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application of logic, expectations, how we think, intuitive leaps, MS, MS progression, MS research, MS study, MS symptoms, MS treatment, Multiple Sclerosis

MS, Motility Issues, and Another Approach

Keep trying. If you keep failing, look for other sources of strength. You can climb higher than you ever have before. O discovered the importance of his feet for this climb, his first rope climbing success.
Keep trying. If you keep failing, look for other sources of strength. You can climb higher than you ever have before. O discovered the importance of his feet for this climb, his first rope climbing success.

During the last week of 2014, my oldest daughter, A, spent three days in the hospital for slow motility issues.  Before A’s recent bouts of stomach issues, I would have been hitting up Google for what “slow motility” might mean in terms of the gut, but after the hospital trip I mentioned in the last post I have been thinking about it a lot.

Slow motility is not a blockage in the gut (constipation).  Rather, it is a great slowing down of the digestive track, a slowing of movement down the track and a slowing of absorption of nutrients.  So with a slowing of the body’s ability to move food down the track being the culprit, I began to wonder why I never hear of MS patients with slow motility.  MS impeding our nerve signals seems to slow every other part of our body’s ability to respond to stimuli.

With that question in mind, I went to patientslikeme.com where Bowel problems are listed as the sixth most common symptom of MS, but included under that symptom umbrella are “any difficulty in passing feces including constipation, bowel incontinence (loss of bowel control), and diarrhea.”  Motility issues are not mentioned, but I note my daughter has had all of those symptoms resulting from her motility issues.  A quick search for “motility” on the site netted nothing.  So I asked the board how many MS patients have motility issues.  The only 2 patients who identified as having motility issues had them predate their MS.  I would also point out many MS patients are on drugs for other MS symptoms which can cause bowel problems, and thus not all bowel problems experienced by MS patients are the result of MS.

If one assumes the common theory of MS these days, the disease is one where our immune system is attacking our nervous system.  These attacks destroy our nerve’s myelin sheath and eventually its ability to transmit signals.  There are numerous studies about the slowing, sometimes to a stop, of parts of the nervous system in MS patients.  There are also numerous studies showing the majority of a healthy immune system resides in our gut-associated lymphoid tissue (GALT).  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515351/

If our immune system is what is attacking our nervous system, why do we have comparatively little damage to the nervous system closest to the largest concentration of cells in our immune system?  This is the question which has been itching me for a week.  I have posted the question to the MSresearch blog out Cambridge England, and one of their researchers said he would have to look to find me the answer.

I have a few theories which would/could explain the issue.

1)  Measurement error:  On patientslikeme.com, bowel problems were reported but not motility issues.  I am not sure most people with bowel problems get motility studies to assess the cause/ true nature of the problem, and I bet this goes double with MS patients.  My experience is the difficult to explain or prove is often assumed to be the result of MS without ever questioning how MS caused the problem.  So many of these bowel issues could be motility related, and we would not know.

2) It is possible the 70% of our immune system is not the part of our immune system attacking our nervous system.  If this is the case, we have effectively eliminated 2/3 of our immune system as a potential cause of our MS.

3) There is something in the gut weeding off or neutralizing the cells responsible for triggering an attack on the nervous system in our gut.  If this is the case, is this cause replicable outside our gut?

I am sure there are more possibilities, but I was never a very good biology student.  I just find myself trying to attack the MS problem from another angle.  Too often, we respond to what we see in MS with regards to symptoms and progression.  It’s natural to have our attention focused on what we can observe and better yet, measure.

If the measure of the power of science is its ability to predict, then it follows science often draws its power from what we observe.  The trick is to recognize when we fail to see what we expect to see.  For even such failures represent an observation. It is with that recognition that we can start looking for the cause of failure in our expectations/hypothesis.  Perhaps, the answer is already obvious to those who have studied our immune system and our gut.  I just rarely see mentioned anywhere in our nervous system immune to the effects of MS.

Maybe we should look where the symptoms fail to appear in an effort to better explain where and how they do.

 

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Christmas, Christmas spirit, Family, family life, family time, stress, stress and MS, Uncategorized

Stress and My MS

 

Our tree 2014
Christmas is coming.

Many of us stress about the holiday season. Some of us worry what that stress may do to us. With MS, it is thought stress can precipitate a flare, though all the evidence I have seen for this is anecdotal. It’s simply not ethical to cause stress on a group of people to see if they suffer an exacerbation which may have long term negative health consequences. So as I go through a fairly stressful time period, I started wondering what research is available outside of MS on the impacts of stress, and I came across two theories.

The first theory is based around the idea stressful events have major health impacts. In 1968, two psychiatrists came up with a stress inventory called the Holmes-Rahe Stress Inventory after asking more than 5,000 subjects to track their major life events. They then looked at how the events correlated with major health incidents over the following two years. Using this data, they scored each event and created the Holmes-Rahe Stress Inventory of the top 43. The cumulative score from the events present over the course of a year was used to categorize the risk of future subjects by putting them into one of three categories. http://www.stress.org/holmes-rahe-stress-inventory/

0-150 had little correlation with increased risk.

150-299 indicated a fifty percent chance for a major health incident in the following two years.

300+ represented an eighty percent chance for a major health incident in the following two years.

As I read through the index, my score was between 215 and 272 depending on how strictly I interpreted the categories. So in my effort to minimize my concern, I started looking for reasons this test does not apply to me. I started with the date the list was created, more than 45 years ago. I thought I was in the clear until I found articles indicating it had been studied more recently with updated versions for the changing times. The only new item was death of a pet…which I recently had. This means I score even worse with the update… The biggest draw back on the following study done in 1970 to validate the original findings was the sample was only men, but this does nothing to invalidate its findings for me.

This got me thinking about just what being in the second category meant. It meant I had an increased risk, but how strong is the correlation between the risk category and the health events. It turns out the correlation is only 0.18. So while there is a statistically significant increase in likelihood of health events, it is not quite as dire as the fifty percent in the category would make one believe.
The first approach deals with the impact of stressful events, and I do not score very well on it, but given the low correlation studies have found between events and health, maybe the better prediction can be made looking at day to day living.

It seems there is a general consensus the daily look at stressors is a more accurate way to look at stress and its impact on our body. The best study I have seen described is from Ohio University in 1992, so again dated material is an issue. Still for the sake of understanding, the write-up at http://www.ohioupsychology.com/files/images/holroyd_lab/Holm%20&%20Holroyd%20The%20Daily%20Hassles%20Scale%20Revised%201992.pdf
is excellent. On pages 8 and 9, it lists seven major categories of daily hassles and components within the categories. The major categories are Inner concerns, Financial concerns, Time pressures, Work Hassles, Environmental hassles , Family hassles, and Health hassles. This report looks also looks at the hassles as possibly being just two categories, inner and external, before coming back to the seven mentioned above with all their elements.

As I look at the measures listed for this approach it quickly became apparent, I would do no better on the daily hassles than the stressful events, and I decided I was better served to look at what I can see stress is actually doing to me. After all, I really do not need various scientific studies to tell me I belong in the “stressed” category. I knew this going into the reading. So I am back to noting far more MS symptoms which is right in line with the original theory about stress causing MS flares. However, I do not have the symptoms constantly. As a result, they do not rise to the level of a flare I need to report. Instead, I just note more times when my vision blurs to the snow channel with quick head movements up and down and more incidents of pain and spasticity.

I guess I should just be thankful and employ all the stress relief techniques I know while praying the rest of my family and friends will do likewise.  For now, I will just go back to my inner Karaoke song of choice, good for any season:

 

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