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Disclaimer: 'MS Views and News' DOES NOT endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, and procedures for your personal knowledge and to keep you informed of current health-related issues. It is not intended to be complete or exhaustive, nor is it a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.

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Tuesday, January 16, 2018

2017 update to McDonald criteria loosens MS diagnosis somewhat

FROM THE LANCET NEUROLOGY
Updates to the McDonald criteria for diagnosing multiple sclerosis (MS), first introduced in 2010, should allow initiation of therapy earlier in the time point of disease. The changes expand some of the criteria that can be used for diagnosis of disease.
Photo of a clipboard with the words multiple sclerosis lying next to pills, an injection needle, and stethoscopecopyright Zerbor/Thinkstock
Overall, the panel concluded that the 2010 McDonald criteria were effective, and that the update should be limited to clarification and simplification. They also felt that changes should promote earlier diagnosis while discouraging misdiagnoses.

The changes include: 
• Cerebrospinal fluid-specific oligoclonal bands can now be used to diagnose MS in patients with a typical clinically isolated syndrome in whom MRI or clinical signs point to dissemination in space (DIS), and if there is no other, better explanation for clinical signs.
• Symptomatic or asymptomatic MRI lesions can be used in the determination of DIS or dissemination in time (DIT). An exception is MRI lesions in the optic nerve in patients with optic neuritis, due to insufficient evidence. Specifically, the panel notes that DIS “can be demonstrated by one or more T2-hyperintense lesions [symptomatic or asymptomatic] that are characteristic of multiple sclerosis in two or more of four areas of the CNS: periventricular, cortical or juxtacortical, and infratentorial brain regions, and the spinal cord.” DIT is defined by “the simultaneous presence of gadolinium-enhancing and non-enhancing lesions [symptomatic or asymptomatic] at any time or by a new T2-hyperintense or gadolinium-enhancing lesion on follow-up MRI, with reference to a baseline scan, irrespective of the timing of the baseline MRI.”
• In patients experiencing brainstem or spinal cord clinically isolated syndrome, symptomatic lesions are sufficient to determine DIS or DIT.
• Cortical or juxtacortical lesions can be used in determining DIS.
• When MS is diagnosed, physicians should determine disease course (relapsing-remitting, primary progressive, or secondary progressive), whether the disease is active or not, and whether it is progressive, using the clinical history over the previous year.
The update was driven by a range of factors, including ongoing developments in imaging, the performance of the 2010 guidelines in diverse populations, and potential confusion between MS and other conditions with similar imaging characteristics, such as neuromyelitis optica spectrum disorders, which should always be considered because symptoms can overlap with MS. These conditions demand different treatment protocols. In addition, in 2016, the European Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) network suggested changes to the MRI criteria for diagnosing multiple sclerosis.
Updates to the guidelines are hardly finished. The panel called for future examination of optic nerve involvement, diverse populations, advanced imaging techniques, and biomarkers.
Continued



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Sunday, January 14, 2018

Contributors to Fatigue in MS -- an MS Video from Aaron Boster, MD

Jan. 14, 2018 - a Video by Aaron Boster, MD

Fatigue is one of the most common and complex symptoms in multiple sclerosis. Here we discuss the multiple contributing factors related to MS fatigue. These include factors related to the underlining disease pathology, factors related to MS symptoms, behavioral and lifestyle considerations, and contributions from other medical problems.




See more Dr. Boster videos by clicking here


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The invisible symptoms of multiple sclerosis - a Video discussion by Aaron Boster, MD

January 13, 2018

MS is sometimes referred to as an "invisible illness." Many of the more debilitating symptoms of multiple sclerosis can be invisible to the casual observer. In this short video Dr. Boster lists some of the common invisible symptoms of multiple sclerosis.




See other Dr. Boster videos by clicking here

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Friday, January 12, 2018

Nine Hole Peg Test (9HPT) - a Boster's MS Corner, video

January 2018





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The Patient’s Right to Decide

Information provided by Craig Dorne, PA
 (the information showing below primarily concerns those living in the State of Florida)
Source: http://www.floridahealthfinder.gov/reports-guides/advance-directives.aspx 

The Patient’s Right to Decide

Every competent adult has the right to make decisions concerning his or her own health, including the right to choose or refuse medical treatment.
When a person becomes unable to make decisions due to a physical or mental change, such as being in a coma or developing dementia (like Alzheimer’s disease), they are considered incapacitated. Only your primary physician can determine if you are incapacitated. To make sure that an incapacitated person’s decisions about health care will still be respected, the Florida legislature enacted legislation pertaining to health care advance directives (Chapter 765, Florida Statutes).  The law recognizes the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures; to designate another individual to make treatment decisions if the person becomes unable to make his or her own decisions; and/or to indicate the desire to make an anatomical donation after death. Additionally, the law states that you do not have to be incapacitated to elect a health care surrogate to make your decisions.
By law hospitals, nursing homes, home health agencies, hospices, and health maintenance organizations (HMOs) are required to provide their patients with written information, such as this pamphlet, concerning health care advance directives.  The state rules that require this include 58A-2.0232, 59A-3.254, 59A-4.106, 59A-8.0245, and 59A-12.013, Florida Administrative Code.

Questions About Health Care Advance Directives

What is an advance directive?

It is a written or oral statement about how you want medical decisions made should you not be able to make them yourself and/or it can express your wish to make an anatomical donation after death.  Some people make advance directives when they are diagnosed with a life-threatening illness.  Others put their wishes into writing while they are healthy, often as part of their estate planning.
Three types of advance directives are:
  • A Living Will
  • A Health Care Surrogate Designation
  • An Anatomical Donation
You might choose to complete one, two, or all three of these forms.  This pamphlet provides information to help you decide what will best serve your needs.

What is a living will?

It is a written or oral statement of the kind of medical care you want or do not want if you become unable to make your own decisions.  It is called a living will because it takes effect while you are still living.  You may wish to speak to your health care provider or attorney to be certain you have completed the living will in a way that your wishes will be understood.

What is a health care surrogate designation?

It is a document naming another person as your representative to make medical decisions for you if you are unable to make them yourself.  You can include instructions about any treatment you want or do not want, similar to a living will.  You can also designate an alternate surrogate.

Which is best?

Depending on your individual needs you may wish to complete any one or a combination of the three types of advance directives.

What is an anatomical donation?

It is a document that indicates your wish to donate, at death, all or part of your body.  This can be an organ and tissue donation to persons in need, or donation of your body for training of health care workers.  You can indicate your choice to be an organ donor by designating it on your driver’s license or state identification card (at your nearest driver’s license office), signing a uniform donor form (seen elsewhere in this pamphlet), or expressing your wish in a living will.

Am I required to have an advance directive under Florida law?

No, there is no legal requirement to complete an advance directive. However, if you have not made an advance directive, decisions about your health care or an anatomical donation may be made for you by a court-appointed guardian, your wife or husband, your adult child, your parent, your adult sibling, an adult relative, or a close friend.
The person making decisions for you may or may not be aware of your wishes.  When you make an advance directive, and discuss it with the significant people in your life, it will better assure that your wishes will be carried out the way you want.

Must an attorney prepare the advance directive?

No, the procedures are simple and do not require an attorney, though you may choose to consult one.
However, an advance directive, whether it is a written document or an oral statement, needs to be witnessed by two individuals.  At least one of the witnesses cannot be a spouse or a blood relative.

Where can I find advance directive forms?

Florida law provides a sample of each of the following forms:  a living will, a health care surrogate, and an anatomical donation.  Elsewhere in this pamphlet we have included sample forms as well as resources where you can find more information and other types of advance directive forms.

Can I change my mind after I write an advance directive?

Yes, you may change or cancel an advance directive at any time. Any changes should be written, signed and dated.  However, you can also change an advance directive by oral statement; physical destruction of the advance directive; or by writing a new advance directive.
If your driver’s license or state identification card indicates you are an organ donor, but you no longer want this designation, contact the nearest driver’s license office to cancel the donor designation and a new license or card will be issued to you.

What if I have filled out an advance directive in another state and need treatment in Florida?

An advance directive completed in another state, as described in that state's law, can be honored in Florida.

What should I do with my advance directive if I choose to have one?

  • If you designate a health care surrogate and an alternate surrogate be sure to ask them if they agree to take this responsibility, discuss how you would like matters handled, and give them a copy of the document.
  • Make sure that your health care provider, attorney, and the significant persons in your life know that you have an advance directive and where it is located.  You also may want to give them a copy.
  • Set up a file where you can keep a copy of your advance directive (and other important paperwork).  Some people keep original papers in a bank safety deposit box.  If you do, you may want to keep copies at your house or information concerning the location of your safety deposit box.
  • Keep a card or note in your purse or wallet that states that you have an advance directive and where it is located.
  • If you change your advance directive, make sure your health care provider, attorney and the significant persons in your life have the latest copy.
If you have questions about your advance directive you may want to discuss these with your health care provider, attorney, or the significant persons in your life.

More Information On Health Care Advance Directives

Before making a decision about advance directives you might want to consider additional options and other sources of information, including the following:
  • As an alternative to a health care surrogate, or in addition to, you might want to designate a durable power of attorney. Through a written document you can name another person to act on your behalf.  It is similar to a health care surrogate, but the person can be designated to perform a variety of activities (financial, legal, medical, etc.).  You can consult an attorney for further information or read Chapter 709, Florida Statutes.

    If you choose someone as your durable power of attorney be sure to ask the person if he or she will agree to take this responsibility, discuss how you would like matters handled, and give the person a copy of the document. 
  • If you are terminally ill (or if you have a loved one who is in a persistent vegetative state) you may want to consider having a pre-hospital Do Not Resuscitate Order (DNRO).  A DNRO identifies people who do not wish to be resuscitated from respiratory or cardiac arrest.  The pre-hospital DNRO is a specific yellow form available from the Florida Department of Health (DOH).  Your attorney, health care provider, or an ambulance service may also have copies available for your use.  You, or your legal representative, and your physician sign the DNRO form.  More information is available on the DOH website or www.MyFlorida.com (type DNRO in these website search engines) or call (850) 245-4440.  

    When you are admitted to a hospital the pre-hospital DNRO may be used during your hospital stay or the hospital may have its own form and procedure for documenting a Do Not Resuscitate Order. 
  • If a person chooses to donate, after death, his or her body for medical training and research the donation will be coordinated by the Anatomical Board of the State of Florida.  You, or your survivors, must arrange with a local funeral home, and pay, for a preliminary embalming and transportation of the body to the Anatomical Board located in Gainesville, Florida.  After being used for medical education or research, the body will ordinarily be cremated.  The cremains will be returned to the loved ones, if requested at the time of donation, or the Anatomical Board will spread the cremains over the Gulf of Mexico.  For further information contact the Anatomical Board of the State of Florida at (800) 628-2594 or www.med.ufl.edu/anatbd
  • If you would like to learn more on organ and tissue donation, please visit the Joshua Abbott Organ and Tissue Donor Registry at www.DonateLifeFlorida.org where you can become organ, tissue and eye donors online. If you have further questions about organ and tissue donation you may want to talk to your health care provider.
  • Various organizations also make advance directive forms available.  One such document is “Five Wishes” that includes a living will and a health care surrogate designation.  “Five Wishes” gives you the opportunity to specify if you want tube feeding, assistance with breathing, pain medication, and other details that might bring you comfort such as what kind of music you might like to hear, among other things.  You can find out more at:

    Aging with Dignity
    www.AgingWithDignity.org
    (888) 594-7437

    Other resources include:

    American Association of Retired Persons (AARP)
    www.aarp.org
    (Type “advance directives” in the website’s search engine)

    Your local hospital, nursing home, hospice, home health agency, and your attorney or health care provider may be able to assist you with forms or further information.

    Brochure:  End of Life Issues
    www.FloridaHealthFinder.gov
    (888) 419-3456

Health Care Advance Directives Downloadable Forms

To download the individual forms click the following:
Produced and distributed by the Florida Agency for Health Care Administration.  This publication can be copied for public use.  To view or print other publications from the Agency for Health Care Administration please visit www.FloridaHealthFinder.gov .
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Saturday, January 6, 2018

Griffin Hospital needs volunteers for study on MS and insomnia

Griffin Hospital’s Multiple Sclerosis Center and the Yale-Griffin Prevention Research Center (which is also at Griffin Hospital), are enrolling patients with multiple sclerosis and chronic insomnia in a study to determine whether a form of meditation can help combat sleeplessness in these patients.


Griffin Hospital’s Multiple Sclerosis Center and the Yale-Griffin Prevention Research Center (which is also at Griffin Hospital), are enrolling patients with multiple sclerosis and chronic insomnia in a study to determine whether a form of meditation can help combat sleeplessness in these patients. Photo: Craftvision / Getty Images / (c) craftvision  DERBY — In his years of working with multiple sclerosis patients, Dr. Joseph B. Guarnaccia has found many of them also suffer from another condition — insomnia.
“It does have an impact on their quality of life and their ability to handle their disease,” said Guarnaccia, director of the Multiple Sclerosis Treatment Center at Derby’s Griffin Hospital.
To help those grappling with both MS and sleeplessness, Guarnaccia is leading a study to examine whether a form of meditation can ease insomnia in MS patients. The study, a collaboration between the Multiple Sclerosis Center and the Yale-Griffin Prevention Research Center (which is also at Griffin Hospital), is enrolling patients with multiple sclerosis and chronic insomnia through the winter and spring.
Multiple sclerosis is an autoimmune disease affecting the central nervous system, which is made up of the brain, spinal cord and optic nerves. Symptoms of MS can include anything from blurred vision and loss of balance to paralysis and blindness. Problems can come and go or get worse over time.


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Human Herpes Virus 6 May Increase Risk of MS, Study Suggests

January 5, 2018 - Iranian researchers have identified another herpes virus that may increase the risk of a person developing multiple sclerosis.
The team identified the human herpesvirus 6, or HHV6, as a potential risk factor for MS through a meta-analysis of several studies.
Scientists have found links between other human herpes viruses and MS, especially the Epstein-Barr virus, also known as human herpesvirus 4.
Recent studies had also suggested a relationship between HHV6 and MS, but the findings have been controversial.
An Iranian team did a meta-analysis of studies published between October 1992 and September 2016 to see if they could shed more light on whether HHV6 and MS are connected. The found 39 studies that they considered suitable for their project.
READ MORE




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Friday, January 5, 2018

David Lyons: My Goal in 2018: Seeing Every Person With MS Active and Fit


I have made it my mission to help everyone with multiple sclerosis get fit and stay fit.
By David Lyons


As we start off a New Year, I want to help motivate and encourage you to start a new you! For those of you who are already pumped up to get in shape, stay in shape, or improve your current fitness level, I applaud your drive to succeed. But there are many who have MS who are not engaged in a fitness program, and there are those who are only applying themselves with a limited effort or who are just not doing it correctly.

I have made it my mission — no, my passion — to help everyone with MS start an exercise regimen, to educate and train them on the proper program that fits their goals, and to see them stick with it.

Now that’s a bold statement! And maybe it’s an impossible one to accomplish, since not every person with MS will follow my advice or take action with me. But nonetheless, this is my vision and my purpose: to help every individual with MS in the world get fit and stay fit!

So how can I possibly do this, you ask?

David Lyons supervises the workout of a client with MS.


Where to Find Me and Other MS Fitness Experts

First and foremost I try to reach as many as you as possible through social media and help to get great advice to you in conquering MS through fitness at our Facebook group,  MS Fitness Challenge Gym. This is a platform for us to share fitness and nutrition tips  and information. It is a group managed by trainers, nutrition counselors, and fitness professionals who either have MS themselves or have worked with MS for many years.

CLICK HERE to READ MORE




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Thursday, January 4, 2018

Evolution, trends, outcomes, and economics of hematopoietic stem cell transplantation in severe autoimmune diseases.


Snowden JA, et al. Blood Adv. 2017.

Abstract

Hematopoietic stem cell transplantation (HSCT) has evolved for >20 years as a specific treatment of patients with autoimmune disease (AD). Using European Society for Blood and Marrow Transplantation registry data, we summarized trends and identified factors influencing activity and outcomes in patients with AD undergoing first autologous HSCT (n = 1951; median age, 37 years [3-76]) and allogeneic HSCT (n = 105; median age, 12 years [<1-62]) in 247 centers in 40 countries from 1994 to 2015. Predominant countries of activity were Italy, Germany, Sweden, the United Kingdom, The Netherlands, Spain, France, and Australia. National activity correlated with the Human Development Index (P = .006). For autologous HSCT, outcomes varied significantly between diseases. There was chronological improvement in progression-free survival (PFS, P < 10-5), relapse/progression (P < 10-5), and nonrelapse mortality (P = .01). Health care expenditure was associated with improved outcomes in systemic sclerosis and multiple sclerosis (MS). On multivariate analysis selecting adults for MS, systemic sclerosis, and Crohn disease, better PFS was associated with experience (≥23 transplants for AD, P = .001), learning (time from first HSCT for AD ≥6 years, P = .01), and Joint Accreditation Committee of the International Society for Cellular Therapy and European Society for Blood and Marrow Transplantation accreditation status (P = .02). Despite improved survival over time (P = .02), allogeneic HSCT use remained low and largely restricted to pediatric practice. Autologous HSCT has evolved into a treatment modality to be considered alongside other modern therapies in severe AD. Center experience, accreditation, interspecialty networking, and national socioeconomic factors are relevant for health service delivery of HSCT in AD.

PMID

 29296926 [PubMed] 

PMCID

 PMC5745133

https://www.ncbi.nlm.nih.gov/m/pubmed/29296926/?i=6&from=multiple%20sclerosis 



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5 Natural Remedies for MS Nerve Pain in the Legs and Feet

a Re-post from Healthline.com



There are many medical conditions that can cause nerve pain in the legs and feet, including chronic ones like multiple sclerosis (MS). Pain, unfortunately, is par for the course with MS. But with the right treatments — both natural and prescription — you’ll likely be able to find some relief.

Why MS causes pain

The nerve pain that people with MS experience can be caused directly by the disease or by related illnesses, such as fibromyalgia and arthritis.
When it’s a direct result of MS, the mechanism is through nerve damage. MS attacks the myelin sheath. This is the natural protective covering of your brain, spinal cord, and entire nervous system. Coupled with the development of lesions and plaques in the nervous system, this can lead to pain in the legs and throughout the body.
MS also makes movement and gait, or the process of walking, difficult. As nerve damage worsens, people with MS are likely to experience stiffness and aching.
MS pain can vary from dull and sporadic to stabbing, severe, and constant. In severe cases, small triggers like a cold breeze or uncomfortable clothing can cause pain in people with MS

At-home solutions

Managing pain usually involves a combination of multiple techniques, including prescribed medications and home remedies. Some of the following treatments may aid in pain relief: 

1. Warm compress or warm bath

According to Barbara Rodgers, a nutrition consultant who also has MS, too much heat can exacerbate symptoms. A hot bath or hot compress may make matters worse. However, warm compresses can provide comfort and relief.

2. Massage 

A massage can serve several purposes, stimulating blood flow in the body and gently relieving muscle pain and tension while promoting relaxation and a sense of well-being. For people with MS, this relaxation is important and often difficult to come by.

3. Therapy

According to the U.S. Department of Veterans Affairs, stress, depression, and anxiety can make people with MS more likely to report pain. Managing these stressors and psychological conditions can reduce the pain they once aggravated. Support groups and working with a therapist are just a few methods to lessen these psychological factors.

4. Nutritional supplements

Nerve pain can be caused and exacerbated by certain deficiencies. Your doctor can help you determine if you may be deficient in:
Your doctor can assess whether a supplement would be right for you. Rodgers also suggests Wobenzym, a supplement that’s intended to help stiffness and soreness.

5. Dietary changes

Frequently, pain and illness are related to an unhealthy diet. Rodgers says that people with MS should take a critical look at what they’re eating and consider eliminating common culprits when it comes to nerve pain. These might include corn, dairy, gluten, soy, and sugar.

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