What Causes an MS Flare-Up?

What triggers a flare-up is different from person to person. Most of the time, a cause cannot be found. Still, to lower your chance of a flare-up, do your best to avoid the things that make them more likely for you:

Stress

It’s a part of life, but doing what you can to manage it can lower your chance of a relapse. Meditation, yoga, and counseling are all ways to lower stress and better equip yourself to handle it. In one study, MS patients reported their stress level cut nearly in half after 6 weeks of yoga.

Fatigue

Lack of sleep can bring a flare-up. Making sleep a priority will help lower your chance of symptoms. Try to get 7-8 hours each night.

Heat

High temperatures may trigger a relapse. If you’re one of those people affected by warm surroundings, you should skip saunas, hot tubs, and hot showers and baths. Most of the time hot weather causes fatigue. Also, do what you can to avoid being outdoors on hot days.

A cool bath and air conditioning are two things that can help. Special hats or clothes that hold ice packs or frozen gel packs can also keep you comfortable. There are also special vests that use a motorized system to circulate cold water around the body. If you have an exercise goal, divide the time you exercise into smaller segments, with rest after each one.

Infections

They cause a third of MS flare-ups. To lower your risk:

Wash your hands.

Do what you can to avoid people who are ill.

Make sure food you eat is fully cooked.

Practice safe sex.

Get your annual flu shot.

Even minor infections like the cold or flu can trigger a flare-up.

If you have an infection, treat it early.

Diet

Eat foods rich in omega-3 fatty acids. They’re believed to fight inflammation. Also, get plenty of fiber and stay away from foods with saturated and trans fats.

A healthy diet helps keep your immune system strong.

Medications

Skipping your MS medicine can increase your risk for a flare-up. One study found about 25% of MS patients who stopped taking their medications suffered a relapse. Certain medications for Crohn’s disease or rheumatoid arthritis may cause MS-like symptoms. So can drug interactions.

Check with your doctor to see if there are medications you’re taking that could be interacting with one another.

Smoking

Smoking is a major risk factor for flare-ups. Stop and you’ll lower your chances of them. Your doctor can help you figure out a game plan.

 

 https://www.webmd.com/multiple-sclerosis/ms-flare-causes?ecd=wnl_mls_122322&ctr=wnl-mls-122322_lead_cta&mb=q80%2F%40kIeuyYKtyaYzOxdbc6RVoMqf%400VkpmvpK5yEEQ%3D

 

 

 

New Advances in MS Treatment

Disease-modifying therapies (DMTs) can help decrease your MS symptoms. The FDA has approved new ones to treat and manage MS:

• Diroximel fumarate (Vumerity) lessens inflammation and stops nerve damage that may cause MS symptoms.
• Fingolimod (Gilenya) reduces the MS relapse rate in adults and children. It’s the first FDA-approved MS drug for kids. 
• Ofatumumab (Kesimpta) is an injectable drug that can prevent MS symptoms from coming back and slow down disability in people with MS.

 More disease-modifying therapies (DMTs) the FDA has approved to treat and manage MS:

• Ozanimod (Zeposia) can help with clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive MS. 
• Ponesimod (Ponvory) can lower MS symptoms coming back by more than 30%.
• Siponimod (Mayzent) and cladribine (Mavenclad) are other MS treatments that can lower your relapse rate if you have MS. They stop certain cells of the immune system from causing nerve damage.
  
  

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Symptoms of Relapsing-Remitting MS

 

No two people with MS are likely to have the same symptoms in the same way. Some may come and go or appear once and not again. The symptoms you have depend on the area of your brain or spinal cord that the disease has damaged. They can include:

• Eye pain and vision problems such as double vision or jumpy vision. These problems may be the first sign you have RRMS.
• Numbness and tingling
• Sensitivity to heat
• Pain that runs down the spine, like a mild electrical shock, when you bend your neck
• Dizziness
• Bowel or bladder problems
• Sexual problems, like trouble getting aroused or climaxing
• Stiff muscles and trouble moving your body
• Feeling weak and tired
• Problems with balance and coordination
• A hard time thinking clearly
• Depression

An RRMS attack can last anywhere from 24 hours to several weeks. It can involve:

• One or many symptoms
• An existing problem that gets worse
• A new symptom

Tell your doctor about signs of a relapse as soon as possible. If you treat it quickly, you might be able to reduce lasting damage and disability.

Chronic Itching May Be Overlooked in MS

Researchers at the University of Miami found that 27 of 77 people with MS reported experiencing chronic itching (also known as pruritus). Itching occurred in the upper and lower limbs and hands, scalp, and face. Compared to people with MS without chronic itching, people with it reported more fatigue, heat sensitivity, cognitive impairment, and depression or anxiety. They also were more likely to have nervous tissue damage in the spinal cord or brainstem (the base of the brain).

Some Treatments Help: Importantly, note the authors, chronic itching in MS is most likely “neuropathic” – meaning it is likely occurring from “short-circuiting” of the nerves that carry signals from the brain to the body because of damage from MS. For this reason, topical itch relief, such as skin creams, are not likely to help. But this type of chronic itch is similar to neuropathic pain, and may respond to nonpharmacologic (acupuncture, mindfulness and meditation, cognitive behavioral therapy) or pharmacologic (anti-seizure medications, anti-depressant medications) treatments. Heat was noted as an aggravating factor in this study, so wrapped ice packs might help as well.

Learn more about pain and itching and treatment in MS, and get a handle on new approaches to relieving neuropathic pain, which may help chronic itching

Read more about this study from University of Miami Health

Read a scientific summary of the study (abstract) in The Journal of the European Academy of
Dermatology and Venereology
 

 

Can Vitamin D Help MS?

 By Stephanie Watson

You might have heard that vitamin D helps to lower the risk for multiple sclerosis (MS). Or that it helps lessen symptoms in people who already have the disease. Evidence suggests that getting enough of this vitamin might protect against MS by holding back your immune system from attacking your own nerve cells.

But the link between vitamin D and MS isn't proven yet.

The MS-Vitamin D Link

This fat-soluble vitamin acts like a hormone in your body. Vitamin D also helps your immune system work better and to tamp down inflammation.

Those protective actions are important in autoimmune diseases like MS where your body turns against itself. In MS, cells of your immune system attack the coating around nerve fibers, called myelin, and leads to such hallmark symptoms as numbness, weakness, and blurry vision.

Research finds that vitamin D might help repair myelin and guards your nerves from damage.

Can Vitamin D Prevent or Slow MS?

Researchers aren’t sure if vitamin D can keep you from getting MS in the first place. Your body makes most of the vitamin D it needs from sunlight on your skin. People in northern climates like Scotland and Scandinavia are more likely to have MS compared with those who live in much sunnier climates. Studies show that people who get more sunlight and more vitamin D in their diets have a lower risk for MS overall.

There's some evidence that vitamin D might slow MS and make the disease less severe. Studies have found a link between higher vitamin D levels in the blood and less active disease, fewer lesions in their brain and spinal cord, and fewer relapses of symptoms.

In other studies, people with MS who had higher vitamin D levels had less severe disease and disability.

Do I Need More Vitamin D?

It's common for people with MS to be low on this vitamin. It may be hard for you to get outside to get sun often enough. Low vitamin D can also be a side effect of corticosteroids and other MS medications.

Your doctor can run a blood test to check your vitamin D level. You might be able to make up the difference by eating more fatty fish, eggs, and other foods that are high in vitamin D. Or, your doctor might suggest you take a supplement.

It's not clear whether taking a daily vitamin D supplement protects people from getting MS, or slows the disease in those who already have it. Studies suggest it might help, but this hasn't been proven. But since supplements are usually safe to take, it may not hurt to try them.

What Dosage Is Best?

Experts can’t say how much vitamin D is needed to prevent or slow MS. Different medical groups disagree on the ideal amount.

Official recommendations for adults is 400 to 600 international units (IUs) of vitamin D daily.

Ask your doctor what’s right for you. Be careful not to overdo it. Vitamin D helps your body absorb calcium, and you might end up with too much of that mineral. High calcium levels can weaken bones, damage the heart, and increase the risk for kidney stones.

If you already have MS, your doctor can check whether your vitamin D levels are too low. If so, it might make sense for you to take a supplement.

 

10 Best Foods for MS

 

From: https://www.webmd.com/multiple-sclerosis/ss/slideshow-ms-best-foods

Turmeric

This bright orange-yellow spice is common in Indian cooking, but you can use it in many dishes. Its main ingredient, curcumin, may protect nerve cells and adjust the body's immune system. You can sprinkle it on everything from cooked vegetables to whole-grain rice, or take it in a capsule. Curcumin is safe for most people, but it may cause side effects if you take some medicines. So check with your doctor before you take it as a supplement.

Vitamin D-Rich Foods

If you have MS, you're at risk of osteoporosis, a condition that makes your bones weaker and more likely to break. Vitamin D can help protect you from the problem. It may also help curb the inflammation that fuels MS symptoms. Sunlight helps your skin make the nutrient, but oily fish like salmon or tuna, yogurt, eggs, cereals, and fortified orange juice are good food sources. You may also want to ask your doctor if you should take a vitamin D supplement.

Fruits and Vegetables

When you eat five servings of them a day, you're loading up on antioxidants, which can help ease inflammation. If you eat them regularly, they may help you prevent relapses. Produce also has plenty of fiber, which keeps your digestion running smoothly. Load your plate with foods high in antioxidants, like onions, apples, citrus fruits, berries, and black grapes.

Ginger

You might use it as a baking spice, but in other parts of the world, ginger is best known as a medicinal plant. Studies show that it may help calm the immune system and might even improve memory problems and muscle pain, which are common MS symptoms. You can take it in a capsule, but fresh ginger root may give you the most benefit. Peel, chop, and add it to stir-fries. Or steep a piece of peeled root in hot water to make tea.

Foods With Fiber

"Insoluble" fiber is your best choice. You'll find it in prunes or their juice, whole wheat bread, brown rice, and other whole grains. Your body doesn't fully digest this fiber, so it passes through your system. That's a good thing. It helps prevent constipation, a common problem for people with MS. Most people should aim to get at least 25 grams of fiber each day. Since it absorbs water, make sure you also drink plenty of fluids each day.

Green Tea

Got muscle weakness and fatigue? A cup of soothing green tea may help. A small study found that some of its compounds, including one called EGCG, may help ease these symptoms. People saw results after they drank green tea every day for at least 3 months. The drink may also bolster the immune system, ease inflammation, and slow the effects MS can have on your thinking.

Dairy Alternatives

Some studies show a link between cow's milk and MS. One theory is that the proteins in dairy products can irritate the immune system. Other research does not suggest a link to MS. But if you do have lactose intolerance, then it is best to stay away from dairy.If you want to try cutting back on dairy products, swap out your usual milk, ice cream, butter, and cheese for versions made from almond, soy, rice, or oats. Look for products that have added calcium to help protect your bones.

Fatty Fish

Herring, mackerel, albacore tuna, sardines, and salmon all have omega-3 fatty acids, which can help reduce inflammation in the body. One large study showed that people with MS who took 10 grams of fish oil a day were less likely to relapse or become more disabled.) If you're a vegetarian or don't like fish, ask your doctor about getting omega-3s from fish oil supplements or flaxseed oil.

 

Lean Protein

Some science has shown that diets low in saturated fat can help people with MS. Plus, it's linked to heart disease and other health problems, so it's best to limit how much you get. When you eat protein, skip fatty red meat for leaner cuts like skinless chicken. Or swap meat for beans and lentils. They're high in fiber and folate, which may help reduce MS attacks.

Whole Grains

Aim to eat 3-5 servings of healthy whole grains such as whole-wheat pasta, quinoa, or brown rice every day. Their complex carbohydrates can prevent energy spikes and help you feel less tired. And their fiber will help you manage your weight and avoid constipation. The right amount of magnesium and iron, which whole grains have, might also help slow the effects of MS, although scientists need more research to know for sure.

 

Multiple Sclerosis (MS): Early Signs and Common Symptoms

 

Multiple Sclerosis (MS): Early Signs and Common Symptoms

Medically Reviewed by Carol DerSarkissian, MD on September 26, 2020

People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Usually the symptoms get better, but then they come back. Some come and go, while others linger.

No two people have exactly the same symptoms. You may have a single symptom, and then go months or years without any others. A problem can also happen just one time, go away, and never return. For some people, the symptoms get worse within weeks or months.

Early Signs of MS

• For many people, the first brush with what’s later diagnosed as MS is what doctors call clinically isolated syndrome (CIS). This episode of neurological symptoms usually lasts 24 hours. It happens when your immune system mistakenly tells your body to attack myelin, the protective sheath over nerve cells in your brain and spine. You may hear your doctor call this demyelination. It causes scars, or lesions, that make it harder for signals to travel between your brain and your body. Monofocal episode: You have one symptom.
• Multifocal episode: You have more than one symptom.

The most common symptoms in CIS are:

Optic neuritis: This condition damages the nerve that connects your eye to your brain. It usually affects just one eye, but in rare cases, it involves both. You might notice:

• Blurry vision
• Colors appear dull
• Pain in your eye, especially when you move it

Numbness & Tingling: It usually affects your legs. You might feel:

• An electric shock-like feeling when you move your head or neck. It may travel down your spine or into your arms or legs.
• Numbness, often in your face
• Tingling

Not everyone who has CIS will get MS. The odds are higher if you have lesions in your brain from loss of myelin. If you have another CIS or other MS symptoms later, your doctor will do a test called an MRI that takes a picture of your brain to look for them. Learn more about the differences between CIS and MS.

Primary MS Symptoms

These come from ongoing damage to your myelin. They aren’t pleasant, but your MS treatment team can help you keep most of them under control with medication, rehabilitation, and other tactics. The most common symptoms are:

Bladder and bowel problems: You may have to pee more often, need to go at night, or have trouble emptying your bladder fully. Bowel issues like constipation are also common. Read more on bladder control problems and bowel problems with MS.

Clumsiness or lack of coordination: MS can make it hard to get around. You might have:

• Trouble walking
• A hard time keeping your balance
• Changes in your gait

View a slideshow on what your walk says about you.

Dizziness: You may feel lightheaded. You may also have vertigo, that feeling that the room is spinning. Know the causes of dizziness and vertigo with MS.

Emotional changes and depression: It’s tough to adjust to the idea that you have a chronic disease, let alone one that’s hard to predict and that will take a physical toll. Fear of the unknown can make you anxious. Plus the disease damages nerve fibers in your brain, and that can affect your emotions. So can medications, like corticosteroids, used to treat MS. Get more information on how to manage depression with MS.

Eye problems: In addition to the optic neuritis that comes with CIS, MS can cause:

• Nystagmus: involuntary eye movements
• Diplopia: double vision

Learn more about vision problems linked to MS.

Fatigue: You may feel very tired. It often comes on in the afternoon and causes weak muscles, slowed thinking, or sleepiness. It isn’t usually related to the amount of work you do. Some people with MS say they can feel tired even after a good night's sleep. Get tips on how to manage fatigue with MS.

Heat-related problems: You might notice them as you warm up during exercise. You could feel tired and weak or have trouble controlling certain body parts, like your foot or leg. As you rest and cool down, these symptoms are likely to go away. Know more on how to manage heat sensitivity with MS.

 

Muscle spasms: They usually affect your leg muscles. They’re an early symptom for almost half the people with MS. They also affect people with progressive MS. You might feel mild stiffness or strong, painful spasms. Read more on how to treat MS-related muscle spasms.

Sexual troubles: These include vaginal dryness in women and erection problems in men. Both men and women may be less responsive to touch, have a lower sex drive, or have trouble reaching orgasm. Learn more on how to maintain intimacy when you have MS.

Speech problems: MS could cause long pauses between your words and slurred or nasal speech. You might have swallowing problems as the disease advances. Get more information on symptoms of speech and swallowing problems with MS.

Thinking problems: It might be hard to focus from time to time. This will probably mean slowed thinking, poor attention, or fuzzy memory. Some people have severe problems that make it hard to do daily tasks, but that’s rare. MS doesn’t usually change your intellect or ability to read and understand conversation. Find out more on how MS affects the brain and cognition.

Tremors: About half of people with MS have them. They can be minor shakes or so intense it’s hard to do everyday activities. Read more about the types of tremors caused by MS.

Trouble walking: MS can cause muscle weakness or spasms, which make it tough to walk. Balance problems, numb feet, and fatigue can also happen. Learn more about mobility aids and assistive devices for MS.

Unusual sensations: In addition to the pins and needles sensation that’s part of CIS, you might also have severe itching, burning, stabbing, or tearing pains. You could feel a tightness around your ribs or upper belly known as the MS hug. Doctors call these uncomfortable symptoms dysesthesia. View a slideshow on unusual symptoms and sensations caused by MS.

Secondary Symptoms

These are problems created by your primary MS symptoms, not by damaged myelin.

• Not being able to empty your bladder can lead to a bladder infection.
• If you have trouble walking and are often fatigued, you’re likely to become less active. That can take a toll on your muscle tone, make your breathing shallow, and even affect your bone density.

Doctors can treat secondary symptoms, but the goal is to avoid them by treating the primary symptoms.

 

Tertiary Symptoms

These are the social, psychological, and job-related problems of life with MS.

• If MS makes it hard for you to walk or drive, you may not be able to do your job well.
• Because it’s tough to get around and hard to talk to people about what life with a chronic disease is like, you may not be as social as you once were.
• You could get depressed. It’s a byproduct of the changes MS makes in your brain and in your life.

Because MS varies so much, it's best not to compare yourself with other people who have it. Your experience is likely to be different. Most people learn to manage their symptoms and can keep leading full, active lives.