Relapse- Did I Cause It?

[Sarahsmom46]

Hello everyone.  It hasxbeen a long time since I have posted but I have been keeping tabs on what is happening on this wonderful forum.

So I am here with a question for anyone who might have some feedck. I have had several relapses over the years and know what a few of my triggers are.  I'm in the hospital right now getting through a nasty relapse that has left me with no feeling in my right leg up to my hip. I think it could have been avoided at least thar is how I am trying to ratio alizw it.  

Does anyone know if  there any studies or from your knowledge that a relapse can be brought on by a suspected trigger or is it truly a random occurrance.  I recently took a trip over taxing my body and ended up with a bad infection when I got home. I keep thinking that if I hadn't taken that trip I would be fine right now.

Julie

[HVAC]

Julie,
   Sorry you are sick again.

Alex

[Sarahsmom46]

Thanks for taking the time to research this info Who.  I had a talk with the neuron who is overseeing my care this morning and asked what he thought about the illness and relapse trigger and he said there is obviously a connection.

The reason I wrote this post was due to someone making me feel that this relapse was my fault because I get sick everytime I travel. I agree with you about not living life in a bubble. I can't. Anne won't live like that not while I still have the ability to go.

Thanks again and I hope you are doing well.

Julie

[shoshin]

I see that my posts are out of order: 1, 3, 2.

FWIW, here is the abstract of a more recent review "Modifiable factors influencing relapses and disability in multiple sclerosis" (http://www.ncbi.nlm.nih.gov/pubmed/20483884)

"A growing body of literature indicates that the natural course of multiple sclerosis can be influenced by a number of factors. Strong evidence suggests that relapses can be triggered by infections, the postpartum period and stressful life events. Vaccinations against influenza, hepatitis B and tetanus appear to be safe. Surgery, general and epidural anaesthesia, and physical trauma are not associated with an increased risk of relapses. Factors that have been associated with a reduced relapse rate are pregnancy, exclusive breastfeeding, sunlight exposure and higher vitamin D levels. A number of medications, including hormonal fertility treatment, seem to be able to trigger relapses. Factors that may worsen progression of disability include stressful life events, radiotherapy to the head, low levels of physical activity and low vitamin D levels. Strong evidence suggests that smoking promotes disease progression, both clinically and on brain magnetic resonance imaging. There is no evidence for an increased progression of disability following childbirth in women with multiple sclerosis. Moderate alcohol intake and exercise might have a neuroprotective effect, but this needs to be confirmed."

[shoshin]

This author then goes on to talk about some details about the above study. He also asserts about risk factors for relapses:

"The past months allowed us to improve our knowledge of putative precipitating factors of relapses in multiple sclerosis. Having to take a poll, I would say that the present evidence of an association of relapses of multiple sclerosis is strong for the post‐partum period (Confavreux et al., 1998), is becoming possibly disputable for infections (Sibley et al., 1985; Buljevac et al., 2002), is minor, if any, for trauma (Goodin et al., 1999) and stress (Mohr et al., 2000), and is none for vaccinations, at least in patients free of relapse for >12 months (Confavreux et al., 2001)."

I'm not sure if there's more recent contradictory evidence on this or not. I think I have read something for stress.

A slightly more recent article "The risk of relapses in multiple sclerosis during systemic infections " (http://www.ncbi.nlm.nih.gov/pubmed/16870812) concludes "There was a significant association between systemic infections and risk of MS relapse, increased MRI activity, and T cells activation."

I do find that illness tends to set off a steeper slope of decline in my MS and thus dread getting sick. As for the trip, well maybe you could make it an indirect cause in that you can be exposed to higher numbers of new causes of illness from new places and people. Airplanes can be bad news as well. Wearing yourself out from traveling could also make you more vulnerable to illness.

[shoshin]

Then again, I think this also points out the fact that we all like to think we have more control than we really do. Or at least I do. Humans are hardwired to see more agency and cause and effect than really exists. So then I wonder what if I did this or that? Would I be better off if I ate a different diet? Could I have prevented some of my decline if I had exercised more before? What would my life be like if I hadn't kissed that one boy and gotten mono (mono is a risk factor for MS)?

However, so much is unknown about MS and it's impossible to predict the effects of so many things. Julie could have stayed home and one of her co-workers could have gone on a trip and brought back some illness. Is it better to stay home with the shades drawn in fear?

sho

PS Sorry for three posts, but it "failed to save" the long one

[shoshin]

Julie, I'm sorry you're struggling with another relapse and I hope you improve quickly and return to where you were before.

I don't know what link Elaine sent, but there is a lot of research suggesting that infections can trigger relapses.

For example:

"Prospective study on the relationship between infections and multiple sclerosis exacerbations:" http://www.ncbi.nlm.nih.gov/pubmed/11960885 (click the icon on the top right to get the full text). "During a predefined at-risk period (ARP) of 2 weeks before until 5 weeks after the onset of a clinical infection (predominantly upper airway infections), there was an increased risk of exacerbations (rate ratio 2.1), which is in accordance with previous studies."

and this response

http://brain.oxfordjournals.org/content/125/5/933.long

"Several epidemiological studies sharing similar features have already addressed this issue. These were observational, prospective studies. Risk periods were defined as encompassing the onset of the clinical infection with the assumption that if a relapse was observed during the risk period, it could be regarded as being associated with the infection. Control periods were made of the non at‐risk periods… These studies showed a highly significant increase (2.5 and 2.1, respectively) in the rate of relapses during the risk period by comparison with the control periods."

[Sarahsmom46]

It is nice yo see you on the forum too. I missed you.  Elaine sent me a link but I can't copy and paste it for some reason. I only have my kindle right now and navigating isn't easy. The jest of the article is that viral infections are the number one culprit for triggering a relapse.  

Elaine, if you see this Platte please help with the link and thanks again.

[PastorDan]

Shucks, I was hoping someone would post something to answer the question for the rest of us to read!

Hey, welcome back.  We pray you are up and about and out of that place really soon.

[Sarahsmom46]

Never mind I got a response that answered this question for me.