Ask the Doctor
Q: Can
MS affect
the heart?
A: This is a complex question. The easy answer is that MS does not cause heart attacks or hardening of the arteries, although occasionally we see irregular heart rhythms in MS patients. Individuals with MS often have symptoms related to the “autonomic nervous system” which controls the cardiovascular system (heart and blood vessels). Cold or overly warm arms or legs can also be a symptom, as well as having blueness or paleness of the skin. Some of these conditions are associated with pain in the affected arms or legs.
Sudden drops in blood pressure, along with associated dizziness upon standing, are other cardiovascular symptoms we occasionally see. Therefore, a more complete answer is that MS can affect the autonomic nervous system which controls blood circulation, but there is no apparent increased risk of heart attacks.
Q: How can regular MS symptoms be differentiated from those caused by an attack?
A: “True exacerbations” are defined as new symptoms or the reoccurrence of old symptoms that: last more than 48 hours; are documented on neurological examination; and have no other explanations for occurring. Magnetic resonance imaging (MRI) studies, however, reveal that new lesions can accumulate, without “true exacerbations.” An estimated 10 “MRI attacks” (new lesions) occur for every one “true exacerbation” documented by the patient and the neurologist. That is one reason some neurologists order “routine MRI’s” every year or two.
Other explanations for increasing symptoms include fever (most common) and even bladder infections without fever. Stress, fatigue, or over-exertion are also commonly associated with increased symptoms, as well as exposure to hot or cold temperatures. These temporary increases in symptoms are called “pseudo exacerbations,” because they mimic exacerbations, but not as a result of actual myelin damage.
Q: What is an optimal treatment plan for someone with MS?
A: There is no “optimal treatment plan” that fits everyone with MS. The hallmark of MS is its “variability of symptoms.” The hallmark of good treatment is that “every patient deserves his or her own treatment plan.” Having said that, let me outline some general principles I usually follow. This is not meant to be a comprehensive care guide. Instead, consider the following to be “food for thought.”
- Early diagnosis is critical to maximizing
best care principles. Seek help early.
- The family should be involved in
discussions from the beginning.
- Education about MS starts immediately
and never stops. Make certain your
educational resources are valid.
Education involves the entire family.
- Early treatment with immunomodulating
therapy should be seriously considered
by every individual with MS who
experiences attacks. Treatment may
prevent some new attacks and reduce
disability in the long run.
- Most MS symptoms are treatable and
can be helped through medication,
therapy, and lifestyle changes.
- Complementary and alternative medicine
treatments should be reviewed with
one’s doctor to discuss potential
negative MS consequences, especially
if they interfere with your prescription
medications.
- Stress management usually helps people
with MS. Counseling is not a sign of
weakness or “giving up.” Individual
and/or family counseling can be helpful
to anyone dealing with changes as a
result of MS.
- Individuals with MS should see their
doctor regularly, even if everything is
stable. I see patients every six to 12
months or more frequently if needed.
Many individuals also see a nurse every
three months, between doctor visits, to
discuss any new symptoms or concerns.
A nurse can help individuals to learn the
procedure for reporting or evaluating
new symptoms.
- Rehabilitation (such as physical,
occupational, speech, and recreational
therapies) and nutrition specialists
offer much help to people with MS.
- Do not neglect your general healthcare
needs. Not everything someone
experiences is related to his or her MS.
Like everyone else, a person with MS
can also suffer from thyroid disease,
diabetes, high cholesterol, high blood
pressure, etc. Family history is important
too; individuals need to be sure to tell
their physician of any medical condition
that other family members may have or
had, so tests may be conducted at the
right time. One’s primary care physician
needs to continue to play a vital role in
his or her health and well-being.
