Understanding Multiple Sclerosis

Dear Dr. Deena,

I am 26 years old, and was just diagnosed with Multiple Sclerosis. What is this disease? 

AG

AG, I am so sorry to hear about your diagnosis. Luckily modern medicine has many treatment options for you that can slow down progression of this disease!

Multiple Sclerosis, commonly known as “MS”, is a disease that effects the central nervous system (which consists of the brain and spinal cord). MS effects  90 in 100,000 individuals. These individuals are mostly young women, with the usual age of onset between 24 and 30 years of age.

To better understand MS, let us look at the structure of a nerve cell (see image the below). The nerve cell is composed of 2 distinct parts: the cell body (outlined by the red square) and the axon (circled in blue). The cell body receives information and nerve signals from other nerves. The axon transmits information to other nerves, muscles and glands.  

Axons are coated by myelin.  Myelin is a fatty substance that protects the nerve cell and allows for proper nerve signal transmission and functioning.   In fact the more myelin that coats the axon, the faster that a nerve signal can be transmitted to other nerves, muscles, and glands.

The CNS is composed of 2 types of matter: white matter and gray matter. Gray matter consists of the cell body and dendrite portion of the nerve cell. White matter consists of the axons of the nerve cell and appears white because of the myelin sheaths covering the axons.

MS is a “demyelinating” disease which means that it damages “myelin” and thus mostly effects the “white matter” of the CNS.

The actual cause of MS is unknown.  Many researchers believe that it is an autoimmune disease (where the body’s immune system attacks itself); however, the true cause for MS is still uncertain. What we do understand is the pathogenesis of this disease- meaning how the disease injures nerves and how the disease might progress overtime if untreated.

The main mechanisms of disease in MS are quite complex. To break it down simply for all of you, the disease begins with inflammation surrounding the nerve cell which leads to demyelination (damage and destruction of myelin)  which then leads ultimately to “sclerosis” (or scarring) of the nerve cell which can ultimately lead to loss of function of that nerve.  

As the myelin is damaged by inflammation, the axon can no longer transmit nerve signals properly, leading to a variety of symptoms that can occur. These symptoms depend on the location of the nerve affected and the degree of damage to that nerve.  

Remember, every MS patient has different symptoms!

Sensory symptoms are very common among MS patients, and symptoms may be described as numbness, tingling, pins-and-needles, coldness, or swelling of the limbs or trunk. 

Motor symptoms can include difficulty with walking, balance and motor coordination. Muscle weakness, tremor, and spasms may also be seen.

Bowel, bladder, and sexual dysfunction can also been seen in patients with MS. The extent of bowel and sexual dysfunction often parallels the degree of motor impairment in the lower extremities. Constipation is quite common among people with MS.

When MS effects the nerves supplying the eye (known as the optic nerve), one might develop “optic neuritis” which can cause eye pain and partial blindness. Luckily this condition can easily be reversed with high dose steroids.

Fatigue is a characteristic finding in MS, usually described as physical exhaustion that is unrelated to the amount of activity performed. MS patients are at risk for development  of depression and changes in cognition (i.e. the brain's ability to process and understand information).

If you are concerned that you might have symptoms similar to MS, contact your MD. Luckily there are many medications available that can slow down the progression of disease, though there still remains no definitive treatment. Depending on the type of MS you have, there is always the possibility to go into remission for years with no substantial change to your quality of life.

I hope this information helps, AG. Thanks for visiting my blog. Once again if you have any new comments or questions, please email them to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Facts about the Bird Flu: Avian Influenza A, H7N9

Dear Dr. Deena,
I keep hearing about the Bird Flu in China. What is this? How can I prevent this?
AJ

Thank you for a great question AJ! Avian influenza also known as the "bird flu" is caused by a virus called Avian Influenza A. Most avian influenza viruses only effect birds; however, there are some rare forms which can infect both humans and birds. 


There are several subtypes of avian influenza infection that  have been reported to effect humans since 1997. None of these cases have been reported in the USA, and have mainly been found in Asia and Africa.

In April 2013 the World Health Organization reported 3 human infections with a new avian influenza A virus known as H7N9 in China.  Since this time more cases of H7N9 infections have been reported, and all have been isolated to China.

Most of the cases of the bird flu in humans have resulted from human contact with infected poultry (specifically domesticated chicken, ducks, and turkeys) or surfaces contaminated with the secretions (saliva, mucous, tears), feathers, or excretions (feces) from infected birds. 


The most important thing to know is that there has been NO sustained person-to-person spread of the H7N9 virus detected at this time. Ongoing (sustained) person-to-person spread is necessary for an epidemic to occur, and currently we are not at the risk for this. 

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (difficulty breathing, respiratory failure, acute respiratory distress syndrome), and even death. 


The best way to prevent infection with avian influenza A viruses is to avoid sources of exposure. Most human infections with avian influenza A viruses have occurred following direct or close contact with infected poultry. 

If you are traveling to Southeast Asia consider avoiding places where domesticated birds might be present, i.e. farms, rural areas, open markets.  I would recommend wearing a mask throughout Southeast Asia (since all birds that you come in contact with have the potential of being infected) and make sure to wash your hands throughout the day (especially after handling poultry, meats, or touching public surfaces).

According to the Food and Drug Administration, bird flu cannot be transmitted by eating properly cooked poultry meat or eggs from infected birds. Poultry meat is safe to eat if it's been cooked to an internal temperature of 165 F (74 C). Eggs should be cooked until the yolk and white are firm.

Seasonal influenza vaccination will not prevent infection with avian influenza A viruses, but can reduce the risk of co-infection with human and avian influenza A viruses. There is currently no vaccination for H7N9, but researchers are currently working towards one.

I hope this information was helpful! Let's continue to hope for the best as China struggles to find the right answers.

Please continue to email me your questions at DoctorDeenaMD@gmail.com.


**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**