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Lies My Neuro Told Me or (Common MS Myths)
I know the title is inflammatory toward doctors, but it is catchy and I want you to read this. I don't usually believe that neuros give misinformation to us, but I believe that a neurologist who presumes to diagnose or treat MS should be up on the current medical literature. Some of these "opinions" which are given to us as gospel are things for which the good doctors should know better!
1) You Have to be 25 years old and female to get MS.
Yes, some us have been told such outrageous things. The age of onset of MS has been found to be between 18 months and 70-some years of age. The average age of diagnosis is just over 35. The classic range is, indeed, between 20 and 40, but the doctor that stops there is an idiot. Below the age of 50, women outnumber men, but the ratio is not heavy like in, say, lupus. I believe that it is close to 3:1. In Late-Onset MS (onset after the age of 50) men and women are represented almost equally (something like 1.5:1)
2) All people with MS have Optic Neuritis at the beginning of the disease.
Patently false, though it is a common presenting symptom and about 80% will have ON at sometime during their illness. Actually, this number may be higher, but we will look at that in the HP on Optic Neuritis.
3) There is no pain in MS.
Arrgh! This is a statement by someone who has not read the literature, but only the Cliff's Notes written by a preschooler. This doctor also has never taken care of people with MS and PAID ATTENTION! The people in his/her care have had their pain dismissed due to other causes. MS has many serious causes of pain. Trigeminal neuralgia is more common in MSers than in the general population. TN has been called the "Suicide Pain". Also, there are other painful neuralgias, radicular pain, as if there was a pinched nerve, new onset of headaches, a huge proportion of MSers have back and neck pain. Spasticity is common and spasticity can have unrelenting and very difficult-to-treat pain. Seriously painful spasms are widely experienced.
4) Depression in MS is due to stress.
Simply said, MS often causes depression PRIMARILY. A major depressive episode should be viewed as an MS attack and counted toward diagnosis rather than used as a reason to send a limbolander off the the psychiatrist.
5) All brain MRI spots are due to aging - no matter what the person's age.
Good data shows that only about 30% of 60-year-olds have age-related spots and it drops with age.
6) You have to have 9 Lesions in order to have MS.
This is so patently stupid that one should run, lurch, hobble or roll away from that doctor as fast as possible. MS can exist - if not be diagnosed - with NO MRI lesions. With the proper history and physical findings even one lesion can make the diagnosis. Two lesions are a little better, but there is not much increase in the number with 3 or more. Thus, you don't have a higher chance of having MS if you have lots of lesions over just having two - if you have had at least 2 clinical attacks and have at least one clinical neurologic abnormality.
The need to have 9 or more lesions is a small part of the McDonald criteria that is used only if the person hasn't had enough attacks or abnormalities on neuro exam. These doctors are uneducable.
7) "You have too few lesions"
See above
8) "You have too many lesions"
what?
9) You aren't getting worse because your neruo exam hasn't changed.
This is a toughy, but the neuro exam is limited in how sensitive it is to small changes. The best neuros are pretty good at getting repeatable results on their exams, but still cannot measure those fine points that we, who are living in our bodies and experiencing something, can be very sure of. A few recent studies have called to our MS doctors to put more stock into our reports. Also remember that the severity of our disease can vary day to day and even hour to hour. We may see the doc on a good day that does not represent our changing norm.
10) You don't need DMD's if your symptoms are mild.
A favorite position of the Mayo Clinic, but one that has been debunked by all of the ongoing studies of the four DMDs. The meds work better the earlier they are used in our disease.
11) Lack of symptoms means the disease is halted.
We know that this disease usually progresses in the background, despite a lack of relapses. Our disease is not merely equal to the relapses we are having.
Well, these were the ones I remembered just now. I invite comment and other submissions. These will become a Helath Page.
Quix
1) You Have to be 25 years old and female to get MS.
Yes, some us have been told such outrageous things. The age of onset of MS has been found to be between 18 months and 70-some years of age. The average age of diagnosis is just over 35. The classic range is, indeed, between 20 and 40, but the doctor that stops there is an idiot. Below the age of 50, women outnumber men, but the ratio is not heavy like in, say, lupus. I believe that it is close to 3:1. In Late-Onset MS (onset after the age of 50) men and women are represented almost equally (something like 1.5:1)
2) All people with MS have Optic Neuritis at the beginning of the disease.
Patently false, though it is a common presenting symptom and about 80% will have ON at sometime during their illness. Actually, this number may be higher, but we will look at that in the HP on Optic Neuritis.
3) There is no pain in MS.
Arrgh! This is a statement by someone who has not read the literature, but only the Cliff's Notes written by a preschooler. This doctor also has never taken care of people with MS and PAID ATTENTION! The people in his/her care have had their pain dismissed due to other causes. MS has many serious causes of pain. Trigeminal neuralgia is more common in MSers than in the general population. TN has been called the "Suicide Pain". Also, there are other painful neuralgias, radicular pain, as if there was a pinched nerve, new onset of headaches, a huge proportion of MSers have back and neck pain. Spasticity is common and spasticity can have unrelenting and very difficult-to-treat pain. Seriously painful spasms are widely experienced.
4) Depression in MS is due to stress.
Simply said, MS often causes depression PRIMARILY. A major depressive episode should be viewed as an MS attack and counted toward diagnosis rather than used as a reason to send a limbolander off the the psychiatrist.
5) All brain MRI spots are due to aging - no matter what the person's age.
Good data shows that only about 30% of 60-year-olds have age-related spots and it drops with age.
6) You have to have 9 Lesions in order to have MS.
This is so patently stupid that one should run, lurch, hobble or roll away from that doctor as fast as possible. MS can exist - if not be diagnosed - with NO MRI lesions. With the proper history and physical findings even one lesion can make the diagnosis. Two lesions are a little better, but there is not much increase in the number with 3 or more. Thus, you don't have a higher chance of having MS if you have lots of lesions over just having two - if you have had at least 2 clinical attacks and have at least one clinical neurologic abnormality.
The need to have 9 or more lesions is a small part of the McDonald criteria that is used only if the person hasn't had enough attacks or abnormalities on neuro exam. These doctors are uneducable.
7) "You have too few lesions"
See above
8) "You have too many lesions"
what?
9) You aren't getting worse because your neruo exam hasn't changed.
This is a toughy, but the neuro exam is limited in how sensitive it is to small changes. The best neuros are pretty good at getting repeatable results on their exams, but still cannot measure those fine points that we, who are living in our bodies and experiencing something, can be very sure of. A few recent studies have called to our MS doctors to put more stock into our reports. Also remember that the severity of our disease can vary day to day and even hour to hour. We may see the doc on a good day that does not represent our changing norm.
10) You don't need DMD's if your symptoms are mild.
A favorite position of the Mayo Clinic, but one that has been debunked by all of the ongoing studies of the four DMDs. The meds work better the earlier they are used in our disease.
11) Lack of symptoms means the disease is halted.
We know that this disease usually progresses in the background, despite a lack of relapses. Our disease is not merely equal to the relapses we are having.
Well, these were the ones I remembered just now. I invite comment and other submissions. These will become a Helath Page.
Quix
I retyped the comments to read "fibs that lazy neuros tell...a/k/a stay away from these people" and put it on a page in my medical book marked "miscl" and thought my new wonderful neuro would roll in the floor laughing.........................
thanks for this thread
thanks for this thread
It is tine to dust this classic off and bring it up for all the people struggling with Neuros .....
Wow! I think I read this before, but it really hit me now. I'm going to copy that and print it out so I can read it over again when I need a reminder that my "imaginary" pain is from MS cause pretty much all your pain spots - new headaches, neck pain, etc. has been attributed to stress, and told MS doesn't cause a whole lot of pain...grrrr.
The topic of pain in MS came back up so I'm bumping this baby for all the new people.
I am sorry Bob, please accept my apology. I realize that after re-reading your post, I mis-understood your meaning. You are correct in saying that the Doctor should provide proof of diagnosis. I am hoping that after the next tests, that I can get a referral to UCLA neurology dept. But I have to go thru the steps first. But if that doesn't work, will contact the insurance directly. I hope to hear from the insurance next week to schedule the MRI. Feeling so wiped out, need get to bed. Take care and thank you for your comments.
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