Ask The Doctor
Q: When researching, diagnosing, and treating MS, how much attention is being given to mercury and other environmental factors, particularly with some people eating more fish for its oil?
A: Mercury is a known toxin to the nervous system and claims have been made that mercury in dental fillings may be responsible for MS. Consequently, some MS patients have had their dental fillings removed. No convincing evidence, however, has implicated mercury toxicity in MS and no data has been presented to show that removing mercury dental fillings has affected the course of MS over the long run.
The neurologic toxicity of mercury in contaminated fish does not resemble MS, so while too much mercury can cause neurologic problems, it does not appear to be related to MS. On the positive side, the potential benefits of fish oil are being substantiated in relationship to heart disease. Some information on fish oil and MS looks promising, but remain controversial.
In summary, while no one should eat fish with high levels of mercury, eating fish may reduce the risk of heart disease. More research with fish oil and MS is needed before any definitive association may be made. With potential benefits outweighing the risks, I often recommend fish and fish oil to my patients.
Please note that any changes to one's diet and supplements should only be made under the advice of one's personal physician.
Q: When applying for Social Security Disability Insurance (SSDI), how important is the physician's letter, and what should it include?
A: The risk of being initially rejected by Social Security is high for people with MS, in my experience. However, on appeal, many of these negative decisions are reversed. In other words, persistence pays off.
The physician's letter is critically important and should provide as much specific information as possible. Detailing the extent of the problems with MS, including fatigue, is vital. Demonstrating how the problems with MS contribute to the disability will often provide Social Security Administration with the information needed to respond positively to a claim. The fatigue factor is especially important since fatigue is specifically mentioned as a potential cause for disability in MS.
Q: How much do genetics and heredity play a role in developing MS, and are gender and types of MS involved?
A: Relapsing-remitting MS is two to three times more common in women than men. Primary-progressive MS, however, affects men and women equally. While no one single gene has been found to be responsible for MS, a genetic susceptibility is seen because people with a family history of MS are at a greater risk for developing the disease.
Specifically, in the northern part of the United States, the risk of getting MS for the general population is about one in 1000 (0.1 percent). With a close family relative with MS, the chance of getting the disease increases to about two to three percent. This is still a low risk. But if one identical twin has MS, the risk of the other twin getting MS is up to 30 percent. This high risk of MS in identical twins contrasts with the five percent risk of a non-identical twin getting MS. Therefore, this data indicates a genetic tendency involving several genes as possibly being implicated in the development of MS.
Q: Is hearing loss ever a symptom of MS, and if so, to what extent, and how is it treated?
A: Hearing loss is an unusual symptom of MS. Therefore, my MS patients with hearing loss get a complete workup to try to discover other potential causes. Hearing aids may sometimes be helpful in patients with hearing loss, but a complete audiology evaluation is important in determining other diagnoses and treatment possibilities. Sometimes MS patients with hearing loss also have trouble with balance.
