Monday, September 29, 2014

Bits and Pieces: Autumn Equinox Edition (also Tysabri, MS and HIV,viruses, relapse rates, misdiagnoses, diet, and asinine research)

Personification of Autumn (Currier & Ives lith...

Personification of Autumn (Currier & Ives lithograph, 1871) (Photo credit: Wikipedia)

Well, according to the full scale replica of Stonehenge that I have sitting in my living room (which is right next to my exact copy of the Sphinx and down the hall from my faux Taj Mahal – it’s incredible what you can fit in a 900 ft.² apartment with a little ingenuity) summer is over and autumn is now upon us. Time for packing away the seersucker, preparing for the harvest, and getting ready for the ceremonial sacrificing of virgins. Luckily, there are no virgins available in my apartment, so we’ll probably make do with sacrificing some gourmet chocolates.

Wish I could say I had an exciting summer, but this one was actually quite dull. A big shout out to Multiple Sclerosis for that one, as the beast has been heavy-handed with me these last few months. Even though I have progressive disease and the overall trajectory of my symptoms is always steadily downward, their severity does tend to inexplicably wax and wane a bit. The last few months they’ve definitely been waxing, and boy, I’m more than ready for a little wane – and I’m not talking about L’il Wayne, the notorious hip-hop artist (click here).

Alas, my replica of the Temple of the Oracle at Delphi tells me that it’s time for another edition of Bits and Pieces, my semi regular compendium of interesting MS related news and notions. Can’t argue with the Oracle at Delphi, lest mighty Zeus unleash a lightning bolt in my direction, and really, I have enough problems. So here goes…

♦ First up, some MS drug news. A study out of Italy has found that Tysabri is even more effective in real life clinical practice than it was during the trials that led to its approval for use in treating RRMS (click here). This study of 343 patients from 12 Italian MS centers found that, over time, treatment with Tysabri resulted in a 68% reduction in MS relapses, that 93% of treated patients saw no disease progression, and that 53% of Tysabri treated patients were free of any signs of disease activity. Very impressive numbers, to say the least, despite the fact that Tysabri is not without its concerns (chiefly the possibility of contracting opportunistic infections, primarily PML, a potentially fatal infection of the brain).

When Tysabri was first introduced I was highly dubious of the stuff, thinking that the drug’s dangers far outweighed its potential benefits, but I must admit that time has, it seems, proven me wrong. I personally know a quite a number of RRMS patients whose lives have been dramatically improved by Tysabri, some so much so that they refuse to come off the drug even after developing a higher risk of contracting PML. I’m still not entirely comfortable with the idea of screwing with the workings of the human immune system for years on end, and it pisses me off immensely that medical science (or at least the pharmaceutical companies) seems content at treating the disease rather than curing it, but if I was a newly diagnosed RRMS patient with a low risk of developing PML (in other words, negative for JC virus antibodies), given all of the available data starting Tysabri would certainly high on my list of treatment options. That's honestly something I thought I'd never say six or seven years ago. There are currently trials ongoing testing Tysabri on progressive disease, and it will be very interesting to see how those turn out.

♦ There’ve recently been a spate of headlines to the effect that “HIV May Help Prevent Multiple Sclerosis” (click here). The basis for these headlines is a study that looked at MS rates among people infected with the HIV virus (the virus that causes AIDS), which found that HIV-infected people were far less likely to develop Multiple Sclerosis then the general population (click here). What could be behind these shocking findings? Well, it’s certainly possible that the HIV virus itself has some kind of anti-MS properties. It’s also possible that HIV, which can do serious damage to the human immune system, suppresses the aberrant immune cells that are thought to lead to the development of Multiple Sclerosis. More intriguing, though, is the possibility that the anti-retroviral drugs given to treat HIV patients, which have become extremely effective over the last decade, may be doing something to curtail the development of MS in HIV infected people.

About a year and a half ago I wrote about an emerging theory that ancient retroviruses which have become part of human DNA over millions of years of evolution may be behind a variety of illnesses, including cancer, schizophrenia, and, yes, so-called autoimmune diseases like Multiple Sclerosis (click here). These ancient viruses are in the same class of virus as HIV, called retroviruses. Long thought to be simply “junk DNA” and merely innocuous remnants of the ancient past, it’s recently been found that some of these viral bits, which are part of every human beings’ genetic structure, might be activated by the presence of certain environmental factors (other viruses, bacteria, or toxins), and thus cause all kinds of trouble. This hypothesis provides an elegant explanation of autoimmunity, in that, if correct, it would mean that under certain conditions our own cells might act as attackers, thus initiating a response by our body's own immune system.

Could it be that the powerful antiretroviral drugs being given to HIV patients are shutting down these ancient retroviruses (called Human Endogenous Retroviruses, or HERVs), and so are preventing the HIV-infected people on these drugs from developing Multiple Sclerosis? An intriguing possibility, and one which is currently being investigated by a group in London who are using some off-the-shelf HIV drugs to treat MS patients in a trial that is now underway (click here). Additionally, another related trial being conducted by a research group in Switzerland is testing a drug specifically designed to target an ancient retrovirus that has been linked by some scientists directly to Multiple Sclerosis. This group recently released the results of a small preliminary trial which tested the drug on progressive MS patients and showed it to be safely tolerated. Furthermore, the trial demonstrated some early indications that the drug may be effective in treating the disease (click here).

This is exciting stuff which could potentially change the way we view and treat many dread diseases in some very profound ways. My gut tells me that there is really something to this research, and I only wish more time, money, and effort was being devoted towards fully exploring this hypothesis and its many implications.

♦ Yet more research on viruses and MS: a recently released study using new testing methods found that the spinal fluid of Multiple Sclerosis patients is rich in antibodies targeted at Epstein-Barr Virus (EBV) and Human Herpes Virus-6 (HHV-6), rather than against human myelin and nervous system tissues, as might be expected if MS were truly an “autoimmune” disease (click here). Epstein-Barr Virus, and to a somewhat lesser extent HHV-6, have long been suspected in playing some role in the MS disease process. Fascinatingly, both of these viruses have been implicated in activating HERVs , the ancient retroviruses that I discussed in the previous item. Could it perhaps be that in genetically susceptible people, common infections such as EBV (which is carried by more than 90% of the population) can turn on DNA switches that lead the immune system to attack tissues of the central nervous system? In the decades before the autoimmune theory took hold, much of MS research was directed at finding the presumed infectious cause of the disease. Perhaps these now discounted theories were in fact on the right track, and strict adherence to autoimmune dogma over the last 20 years has led MS research astray. Again, clues like those divulged by this study demand that more attention be paid to this area of research.

♦ Here’s one that belongs in the MS version of Ripley’s Believe It or Not. The gold standard of medical research is the double-blind trial, in which one group of patients is given whatever treatment is under study and another is given a placebo (such as a sugar pill or saline solution), so that the responses between the two groups can be compared. In MS research, one of the most common measures by which an experimental drug’s efficacy is judged are annual relapse rates, the number of MS attacks experienced by relapsing remitting test subjects over the course of a year. Strangely, over the last two decades the annual relapse rates of patients in the placebo arms of late stage drug trials has dropped by half (click here). That’s right, since the 1990s the rate of relapses experienced by patients being given “fake” drugs has declined by 50%, while the rates of people getting MS worldwide have gone up (click here). And no one knows why. Isn’t that reassuring?

♦ Some more reassuring news: I came across a list of the 15 most misdiagnosed diseases (click here), and wouldn’t you know it, our good friend and close confidant Multiple Sclerosis is right up there. Given the many mysteries surrounding MS and the fact that there is no diagnostic test that definitively determines whether or not a patient does indeed have MS, this really shouldn’t come as much of a surprise. Truth is, most experts peg the misdiagnosis rate of MS at somewhere between 5%-15%, meaning that perhaps 1 out of 10 of the MS patients reading this don’t actually have the disease. There are literally dozens if not hundreds of diseases and conditions which can mimic MS. Here’s an academic paper on the subject, which lists at its end 100 illnesses that can be mistaken for MS (click here). It’s easy to drive yourself crazy with such information, so be careful, but if you suspect you may have been misdiagnosed, there’s a reasonable chance that you could be right.

♦ The relationship between diet and MS has become a very hot topic of late. Through the years, many different diets have been said to be “anti-MS”, most often low-fat or low-carb diets rich in anti-inflammatory and antioxidant foods. In fact, I’m currently trying the Paleo diet, a way of eating that is supposed to resemble the dietary habits of our ancient ancestors. The theory is that the function of our digestive systems evolved over the millions of years that our forebears were hunter gatherers, and that much of what we’ve taken to eating since the discovery of agriculture some 10,000 years ago is actually bad for our health. The Paleo diet cuts out all sugar, dairy, wheat, and some of the most common cultivated crops. This means that people on the diet can’t eat bread, milk, cheese, rice, potatoes, corn, or many of the other staples of the modern menu.

Given the fact that I’m giving Paleo a try, my interest was quite peaked by this article (click here), which details the results of a study that followed dietary habits of 185,000 women over 20 years and found that diet seems to have absolutely no impact whatsoever on whether or not they developed Multiple Sclerosis. In fact, the numbers appeared to show that those eating what is considered to be an unhealthy Western diet developed MS in lesser numbers, although this trend did not reach statistical significance.

Now, I know there are many patients who swear that a radical change in diet has noticeably lessened the impact of their disease and some have gone as far as to claim that diet can even cure MS, and I’m certain that most of these claims are made in all earnestness. I'm not saying that this study is the last word on the subject, but it should provide food for thought (pun intended). At the very least a healthy diet is, well, healthy, and that can only be a good thing especially for people suffering from chronic illness. And for those who are wondering how I’m doing after more than two months on the Paleo diet, I’m sorry to report that I’m feeling pretty crappy, worse, I think, than before starting the diet. I have dropped a few pounds, which is definitely good since I was beginning to resemble a walrus (sitting in a wheelchair does nothing for the physique), but given my lack of results otherwise I believe my time eating like a caveman may be drawing to a close. I’m thinking that the next diet I try might be one of my own invention, which I dub the “Nothing But Philly Cheesesteaks Diet”. Probably not very healthy but… Yum.

♦ Okay, time for yet another edition of ASININE RESEARCH! Once again, I present another in apparently endless stream of studies that that delve into the ever enigmatic conundrum that is the relationship between multiple sclerosis, difficulty walking, and falling down. This topic really seems to float the boats of top-notch medical researchers who apparently can’t get enough of publishing papers probing the seemingly unfathomable relationship between a crippling disease and its patently obvious effects on ambulation.

Today’s asinine research paper is tantalizingly titled “Concern about Falling Is Associated with Step Length in Persons with Multiple Sclerosis” (click here). The abstract starts out with this sentence: “Fear of falling is one of the major concerns of people with multiple sclerosis.” Yes, yes, a dazzling observation! And fear of ruining ones undergarments is one of the major concerns of people suffering from explosive diarrhea. From this auspicious start, the paper goes on to detail research looking at how concern about falling alters the way MS patients walk. While investigators suffering from severe oxygen deprivation might assume that MS patients stride like Rockettes and strut about with all of the bravura of a young Mike Tyson, after much mumbo-jumbo about “spatio-temporal parameters of gait” and “gait asymmetry patterns” this study instead shockingly finds that multiple sclerosis patients tend to walk slower and take smaller steps than their healthy counterparts, and that this astounding effect is greater in those with a higher fear of falling. The study concludes by postulating that measuring step length might be a good tool for assessing the level of fear of falling in people with MS. I suppose assessing the level of terror on their faces is just too bothersome.

Did it ever occur to the researchers that MS patients walked slower and took smaller steps as a result of the disease, and that this might in fact be the reason behind their fear of falling and not the other way around? I certainly don’t remember having a healthy fear of falling before, you know, the disease took a hammer to the connection between my brain and my legs and left me no choice other than to walk slower and take smaller steps. In fact, these days if my steps get any smaller or my walking gets any slower my attempts at ambulation might better be termed "standing still". Yes, this all makes for a frightening experience, but it's not the fear that keeps my legs from moving, it's some little-known phenomena called "weakness" and "paralysis". Sheesh.

♦ It’s become my custom over the past several Bits and Pieces posts to end with some music from the “Neo-Soul/Retro-Soul” movement. Words can’t express how smitten I am with much of this music, which never fails to put some funk in my junk, some glide in my stride, some pep in my step, and some growl in my prowl. Hey, wait a minute, as mentioned above these days I can barely manage a stride, step, or prowl, so I’ll have to amend that – this funky stuff puts some chimp in my limp, some jumble in my stumble, and some gall in my fall. Can I get an Amen? Hallelujah!

The following ditty is by St. Paul and the Broken Bones, a band I was lucky enough to see at a free concert outside of Lincoln Center a few months ago. I went to the show primarily to see Charles Bradley, who I featured in a previous Bits and Pieces, but I was unexpectedly blown away by these guys, who I’d never heard of before they took the stage. As I mentioned earlier, this summer wasn’t a particularly terrific one in my book, but this show was definitely a highlight…

Thursday, September 11, 2014

Supplements, My Supplements

Arabic herbal medicine guidebook

Arabic herbal medicine guidebook (Photo credit: Wikipedia)

Using natural supplements to help treat MS is always a topic of much interest amongst patients. In the face of the sometimes daunting side effect profiles of the pharmaceutical drugs approved to combat the disease, the use of herbs and other natural substances, widely perceived as being more benign than the immunosuppressant/immunomodulating pharmaceutical products, holds great appeal for many dealing with Multiple Sclerosis. MS research headlines regularly trumpet one natural remedy or another as having been discovered to slay or at least tame the MS beast, and stories of miracle cures abound, percolating their way around the Internet. It can be awfully hard to separate the wheat from the chafe, so to speak, making the whole topic of herbal remedies a great big ball of confusion.

I’m very fortunate that the MS clinic at which I’m a patient, The International Multiple Sclerosis Management Practice here in New York City (click here), has on staff a naturopathic doctor specializing in the treatment of neurologic illness. Dr. Deneb Bates is one of the sharpest physicians of any specialty that I’ve had the pleasure of working with during my experience as an MS patient, and with her guidance I take a variety of herbal remedies and concoctions designed to alleviate my symptoms as much is possible. I can’t say that the witch’s brew of natural substances that have become part of my daily routine has put the brakes on my disease progression, since my illness seems intent on defying any efforts to rein it in, but I hope they may have at least slowed my progression a bit, and I’m certain they’ve at the very least helped to dampen some of the symptoms of my condition.

Before I spill the beans (ha ha, just a little natural supplement humor) on the rather long list of supplements I take, let me first state that mine is a very atypical case of MS, if it is even MS at all. I’ve been poked and prodded by some of the world’s best MS specialists, and none has been able to come up with an absolutely definitive diagnosis for whatever it is that ails me. Clinically my disease presents like Primary Progressive Multiple Sclerosis (PPMS), but many of my test results leave physicians scratching their heads. In fact, after some disagreement, my neurologist and I have settled on calling my disease PPMS with the caveat that in my case those initials stand for the “Peculiar Paralysis of Marc Stecker”.

Additionally, I have several complicating factors that make me an especially difficult patient to treat. I have a wide array of endocrine problems, stemming from autoimmune thyroid disease and an increasingly faulty pituitary gland (also possibly due to autoimmune problems). My many hormone imbalances can result in symptoms that mimic those of neurologic illness, such as fatigue and muscle weakness, making it sometimes hard to figure out just what physical defect is causing which misery.

I also suffer from Avascular Necrosis (also called AVN), which is a very rare side effect of intravenous steroid use. AVN causes the bones in the major joints to perish, at which point they quite literally crumble and, as you might imagine, cause immense pain. I have AVN in both hips and both shoulders, which means that I’ve been living the last five or six years with the equivalent of two broken hips and two broken shoulders. To call the condition painful would be a gross understatement. If my overall health were better I’d have had both hips replaced years ago, but due to the ravages of MS and all of my hormonal deficiencies undergoing such major surgery would be extremely risky. Instead, I live each day gritting my teeth through pain that varies from uncomfortable to excruciating to, well, there really are no words for it, though at times long and creative strings of obscenities attempt to fit the bill. In order to try to keep my AVN pain down to a roar, I’m on very strong anti-inflammatory medications as well as the occasional opioid painkiller, all of which can cause problems of their own, such as liver and kidney toxicity.

Lastly, careful screening of my cerebral spinal fluid by my MS clinic’s on site laboratory has shown that I have extremely high levels of oxidative stress and extremely low levels of natural antioxidants in my central nervous system, the combination of which may be contributing to my ongoing neurodegeneration. Oxidative stress occurs as the result of the body burning nutrients to create energy, the process of which releases nasty little molecules called free radicals that can smash through cell walls and damage vital tissues and organs (click here). Think of these free radicals as the body’s equivalent of the noxious exhaust fumes put out by an automobile engine when it burns gasoline. The human body is normally equipped with natural antioxidants that soak up many of these free radicals, but even in the healthiest people some antioxidant supplementation isn’t a bad idea. In my case, with my natural levels bizarrely low, it’s just about requisite that I try to boost these levels with antioxidant rich supplements.

As you’ll see, many of the natural supplements on my list are anti-inflammatories and/or antioxidants, which can be helpful to all MS patients (a major component of the MS disease profile is inflammation, after all) but are especially so in my case due to my problems with AVN and low levels of natural antioxidants. Some of the other items on my list are targeted at helping kidney and liver function, which can be compromised by many of the medications MS patients take to help control their symptoms. None of these supplements should be taken without first consulting your doctor. Don’t be fooled into thinking that anything thought of as “natural” is without the potential to do some harm. Indeed, some of these supplements are strong medicines, and can adversely interact with pharmaceutical meds, making it vitally important that their use not be embarked on as a do-it-yourself adventure.

Okay, with that rather long prelude out of the way (is it no wonder I shy away from twitter? I don’t think I could say hello in 140 characters) here is the list of natural supplements I take each and every day, in no particular order. I’m intentionally not including the dosages to discourage folks from simply taking these things willy-nilly, without first consulting a physician. Please don’t hate me…

Vitamin B Complex - Vitamin B comes in many forms, most of which play an important role in the function of the central nervous system and metabolic processes (click here). In fact, people with severe vitamin B deficiencies are sometimes misdiagnosed as having Multiple Sclerosis. Since the most obvious symptom of my disease is a slow and steady decline of neurologic function, making sure my body is well stocked with Vitamin B just makes sense.

Green Tea Extract - as the name implies, this stuff is derived from green tea, which is tea in its unfermented form (unlike black tea). Green tea is among other things an extremely effective antioxidant, and has been shown to be helpful with cognitive functioning (click here). You could likely get the same benefit from drinking 5 or 6 cups of green tea a day, but given my bladder frequency/urgency issues, if I were to go that route I’d have to spend the better part of my day in the bathroom, and might, in fact, never stop peeing. So, I choose to take the stuff in pill form instead.

Curcumin - curcumin is the active ingredient in tumeric, the spice which is the basis of curry powder. Curcumin is both a very strong anti-inflammatory and antioxidant (click here), and is purported to have a very long list of health benefits. Interestingly, countries with a curry rich diet often have very low rates of autoimmune diseases, but of course other factors may come into play.

Milk Thistle - milk thistle is a flowering plant related to the daisy family, and is very effective in helping to maintain proper liver functioning (click here). Since I take many medications that are metabolized in the liver, my liver function has always been of great concern to my physicians, and milk thistle has been effective in keeping my liver enzymes within the normal range ever since I started taking it. Before I started taking milk thistle, blood tests would often reveal my liver enzymes creeping above acceptable levels. So, milk thistle, good stuff.

Pellitory of the Wall (Parietaria) - what milk thistle does for the liver, this stuff does for the kidneys. Because of the problems in my hips and shoulders, I take a very powerful, prescription only nonsteroidal anti-inflammatory (NSAID) which helps keep the pain in my joints to manageable levels. Unfortunately, this drug can wreak havoc on the kidneys, and my pain management Dr. is always hyper concerned about checking my kidney function via blood tests. Before I started taking Pellitory of the Wall my kidney function tests would often veer into dangerous territory, but after consulting with my naturopath and starting on Parietaria my kidney function numbers have all fallen comfortably within normal ranges. My pain management doctor. was so shocked by this reversal in kidney function levels that he insisted on calling my naturopath to find out more about the stuff. Pellitory of the Wall has also been used traditionally to treat urinary tract infections, rheumatic elements, and some circulatory system problems (click here). Again, good stuff.

Licorice Solid Extract - one of my endocrine problems is low levels of cortisol, one of the body’s natural steroids which is manufactured by the adrenal glands. Licorice is very effective in helping to maintain adrenal function (click here), and taking it has in fact increased the level of cortisol circulating in my blood. Licorice solid extract is a concentrated form of natural licorice and is very effective in helping to deal with fatigue, which is a well-known and very problematic MS symptom. This stuff isn’t to be fooled around with, though, as it can raise blood pressure and heart rate, in some people to dangerous levels. Be aware that most licorice candy has little if any real licorice in it at all, so eating lots of Twizzlers won’t have the same effect.

Eleuthero Solid Extract - although Eleuthero is sometimes referred to as Siberian Ginseng, this root is only a very distant cousin to the more common Asian and American ginsengs. In naturopathic terms, Eleuthero is considered an adaptogen (click here), a substance used to keep the body in balance. Eleuthero is purported to help with stress-related conditions, colds and respiratory infections, immunologic functions, and fatigue, among other uses (click here). I’m taking it because I have a long history of chronic sinus infections, as well as to try to counteract my usual host of endocrine problems. I’ve found that Eleuthero does seem to help with my MS and/or endocrine related fatigue.

N Acetyl Cysteine (NAC) - NAC is an amino acid that is a powerful antioxidant (click here). The substance is a precursor to glutathione, which is the body’s own natural and most powerful antioxidant, used to combat all of those nasty free radicals that result from the body metabolizing food into energy. As I mentioned previously, tests of my cerebral spinal fluid have shown me to be severely deficient in natural antioxidants, so, in theory, I stand to benefit from as much antioxidant support as I can get. NAC is also known to have antibiotic and perhaps antiviral properties.

L-lysine - L-lysine is an “essential” amino acid that cannot be manufactured by the body. It’s considered very effective in helping with the symptoms of osteoarthritis and is supposed to have prominent antiviral properties (click here). Many researchers believe that a virus or viruses play some role in the MS disease process. L-Lysine also plays an important role in the production of hormones, antibodies, and enzymes. The stuff additionally aids in the production of collagen, which is essential for the health of bones and skin, and it shows up in many skincare products.

Boswellia Extract - Boswellia is also known as frankincense, which, according to the Bible was one of the gifts the three wise men brought to the baby Jesus. Hey, if it’s good enough for the baby Jesus, it’s good enough for me. I’m hoping that if I take enough of it I may someday be able to walk on water, which would really be a miracle since I currently can’t even walk on solid ground. Boswellia is a powerful anti-inflammatory agent, and it also has anti-oxidative properties (click here). Like some of the other natural supplements on this list, Boswellia has also been shown to have germ fighting properties. Inflammation, oxidative stress, germs, BAD. Boswellia, GOOD.

Vitamin D - by now, I’m sure most MS patients have heard of the importance of vitamin D in helping to potentially ward off the disease in those who don’t already have it and perhaps dampen its impact on those who do (click here). Depending on the level of vitamin D in a patient’s blood, it’s pretty much generally agreed that most patients should be taking some amount of Vitamin D supplementation. Careful, though, as taking too much vitamin D can be toxic, so you don’t want to overdo it.

MitoQ - this supplement is basically a supercharged version of CoQ10, a very powerful antioxidant. MitoQ is specifically targeted at mitochondria, organelles that are known as the “powerhouse of the cell” which play a vital role in metabolic processes. Recently, some studies have shown MitoQ to be remarkably effective in treating the mouse model of MS (click here). As with all MS research done on mice, the results of these studies should best be taken with a few grains of salt, since the mouse model of MS is an absolutely horrible stand-in for the human version of the disease. That said, MitoQ’s antioxidant properties alone make it a good option for someone like me who has been shown to be sorely lacking in natural antioxidant levels.

Magnesium Glycinate - repeated blood tests have shown me to have low levels of magnesium, a mineral which is important to the health of cells, nerves, muscles, bones, and the heart (click here). Additionally, magnesium has laxative properties, which make it a good candidate for those of us suffering from the all too common MS pooping problems. Or, more correctly, lack of pooping problems.

Krill Oil - krill oil is a form of fish oil, made from shrimp like creatures called, you guessed it, krill. Like fish oil, krill oil is rich in omega-3 fatty acids, which have been shown to lower cholesterol and are also suspected to help ease MS symptoms (click here). The major advantage that krill oil has over fish oil is that the stuff made from krill doesn’t lead to fishy tasting burps and an unpleasant aftertaste. One of my longtime mottos as always been “whenever possible, avoid fishy burps”, so krill oil helps keep me true to my credo.

Well, there you have it, 14 dietary supplements that are part of my daily routine. Please consult your physician before starting any of the above-mentioned supplements. Mother Nature can be a beautiful maiden, but one not without teeth.

Most MS patients probably don’t need to take nearly as many supplements as I do, but since I have problems compounding my problems, it’s my hope and belief that at least some of the supplements are contributing to making my life more livable. As I stated previously, in addition to my neurologic problems I also have all kinds of endocrine dysfunctions as well as crumbling bones in my hips and shoulders, so I can certainly use all the help I can get.

Yes, when it comes to MS, I hit the triple jackpot – my initials are MS, I have MS, and I am a mess. Thank you, universe…