried a negative connotation among members of the MS community. However, when this term was first coined, the understanding of the pathophysiology of MS – which is how the disease progresses and its effects – was very limited. Neuro-diagnostics, which use advanced technology to diagnose, evaluate, and sometimes treat certain neurological conditions, were in their infancy, and the therapies that could slow progression were lacking. Fortunately, the MS world is changing.

Currently, no criteria have been defined to determine definitively when a person with MS has progressed from RRMS to SPMS. However, criteria are in place for a diagnosis of SPMS, which requires the onset of the disease with at least one clinical relapse (differentiating it from PPMS), followed by a gradual decline in neurologic function over the course of at least six to 12 months. This decline must be separate from the worsening that occurs during relapses.

The diagnosis of PPMS has distinct criteria based on 2010 McDonald criteria for the diagnosis of MS. To receive a diagnosis of PPMS, a person with MS must have one year or more of gradual decline in neurologic function, in addition to two or more of the following:

• abnormal lesions consistent with MS on MRI
• two or more lesions consistent with MS in the spinal cord
• cerebrospinal fluid (CSF) analysis consistent with the diagnosis

Individuals with RRMS are usually diagnosed between the ages of 15 and 40. The average age of onset of SPMS and PPMS is in the fifth and sixth decades of life, when people are in their 40s or 50s. While RRMS often affects women two-to-three times more often than men, the gender ratio in PPMS is equal between males and females.

In both SPMS and PPMS, the rate of decline in neurologic function occurs at a similar rate. Individuals with PPMS generally have more spinal-cord lesions than those with SPMS. It is important to note that the diagnosis of the type of MS is based on clinical history, which is determined through doctor visits and evaluations. Progressive forms of MS cannot be diagnosed with an MRI or spinal-fluid analysis alone.

As part of the 2013 International MS Phenotype Group revised MS classification criteria, three important modifiers were added to the description of MS: activity, worsening, and progression. These modifiers help to more accurately reflect the current disease process in a specific individual with MS.

• Disease activity refers to a new clinical MS attack (relapse) or a new bright spot (showing inflammation) on the MRI.
• Disease worsening simply reflects that a specific person’s neurological examination has gotten worse compared to prior examinations, possibly related to an MS attack (relapse).
• Disease progression indicates worsening on an exam, independent from an attack (relapse).

In summary, people with progressive MS can and do have attacks (relapses), albeit infrequently, and develop new spots (or lesions) on MRI. Both relapses and new lesions are types of disease activity. Additionally, MS may be “clinically silent,” showing no increase in symptoms, yet continuing to show signs of disease activity within the CNS, as seen on MRI. Conversely, these same people can experience long periods of time without progression and without worsening. These variations in disease activity show how dynamic MS is, while affecting each individual differently.

Non-MS Causes of Clinical Worsening

Clinical worsening in MS, or the gradual decline in function, should not immediately be attributed to MS as the only cause. Individuals with MS can also acquire other medical problems that can mimic MS progression. These include:

• cervical stenosis – a narrowing of the spinal canal in the neck, which can put pressure on the spinal cord and cause a worsening of gait, sensation, strength, as well as a worsening of bowel and bladder control
• vitamin deficiencies, such as B12
• thyroid disease
• other conditions not related to MS

As a result, a thorough evaluation by a neurologist as well as a regular follow up with a primary-care physician are important. If alternative causes are ruled out, then a neurologist may confirm that progression is directly related to one’s MS.

Previous: Preface | Table of Contents | Next: Part II: Treating Progression in MS

Multiple sclerosis (MS) – common symptoms

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that can affect the brain, spinal cord and optic nerves. It can result in a range of symptoms and functional impairments.

MS symptoms are varied and unpredictable, depending on which part of the central nervous system is affected, and to what degree. It is important to remember that some people may not have many symptoms at all. Symptoms may last for a short time or only occur during the short period of a relapse, depending on the affected areas and the degree of inflammation present.

Symptoms can be a combination of changes in:

• levels of fatigue
• sensory function (such as pins and needles or burning pain)
• vision (such as blurred or double vision)
• bladder function (such as urgency, frequency or difficulty in emptying the bladder)
• bowel function (such as constipation or incontinence)
• sexual function
• motor function (such as problems with weakness, balance, spasms or functioning of the legs and arms)
• mood (such as depression or anxiety)
• cognition (such as problems with memory and information processing)
• pain (such as acute pain with a relapse or chronic with spasticity).

The symptoms of MS can be both visible and invisible to others. They can also be unpredictable and vary from person to person and from time to time. Symptoms can also interact with each other and other co-occurring conditions or diagnoses.

The key goals in managing MS are to:

• minimise relapses
• eliminate inflammation
• prevent new lesions
• slow down brain atrophy at all stages of the disease
• restore function
• minimise the impact of symptoms on your day-to-day life.

See your doctor or specialist MS healthcare team for investigation and diagnosis of any new symptoms, as some symptoms can be caused by other illnesses or may be indicative of a relapse.

Watch this MS Australia animation about the invisible symptoms of MS.

Fatigue and MS

Fatigue is a side effect of nervous system damage and is one of the most common symptoms of MS, affecting up to 90% of people.

Unlike ordinary fatigue, MS fatigue usually occurs more rapidly, lasts longer and takes longer to recover from. It can be temporary such as during a relapse, an infection or unrelated illness, or when starting some MS medications. Or it can be ongoing (chronic), even after rest.

MS fatigue may occur when you wake, in some cases every day, even if you have had a good night’s sleep and:

• tends to worsen as the day progresses
• appears more easily and suddenly than ordinary fatigue
• is generally more severe than ordinary fatigue
• tends to be aggravated by heat and humidity
• is more likely to interfere with daily activities.

Fatigue in MS is thought to be partly caused by MS itself (known as primary fatigue) and partly by other factors (secondary fatigue) that affect people with MS, more than those without the condition.

How to manage MS fatigue

It can be useful to learn to recognise the early signs of fatigue and how it affects you. Likewise, talking with family, friends and/or colleagues may help them understand any limitations.

MS fatigue often results from secondary factors, such as co-existing medical conditions, poor diet, lack of fitness or sleep, medication side effects, stress, depression, hormonal changes or heat sensitivity. Identifying any contributing factors, should help you to develop a tailored management plan.

Fatigue management strategies include:

• Maintain a well-balanced diet and stay hydrated.
• Stay active – exercises to increase your stamina and strength may be useful.
• Monitor sleep patterns and address any issues.
• Manage other contributing MS symptoms, such as depression.
• Rest/take breaks.
• Vary heavy with lighter tasks – for example, if you have more fatigue in the afternoon, do harder jobs in the morning.

Vision and MS

Visual problems are often the first symptoms associated with MS.

The optic (eye) nerve can become inflamed (optic neuritis) as the optic nerve is a common area where damage to the protective covering of nerves (demyelination) occurs.

More than half of people with MS will experience at least one issue with vision. Talk to your GP, MS nurse or neurologist as soon as possible if you:

• feel eye pain
• think colours appear to have faded (especially red)
• experience double or blurred vision or visual field defects (part of your vision is missing in different areas of your visual field)
• seem to have ‘blind spots’.

An eye assessment can determine how much inflammation is present and inform your doctor whether special treatment is needed.

Sensory symptoms and MS

Changes in sensations such as numbness, pins and needles and tingling are common MS symptoms, related to damage to nerve covering in certain areas. These sensations can occur anywhere on the body such as the arms, legs and face. They can be mild or could interfere with your ability to use the affected part of your body, such as difficulty in writing with a pen.

The new onset of sensory symptoms may be associated with a relapse and should be reported to your MS healthcare team.

Pain and MS

Pain in MS can be primarily due to demyelination or may be due to secondary conditions, such as musculoskeletal problems resulting from altered posture or spasticity. Weakened leg muscles commonly trigger aches and pains in the back or knees, but people with MS may experience pain anywhere. Sensory pain may also feel like ’burning’ pain.

As pain can significantly affect quality of life, it should be reported to your healthcare professional for assessment.

Changes to bladder and bowel function with MS

Issues with bladder and bowel function can be a common problem for people with MS at some stage in their life. These issues may be related to other conditions, so it is important to report any changes, so the right assessments can be made.

Issues with bladder and bowel function may include:

• Incontinence – an accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence). It is a widespread condition affecting many Australians, so you should not feel alone.
• Bladder dysfunction symptoms – including greater or less frequency of passing of urine, urgency, incontinence, urinary tract infections and the need to urinate frequently overnight.
• Bowel issues – including severe constipation, faecal incontinence and diarrhoea.

With the right advice, you can manage these symptoms and prevent complications or associated illnesses.

You can also make small changes that could make a big difference, including:

• Treatment and medication – if you have bladder or bowel concerns talk to your GP, MS nurse or neurologist about medication, aids, diet and lifestyle adjustments. Tell your neurologist about new and/or persistent symptoms. For serious concerns, you may be referred to a urologist (bladder) or gastroenterologist (bowel) for further assessment of the problem and management.
• Continence aids – aids such as disposable pads are available at supermarkets and pharmacists.
• Plan ahead – peace of mind about toilet facilities and their locations can make a big difference (check out the National Toilet Map). Consider calling ahead to your destination to ensure there are adequate, accessible facilities.
• Drink enough fluids – for anyone with bladder problems, it is still important to drink plenty of water to avoid complications such as urinary tract infections or constipation. Not enough water makes urine concentrated and irritates the bladder, causing more frequent urinating. Do not try to manage bladder symptoms by rationing your fluid intake.
• Maintain a healthy diet – a healthy bowel pattern benefits from a well-balanced, high-fibre diet.
• Limit caffeine and alcohol – caffeinated or alcoholic drinks can exacerbate frequency of urination.
• Exercises – exercises such as those to strengthen the pelvic floor (the muscles that support the organs inside the pelvis) can help, as well as keeping as fit and exercising in general.

Sexual function and MS

Sexual dysfunction is common in MS. It can be directly related to MS from brain or spinal cord lesions, or more indirectly related due to other MS symptoms such as depression and fatigue, or from wider relationship and social issues stemming from MS.

Although a difficult area to talk to your health professional about, it is an important area to maintain your quality of life and self-confidence. There are many avenues of help available from physical to psychological and your GP, MS nurse or neurologist can point you in the right direction for the most appropriate assessment and assistance.

Motor symptoms and MS

Difficulty with walking or a change in walking style (gait) can be one of the first MS symptoms noticeable to others, for example beginning to stumble or trip.

Nerve demyelination can cause damage to the nerves that direct the affected muscles, causing incoordination. In some people, balance may also be affected, if special areas of the brain are demyelinated, and can lead to feeling off-balanced and leaning to one side, or difficulties in perception of where the body is in space (ataxia).

Balance and walking problems vary considerably from one person with MS to another and may include:

• tripping, stumbling or falling
• unsteadiness when walking or turning
• needing support from walls, furniture or other people
• a heavy feeling in the legs when stepping forward
• leg weakness when weight bearing
• difficulty placing the foot squarely on the ground
• taking slower, shorter steps
• loss of confidence when walking.

Spasticity is a symptom of MS that causes your muscles to feel stiff, heavy and difficult to move. A spasm is a sudden stiffening of a muscle which may cause a limb to kick out or jerk towards your body and can also cause pain.

Not all motor problems are caused by MS, so it is important to seek professional advice. A health professional, such as a neurologist, an MS nurse, GP or physiotherapist can work with you to determine the cause of your walking and balance problems and advise on management.

Other MS symptoms can impact on walking and balance and increase the risk of falling. These include pain, tremor, dizziness, vertigo and visual problems.

Speech and swallowing changes with MS

Speech and swallowing changes can occur due to affected nerves being damaged. This may present as changes to the voice tone and quality, or coughing when eating.

These symptoms should be reported to your MS healthcare team for assistance from a speech therapist, who can advise on appropriate management.

Psychological aspects of MS

Mood issues can be very common in MS, not just around the time of diagnosis, but at various stages of life. The most common mood disturbances are depression and anxiety which can be short or long term.

The most important thing to remember is to talk to your MS healthcare team as soon as you start to notice symptoms, so that you can access appropriate help, to improve your quality of life.

Depression

Depression can be a symptom of MS or develop due to diagnosis or a change in your condition. Inflammation because of MS can affect the areas in the brain which regulate mood. Around half of people diagnosed with MS will have a depressive episode – 3 times higher than for the general population.

Depression can range from feeling down or having negative thoughts, to the more severe form of clinical depression that can last for months and impact your day-to-day life.

Depression does not discriminate or indicate weakness, nor is it something to hide. Often out of your control, depression can come and go, occur once, build up slowly or fast.

Help is never far away. Talk to a professional and family and/or friends. It can be hard to discuss mental health, but family and friends can also play a key role in helping you identify, recognise, or even manage and prevent depression.

Prevention strategies for depression and ways to manage your mental and physical health may include:

• regular exercise
• sunshine, warmth, light and fresh air
• positive thoughts, avoid being hard on or comparing yourself to others
• recognising risk factors can be important, so keeping a diary can be valuable.

Without the right help early on, depression can spiral out of control and may also affect your MS management, and other MS symptoms.

If you have mood or motivation issues, it may be helpful to review your MS management and medications with your GP and neurologist. There are also many avenues for help and therapy with allied healthcare professionals, such as psychologists.

Anxiety

Anxiety issues can also play havoc in MS, often at the start of the MS journey around the time of diagnosis but can also occur with relapses or other changes in your condition.

Working with a healthcare professional such as a psychologist, can be an effective way to cope with the emotional demands of a complex and unpredictable disease such as MS. Learning coping and behaviour strategies can be a life-long investment when dealing with chronic disease.

Talk to your GP, MS nurse or neurologist about any anxiety issues that you have noticed and get the right help early on.

Cognitive changes and MS

About half of all people with MS will experience issues with aspects of cognition, memory, attention span, planning, decision-making, understanding or concentration. These symptoms may be mild and not noticed by others or can be more serious, and begin impacting on employment, social interactions and relationships.

Reporting cognitive changes early to your GP, MS nurse or neurologist, can lead to a formal assessment to identify specific areas of concern and interventions to better manage your cognitive function and quality of life.

Brain health lifestyle strategies and MS

There is increasing evidence to support the importance of general good health and wellbeing when living with MS, with a particular focus on brain health. To keep your brain as healthy as possible, you can make these positive lifestyle choices:

• Keep active – high levels of aerobic fitness are associated with faster information processing and preserving brain tissue volume. Many MS-related symptoms can be reduced through physical exercise, including bladder and bowel issues.
• Keep your mind active – education, reading, hobbies and artistic or creative pastimes, can help protect against cognitive problems in MS, when pursued over the long term.
• Keep your weight under control – there is strong evidence that increased body weight and obesity is associated with a higher number of MS lesions. Numerous studies have shown that being overweight/obese, particularly during adolescence, is associated with a 2–3-fold increase in the risk of developing MS.
• Avoid smoking – smoking is associated with decreased brain volume in people with MS. It has also been associated with higher relapse rates, increased disability progression, more cognitive problems and reduced survival compared to not smoking at all. Smoking is known to cause an increase in inflammation, and chemicals in cigarettes and smoke can also directly alter the function of some immune cells, potentially contributing to the development of MS.
• Watch how much you drink – higher levels of alcohol use are associated with disability progression and reduced survival in people with MS.
• Avoid stress – MS by itself can be stressful. However, studies have linked severe stress with an increase in MS relapses. Find strategies that work for you to reduce your overall stress levels.
• Reorganise your life and priorities – recognise your strengths and build on those. Work toward achieving your goals for your life, family and health by being flexible, thinking creatively about solutions and delegating where possible.
• Find your support team – be the CEO of your life and support plan. Where possible, seek support from healthcare professionals who specialise in MS.
• Continue taking other medicines that your doctor prescribed – if you have other diagnoses or health conditions, be responsible for monitoring and managing them, including taking your prescribed medication.
• Continue to attend regular check-ups and screening appointments – conditions such as high blood pressure, high cholesterol, heart disease and diabetes can worsen your MS symptoms.

Where to get help

Multiple sclerosis (MS) – Illnesses & conditions

Contact your specialist MS nurse or GP if you think you’re having a relapse.

A flare up of symptoms can sometimes be caused by something other than a relapse, such as an infection, so your nurse or GP needs to check for other possible causes.

Treatment for a relapse usually involves either:

• a five-day course of steroid tablets taken at home
• injections of steroid medication given in hospital for three to five days

Steroids can help speed up your recovery from a relapse, but they don’t prevent further relapses or stop MS getting worse over time.

They are only given for a short period of time to avoid possible steroid side effects, such as osteoporosis (weak bones), weight gain and diabetes, although some people will still experience problems.

Not using steroids more than three times a year (if possible) will also help to reduce the risk of side effects.

Treatment for specific MS symptoms

MS can cause a range of symptoms that can be treated individually. Treatments for some of the main symptoms are outlined below.

Fatigue

Many people with MS experience fatigue.

For fatigue caused by MS, you may be prescribed amantadine, although this medication may only have a limited effect. You should also be given general advice on ways to manage fatigue, such as exercise, keeping healthy sleep patterns, energy-saving techniques and avoiding medications that can worsen fatigue (including some painkillers).

Specialist fatigue management courses or therapy, such as cognitive behavioural therapy (CBT), can also help some people with MS cope with their fatigue.

Visual problems

MS-related visual problems will often improve on their own, usually within a few weeks, so you may not need any treatment. If your symptoms are particularly severe, you may be prescribed steroids to help speed up recovery.

If you have problems with involuntary eye movements, medication such as gabapentin can sometimes help. Some people with double vision need help from ophthalmologists (eye specialists).

Muscle spasms and stiffness

Muscle spasms and stiffness (spasticity) can be improved with physiotherapy. Techniques such as stretching exercises can help if your movement is restricted.

If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.

These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which of these would be best for you with your specialist MS nurse or GP.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity (see above), but they can also be caused by muscle weakness, or problems with balance or dizziness.

If you have problems with mobility, you might benefit from:

• an exercise programme supervised by a physiotherapist
• special exercises called vestibular rehabilitation, if you have problems with balance
• medication for dizziness or tremors
• mobility aids, such as a walking stick, or occasionally a wheelchair
• home adaptations such as stair lifts or railings

An occupational therapist can carry out an assessment of your home and suggest adaptations that may be of help.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation.

This type of pain can be treated using the medicines gabapentin or carbamazepine, or with a medication called amitriptyline. This is an older type of antidepressant, but these days it’s mainly used for pain control.

Musculoskeletal pain

Living with MS can cause stresses and strains to the muscles and joints in your body.

A physiotherapist may be able to help with this pain by suggesting exercise techniques or better seating positions.

If your pain is more severe, you may be prescribed painkillers. Alternatively, you may have a device that stimulates your nerves, called as a transcutaneous electrical nerve stimulation (TENS) machine.

Problems with thinking, learning and memory

If you experience problems with thinking and memory, any treatment you receive will be fully explained and recorded, so that it’s clear to you.

You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them.

Emotional problems

If you experience emotional outbursts, such as laughing or crying for no apparent reason, you should be assessed by a specialist such as a clinical psychologist. They may suggest treatment with an antidepressant.

People with MS who have depression can also be treated with antidepressants or therapy, such as CBT.

If you often feel anxious or worried, you may be prescribed antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect.

Sexual problems

Men with MS who find it hard to obtain or maintain an erection (erectile dysfunction) may be prescribed medication to temporarily increase the blood flow to the penis, such as sildenafil (Viagra). This is provided by the NHS if you have MS.

Relationship counselling or seeing a sex therapist may also help both men and women with MS who are having problems with reduced interest in sex or difficulty reaching orgasm.

Bladder problems

Various medications are available if you have an overactive bladder or need to pee frequently during the night.

If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can also help some people to start peeing or to empty the bladder.

Occasionally, a catheter can be used to empty the bladder when needed. In rare cases, people with MS may need a long-term catheter to keep the bladder emptying safely.

You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as botulinim toxin injections, bladder exercises or electrical treatment for your bladder muscles. Read more about treating urinary incontinence.

Bowel problems

It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives.

More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. An enema involves having a liquid medication rinsed through your bottom and large bowel, which softens and flushes out your stools.

Bowel incontinence can sometimes be treated with anti-diarrhoea medication or by doing pelvic floor exercises to strengthen your rectal muscles.

Speech and swallowing difficulties

A speech and language therapist can help you find ways to overcome problems with speech and swallowing.

For example, they can offer advice about foods that are easy to swallow and they can recommend exercises to strengthen the muscles used in speech and swallowing.

If swallowing problems become very severe, some people need to be fed using a tube, which is fitted into the stomach through the skin.

Disease-modifying therapies

Although MS can’t currently be cured, there are medicines that can help to reduce the number and severity of relapses in some people. These are called “disease-modifying therapies”.

These aim to reduce the amount of damage and scarring to the myelin sheath (layer surrounding your nerves), associated with MS relapses.

These treatments may also help to slow worsening disability in MS, although definitive research into their long-term benefits is limited.

Disease-modifying therapies are not suitable for everyone with MS. They’re only prescribed to those with relapsing remitting MS or secondary progressive MS who meet certain criteria, such as the number of relapses they’ve had.

People without relapses are very unlikely to benefit from the treatments and could still experience side effects from them.

Beta interferon

The types of beta interferon licensed for use in the UK are interferon beta-1a (Avonex, Rebif and Plegridy) and interferon beta-1b (Betaferon and Extavia). These are all given by injection.

You may be offered treatment with one of these medicines if either:

• you’ve got relapsing remitting MS and you’ve had a recent relapse and/or MRI scans show that your MS is active
• you have secondary progressive MS and still have significant relapses

All beta interferons often cause mild side effects, particularly flu-like symptoms (headaches, chills and mild fever), for 24-48 hours after they’re injected, and temporary pain or redness at the injection site.

Glatiramer acetate

One brand of glatiramer acetate, called Copaxone, is licensed for use in the UK. It’s injected under the skin either every day or at a higher dose three times a week. 

You may be offered treatment with glatiramer acetate if you’ve got relapsing remitting MS and you’ve had a recent relapse, and/or MRI scans show that your MS is active.

Common side effects of glatiramer acetate include problems with redness or hardening of the skin at the injection sites, and occasionally palpitations or flushing after the injection.

Teriflunomide

Teriflunomide, branded as Aubagio, is a tablet taken once a day.

You may be offered treatment with teriflunomide if you have relapsing remitting MS and you’ve had a recent relapse, and/or MRI scans show that your MS is active.

Common side effects of teriflunomide include headaches, feeling sick, diarrhoea and hair thinning or hair loss. You’ll also need blood tests frequently in the early months of treatment to check for problems with liver function.

Natalizumab

Natalizumab, branded as Tysabri, is injected into a vein (known as an infusion) once every 28 days.

You may be offered treatment with natalizumab if you have severe relapsing remitting MS that’s getting worse quite quickly – for example, if you’ve had two or more severe relapses within a year and MRI scans show that your MS is getting worse.

Side effects of natalizumab are rare, but can include an increased risk of an itch or rash (hives), headaches, dizziness, joint pain, and feeling or being sick at the time of the infusions.

The main concern of treatment with natalizumab is a risk of a brain infection called progressive multifocal leukoencephalopathy (PML). This is uncommon, but can become a significant problem with long-term treatment in some people.

Fingolimod

Fingolimod, branded as Gilenya, is taken as a capsule once a day.

You may be offered treatment with fingolimod if you have relapsing remitting MS and you experience the same or an increased number of relapses, despite treatment with other medications such as beta interferons.

The medication doesn’t usually cause significant side effects, but some people experience an increased risk of infections, headaches, diarrhoea, liver problems and visual problems.

Alemtuzumab

Alemtuzumab, branded as Lemtrada or Genzyme, is initially given into a vein once a day for five consecutive days. This is followed by a second course of treatment a year later, which lasts for three consecutive days.

You may be offered treatment with alemtuzumab if you’ve got relapsing remitting MS and you’ve had a relapse in the past year, and/or MRI scans show that your MS is active.

Common side effects of alemtuzumab include an increased risk of infections, headaches, rashes and fever. Regular blood and urine tests will be carried out to monitor treatment.

Dimethyl fumarate

Dimethyl fumarate, branded as Tecfidera, is a tablet taken twice a day.

You may be offered treatment with dimethyl fumarate if you’ve got relapsing remitting MS and you’ve had a recent relapse and/or MRI scans show that your MS is active.

Common side effects of dimethyl fumarate include hot flushes, diarrhoea, nausea, abdominal (tummy) pain and headaches. Stomach upsets usually settle after a month or so. The flushes can continue, but aren’t normally a major issue.

Want to know more?

Clinical trials

Much progress has been made in MS treatment thanks to clinical trials, where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.

Speak to your care team if you’re interested in taking part in a clinical trial.

Complementary and alternative therapies for MS

Some people with MS find that complementary therapies help them feel better. Many complementary treatments and therapies claim to ease symptoms, although scientific evidence is often not clear about how effective they are.

Many people think that complementary treatments have no harmful effects. However, people can occasionally experience problems, and it’s not a good idea to use them as an alternative to medicines prescribed by your doctor. If you’re considering using an alternative treatment alongside your prescribed medicines, it’s important to let your doctor know your plans.

Care and support

If you find it difficult to look after yourself, your local authority may be able to provide you with some help. Ask for a care and support needs assessment. For more information, read about assessing your care and support needs.

90,000 Is it possible to survive a heart attack and not even notice it?

• Claudia Hammond
• BBC Future

September 14, 2017

Photo author, iStock

It seems to us that the signs of a heart attack should be so serious that they cannot be overlooked. But that isn’t always the case, warns BBC Future columnist .

The classic description of the condition in myocardial infarction includes pressure behind the breastbone, which develops into severe pain, and a feeling of fear.

In feature films, it is usually portrayed like this: a person grabs his chest, panic in his eyes, and he falls to the floor. And this really happens. But not always.

Myocardial infarction occurs when blood flow to the heart muscle is drastically reduced due to a blockage of a coronary artery by a blood clot.

But in some cases, people do not feel any chest pain, despite everything that happens in their bodies. And because of this, they do not seek help, wasting time.

If a little pain is felt, they blame it on something else – like an upset stomach. And only later does the electrocardiogram show how much damage to their heart was caused by a heart attack that happened to them.

This form of heart attack is called painless. One study published in 2016 claims that up to 45% of heart attacks can occur this way.

True, the data for this study was collected in the late 90s. Since then, the diagnosis of heart attacks has stepped forward, so today, perhaps, the numbers would not be so high.

However, even now every year people who do not even suspect that they have already suffered a myocardial infarction turn to doctors every year.

There are other patients: they admit they were sick, but they don’t know what. They experienced pain in the neck, shoulders, abdomen, jaw or back, difficulty breathing, weakness or dizziness, and excessive sweating. They were nauseous, even vomiting.

This combination of symptoms, even if there was no severe chest pain, is sufficient to make a diagnosis.

Photo author, iStock

Photo caption,

Chest pain during a heart attack is more common in men

It is often heard that such heart attacks – without chest pain – are more common in women, which is why they are late in seeking medical help, thereby reducing the chances of full recovery, if not salvation.

To determine if this is true, in 2009, Canadian researchers decided to systematically study the symptoms of heart attack in 305 patients who underwent angioplasty (in this procedure, doctors dilate narrowed or blocked vessels with a tiny balloon).

During the procedure, the patient briefly experiences the same symptoms as in a heart attack, and when the small balloons in the vessels inflated, expanding, the researchers asked the patients to describe their feelings.

Scientists have found no difference in how men and women feel when it comes to chest pain, arm pain, shortness of breath, sweating or nausea.

But, as it turned out, women were more likely to experience neck and jaw pain – in addition to chest pain.

SYMPTOMS OF MYOCARDIAL INFARCTION

• severe, compressive pain behind the sternum
• increasing feeling of anxiety, fear
• pain in the arms, jaw, neck, shoulders, back
• heart rhythm disturbance

shortness of breath

obstructed breathing

• weakness, nausea and vomiting
• headache
• dizziness and loss of consciousness

What was found in other studies was often contradictory and subsequently unconfirmed.In addition, studies often included other diagnoses.

Therefore, in the end, it was decided to make a scientific review of the research with the sole purpose of determining whether there was a difference in the symptoms of heart attack in men and women.

This review was done in 2011. It included studies conducted in the United States, Japan, Sweden, Germany, Canada and the UK, with the largest of them operating on data on more than 900 thousand people.

So, the data was taken from the best 26 studies, combined and re-analyzed.

The conclusion was that women are less likely than men to experience chest pain [with a heart attack] and are more likely to have symptoms such as weakness, nausea, dizziness and loss of consciousness, as well as pain in the neck, arms and jaw.

Most of both men and women experienced chest pain, but a third of patients and almost a quarter of patients experienced a heart attack without such symptoms at all, which made it difficult to understand what was happening to them.

Photo author, iStock

Photo caption,

In some cases, myocardial infarction does not have the symptoms that we are often shown in the movies

It is clear that if you do not know how serious what is happening to you, you are less likely to contact to the doctor.

Indeed, people in such cases were in no hurry to resort to professional medical care, referring to a doctor two or even five hours after a heart attack.

In another study, researchers wanted to understand how the decision-making process – to see a doctor or not – occurs in a situation where any delay could cost life.

Detailed interviews with a small number of women with heart attacks revealed that half of them understood that something dangerous was happening and immediately sought help.

Three had mild symptoms at first, but gradually increasing, which eventually made them go to the doctor.

However, the rest did not understand at all that what they were experiencing had to do with the heart. They did not tell anyone about this, deciding to wait and see what happens next.

What is the conclusion from all that has been said?

Severe chest pain is very serious and may indicate myocardial infarction. But – attention! – in the same way, a set of other symptoms, often not at all similar to what we see in films, can indicate a heart attack.

Legal information. This article is for general information only and should not be construed as a substitute for the advice of a physician or other healthcare professional. The BBC is not responsible for any diagnosis made by the reader based on the materials of the site. The BBC is not responsible for the content of other sites linked to on this page, nor does it recommend commercial products or services mentioned on these sites. If you are concerned about your health, see your doctor.

To read the original of this article in English, visit BBC Future .

How not to get murine fever?

Mouse fever (hemorrhagic fever with renal syndrome – HFRS) is a viral infectious disease. Small mammals, mainly wild rodents, are the source of human infection. Most often, infection occurs from bank voles, wood mice, which secrete an infection with saliva, urine and feces.In the Republic of Bashkortostan, HFRS takes one of the first places in terms of human morbidity among natural focal infectious diseases.

Infection often occurs by air-dusting, when cleaning premises where there is excrement from infected mice. In nature, infection occurs during recreation – during hunting, fishing, picking berries, mushrooms, during the harvesting of hay, firewood, etc. People of all ages are susceptible to infection, but most often men from 20 to 50 years old get sick.

Symptoms of mouse fever do not appear immediately, depending on the incubation period, they vary from 4 to 30 days, rarely up to 7 weeks.The main symptoms of mouse fever are: fever up to 40 degrees (fever lasts for 5-7 days), joint and muscle pain, nausea, vomiting, blurred vision, headache and nosebleeds.

When the first symptoms of the disease appear, an urgent need to consult a doctor, since the disease is very dangerous and has many complications!

To date, there is no vaccine against HFRS, therefore the main way of prevention is measures to exterminate rodents by laying out baits with poison both inside houses and in the surrounding area, the use of mechanical mousetraps.

To avoid infection with mouse fever, it is necessary to carry out deratization in their areas in spring and autumn. In country and garden houses, the floors should not be swept, but it is better to carry out wet cleaning using a 3% chloramine solution, the same solution can be used to process dishes. Any work related to dust formation must be carried out with a gauze mask and gloves. It is better to store food in iron containers with lids, out of the reach of rodents.

90,000 Snoring treatment in Rostov-on-Don.Treat sleep apnea with NightLase

laser

Why snoring is dangerous

Do you or your partner snore at night?

Yes, this is not a pleasant phenomenon, because delivers a lot of inconvenience to both the snoring person and the person next to him. After all, it is very difficult to fall asleep and sleep under the rolling sounds of snoring. And often, the one who cannot fall asleep tries in various ways to drown out the sounds of snoring, as a result, interrupting the sweet sleep of the snorer.As a result, both suffer, trying to fall asleep again.

If snoring is left untreated, over time it can develop into obstructive apnea – a short-term cessation of breathing during sleep lasting 10-25 seconds. Sleep apnea syndrome is accompanied by muscle relaxation, which leads to the closure of the respiratory lumen, which can lead to serious problems: impaired concentration, cardiovascular disease, decreased potency and even depression.

Therefore, snoring needs to be treated.

What is the procedure for laser snoring treatment?

The procedure lasts 15-20 minutes and does not require anesthesia.

The next day, you may feel a slight sore throat. The patient can immediately return to the usual way of life.

No special therapy or care is required after laser exposure. During the procedure, the laser beam is manually aimed at the target by a specialist. The beam emits a pulse to the soft tissue inside the mouth.Radiation in a special way heats the tissue, causing it to contract, which leads to softening of the patient’s snoring and reducing the effects of obstructive sleep apnea. A full course of NightLase® therapy consists of three separate treatments, each 2 weeks apart. The delayed positive effect can build up within a year after laser exposure.

The patient does not need to wear any additional devices while sleeping and is not exposed to chemicals.At the same time, the tissues are tightened, the sound intensity of snoring decreases and the holding of breath during sleep may stop.

An exceptionally high rate of improvement in sleep quality. After a complex of procedures, patients notice a significant reduction and softening of snoring. According to the results of scientific studies, after the first procedure, there is an improvement in the condition, on average, by 30%, after the second 40-60%, and after the third – by 70-90%. The procedure for getting rid of snoring with a laser using the Laser DaVinci na technology has no analogues.Fotona cosmetic lasers are characterized by unprecedented reliability thanks to in-house production and strict quality control. Laser technology

DaVinci is a highly effective and reliable method with consistent, pronounced results. It is a gentle and easy way for the patient and their loved ones to regain their night’s peace.

• Non-destructive laser (Er: YAG) strengthening of the uvula, soft palate and surrounding tissues;
• No pain medications and no medical preparation for surgery;
• Absence of pre- or postoperative pain;
• Three 15-minute sessions in 1 month;
• Immediate results after the first treatment (average 30% reduction in snoring) and up to 90% after the third treatment;
• Patients can return to normal life immediately;
• No special therapy or maintenance required after laser exposure.

According to the World Health Organization, every eighth person fights snoring, and almost 50% of the adult population snores from time to time without even knowing it. This malaise increases with age: in people over 60, it occurs in 60% of men and 40% of women. If snoring is left untreated, it can develop into sleep apnea over time.

What is NIGHTLASE snoring and sleep apnea?

NightLase® is a patented non-invasive laser surgery that uses the state-of-the-art Fotona SpectroSP system to treat the soft tissues of the throat with a laser beam.As a result, the collagen fibers contract and the tissue itself becomes denser. The therapy also promotes the growth and formation of “young” collagen, which is “tightened” during the next procedure.

The full course of NightLase® therapy consists of 3 separate treatments 2 weeks apart. The delayed positive effect can build up within a year after laser exposure.

The procedure lasts 15-20 minutes and does not require anesthesia.The next day, you may feel a slight sore throat. The patient can immediately return to the usual way of life. No special therapy or care is required after laser exposure.

Therapy is a safe, effective and simple way of restoring a good night’s rest to the patient and his environment. The patient does not need to wear any additional devices while sleeping and is not exposed to chemicals. At the same time, the tissues are tightened, the sound intensity of snoring decreases and the holding of breath during sleep may stop.

NightLase Snoring Treatment Results

Referring to the results of scientific research, after the first procedure, there is an improvement in the condition, on average, by 30%, after the second – 40-60%, and after the third – by 70-90%.

There is no complete objective diagnostic method to identify 100% of the cause of snoring. In rare cases, despite treatment, there is absolutely no improvement, except in cases where the cause of the problem is the relaxation of the muscles of the nasopharynx.

NightLase therapy from FOTONA based on erbium laser helps to quickly, without surgery, improve the quality of the patient’s sleep. By exposing the soft tissues of the respiratory tract to the erbium laser, it is possible to reduce breath holding during sleep and significantly reduce or completely stop snoring.

CONTRAINDICATIONS:

• pronounced pharyngeal reflex;
• trismus of the jaw, temporomandibular joint disorders;
• taking drugs that cause photosensitivity;
• epilepsy;
• Pregnancy and lactation period;
• oncological diseases.

Before starting treatment, it is necessary to consult an otorhinolaryngologist!

Causes of snoring

Excessive soft palate is a common cause of snoring, but it is by no means the main cause. Snoring can cause and intensify obesity, smoking, micro- and retrognathia (small and displaced back lower jaw), difficulty in nasal breathing, enlarged tonsils, decreased thyroid function, neuro-dystrophic processes, myopathies, etc.e. Moreover, the same patient may have 2-3 or more reasons for snoring.

For example, in a patient with obesity, retrognathism and an excess soft palate, the latter may contribute only 10-15% to the cause of snoring.

Recommendations for the treatment of snoring and apnea

Lifestyle changes should be an integral part of your snoring and obstructive sleep apnea program:

1. Decrease in body weight.

In obese and overweight patients, a 10% weight loss leads to a 30% decrease in the respiratory distress index

2.Smoking cessation.

The smoking process leads to constant chronic inflammation, swelling and decreased tone of the muscles of the pharynx and trachea.

3. Refusal (if possible) from the constant intake of sleeping pills and sedatives.

Drugs belonging to the groups of tranquilizers and hypnotics additionally reduce the tone of the airways and lead to an increase in the severity of the syndrome.

4. Refusal to drink alcohol before bed

Drinking alcohol leads to relaxation of the pharyngeal muscles and aggravation of sleep apnea syndrome.

5. Do not sleep on your back.

If episodes of respiratory distress occur in the supine position, it is necessary to develop the habit of sleeping on your side. To do this, it is necessary to sew a pocket between the shoulder blades, in which to put a tennis ball or a flap of fabric imitating it.

6. Choose an orthopedic pillow for sleeping to ensure the physiological position of the head and trunk.

• Name of service

  Price

• Laser treatment for snoring “Nightlase”

  12 000 RUB

Service reviews

90,000 on the wave of age without menopause symptoms, Pasman Clinic

Menopause: what causes it and how it goes

Contrary to prejudice, menopause is not synonymous with aging, although a woman may think so. After all, the symptoms of menopause, if not stopped, can really turn an active and positive mature beauty into an ever tired grumpy old woman.

Menopause begins at about 45 years of age and is divided into perimenopause (45 to 52 years) and postmenopause (up to 69 years). Changes in a woman’s body that occur at this time are due to the growing and progressive deficiency of estrogens – the main female sex hormones produced in the ovarian follicles.

It is thanks to the action of estrogens that at the age of 11-14 years old an angular teenage girl blossoms and turns into a beautiful girl. These hormones, together with progesterone, the second ovarian hormone, provide the main functions of the female body – menstrual and childbearing.Every woman is born already gifted with a huge (but limited!) Number of follicles – more than 400 thousand! How she will manage this reserve throughout her life depends on the time of cessation of ovarian function and the onset of menopause.

So, irreparable harm to the ovaries and other organs of the reproductive system is caused by smoking, which, together with other reasons, can lead to premature ovarian failure at 35-37 years of age.

Of the gynecological diseases that can lead to follicular loss and early menopause, genital endometriosis, which often begins at a young age, is in the first place.It is worth being late with the treatment of endometrioid cysts – and estrogen deficiency can occur at the age of 19-20.

The mother of the girl contributes to the amount of follicle reserve: diseases suffered during pregnancy – severe infections, preeclampsia, placental insufficiency – can affect the child’s ovarian reserve.

Thus, estrogen deficiency can occur depending on the initial gynecological health at any age – from 18 to 50 years.And hello menopause. Welcome to the world of hot flashes, changeable mood and poor sleep, apathy and fatigue, discomfort in intimate life, abrupt age-related changes in appearance. Is it possible to avoid all this by stepping on the next step of the age ladder (the word “climax” – from the Greek “ladder”)?

In general, do you need to fight your body?

It is a big mistake to think that the abrupt extinction of femininity in menopause is a natural process that does not require correction.No no and one more time no! Age-related changes are normal, but change over the years should be easy, beautiful and in no case should you suffer at the same time.

After all, we are trying to restore the mobility of aged joints, we turn to an ophthalmologist for an eye lens with cataracts, and we correct hyperopia with glasses that have arisen with age. The body changes over the years, but it is only in our power to return the quality of life by turning to the possibilities of modern medical technologies.

So menopause should be taken as a signal that more attention should be paid to health and appearance. If done right, you can look and feel 20 years younger at 55-60.

Hormone Replacement Therapy – Your Friend

Today, more and more doctors are recommending that mature patients consider hormone replacement therapy (HRT) as a means of correcting menopausal ailments.

Now HRT, used by patients over 45 years old, is called MHT – menopausal hormone therapy.HRT and MHT have been used in the world for over 45 years, they have been excellently studied and researched both from the point of view of minuses and pluses (of which there are incomparably more).

Minus, perhaps, one (and is it a minus?) – hormonal correction is performed only under the supervision of a gynecologist. It is forbidden to use drugs on your own, as well as to play arbitrarily with dosages. This type of therapy has a number of strict contraindications that should be excluded during the preliminary examination (at least, ultrasound of the small pelvis and mammary glands should be performed, an analysis for hemostasis should be performed, and blood biochemical parameters should be identified).A gynecologist or gynecologist-endocrinologist selects the drug that is optimal for a particular patient.

There are a lot of drugs – and not only in tablets! With pronounced problems with the stomach or liver, the doctor will help you make a choice among the assortment for topical use – patches attached to the skin, gels and even nasal sprays – they will help deliver the active substance to the body, bypassing the gastrointestinal tract. For those who do not want to fill their heads with doses and a regime, hormone-containing intrauterine devices have been developed – I put it once and forgot for a long time!

And now about the pluses

MHT allows you to treat absolutely all types of climacteric disorders – from psychoemotional and autonomic disorders (hot flashes, poor sleep, depression), to genitourinary syndrome (urinary incontinence, atrophic colpitis) and osteoporosis.

This menopause therapy is as natural as possible. Unlike the popular contraceptives with synthetic estrogens, which are used by most modern women, the preparations for menopausal hormone therapy contain female sex hormones that are similar to natural ones, that is, they are healthier, perceived by a mature body as their own.

That is why MHT is not addictive and medications can be stopped at any time. True, would a woman want to do this, having regained the activity and charm of youth?

About youth it is not said for a catchphrase: often patients are sent to a gynecologist by cosmetologists.It’s simple: if you do not compensate for the deficiency of hormones, no cosmetic procedures and even plastic surgery will give the desired effect. The fight against aging must start from the inside.

Groundless fears that drugs can cause cancer have long been dispelled by doctors and scientists. Moreover, the World Health Organization cites data that, thanks to the use of such funds, it is possible to prevent the development of cancer, since the composition contains cancer blockers.

Thrombosis is also not to be feared: accurate dosage, regular monitoring by a doctor – and no problems.

With the help of MGT, you can also restore a beautiful figure. With a decrease in the amount of female sex hormones, male ones come to the fore, changing the usual bends and shapes. We abolish masculinity and at the same time do not recover a single gram: estrogens do not affect the mass gain in any way.

The quality of intimate life increases significantly. Discomfort in bed due to thinning of the vaginal mucosa and, as a result, dryness and painful sensations, disappears as if by magic.The positive effect of the patient is noted already in the first 6-8 weeks after the start of taking the drugs, and for some, only three days are enough to bloom again!

Bad mood – down! Hormones work much better than antidepressants. When a woman regains radiant skin, she clearly sees a reduction in wrinkles and a lifting of the oval of the face; from the very morning she has the strength to move mountains, and in the evening she goes to a meeting with her beloved man with a desire, then she really understands: life – bright and active, full of travel, hobbies, feelings and emotions – is just beginning!

How is MGT applied?

The law is at work here: the sooner the better.It is advisable to prescribe therapy in the first 5-10 years of menopause: then you can manage to prevent all the consequences of untreated menopause – and these are vascular disorders, and an increased risk of heart attacks, strokes, etc. the current period of life, but also all kinds of complications of the menopausal period in the future are prevented.

How long can MHT be used? In 2018, at the World Congress in Florence, a separate plenary session was devoted to the problem of IHT after 65 years.At this age, if the benefits outweigh the risks (and the older the woman, the higher the risks of side effects from any drugs), natural estrogens are prescribed in minimal doses after careful examination.

Control of the gynecologist during the appointment is mandatory: once every six months, tests are required to confirm that everything is going according to plan. The close attention to a woman’s well-being explains why patients receiving substitution therapy feel so much better than their peers.

And what if menopause is allowed to take its course?

Women using therapy admit that life is divided into before and after, because they have not felt so healthy and healthy for a long time. But there are those to whom, in their words, “and so it is normal” – really the climax has no power over them?

Indeed, there is a small percentage of women in whom the process of ovarian extinction occurs gently: the autonomic system is so stable that menopause practically does not affect the body and mood.But if nothing bothers, it does not mean that nothing is happening. The consequences of menopause appear after 2-7 years.

First, it is brittle nails and hair, dry skin and bleeding gums.

Then the sexual desire fails. The quality of intimate life deteriorates due to the development of genitourinary syndrome – atrophic processes of the vaginal mucosa and bladder, which is manifested by discomfort during sexual intercourse, stress urinary incontinence (when coughing, sneezing, physical exertion), as well as an overactive bladder (sudden desire to urinate).In addition to the appointment of MGT, plasmolifting, intimate plastics will help; with the omission of the walls of the vagina – plastic pelvic floor.

The figure is floating: a decrease in metabolism, coupled with an increase in appetite and cravings for fast carbohydrates, leads to a sharp increase in weight – up to 20 kilograms or more. And the one who was always the first beauty now sits sadly at the TV with a bun in her hand.

A third of women develop metabolic syndrome, which is manifested not only by an unusually large number on the scales, but also by insulin resistance, the development of type 2 diabetes mellitus, and an increase in blood pressure.Insulinsensitizers – drugs that increase the body’s sensitivity to the action of insulin – help in treatment.

Hello, sadness! The climacteric period is associated with psychological problems: depression, low self-esteem, aggravated by an increase in body weight and loss of pleasure in intimate life.

But even that is not the worst thing. Diseases in menopause are becoming the main danger: estrogen deficiency leads to the development of arterial hypertension and coronary artery disease, osteoporosis and decreased cognitive function, increases the risk of Alzheimer’s disease and senile dementia.

The picture is not joyful, although there is good news: all the initial symptoms are stopped by the appointment of natural estrogens for 6-8 weeks – the main thing is to start on time and not bring yourself to menopause to serious diseases.

Bonus: a lifestyle that guarantees female health in adulthood.

Pasman Clinic doctors recommend hormone replacement therapy during menopause. The experience of decades allows us to see how this has a beneficial effect on patients, and the skill helps to approach the examination of each of the fair sex with special attention and prescribe delicately precise doses for maximum benefit.

Can you make life even better in your golden age? Yes! Here’s what you need to do this:

1. To know that at 45 years of age, life does not end, even reproductive function is preserved, therefore, from 45 to 52 years old, it is important to take care of effective and safe contraception together with your gynecologist.

2. Remember that in women after 40 years, the intensity of metabolic processes decreases, and it is necessary to increase physical activity by at least 30% and reduce the number of calories consumed by a third.Then you will not have to complain about the growing weight and change your wardrobe for clothes of large sizes.

3. After 45 years, the body needs not only to reduce the caloric content of food consumed, but also in a healthy diet with a lot of vegetables and fruits, fiber. We remove fatty foods and easily digestible carbohydrates, drink clean water without gas up to 1 liter per day, allow ourselves unsweetened fruit drinks and compotes.

4. Any morning exercise – at least 10 minutes, 10 thousand steps a day, pleasant physical activity (gym, pool, bike, track).Muscles and joints also work in a state of estrogen deficiency and more than ever need movement and increased blood supply.

5. Give up bad habits – first of all, from smoking, which kills the remains of estrogen and is a proven risk factor number 1 in the occurrence of many cancers: breast cancer, cervical cancer, lung cancer.

This is the basis of the recommendations: at the XVIII World Congress on Gynecological Endocrinology in Florence in March 2018, where the clinic’s specialists took part in presentations, a healthy lifestyle was put on the first place in the treatment of all gynecological diseases – from polycystic ovaries to tumors.

In addition to physical activity, healthy eating and giving up bad habits, you need to pay more attention to your appearance: regularly visit a beautician and massage therapist who will make you even more beautiful. Be healthy and happy in this sunniest period of your life!

Thank you for your help in preparing the material Natalia Mikhailovna Pasman, doctor of medical sciences, professor, obstetrician-gynecologist of the highest category, Honored Doctor of the Russian Federation, and Sergeantova Ekaterina Nikolaevna, obstetrician-gynecologist of the highest category.

90,000 Details of negotiations with an Irkutsk resident who threatened to throw out his son

Valentina Kharinskaya, psychologist of the Ministry of Emergency Situations of Russia in the Irkutsk Region, revealed details of how negotiations took place with a resident of Irkutsk who threatened to throw his 3-year-old child from the 13th floor. The interview with the negotiator was published on July 14 on the agency’s website.

Information that a man with a small child is standing on the eaves of the balcony on the 13th floor began to arrive at emergency services from 16 o’clock.Before the arrival of the emergency services, his neighbors in the stairwell spoke with the man: an Irkutsk woman, Lyudmila Litvinova, and her 16-year-old son Anton. They helped to orientate themselves in a situation when a psychologist from the Ministry of Emergency Situations entered their apartment together with Ksenia Kuchina, an inspector for minors of department No. 7 of the Irkutskoye municipal administration of the Ministry of Internal Affairs.

“Firstly, it became clear that it was impossible to go out on the balcony in uniform. The man is determined – at the sight of the employees he could feel a threat and not make contact.He also reacted aggressively to the appearance of men in the line of sight, which means that this provoking factor should have been excluded for a while. We were given clothes, we changed into civilian clothes. The legend was created right there: we are new tenants who have recently moved into one of the apartments and are planning to celebrate a housewarming. Everything happened very quickly – it was simply dangerous to leave the man alone with his thoughts, ”Valentina Kharinskaya is quoted in the message.

She explained that the man reacted adequately to the appearance of new people, entered into a dialogue.It was possible to find out that his main requirement was to see his wife, with whom they had quarreled. According to the psychologist, the situation was dangerous for the child, on the one hand, the man used his son for manipulation, on the other hand, the Irkutsk resident was tired and could not keep the child. Experience in crisis situations helped the psychologist to distribute attention to everyone: a man, a child and a woman, the mother of the baby.

“You see that the guy loses interest in the conversation, starts to move along the ledge, deviates dangerously, looks down – you concentrate on him and again involve him in the dialogue.When the boy starts to open his hands from fatigue, cold, fear – you turn to him, shout that he should hold on to dad tighter, because he will protect him, and the child reacts, cuddles more tightly. And his father, by the way, also listens to our words – he hugs his son tighter, ”explained Kharinskaya.

According to her, the mother of the child especially needed support – she fainted several times from stress, but she still found strength and went out onto the balcony to talk with her husband.“We instructed her: she agreed with all his demands,” the psychologist emphasized.

“The man wanted a conversation with his wife – it took place. He saw that they sympathized with him, supported him, heard from his wife that she had forgiven him. And that was probably the turning point. In fact, he had no more demands, he was physically tired. I could not make a decision myself – we tried to direct it: we repeated, as usual, already in an imperative form, that the child needs to eat, go to the toilet, which means they need to return to their apartment.And they offered to smoke, and already all together to celebrate “our interrupted housewarming.” And he agreed, “- said Kharinskaya, how they managed to successfully complete the negotiations.

When the man let people into his apartment, the specialists got a second wind. The mother took the child in her arms, wrapped him in a blanket. The man began to ask them for forgiveness. Valentina Kharinskaya suggested that the Irkutsk resident bandage his leg, which he had injured with glass. “You know, I exhaled at the moment when I made the last turn of the bandage, tied the knot, and the man was picked up and led to the exit.This is the end of this horrifying story. And we were able to direct all our efforts to work with the mother and child. Both are given hot tea, cookies. To get the boy interested in toys, ”the psychologist shared.

In total, the negotiations lasted 3.5 hours.

A man with a child climbed onto the balcony on the evening of July 13. As the correspondent of IrCity reported, he either let the child go deep into the balcony, then dragged him closer to the open window.

The man demanded a meeting with his wife, she was brought to the scene by the officers of the Ministry of Internal Affairs, she talked to him from the next balcony, together with the psychologist of the Ministry of Emergencies and the inspector for minors.After more than 2 hours of negotiations, he was detained. A criminal case was initiated under the article “Preparation for the murder of a young child.”

According to the police, one of the reasons for this was family problems. During interrogation in the TFR, the man said that he climbed out onto the balcony with the child in order to attract the attention of his wife.

Ksenia Vlasova 21:45, 14 July 2021

The first calls of the virus – MOO “Positive Dialogue” Society of HIV-infected and AIDS patients. Interregional public organization

The immunodeficiency virus belongs to a special group called retroviruses.It cannot be transmitted in a household way. Infection occurs as a result of sexual contact, through blood and breast milk. After a person becomes infected with it, outwardly the symptoms of the disease do not appear in any way. Even if tested during the “window period”, from three weeks to six months after infection, it is almost impossible to identify the disease.

When do the first signs of HIV appear

After 2 weeks of illness, an HIV-positive person develops the first symptoms, which are manifested in the following:

• mild illness similar to a cold or flu;
• fatigue appears, the temperature may rise;
• headaches;
• rashes or colorless areas with different shapes appear on areas of the skin;
• loss of appetite resulting in weight loss;
• there is an increase in lymph nodes.

In some people, at the initial stage, the liver or spleen may enlarge, they are tormented by frequent diarrhea. If you have these symptoms, it is recommended to visit a doctor and get tested for HIV infection.

This condition can last for several weeks or months, and then the symptoms of the immunodeficiency virus disappear for a long period, the latent stage of the disease begins. A person feels completely healthy and thoughts about the disease do not visit him.The duration of this phase can be calculated in years (from two to ten years). It is possible to detect HIV infection during this period only by laboratory means.

The latent period is replaced by the next phase. In medicine, it is called persistent generalized lymphadenopathy.

It is characterized by an increase in lymph nodes in the armpits, neck and groin. Some HIV-positive people have a noticeable enlargement of the spleen and liver, and sweating appears.

The last stage of HIV is called terminal, turning into AIDS. The patient develops pronounced signs of the immunodeficiency virus. A person becomes very weak, his body is greatly depleted, even the simplest infections proceed with severe complications.

Men often change sexual partners, while neglecting basic methods of contraception. Therefore, they are much more likely to get sick than women. The great danger of HIV infection is that for a long time it does not make itself felt, and the diagnosis can be made only after passing a special test.Doctors strongly recommend that men, at the first symptoms of the disease, immediately consult a medical institution, undergo the necessary examination and take a test for the presence of HIV in the body.

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