MS comorbidities: Welcome to the party!

 Multiple sclerosis is a wacky disease. Ask anyone battling it. The constellation of possible MS symptoms is baffling to contemplate. Experientially, MS brings a host of surprises, as the MSer’s body seems to betray him or her in all sorts of surprising (and seemingly unrelated) ways. 

 

 Vision disturbances can crop up. A limb may go numb for a while or longer. Incontinence may sink in. Spasticity might strike. Walking can become difficult. Vertigo could stop by for a spin. Fatigue might suddenly become overwhelming.

Once diagnosed, we find it’s easy to blame all sorts of health complaints on MS. On the other hand, MSers can be prone to several other illnesses and complications. That’s called comorbidity.

 

What are the most frequently found comorbidities with MS?

Here’s a garden variety:

• anxiety
• arthritis
• asthmatic bronchitis
• cardiovascular disease
• chronic lung disease
• cognitive/memory issues
• deep vein thrombosis
• depression
• diabetes
• high cholesterol
• inflammatory bowel disease
• migraines
  
• obesity
• psoriasis
• sleep issues
• stroke
• thyroid disorders
• urinary tract infections
• and more.

 In many instances, medical experts aren’t altogether sure whether MS causes a certain comorbidity or vice-versa. For example, MS can cause a person to live a more sedentary lifestyle, which could lead to (or aggravate) blood pressure issues, diabetes, heart or lung disease, obesity, and other ailments.

 Additionally, comorbidities may arise together, perhaps randomly. And lots of medical conditions share symptoms, so it may be difficult to pinpoint whether a symptom stems from MS or from an existing comorbidity. 

Comorbidities can also delay and complicate a person’s initial diagnosis of MS, as symptoms of other conditions may mask MS’ appearance. They can also make MS treatment more difficult to manage and may even set the stage for MS to progress faster in some patients.

 It’s a crazy world out there, especially with the less-than-pleasant bonus of comorbidities with MS.

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Image/s: Public domain photo and user-created word-graphic

Feel free to follow on Twitter. Please visit my Amazon author page as well. You are invited to join the Kicking MS to the Curb page on Facebook and the Making the Most of MS board on Pinterest.

Dizziness isn't always all-ears

 

Whirling vertigo often begins in the ears … but not always. Ask anyone with multiple sclerosis or migraines. Better yet, ask anyone with the double bonus of both. The combination abounds!

 Vertigo can be a symptom of migraine. And it’s extra special when it comes from an MS migraine, which is an entity (or agony?) all its own.

The American Speech-Language-Hearing Association put it this way:

 Specifically, vertigo, which is the sensation of perceived motion without actually moving, is reported by up to one third of people who have migraine, and general dizziness or unsteadiness is reported by up to three quarters of all patients with migraine.

The folks at Johns Hopkins Medicine point to vestibular migraine as a frequent source of vertigo and related symptoms:

 Migraine headaches are a common neurological condition. Although common migraines are characterized by a moderate to severe pounding or throbbing headache, vestibular migraine may or may not involve headaches in combination with vestibular symptoms such as vertigo, imbalance, nausea and vomiting.

Stanford Medicine agrees:

 Unlike the classic migraine, which is described as severe, throbbing headache, vestibular migraine has no pain associated with it 50% of the time. Vestibular migraine causes episodes of dizziness described as rocking, spinning, floating, swaying, internal motion and lightheadedness. They most often occur spontaneously, but can be triggered by stress, sleep problems, skipping meals, dehydration, other illnesses.

 Wow. So it’s possible (and not even unlikely) to have a migraine without suffering a severe headache.

Finally, someone’s talking my language!

 After years of going around and around (See what I did there?) with my primary care physician, in which he insisted that my frequent and severe vertigo / lightheadedness / dizzy / off-balance symptoms were caused by inner-ear crystals (including multiple physical therapy sessions for this diagnosis, which proved unfruitful and actually aggravated my symptoms, I found this migraine-related information to be a complete game changer.

OK, for the vast majority of vertigo sufferers, a simple physical therapy maneuver can work miracles. (Got vertigo? Try this first!)  But for the MSer (or anyone with central vertigo, rather than benign positional vertigo) or the migraineur, it generally proves a bust.

 I’ve had migraines since my Junior High years. But they always used to include major headaches. And apparently vestibular migraines (and the frequently associated vertigo) are most common among those who were particularly susceptible to motion sickness, especially as children. Bingo! That was me.

 Enter MS. Within the past few years (especially since hormonal changes kicked in with a vengeance), my migraines have evolved. Sure, I occasionally have the head-in-a-vise pounding variety. But more often, I battle a dull headache behind the agonizing whirling and unsteadiness of vertigo.

 Thankfully, my MS doctor affirmed my description of symptoms and flat-out said the frequent (sometimes daily) vertigo I face is related to migraines, which are common with MS. As such, she recommended avoiding food-related migraine triggers (as I already do), getting much-needed rest, drinking plenty of water, and taking travel-sickness medication when vertigo strikes. (See Simple OTC product helps vertigo?)

 That means no more neck twisting, which only aggravated some of my existing MS demyelination and didn’t fix the lightheaded spinning problem anyway.

 

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• MS and vision: How many types of glasses do I need?
• MS is like the cancellation disease.
• MS makes me clumsy sometimes.
• Not all nose-dives are MS' fault.
• Self-advocacy: When therapy is not therapeutic
• Simple OTC product helps vertigo?

 

 Image/s: Excruciating Headache, M. Egerton, 1827, public domain

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Self-advocacy: When therapy is not therapeutic

 

Multiple sclerosis pits a person against his or her own body – and sometimes against medical experts.

 Ask any of us who battle MS daily, and you’ll likely hear about how our own bodies betray us, as our central nervous systems mutiny against our limbs, eyes, and countless other components. Maybe that’s why it seems extra frustrating when we have to combat false assumptions and unhelpful advice, particularly when it comes from medical professionals we have enlisted to help us.

 

Ouch.

 Recently, my physician sent me for vestibular therapy, explaining that my recurrent (and increasingly severe) vertigo episodes might be traced to benign paroxysmal positional vertigo. Simply described, that’s a condition that arises when inner-ear crystals slip out of place, causing dizziness.

 

That’s not what’s caused my vertigo.

 More than a decade ago, my (now-retired) neurologist/MS specialist attempted the Epley Maneuver on me, simply to rule out BPPV. This little trick involved lying flat (supine) on the exam table, while the practitioner bends and turns my head to one side and then the other.

 

The Epley Maneuver can work wonders for someone with BPPV. But for the MSer, it can wreak havoc.

 Way back when (and again recently), this technique sent me spiraling into vertigo hell for hours.

 

Fast-forward to last week.

 The young physical therapist, apparently specializing in vestibular issues, put me through a full battery of balancing, rolling, and head-turning trials. She set me supine on the flat exam table and tipped the top (head) section downwards by 30 degrees. Adapting the popular 1-10 pain scale, my vertigo went from a 3 to an 8.

 In our initial discussion, I had already explained to her that I needed to elevate my head at least 30 degrees whenever on my back (as for an exam, fitness class floor exercises, or a yoga class). I mentioned that I sleep with two pillows. All of these allowances are vertigo-preventative, as I have demyelination in my cervical spine area.

 Ever determined, however, she put me through the paces.

 Then she concluded that my vertigo was not vestibular-related, but only after I’d endured her full checklist of tests and potentially therapeutic head positions and movements. Even so, she said she recommended repeating the same exercises, intentionally precipitating vertigo, on the chance that might retrain my brain to adjust to vertigo.

 

Um, what?

 Afterwards, I contacted my physician and reported on the experience. I told him I was not inclined (no pun intended) to continue the vestibular therapy, as it only triggered and increased my symptoms and as my vertigo clearly was not vestibular in nature.

 Holy moley. My head is still spinning over this ordeal. But I had to find my way to standing on my own two feet (literally and figuratively) to avert repeat occurrences.

 Phew! They don’t call us MS Warriors for nothing. (At least, perhaps they should.)

 

Related items:

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Image/s: 3 Wise Monkeys at Tosho-gu Shrine, Nikko, Japan, by Ray in Manila - CCA lic.

 

 

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MS episode: Is it a relapse, a new lesion, or what?

 

“So you don’t have MS anymore?” a close friend asked, after my latest scans showed no new changes.

 Not long after that, one-eye blurriness and various limb tingling and dizziness suddenly hit me. The MonSter of multiple sclerosis reared his angry head again.

 “We’re not making this up, folks. Even if we do look too good to be sick.” (Raise your hand, if you’ve heard that one.)

 

All together now:  The absence of new lesions doesn’t mean MS has vanished.

 It’s probably an exacerbation. Or it might be a paroxysm. Let’s hope for that one, as it won’t likely last as long. But then, all bets are off, when it comes to the mysterious MS.

 An exacerbation of MS (also known as a relapse, attack or flare-up) is the occurrence of new symptoms or the worsening of old symptoms, according to the National MS Society. Their explanation elaborates on this definition by saying this: “To be a true exacerbation, the attack must last at least 24 hours and be separated from the previous attack by at least 30 days. It must also occur in the absence of infection, or other cause. Most exacerbations last from a few days to several weeks or even months.”

 But MSers can also experience something called paroxysms, which are sudden recurrences of spasms, seizures, or other MS symptoms. A frequent example is known as Uhthoff Phenomenon (or Uhthoff Sign or Uhthoff Syndrome), which occurs when overheating (especially a rise in the core body temperature) triggers the MSer’s symptoms, usually until that person is able to cool off. (This is why many MSers choose to wear cooling scarves or vests during hot weather.)

 

Neither an exacerbation nor a parosysmal episode necessarily points to the appearance of new lesions (scarring) in the MSer’s central nervous system.

 Sometimes that’s the case, but the conditions of living with multiple sclerosis often mean that existing damage can already cause reoccurring episodes.

 People who don’t have multiple sclerosis or who are not well-versed in the nature of this chronic condition may struggle to understand this concept.

 

My own primary care physician is a prime example of this type of misunderstanding.

 Recently, I visited my general doc for a basic routine physical, but I also expressed some (likely MS-related) symptomatic complaints. He ordered a brain MRI. It came back as stable and unchanged.

 “Your symptoms aren’t from MS,” he concluded confidently, “because you have no new lesions.” Then he ordered additional non-MS-related testing to address the symptoms.

 No MSer will be surprised to find that the additional testing led nowhere. Clearly, MS was causing the symptoms, which I’d experienced many times before during MS flare-ups.

 

Family members and friends can also be confused by the no-new-lesion concept.

 Yes, any MSer rejoices when a scan shows no new lesions. We love finding no additional CNS damage. At the same time, this doesn’t mean we no longer experience relapse-remitting or ongoing symptoms. It doesn’t promise that our proven triggers can't also set these misfires into motion.

 

 Sure, it’s confusing. Try living it.

 I’m not a doctor, but I play one in my own very-real life. If you’re an MSer, you probably know the feeling.

 

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• With MS, a hot flash may not be a hot flash at all.

 

 Image/s: Adapted from public domain image/s.

 

 

Feel free to follow on Twitter. Please visit my Amazon author page as well.

You are invited to join the Kicking MS to the Curb page on Facebook and the Making the Most of MS board on Pinterest.