Health Chats
Multiple Sclerosis: Understanding the Disease and Managing Symptoms
Tuesday Aug 16, 2011, 06:00PM - 07:00PM (EST)
Jonathan Howard, MDBlank
Multiple Sclerosis is a challenging disease to treat. Symptoms vary greatly from one patient to the next and can often wax and wane. Knowing what to expect and how to cope with the overall progression of the disease goes a long way toward living the highest possible quality of life with MS. Join us with Dr. Jonathan Howard, an attending physician at the NYU multiple sclerosis center, where he will provide answers to your questions about the complexities of MS and how to best manage the disease.<br><br> Doctor Jonathan Howard graduated from the University of Southern California Keck School of Medicine in 2003. After this, he completed a dual residency in both neurology and psychiatry at New York University Langone School of Medicine and Bellevue Hospital. He is currently board certified in both psychiatry and neurology. After residency, Dr. Howard completed a fellowship in multiple sclerosis at the New York University Multiple Sclerosis Care Center.<br><br> Currently, he is an attending physician at the NYU multiple sclerosis center where he practices both psychiatry and neurology. Dr. Howard believes that it is just as important to treat the mind as well as the body, especially for chronic neurological illnesses such as MS. He also established a weekly MS clinic at Bellevue Hospital, the oldest public hospital in the United States. He is working on publishing several books for medical students using modern media to educate about the brain and neurological disorders.
lisabeth310:
Not diagnosed, but wondering if arm weakness/tingling that comes and goes throughout the day could be ms.  Seems to subside during the day when I'm busy.  I have not had any anxiety before.
Jonathan Howard, MD:
This COULD be MS.  But I am not too concerned.  Usually symptoms from MS last longer than you describe.  They don't come and go throughout the day, but last days to weeks.  Getting an MRI, if normal would rule out MS, but other diagnoses, such as peripheral neuropathies need to be considered.
missm868:
I have had ms for 23 years, at least. I also have low white blood cell count, all the time. Does anyone else with ms have this problem?
Jonathan Howard, MD:
This is not a usual problem in MS to my knowledge.  Some people seem to have a low white blood count, but this might just an incidental finding.  Some of the medicines that we use to treat MS can cause a low white blood count, but these are not the standard medications most people are familiar with.
Jonathan Howard, MD:
I received an earlier question on what is up and coming in MS.  I erased it accidently, but it is a good question.  Briefly, there is a lot of the horizon.  There are several new oral medications on the horizon, though one promising agent, laquinimod, failed in its study.  
Jonathan Howard, MD:
One pill called BG12 looks very promising, but we'll have to wait until all the studies are done.  Other medicines like Tysabri, such as Campath and Daclizumab seem promising as well.  So a lot will change with MS in the next few years.  Doctors and patients will have many more complicated decisions to make.  But this is good.  Prior to 1993, there were no FDA approved meds.  So the rate of discovery is remarkable, though not fast enough, I know.
squinun:
In January 2011 my MRI showed new lesions but the only real "symptom" I had was a tightening of the thigh muscles when standing up, but the tightness would relax after a few seconds. My question is that are new lesions signs of MS progression or a flare-up?
Jonathan Howard, MD:
So the MRI often detects new lesions that have no clinical correlate.  Studies have shown that the MRI typically detects 5-10 times more lesions than a patient feels clinically.  This is one of the reasons doctors are reluctant to diagnosis MS in people with a normal MRI.
Jonathan Howard, MD:
It is somewhat controversial about what to do about people who have new lesions on their MRI.  Should they change their treatment?  I think most MS docs would say that if people are continually getting new lesions on their MRIs, than their treatment should be reconsidered.
Jonathan Howard, MD:
I have had a lot of questions on the MRI and its use.  On my Healthline Blog, I have a series of 4 posts on this topic.  The first one just posted, and I assume the others will follow soon.  The address for that is:  http://www.healthline.com/health-experts/bio/jonathan-howard
Sailorsong:
Breathing problems in SPMS. I have developed daily hiccups and shortness of breath in the last couple of months and have felt like I was going to pass out after just a couple of coughs. Just had O2 level checked while walking at 97%, What kind of other testing should be done as this seems to only happen once in a while? Thhankyou
Jonathan Howard, MD:
This sounds really rough.  I am sorry to hear about this.  I would suggest that you see your general practitioner or a cardiologist or pulmonologist.   MS patients have other health conditions as well, and it is a mistake to blame every symptom on MS.   Other health conditions could get overlooked that way.
vicas299:
Is there a diet a newly diagnosed MS sufferer should follow? Any special foods you recommend?
Jonathan Howard, MD:
Good question.  The simple answer is that I know of no special MS diet.  I think good nutrition is important for everyone, but has more to do with cardiovascular health than MS.  There are a lot of claims regarding MS and diet, but none have been properly studied, including the Swank diet.
Jonathan Howard, MD:
Many of my patients do start eating more healthy when they are diagnosed as it gives them as sense of control over their illness.  This is good.  But food is one of life's great pleasures, and as I am writing, I am drinking ginger ale and eating M&M cookies.  So I would be a hypocrite to say anything else.  Let me also say that most of my patients are young, healthy non-obese people who clearly do not eat fast food for every meal.
ihealth:
You mention it is important to catch MS a.s.a.p as it may be able to be stopped - how can one stop it progression?
Jonathan Howard, MD:
Most doctors, myself included, think that it is better to treat MS soon rather than later.  This opinion is not universally shared.  There is a certain class of patients with so-called "benign" MS who would do well without treatment.  Some docs prefer to wait and see if they are dealing with such a patient.
Jonathan Howard, MD:
Also, some countries health systems do not permit the treatment of every patient with MS for economic reasons.  But as a said, damage once it has been done cannot be repaired.  So it is best to try to prevent it.  There are several FDA approved medicines to slow down relapses, but nothing to prevent progression.
MedHelp:
Unfortunately, that's all the time we have today. Thank you everyone for participating in today's chat and a big thank you to Dr. Howard for taking the time to answer everyone's questions.
Jonathan Howard, MD:
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Jonathan Howard, MD:
Let me say that this was a really interesting experience.  All the questions were great.  I am sorry I did not get to all of them.  I do answer a lot of these questions on my blog and I will be doing more posts on these topics soon.
Jonathan Howard, MD:
You can also write me at perspectivesinms@healthline.com
Jonathan Howard, MD:
I will try to answer your questions, but might get a lot of them after tonight.  I will also suggest that we do another one of these sessions soon!  Thanks!