Multiple Sclerosis - WHAT IS IT

Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul. And today our topic is going to be multiple sclerosis, which is a neurological condition. And so we want to go through 4 different parts about it. The first being, what is it? The second being, what other things could be going wrong that might look like multiple sclerosis? Then we're going to go through standard treatments, and then we're going to go through integrative and naturopathic potential treatments as well. So a lot to do. So we'll get rolling. First off though, remember nothing we say here is medical advice. This is just general information. You should always seek your own healthcare advice from your own healthcare providers. So don't take advice from people on the radio or TV or YouTube or anywhere else. for your medical care. But we have some good information for you today. So multiple sclerosis is a neurological disorder which comes from the breakdown of some of the protective and helpful covering on your nerve tissue. And it's sort of a weak analogy, but it kind of works, that if you had a wire that had electricity going through it, which, uh, on a more complex level is sort of like a nerve, and then you took the insulation off of the outside, one of the problems outside of shocking people, you know, that might grab the wire would be it's easy for that wire to touch other things and ground out. So the electricity goes the wrong direction. Well, the myelin that protects your, uh, nerve cells and transmission has very specific roles in that. And so if we're attacking that and it's breaking down, we're going to so-called, you know, ground out. We're going to have different types of neurological activity that your brain is not going to understand and interpret because things are not wired the way that they're supposed to, not going in the direction that they're supposed to. One of the problems with multiple sclerosis is the ability to accurately diagnose it because there are so many symptoms that are fairly broad, and many of those symptoms can be laid off on other types of disorders. And so you will often see people who have been, you know, maybe going in, maybe seeing a neurologist, etc., complaining about particular symptoms, and sometimes it takes a while before the diagnosis is Or it takes a while before they have more of a confirmatory diagnosis. So we'll get into that as well. Now, there's some, as I said, mostly neurologically driven symptoms. So you have things like, they call it the MS hug. This is a constricting feeling like someone's squeezing your torso in. That's not uncommon. You can have difficulties with movement, walking, difficulties with coordination. You can develop certain types of spasticity, which is literally where muscles will spasm and you don't want them to. It's an automatic response spasm. You can have global symptoms such as fatigue that can be very profound. You can have numbness and tingling and weakness. And there's an idea of you know, hands and feet often getting involved in having either trouble feeling or coordination problems or weakness, etc. But those things aren't mediated through normal neurological patterns. For example, in the case of your hand, you've got, you know, 3 different nerves that operate different muscles that help you with the coordination of what your fingers do. In the case of MS, instead of it being like a single nerve, you know, neuropathy, etc., they all might be involved. So again, it sort of doesn't follow certain patterns when you see these things. You also can have unexplainable headaches. You can have other pain syndromes. You can have neuropsychiatric issues. You can have trouble with cognition, ability of of your brain to work and process. You can have difficulties in the area of, you know, sleep disorder, more depression or anxiety, or really many, many other things. And so you can see that these are symptoms that are sort of all over the map. Now, they tend to revolve around neurological function, but there's a lot of other things that could cause these symptoms, which is something to keep in mind. The next thing is that over time we have evolved our understanding of multiple sclerosis. So now there are 4 subcategories, and then there is a 5th, what you might call a bonus category, because it, it doesn't fit into the first 4 criteria, but it's sort of illustrative, and it's something that, that we do notice in patients. So the first one is called a clinically isolated syndrome, or CIS. And that is where you have some kinds of symptoms, like I was just talking about, that are triggered by, you know, inflammation and this attack on the myelin layer in your central nervous system. And in order to fit the criteria, the symptoms have to last for greater than 24 hours. They have to be symptoms that would be characteristic. So from that prior set of symptoms that I just shared with you. And the other part of it is that this may or may not happen again. So statistically, there's a lot of people that have these symptoms, and it's called a clinically isolated syndrome because it comes and then it just goes. And some of those people will progress on to have MS, and some people will not. And And you're going to see this as a pattern that goes on with multiple sclerosis, where there's a lot of sort of early entry-level issues, and a group of people will progress forward into multiple sclerosis, a group people won't. And therein lies a lot of the problems with the diagnosis and getting it really locked in early on. And so that's a lot of the reason that people have some frustration around their diagnosis. Then there is relapsing and remitting multiple sclerosis, which is just what it says, where you have an event and then you have a break. That's a remission. And then you relapse into the event, or you get some new ones, and you have a remission again. And so it's this up and down and up and down. And sometimes, because, as you heard, those those descriptions that we gave earlier, these are symptoms that could be really from a whole bunch of other reasons, a bunch of other causes. A lot of people may not get them worked up if they have relapsing and remitting until later when they realize that there's a pattern to this. Or, you know, because a lot of times when it's just human nature, if we have symptoms right now but then they go away, we think, well, they're probably gone forever, right? I mean, that's what we hope. But then if it comes back again, we might think, well, maybe this is a pattern, maybe not. Oh, it went away. So we're happy again. And then it comes back again. And usually somewhere in that pattern, people will seek some help. And then there's 2 progressive forms. So relapsing and remitting is essentially sort of like a bump up and a bump down and a bump up. And it's, it's kind of on the same amplitude, the same levels as you go along. The progressives, you have A secondary progressive and a primary progressive type. The bottom line is, is that as opposed to going up and then back down to baseline and up and back down to baseline, the progressive forms go up and they kind of trend up over time. And secondary and primary just have different patterns to them that go on. Now, the extra diagnosis, if you will, or pattern, etc., is called radiologically isolated syndrome, or So it doesn't really count as one of the four types, but it is a phenomenon that is noticed by neurologists and radiologists, and basically they find brain abnormalities, and those brain abnormalities are not explained by any other diagnosis, and yet they don't really have any current or historical neurological symptoms that would match. the case of multiple sclerosis. So, one of the problems with this is that there are findings in the brain on imaging that can be found in other problems. So, they look the same. And that's another frustration with MS. All right. I talked a lot yesterday, so I'm keeping my throat wet. So we've got these different types. We've got all of these symptoms all over the place. How is it that we wind up diagnosing multiple sclerosis? Well, the typical diagnosis is going to be in a collaboration between radiologists doing the particular types of usually MRI studies for the purposes of finding the lesions in the brain spinal cord. But the typical full diagnosis and then treatment regimen is normally mediated through the specialty of neurology. So your neurologist would normally be doing that. And certainly if you have these type of symptoms, you might have gotten, you know, an MRI already, maybe from your primary care doctor, and you might be moving forward with that. you know, with your primary care doctor. They've got signs and symptoms. And if the signs and symptoms are concerning enough and the MRI is positive, and again, signs and symptoms could be many other things other than MS, and the MRI findings could be not MS either. So the findings in the MRI are not 100%, associated with MS. The primary care will often at that point refer you over to the neurologist to monitor you and maybe get a diagnosis. So you kind of have the 3 big pillars of diagnostic criteria being imaging of the brain and the spinal cord. So here's the other thing. You could have these lesions in your brain, but you could also have them in the spinal cord in your neck or your upper back or your lower back. And so typically the imaging is done both of the brain as well as the spinal cord to see how many locations the lesions are at. Now you could imagine if you have these lesions and if they're in your central nervous system in the brain part, then whatever areas they're in might be inhibited with regard to the function of your brain and its output. But also think if it's in your spinal cord, which is also part of the central nervous system, that might be in a control area or it might be in a receptive area where the sensory nerves are sending information in. So there may be local or segmental confusion there that would add to the symptoms as well. So we have imaging, we have signs and symptoms. So how are you feeling? What's the pattern of it? How many different criteria do you seem to have of multiple sclerosis? And then in most cases, there is also a lumbar puncture that's done. So lumbar puncture is also known as a spinal tap, and that's where generally in a very low part of your spine, which is down below the area where, where the spinal cord proper ends, and then the nerves come out sort of as filaments, call it the cauda equina or the horse's tail. So it looks like these filaments. So you put the needle in there for, for a lumbar puncture, you're not going to run into a solid spinal cord down in that area. That's why it's done there. So, a lumbar puncture will show a lot of things that are going on in the immune system around the cerebrospinal fluid, which goes around your spinal cord and your brain. And there are, again, signs and symptoms in the findings around the cerebrospinal fluid that can help either make more weight towards a multiple sclerosis diagnosis or less weight and take you in the direction of a different type of disease. And we'll, we'll talk about other things that MS might be, other diseases, etc., in the next section. So that's all coming up there. Now, in addition to looking at your signs and symptoms, your history, looking at the imaging, looking at the lumbar puncture findings and results, normally there are also a set of laboratory tests done. Now, these laboratory tests are not to confirm multiple sclerosis necessarily because there's not one, you know, magnificently sensitive and specific test for multiple sclerosis under any circumstances. But those things are done to see a number of things such as, would there be any other reason for these symptoms? Does the person have kidney or liver problems? Are they anemic? Do they have electrolyte issues? Do they have any signs in their blood count of inflammation, infection, etc.? Do they have blood sugar control issues? Is their thyroid okay? Are they tending towards an autoimmune picture? Are there any autoantibodies that we find? And on and on. So normally, like I say, those things, a lot of times these things are worked up at primary care and then move forward to the neurologist. But if you haven't really had any workup done, the neurologist will also do that group of blood tests. And like I say, they're not so much to confirm that you have MS, but they are there to let you know, A, that there's nothing else going on, and B, maybe there's some markers that might show we're getting more autoimmune, more inflamed, etc. So in the workup and everything, and we just got like a minute left here, you need to have 2 places in your central nervous system that are on the imaging and positive. You need evidence that the damage has given you symptoms at 2 different points in time in the past. So not just one clinically isolated syndrome. And then you have to rule out other diagnoses that may be a problem, which is the point of the next talk. But we are ready to transition on here. We're going to take a quick break and we'll be right back looking at other things that can cause multiple sclerosis-like signs and symptoms. Here on Medicine and Health, want to thank you for for subscribing and listening, whether it's on Facebook Live or CTR Network Live. Also, we're on all of the pod burners, and so you just go Medicine and Health with Dr. Paul Anderson. You'll find me there, or on YouTube. It's just DRA Online, Dr. A Online on YouTube. And if you can't find any of those, go to the hub website dranow.com. dranow.com, and, uh, you will find us there, and there will be links to all of these various outlets and places. All right, we're going to go to a break. We'll be right back.