MS Awareness Month

May 21, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Boom! Thunk. I ran back to Eric's room to see if he was okay. Of course, he was. It was just the execution of another menial task that Eric and I disagreed upon. We disagreed if students should get up before noon now that school is online. We disagreed if one should stop video gaming before midnight. We disagreed if dog walking and dishwasher loading are important daily tasks. These disagreements are probably not surprising to anyone. But some of our disagreements are more strange. Like ones that outwardly make me enraged, while inwardly make me giggle at their creativity and stupidity.

May is Multiple Sclerosis awareness month. Normally, there would be MS Walks all over Manitoba and Canada to raise money for MS research and services. But because of COVID-19, we can't have large gatherings. But there will be a Virtual MS Walk May 24. If you wish, go to the MS Society website to donate or participate in the Virtual Walk.

What is MS or multiple sclerosis? It is an unpredictable and often debilitating disease of the brain and spinal cord. Some of the long nerves in the brain and spinal cord have a covering called myelin. Remember when telephone receivers were attached to the base by spiral cord? Myelin works a like the plastic covering around a telephone cord. Without the insulating plastic cover, some of the signal that goes down the telephone wire would leak out. The voice on the phone would sound delayed, weakened, garbled or possibly not there at all. In MS, the body's immune system mistakenly attacks the insulating myelin sheath around some of the nerve fibers. The signals from the brain to the body or body back to the brain get weaker, delayed, garbled or go missing altogether.

Since MS affects some myelin covers some of the time, this leads to one of the most fascinating and frustrating facets of the disease. The symptoms of MS change and are unpredictable. The most common form of MS, relapsing and remitting MS, has well defined attacks followed by complete or partial recovery. It can go away and come back. And it can affect vision, hearing, memory, balance and mobility. And this is not just that the disease affects different people in different ways. The same person can have different symptoms each attack. You can imagine how frustrating it would be to both worker and employer if a worker came to work one week in a wheel chair and then the next month she could walk. Then a year later she could still walk, but says she can't read her computer screen without magnification. And then she is fine. And then a year later she calls in sick for 3 weeks because she is too fatigued to leave the house. Unfortunately, since people with MS often don't look sick and they have symptoms that come and go, some confused employers treat an employees with MS unfairly.

There is a new oral treatment available for secondary progressive MS. It is called Mayent or siponimod. As mentioned, most people with MS have what is called relapsing-remitting MS. Over time, about half of the people with relapsing-remitting MS start getting worse. Their symptoms don't go away or don't go away completely. And then the symptoms just keep getting worse over time. We call this secondary progressive MS.

Since we believe the main problem in MS is that the person's immune system mistakenly attacks the myelin sheathe, that is why siponimod suppresses part of the immune system. Siponimod seems to stop white blood cells from getting into the brain and spinal cord and doing damage. The studies on siponimod show that if you treat 19 people for 3 years, 1 person will have a small delay in the progression of their physical disability compared to placebo. While it is good some people's symptoms don't go downhill as fast, a small improvement in1 out of 19 people over 3 years is not considered to be a huge improvement. As for side effects, patients may feel dizzy or tired when they start siponimod. This is because siponimod slows their heart rate. This feeling should go away in a few weeks. Because siponimod decreases heart rate, we will try to avoid using other heart rate lowering medications like beta-blockers on siponimod patients. In clinical practice, siponimod will probably be used only for certain secondary progressive MS patients. Patients such as those who have signs of active inflammation, like an MRI showing a new brain lesion, despite already being on an MS drug like beta-interferon. Finally, siponimod is expensive. It is close to $3000 per month.

The original "Boom! Thunk" that made me worried about Eric's safety, turned out to be a deodorant stick. Eric was comfortable in his bed. He was watching Burt Reynolds in Smokey and the Bandit instead of getting up. Interesting choice for a not quite 15 year old, but I digress. I had previously opened his bedroom door and turned on the lights to get him up. Eric now wanted the door closed. Instead of taking 2 steps across his room, he found a deodorant stick and threw it. There were just so many obvious holes in his plan. There was a good chance the deodorant stick would damage the door, the wall beside the door or his Xbox screen depending on his aim. There was also a good chance the plastic deodorant stick itself would explode all over his room. Finally, the mass of deodorant stick is just too low for it to swing, close and latch a door. Momentum is still conserved, even when school is online only. Is there any chance Eric will understand that physics reference? Probably not, unless it is uttered by Burt Reynolds.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

MS Society of Canada www.mssociety.ca

MS Virtual Walk site - https://secure3.convio.net/mssoc/site/SPageServer/?pagename=walk_homepage&s_locale=en_CA

 


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