TRANSCRIPT: Ask the Expert with Dr. Anne... - My MSAA Community

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TRANSCRIPT: Ask the Expert with Dr. Annette Howard

Good evening and welcome, My MSAA Community, to our Ask the Expert with Dr. Annette Howard! We are grateful to have Dr. Howard joining us to answer YOUR questions.

Dr. Howard is medical director of the Multiple Sclerosis Institute of Texas in Houston and a private practice neurologist since 2001.

For the next hour, please feel free to ask Dr. Howard your questions concerning issues related to women and MS as a reply to this post. Don’t forget to keep refreshing the page to see the latest questions and responses.

Bring on your questions below!

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34 Replies
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Thank you for being here with us. How do men and women differ in symptoms and disease progression?

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A very good question. I think the symptoms of MS those occurring anywhere from the top of your head down to the tips of your toes are the same. But, the way women and men experience those symptoms are different. Most women state fatigue is a major symptom and men may state walking or sexual dysfunction as their major symptom.

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Do you see differences in the rate of progression between men and women?

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Men and women may experience the same symptoms but express them as a difference in frequency and intensity. Because women carry the diagnosis of MS 2-3 times greater than men we cannot show comparable progressive data. The goal of treatment is to keep everyone on the relapsing-remitting phase and not the progressive phase.

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Hello and Good evening! It is my pleasure to serve as Your MS Expert today.

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Should women avoid getting pregnant if they have MS?

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MS is not a contraindication or reason to avoid pregnancy. Most women who get the diagnosis of MS have for the most part completed their families. Yet, as women have been delaying pregnancy for other reasons, it can be an issue. First, determine that your MS is stable, that means no relapses, new MRI lesions, or progression. Speak with your health care provider about is this a good time for me to be pregnant. If the answer is yes, then get busy!

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Good question johnMSAA We have one member that I can think of that is 21 weeks pregnant with her second child. I believe her handle is kdali Great young lady and is a enjoyable member of our group.

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Thank you for joining us today, Dr. Howard. Do you think that there are more women with MS? I was diagnosed with MS Dec. 2016, age 68. I recall being very heat sensitive 2 years before I went numb in 2016, could that have been the beginning of MS symptoms?

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Although that is an older age for first time new diagnosis of MS, as you look back over your life you may be able to recall having symptoms of MS that were mild, did not last long, and went away.

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Thank you Dr. Howard. I was a very active, healthy long distance bicycle rider right up until the day I started going numb. I believe that staved MS from joining me.

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You were like so many people who have been diagnosed with MS, young, active, healthy pursuing so many activities of daily living.

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Do women with MS typically experience relapses during pregnancy?

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We are analyzing a lot of data about pregnancy and MS. It seems that about 50% of women have relapses and most of them are usually treated with some form of steroids.

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Is MS hereditary?

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That is a yes and no question. Yes, there are studies that show there are inherited traits on genes that are passed down in families, although it is very rare. So rare, that we advise would be parents to not worry about MS in their children. The risks of passing down more worrisome factors like high blood pressure, diabetes, and cholesterol are more pressing to health care professionals.

We also find that passing down other autoimmune conditions is more likely, such as thyroid disease, lupus, rheumatoid arthritis, inflammatory bowel disease than MS.

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How do you manage symptoms like fatigue / bladder frequency / problems with memory?

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I'm going to jump in here and say a few things that I am able to do. Being retired, I can take cat naps, for the fatigue, do what I can. I'm keeping the post-it people in business with all the notes I make for myself. I do make a "To Do List" and feel good if I get 2 of 3 done.

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That is a great idea! For most of us, whatever the symptom, we have to acknowledge that we have a problem and then the strategies will come.

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I will take each one separately.

Fatigue is best managed by first understanding that you will have to do things that require the most energy at the time of day when you have the most energy. Maybe you have to go to your car and take a nap at lunch instead of going out to eat with everyone. Second, we use medications to give energy boosts when needed like anti-depressants and stimulants. We also found that the first symptom that Ampyra, known as the walking pill, helped was in managing fatigue.

Most women have bladder urgency and frequency, a got to go feeling all the time, with knowing where everyone bathroom is. We use the medicines that treat overactive bladder, botox, and catherization to help this problem.

For problems with memory, concentration, and judgement concerns we first ask you use certain memory strategies, like writing things down and enlisting others to help you with your memory. We also use medicines like anti-depressants, stimulants, and those used to treat Alzheimer's Disease to help with memory issues.

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Do MS symptoms increase during menopause?

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Symptoms do not increase during menopause. But if you have MS and go through menopause at first it will feel as if your MS is worsening. After a few questions about the changes in the menstrual cycle, I will refer the patient to the gynecologist to figure out if this menopause and to recommend hormone replacement treatment.

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Can women take disease-modifying therapies while pregnant?

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Currently, there are no approved MS treatments for pregnancy. If the potential pregnancy is planned, the patient will be off the disease modifying treatment at least 30 days. If the patient becomes pregnant while on a MS treatment, then it should be stopped immediately and let the Obstetrician give further advice.

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I have allot of problems with my legs, especially at night. Baclofen and Gabapentin have helped lessen the spasms. Often, my legs feel as though they are burning, like a bad sunburn. This happens at night and we just try to massage my legs. What would you think might help this burning feeling?

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Let me offer some suggestions for you to discuss with your doctor. Tizanidine is another muscle relaxer we prescribe in MS and can help with muscle spasms and spasticity at night. It may make you sleepy when taken in the daytime. Also it requires about 1800-2400 mg of Gabapentin a day to lessen nerve pain. Ask about Lyrica, which now comes in a once a day extended release version.

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Thank you! I will discuss with Dr. at next appointment.

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Your are welcome.

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Can you provide resources that may be helpful for women who have MS?

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You are on one of the best resources available right now. The MSAA has a variety of formats for just about anything MS. You can also plug in MS resources with Dr. Google and it can direct you to other MS advocacy organizations. I want to encourage to keep learning about MS, so that you can keep living well with MS. Thank you for tuning in and we will chat next time.

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Thank you so much for this session. I am always learning more and more about MS. These were great questions. Thank you for your time today.

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Thank you and good luck in managing all your MS needs.

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On behalf of everyone here at MSAA, we thank Dr. Annette Howard for her time and expertise, as well as our My MSAA Community members who have participated and asked questions! We would also like to thank EMD Serono for supporting this Ask the Expert program through an educational grant.

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It was my pleasure!

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