“Key Facts on Endometriosis:

• Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility (1).
• Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally (2).
• It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility.
• The variable and broad symptoms of endometriosis mean that healthcare workers do not easily diagnose it and many individuals suffering from it have limited awareness of the condition. This can cause a lengthy delay between onset of symptoms and diagnosis (3).
• At present, there is no known cure for endometriosis, & treatment is usually aimed at controlling symptoms.”.

World Health Organization – WHO (https://www.who.int/news-room/fact-sheets/detail/endometriosis)

Endometriosis Risk Factors:

Research shows that there are some things that put a person at higher risk of developing endometriosis, including having:

• A mother, sister or daughter who has endometriosis
• An abnormal uterus, which is diagnosed by a doctor
• Early menstruation (before age 11)
• Shorter menstrual periods (less than 27 days on average)
• Heavy menstrual periods lasting more than seven days

Some things that can lower the risk of endometriosis include:

• Pregnancy and breastfeeding
• Having your first period after age 14
• Eating fruits, especially citrus fruits

Endometriosis prevention:

Endometriosis is an idiopathic condition, meaning there is no known cause. There are also no specific ways to prevent endometriosis. However, being aware of the symptoms and whether you could be at higher risk can help you know when to discuss it with a doctor.

Endometriosis Stages:

Doctors classify endometriosis from stage 1 to stage 4. The stages are based on where endometrial tissue occurs in the body, how far it has spread and how much tissue is in those areas.

Having a more advanced stage of endometriosis does not always mean you will have more severe symptoms or more pain. Some women with stage 4 endometriosis have few or no symptoms, while those with stage 1 can have severe symptoms.

“A woman’s uterus is lined with endometrial tissue. This lining is called the endometrium. Your body grows a new endometrium with each menstrual cycle to prepare for a fertilized egg. Endometriosis is a condition in which endometrial tissue grows outside the uterus.  Endometriosis affects up to 10% of women between the ages of 15 and 44. It most often occurs on or around reproductive organs in the pelvis or abdomen and grows outside the uterus. The buildup of abnormal tissue outside the uterus can lead to inflammation, scarring and painful cysts. It can also lead to buildup of fibrous tissues between reproductive organs that causes them to “stick” together.”

John Hopkins Medicine (https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis)

What is Endometriosis?

The uterus is a female reproductive organ located between the bladder and the rectum, in the pelvic area. The uterus has three layers: the inner lining (endometrium); the middle muscular layer (myometrium); and the outer layer (perimetrium). The uterus is connected to the fallopian tubes, the cervix and (via the cervix) the vagina.

Endometriosis is a painful, chronic disease that affects at least 6.3 million women and girls in the U.S., 1 million in Canada, and millions more worldwide. It occurs when tissue like that which lines the uterus (tissue called the endometrium) is found outside the uterus.  The symptoms occur during menses and the endometrial tissue outside the uterus will be painful like the uterus cramps due to the period.

What Causes Endometriosis?

The cause of endometriosis is unknown. The retrograde menstruation theory (transtubal migration theory) suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows.  Some experts believe that all women experience some menstrual tissue backup and that an immune system problem or a hormonal problem allows this tissue to grow in the women who develop endometriosis.

Another theory suggests that endometrial tissue is distributed from the uterus to other parts of the body through the lymph system or through the blood system. A genetic theory suggests that it may be carried in the genes in certain families or that some families may have predisposing factors to endometriosis.

Surgical transplantation has also been cited in many cases where endometriosis is found in abdominal scars, although it has also been found in such scars when accidental implantation seems unlikely.

Another theory suggests that remnants of tissue from when the woman was an embryo may later develop into endometriosis, or that some adult tissues retain the ability they had in the embryo stage to transform reproductive tissue in certain circumstances.

Research by the Endometriosis Association revealed a startling link between dioxin (TCCD) exposure and the development of endometriosis. Dioxin is a toxic chemical byproduct of pesticide manufacturing, bleached pulp and paper products, and medical and municipal waste incineration. The EA discovered a colony of rhesus monkeys that had developed endometriosis after exposure to dioxin. 79% of the monkeys exposed to dioxin developed endometriosis, and, in addition, the more dioxin exposure, the more severe the endometriosis.

Endometriosis tissus found outside of the uterus:

• Outside and back of your uterus.
• Fallopian tubes.
• Ovaries.
• Vagina.
• Peritoneum (the lining of your abdomen and pelvis).
• Bladder and ureters.
• Intestines.
• Rectum.
• Diaphragm (a muscle near the bottom of your chest that plays an important role in breathing).
• Less commonly they are found in the lung, arm, thigh, and other locations.

This misplaced tissue develops into growths or lesions which respond to the menstrual cycle in the same way that the tissue of the uterine lining does: each month the tissue builds up, breaks down, and sheds. Menstrual blood flows from the uterus and out of the body through the vagina, but the blood and tissue shed from endometrial growths has no way of leaving the body. This results in internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation — and can cause pain, infertility, scar tissue formation, adhesions, and bowel problems.

Pain before and during period: Pain with sex, Infertility, Fatigue, Painful urination during periods, Painful bowel movements during periods and Other Gastrointestinal upsets such as diarrhea, constipation, nausea.

In addition, many women with endometriosis suffer from:

• Allergies
• Chemical sensitivities
• Frequent yeast infections

Diagnosis:

Diagnosis is considered uncertain until proven by laparoscopy, a minor surgical procedure done under anesthesia. A laparoscopy usually shows the location, size, and extent of the growths. This helps the doctor and patient make better treatment choices.

“Managing MS is an ongoing process, beginning with the very first symptoms and continuing throughout the disease course. It’s never too soon or too late to think about how to access high quality, comprehensive, interdisciplinary care. Knowing what to look for, where to find it, and how to work effectively with your doctor and other health professionals is essential to your health, wellness and quality of life.  Establishing and following a treatment plan with your healthcare provider is the best strategy for managing your MS. Medications are used in multiple sclerosis (MS) to modify the disease course, treat relapses — also called attacks or exacerbations — and manage symptoms. Along with the other essential components of comprehensive MS care, these medications help you manage your MS and enhance your quality of life.”.

National Multiple Sclerosis Society (https://www.nationalmssociety.org/Treating-MS/Medications)

Treatment for Multiple Sclerosis:

Today multiple sclerosis (MS) is not a curable disease. Effective strategies can help modify or slow the disease course, treat relapses (also called attacks or exacerbations), manage symptoms, improve function and safety, and address emotional health.

The model of comprehensive MS care involves the expertise of many different healthcare professionals — each contributing in a unique way to the management of the disease and the symptoms it can cause. Sometimes this team works within a single center, offering “one-stop shopping” for people with MS. More often, people are referred by their MS physician to other specialists in the community.

In either case, the goal is comprehensive=coordinated care to manage the disease and promote comfort, function, independence, health and wellness to its OPTIMAL LEVEL.

There are several types of MS:

For an acute exacerbation of multiple sclerosis that can result in neurologic symptoms and increased disability or impairments in vision, strength or coordination, the preferred initial treatment is usually a type of steroid called a glucocorticoid. Patients who do not have a good response to steroidal therapy are often treated with plasma exchange. Plasma exchange is an extreme therapy that removes antibodies to myelin from the blood.

Some patients have disease that will have an acute exacerbation followed by a prolonged quiet period, which can last years or decades. This form of disease is referred to as relapsed remitting MS, or RRMS. Patients with relapsing MS=RRMS are often treated with immune-modulating drugs such as interferon or glatiramer acetate. Glatiramer is an exciting drug. It is a series of small proteins that are similar to myelin protein. It is thought to prompt the immune system to avoid attacking myelin.

Others have a disease that gets progressively worse over time.

There are two types of progressive disease:

1 In primary progressive MS, or PPMS, symptoms steadily worsen over time from the very beginning.

Progressive MS also referred to as disease-modifying therapies (DMTs).

Presently, these include 15 drug therapies to slow MS activity and progression, each of which is approved by the United States Food and Drug Administration (FDA) for relapsing forms of MS (and some are also approved for clinically isolated syndrome, prior to the diagnosis of MS). One of the medications, Ocrevus™ (ocrelizumab) is also approved for primary-progressive MS. In nearly all instances, these drugs are prescribed individually, so a patient only takes one DMT during any time period. Of these 15 approved drugs, eight are given at home via injection; four are given by a medical professional via intravenous (IV) infusion; and three are taken orally.

In brief, no clinical trial has shown convincing evidence of benefit in the treatment of primary progressive MS. All suggested treatments for PPMS are empiric. Several drugs that are more commonly used in the treatment of malignancy, cladribine and mitozantrone, appear to have some activity.

2 Secondary progressive MS, known as SPMS, begins as relapsed remitting disease and becomes progressive over time.

Available treatments of primary and secondary progressive MS are of limited efficacy and have significant side effects. An additional fact to consider is that most trials have not lasted longer than two or three years and give only hints about long-term results of treatment.

In brief, no clinical trial has shown convincing evidence of benefit in the treatment of primary progressive MS. All suggested treatments for PPMS are empiric. Several drugs that are more commonly used in the treatment of malignancy, cladribine and mitozantrone, appear to have some activity.

In contrast, there is definite modest benefit in some treatments for secondary progressive MS. These treatments include various regimens of steroid therapy (the anti-inflammatory effect) and the use of some drugs that modulate the immune system. Many of these drugs are more commonly used in treatment of cancer and rheumatoid arthritis such as cyclophosphamide, methotrexate and interferon.

MS should be treated by a neurologist who majors in MS with experience in managing it for years.  The doctor with knowledge is so important regarding the specific disease.  Do your research on experts treating this from NY to CA.

Remember the MS treatment is in parts to make up a whole plan:

1 Modifying the disease:

More than a dozen disease-modifying medications have been approved by the U.S. Food and Drug Administration (FDA) to treat relapsing forms of MS. These medications reduce the frequency and severity of relapses (also called attacks or exacerbations),  reduce the accumulation of lesions in the brain and spinal cord as seen on magnetic resonance imaging (MRI) and may slow the accumulation of disability for many people with MS. No medications have yet been approved to treat primary-progressive MS.

2 Treating the Exacerbations:

An exacerbation of MS is caused by inflammation in the central nervous system (CNS) that causes damage to the myelin and slows or blocks the transmission of nerve impulses. To be a true exacerbation, the attack must last at least 24 hours and be separated from a previous exacerbation by at least 30 days. However, most exacerbations last from a few days to several weeks or even months. Exacerbations can be mild or severe enough to interfere with a person’s ability to function at home and at work. Severe exacerbations are most commonly treated with high-dose corticosteroids to reduce the inflammation.

 3 Managing symptoms

In MS, damage to the myelin in the CNS and to the nerve fibers themselves interferes with the transmission of nerve signals between the brain and spinal cord and other parts of the body. This disruption of nerve signals produces the symptoms of MS, which vary depending on where the damage has occurred. MS symptoms can be effectively managed with a comprehensive treatment approach that includes medication(s) and rehabilitation strategies.

4 Promoting function through rehabilitation

Rehabilitation programs focus on function — they are designed to help you improve or maintain your ability to perform effectively and safely at home and at work. Rehabilitation professionals focus on overall fitness and energy management, while addressing problems with accessibility and mobility, speech and swallowing, and memory and other cognitive functions. Rehabilitation is an important component of comprehensive, quality healthcare for people with MS at all stages of the disease. Rehabilitation programs include cognitive and vocational rehabilitation, physical and occupational therapy, therapy for speech and swallowing problems, and more. 

5 Providing emotional support

Comprehensive care includes attention to emotional health as well as physical health. Mental health professionals provide support and education, as well as diagnose and treat the depression, anxiety and other mood changes that are so common in MS. Neuropsychologists assess and treat cognitive problems.

MS is only part of overall health for a pt diagnosed with this disease!  Comprehensive MS care is only a part — but not all — of a person’s overall health management strategies.

Like the general population, people with MS are subject to medical problems that have nothing to do with their MS — which means that regular visits with a primary care physician and age-appropriate screening tests are just as important for them as they are for everyone else. And the same goes for family members — your health and well-being are important too.

Updated 3/16/2023

“The symptoms of MS are often unpredictable. They may be mild or severe, short-term or long-lasting. They may appear in different combinations, depending on the area of the nervous system affected. About 50% of all people with MS have thinking (cognitive) problems linked to the disease. The effects of these problems may be mild. Your healthcare provider may only find them after much testing.”

John Hopkins Medicine (https://www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-sclerosis-ms)

Multiple sclerosis (MS) is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body.

It can be a challenge for doctors to diagnose multiple sclerosis (MS). There’s no one test that can definitely show if someone has it. And there are many conditions with symptoms that can seem like MS.

But a neurologist who specializes in treating the disease should be able to look into how you’re feeling and help you figure out if your symptoms mean you have MS or another problem.

SYMPTOMS OF MULTIPLE SCLEROSIS:

Multiple Sclerosis symptoms vary from person to person but there are common symptoms with MS. Those could be the following:

*Fatigue-Occurs in about 80% of people, can significantly interfere with ability to function at home and work, and may be the most prominent symptom in a person who otherwise has minimal activity limitations.

*Difficulties with your walking gait-Related to several factors including weakness, spasticity, loss of balance, sensory deficit and fatigue, and can be helped by physical therapy, assistive therapy and medications.

*Numbness or Tingling-Numbness of the face, body, or extremities (arms and legs) is often the first symptom experienced by those eventually diagnosed as having MS.

*Spasticity-Refers to feelings of stiffness and a wide range of involuntary muscle spasms; can occur in any limb, but it is much more common in the legs.

*Weakness-Weakness in MS, which results from deconditioning of unused muscles or damage to nerves that stimulate muscles, can be managed with rehabilitation strategies.

*Visual Problems-The first symptom of MS for many people. Onset of blurred vision, poor contrast or color vision, and pain on eye movement can be frightening — and should be evaluated promptly.

*Dizziness or Vertigo-People with MS may feel off balance or lightheaded, and for some even much less often have the sensation that they or their surroundings are spinning (vertigo).

*Bladder Problems-Bladder dysfunction, which occurs in at least 80% of people with MS, usually can be managed quite successfully through dietary and fluid management, medications, and catheterization.

*Sexual Problems-Very common in the general population including people with MS. Sexual responses can be affected by damage in the central nervous system, as well by symptoms such as fatigue and spasticity, and by psychological factors.

*Bowel Function-Constipation is a particular concern among people with MS, as is loss of control of the bowels. Bowel issues can typically be managed through diet, adequate fluid intake, physical activity and medication.

*Pain-Pain syndromes are common in MS. In one study, 55% of people with MS had “clinically significant pain” at some time, and almost half had chronic pain.

*Cognitive changes-Refers to a range of high-level brain functions affected in 50% of people with MS, including the ability to learn and remember information, organize and problem-solve, focus attention and accurately perceive the environment.

*Emotional changes-Can be a reaction to the stresses of living with MS as well as the result of neurologic and immune changes. Bouts of depression, mood swings, irritability, and episodes of uncontrollable laughing and crying pose significant challenges for people with MS and their families.

*Depression-Studies have suggested that clinical depression — the severest form of depression — is among the most common symptoms of MS. It is more common among people with MS than it is in the general population or in persons with many other chronic, disabling conditions

Less common symptoms:

*Speech problems-this including slurring (dysarthria) and loss of volume (dysphonia) occur in approximately 25-40% of people with MS, particularly later in the disease course and during periods of extreme fatigue. Stuttering is occasionally reported as well.

*Swallowing problems — referred to as dysphagia — result from damage to the nerves controlling the many small muscles in the mouth and throat.

*Tremor, or uncontrollable shaking, can occur in various parts of the body because of damaged areas along the complex nerve pathways that are responsible for coordination of movements.

*Seizures — which are the result of abnormal electrical discharges in an injured or scarred area of the brain — have been estimated to occur in 2-5% people with MS, compared to the estimated 3% of the general population.

*Breathing Problems-Respiration problems occur in people whose chest muscles have been severely weakened by damage to the nerves that control those muscles.

*Itching-Pruritis (itching) is one of the family of abnormal sensations — such as “pins and needles” and burning, stabbing or tearing pains — which may be experienced by people with MS.

*Headaches-Although headache is not a common symptom of MS, some reports suggest that people with MS have an increased incidence of certain types of headache. 

*Hearing Loss-About 6% of people who have MS complain of impaired hearing. In very rare cases, hearing loss has been reported as the first symptom of the disease.

Stayed tune Part III in modern treatments with Types of Multiple Sclerosis tomorrow!

Updated 3/16/2023

“Multiple sclerosis is a disease that impacts the brain, spinal cord and optic nerves, which make up the central nervous system and controls everything we do. The exact cause of MS is unknown, but we do know that something triggers the immune system to attack the CNS. The resulting damage to myelin, the protective layer insulating wire-like nerve fibers, disrupts signals to and from the brain. This interruption of communication signals causes unpredictable symptoms such as numbness, tingling, mood changes, memory problems, pain, fatigue, blindness and/or paralysis. Everyone’s experience with MS is different and these losses may be temporary or long lasting.”

National Multiple Sclerosis Society (https://www.nationalmssociety.org/What-is-MS)

MS=Multiple Sclerosis is a long-lasting disease that can affect your brain, spinal cord, and the optic nerves in your eyes. It can cause problems with vision, balance, muscle control, and other basic body functions.

The effects are often different for everyone who has the disease. Some people have mild symptoms and don’t need treatment. Others will have trouble getting around and doing daily tasks.

MS happens when your immune system attacks a fatty material called myelin, which wraps around your nerve fibers to protect them-an outer shell. Without this outer shell, your nerves become damaged. Scar tissue may form and transmission of signals from brain to the nerve endings with messages to do functions are obstructed in allowing the body to do functions.

Your nerves are the channels from the brain to the muscle it is going to.  Understand that when your a fetus the brain first grows, and than the spinal cord continues to grow from the brain.  They are both the same tissue.  In MS this damage means your brain can’t send signals through your body correctly. Your nerves also don’t work as they should to help you move and feel.  In multiple sclerosis (MS), the body’s immune system T cells attack the myelin sheath that protects the nerve fibers. The T cells either partially or completely strip the myelin off the fibers, leaving the nerves unprotected and uninsulated. Due to patches of the myelin sheath in your nerves unable to give messages so sensation and movement that the brain controls in the CNS is destroyed.  Ending line making the mobility of the patient destroyed.

Multiple sclerosis (MS) is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and nerves throughout the body.

It can be a challenge for doctors to diagnose multiple sclerosis (MS). There’s no one test that can definitely show if someone has it. And there are many conditions with symptoms that can seem like MS.

But a neurologist who specializes in treating the disease should be able to look into how you’re feeling and help you figure out if your symptoms mean you have MS or another problem.

The causes of MS – Multiple Sclerosis:

Doctors don’t know for sure what causes MS, but there are many things that seem to make the disease more likely.

People with certain genes may have higher chances of getting it.

Smoking also may raise the risk.

Some people may get MS after they’ve had a viral infection — like the Epstein-Barr virus or the human herpesvirus 6 — that makes their immune system stop working normally. The infection may trigger the disease or cause relapses. Scientists are studying the link between viruses and MS, but they don’t have a clear answer yet.

Some studies even suggest that vitamin D, which you can get from sunlight, may strengthen your immune system and protect you from MS.

Some people with higher chances of getting the disease move to sunnier regions seem to lower their risk; like my cousin from the NJ to South Carolina.

There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis.

Diagnostic Tooling done for ruling out multiple sclerosis is:

*Imaging tests, like an MRI– to take a closer look at your brain. Magnetic resonance imaging, nuclear magnetic resonance imaging, or magnetic resonance tomography is a medical imaging technique used in radiology to image the anatomy and the physiological processes of the body in both health and disease. MRI scanners use strong magnetic fields, radio waves, and field gradients to form images of the body.

MRIs can reveal areas of MS (lesions) on your brain and spinal cord. You may receive an intravenous injection of a contrast material to highlight lesions that indicate your disease is in an active phase.

*Spinal taps, also called lumbar punctures, to check the fluid that runs through your spinal column  When doctors do this test, they’re looking closely at the fluid in your spine, called cerebrospinal fluid, for higher levels of proteins and other substances that are signs of the disease. These can be helpful in diagnosing MS, but they’re not absolute proof of the condition. Your doctor can tell you if you need to have a spinal tap

*Electrical tests, called evoked potentials, to see if MS has affected your nerve pathways.   Electrical tests of your nerves, called evoked potentials, can help doctors confirm if the condition has affected the parts of your brain that help you see, hear, and feel. Your doctor will place wires on your scalp to test your brain’s response as you watch a pattern on a video screen, hear a series of clicks, or get electrical pulses on your arm or leg.

The MD record the electrical signals produced by your nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which you watch a moving visual pattern, or short electrical impulses are applied to nerves in your legs or arms. Electrodes measure how quickly the information travels down your nerve pathways.

*Blood tests. Tests to check for specific biomarkers associated with MS are currently under development and may also aid in diagnosing the disease.

*Evoked potential tests.  Which record the electrical signals produced by your nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli. In these tests, you watch a moving visual pattern, or short electrical impulses are applied to nerves in your legs or arms. Electrodes measure how quickly the information travels down your nerve pathways.

Stayed tune to Part II tomorrow regarding signs/symptoms!

Updated 3/16/2023