Multiple sclerosis is a lifelong disease that requires various modalities of treatment. Plan of care considerations include (1) the patient’s age at onset of illness; (2) sex; (3) the extent of the disability at the time of diagnosis as well as (4) the form of multiple sclerosis. Treatment will be a multidisciplinary approach that involves specialists such as neurologists, rehabilitation specialists, neuro-urology experts, psychiatrists, occupational therapists, physiotherapists and social workers. This method is essential to ensure that all aspects of the disease are considered to help improve their quality of life.
The management of multiple sclerosis consists of a four-prong approach that involves: (1) management of acute exacerbations; (2) reduction of the frequency of relapses; (3) administration of the complications and (4) management of permanent disability that has already occurred. These are the goals of the management. No cure for the disease has been established.
High-dose steroids such as corticosteroids are the cornerstone of treating acute exacerbations because they reduce and control inflammation. Steroids are generally reserved for patients with exacerbations severe enough to cause functional disability or in those that exacerbations are prolonged beyond the duration of 24 hours. Corticosteroids work by reducing the inflammation which is a primary cause of the systems of multiple sclerosis. They work by binding to receptors on the cell surface and preventing the formation of various proteins. This, in turn, leads to inflammatory activity suppression. 2014 guidelines recommend pulsing with intravenous methylprednisone or methylprednisone given orally at doses of 500mg to a maximum of 1 g and 2 g respectively for a total of 3-5 days. The steroids can then be tapered off over two weeks or, be followed by a dose of prednisone 60-80 mg once a day which can be tapered off over two weeks.
Pulsing with high-dose steroids helps to reduce the severity of the acute attack as well as reduce the number of days of disability. However, their benefit in preventing future relapses or halting disease progression has not been shown. Their use is limited to a maximum of three times a year due to the multiple adverse effects that result from chronic steroid use. These include: osteoporosis, psychosis, mood lability, cataracts, gastritis, fluid retention, weight gain, Cushing’s syndrome, increased insulin resistance and increased the incidence of infections. Proton pump inhibitors such as esomeprazole have been used for prevention of gastritis especially in patients who report the incidence of peptic ulceration. Histamine receptor antagonists have also been used. Lithium, a mood stabilizer, has been used in the management of the mood disorders that result.
Plasmapheresis has also been used in the management of acute episodes where corticosteroids fail. Its wide use is limited by resources as it is quite expensive.
The relapsing-remitting form of multiple sclerosis is characterized by episodes of attacks followed by periods of disease remission. One of the goals of treating these patients is to prevent the relapses. Disease modifying drugs are used to achieve this. The two main drugs used are Glatiramer acetate and Interferon beta (IFN β). These two drugs should be initiated before permanent disability sets in because they have no effect on permanent neurological deficits. Four conditions need to be met before therapy with these agents can be started. They are: (1) the patient should be physically fit and able to walk for a substantial distance without assistance; (2) they should have a history of at least two severe relapses in the past 24 months; (3) they should be above 18 years and (4) they should have no contraindications to the use of the two drugs.
Interferon β belongs to a group of cytokines in the body called interferons. It is classified under Class 1 of that group. The two forms of interferon β have been found to be useful in the management of relapsing/remitting multiple sclerosis are as follows: interferon β 1a (Avonex and Rebif) and interferon β 1 b (Betaferon). The mechanism of action of these drugs involves reducing the frequency and severity of attacks by (1) lessen the manifestation of Major Histocompatibility Complexes (MHC) on the surface of antigen presenting cells; (2) inhibiting cytokines that favor inflammation and increasing those that regulate the levels of other cytokines; (3) reducing T-cell proliferation and (4) lessen the entry of inflammatory cells into the central nervous system.
Avonex is given as an intramuscular injection, 30 micrograms once per week. Rebif is given subcutaneously, 44 micrograms three times a week. Betaferon is also given subcutaneously, 250 micrograms every other day. Some of the common side effects of interferon therapy include skin reactions at the sites of injection causing necrosis; lipoatrophy due to the subcutaneous injections and flu-like symptoms like headaches, fever, fatigue and muscle aches.
Glatiramer acetate is an immunomodulatory drug that contains four amino acids: glutamic acid, lysine, alanine, and tyrosine. It has been shown to reduce the frequency of attacks in patients with relapsing- remitting form. The mechanism of action is not well elucidated, but various theories exist. Some of these theories suggest that glatiramer can facilitate the conversion of inflammatory T cells into non-inflammatory forms as well as act as a decoy since it has a similar structure to the myelin which is the target of the inflammation. It has however not been shown to influence the permeability of the blood-brain barrier as the interferons do. Glatiramer is given as a subcutaneous injection, 20 mg daily. Just like Interferon β, it causes injection site reactions.
Other drugs that have been used in the prevention of attack rate include Natalizumab, Fingolimod, Teriflunomide, Mitoxantrone Hydrochloride, Cladribine, Intravenous Immunoglobulins, Methotrexate, and Cyclophosphamide.
There is a strongly held view among many individuals that an athlete cannot be a vegan. In the current day context, when a large number of men and women from varying professions and fields of life are consciously opting for meat and dairy-free food, the question arises about how athletes, especially those who are involved in high-end competitive sports can cope and sustain their performance on a vegan diet.
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Eggs and dairy products such as milk, cheese, and cottage cheese are among the most commonly available sources of protein for those who prefer to follow a plant-based diet. However, in the case of vegans,especially the athletes, when even these sources of protein are eliminated from their diet, the best high-protein foods available include grains and nuts, not to mention soy and soy-based products.
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Meat remains one of the few sources of vitamin B12, which is considered essential for everyone. Meat is especially necessary for athletes. Vitamin B12 levels need to be adequate in order to prevent muscle fatigue and enhance the endurance of the athletes. Unfortunately, an entirely plant-based diet would be near devoid of vitamin B12. However, on the plus side, there are now a large number of cereals and vegan food products that are fortified with vitamin B12 so that an athlete gets their daily requirement of vitamin B12.
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A good diet plan requires the inclusion of adequate protein and most athletes require at least 90 to 100 grams of protein intake per day. Merely adding a handful of cereals or sprouts to one’s salad would not have a major impact. Supplementation with vegan high-protein foods is essential for athletes who choose to be vegan. Moreover, one needs to consume a variety of proteins spread throughout the day to ensure the production of all the necessary amino acids. Apart from this, it is also essential that the diet plan of athletes who are vegans includes adequate carbohydrates and both macro and micronutrients to ensure sufficient energy, stamina, and endurance. Although many people fail to give importance to hydration, they must remember that staying hydrated all the time is another significant component.
High-protein foods that are vegan and plant-based are now increasingly popular and more accessible both at retail stores and online as well. Some of the best high-protein foods that can be included in the daily meal plan of any athlete who is vegan by choice would include the following.
There are many different types of cancer such as leukemia, breast cancer, and melanoma. This means that there are many different warning signs to look out for. However, if you figure out that you or a loved one has cancer, there are plenty of treatment options to consider. Cancer drugs like Eribulin, Omacetaxine, and Vorinostat can work to treat cancer in a variety of patients. Specifically, AYVAKIT® (avapritinib) for unresectable or metastatic gastrointestinal stromal tumor (GIST) is an option for those with GIST to consider. Additionally, various therapies are available to treat cancer such as hormone therapy, immunotherapy, radiation therapy, and more. If you or your loved one has cancer, it’s important to consult with a medical professional about tailoring the best possible treatment plan. Otherwise, if you suspect that you or your loved one may have cancer, here are 4 early warning signs to keep an eye out for:
1. Pain
While this warning sign is very general and can, of course, be caused by any number of things—various conditions, illnesses, lifestyle choices, and more—pain can also be caused by cancer. The disease can result in different types of pain due to the chemicals that a cancer releases, the spread of cancer throughout the body—also known as metastasis—and a tumor or mass putting pressure on another area of the body. Experiencing persistent pain is always worth getting checked out by a medical professional, whether the underlying cause is cancer or otherwise.
2. Skin changes
There are various skin changes that can be early warning signs of cancer. Jaundice—also known as the yellowing of the fingertips or eyes—is one of these, while noticeable changes in a mole is another. For the latter, it’s best to contact a medical professional if a mole is large or growing larger, has changed color or is getting darker, is asymmetrical or has jagged edges, or has irregular borders.
3. Fatigue
Plenty of us know how it feels to be exhausted after an all nighter. Fatigue, however, differs from the typical exhaustion that many of us are accustomed to: if your tiredness refuses to ebb away with sleep or rest, this could be an early warning sign of cancer. Since cancer uses the nutrients present within the body to grow, the nutrients that your system is used to having are no longer readily available, thus resulting in fatigue.
4. Blood in the stool
If you notice blood in your stool, this is usually coming from somewhere in the stomach, intestines, esophagus, or GI tract. While bright red blood can indicate an issue in the rectum or end of intestines, dark red blood can indicate an issue located higher up, such as somewhere in the stomach. Finding blood in the stool can be a sign of cancer, but it could also be a sign of many other conditions such as stomach ulcers, hemorrhoids, and more. No matter what, it’s important to reach out to a medical professional if you notice blood in your stool.
Hereditary angioedema, a rare genetic disorder, manifests with recurring episodes of severe swelling affecting the face, extremities, gastrointestinal tract, and airways, often leading to breathing difficulties. While these episodes can be distressing, there are treatment options available, including Haegarda, Berinert, Firazyr, Takhyzyro, and Orladeyo, to name a few. Various factors can trigger these episodes, such as mental stress, infections, trauma, fatigue, physical exertion, weather conditions, and dietary choices. In this article, we’ll focus on common food triggers associated with breathing issues in hereditary angioedema:
1. High-histamine foods
Histamine is a chemical in the body that plays a role in allergic reactions, and some foods are naturally high in it, potentially triggering episodes in individuals with hereditary angioedema. Some of the foods include: aged cheeses, smoked and cured meats, fermented foods like sauerkraut, and certain alcoholic beverages, such as red wine and champagne. With HAE, it’s important to be mindful of your histamine intake, as these foods may contribute to swelling and breathing difficulties.
2. Tree nuts
People with hereditary angioedema are frequently advised to steer clear of tree nuts, as they commonly trigger swelling and breathing problems. This category includes walnuts, cashews, almonds, and similar nuts.
3. Spicy foods
Ingredients like chili peppers, hot sauces, jalapeños, cayenne pepper flakes, and other spicy components often used to add flavor to dishes can pose risks for individuals with hereditary angioedema. Spice is a known trigger, so consider reducing the level of spiciness in your meals or entirely eliminating spicy foods and ingredients from your diet.
4. Food additives
Surprisingly, some food additives such as preservatives and artificial sweeteners can act as triggers for hereditary angioedema in certain individuals. Always read food labels carefully and avoid products containing these additives.
5. Artificial food coloring and flavorings
Artificial food coloring and flavorings found in many processed foods and beverages can be problematic for individuals with hereditary angioedema. These artificial additives have been known to trigger allergic reactions and exacerbate symptoms in some cases, so be sure to review ingredient labels carefully and consider opting for natural and unprocessed alternatives whenever possible.
It’s crucial to remain vigilant and attentive to your body’s reactions after consuming various foods. If any food item triggers an episode, make a note of it and avoid it in the future. Always consult with your healthcare provider regarding dietary choices, as individual reactions can vary significantly. Work closely with your doctor to create a personalized diet plan tailored to your specific needs and sensitivities.
Eosinophilic esophagitis is a chronic allergic/immune condition of the esophagus, causing a large number of white blood cells (known as eosinophils) in the inner lining of the esophagus. These eosinophils can release substances into surrounding tissue, causing inflammation, eosinophilic asthma symptoms, and other symptoms such as decreased appetite, abdominal pain, trouble swallowing, vomiting, and so on. Symptoms often vary by age, but the biologics for eosinophilic esophagitis include medications like Dupixent, Dupilumab, proton pump inhibitors, and topical steroids. To help manage the condition, there is also the option of dietary therapy, in which you practice the six-food elimination diet (SFED), outlined below:
1. Wheat
The SFED diet has patients eliminate wheat from the diet, as it is a common allergen and food trigger for some conditions, especially eosinophilic esophagitis. Some substitutes for wheat ingredients in a meal include barley, oats, corn, potatoes, and beans.
2. Milk
Milk is another top allergen and food trigger for a variety of conditions—so much so that it is often recommended you eliminate dairy and wheat first on this list of foods. Milk goes hand in hand with all dairy products, but luckily there are many dairy substitutes made with bases like almond milk, oat milk, coconut milk, and rice milk.
3. Egg
Another common allergen and trigger are eggs, earning them a spot on this list of foods to eliminate. While they are a great source of nutrients, you can substitute them for alternatives in cooking and baking with items like applesauce, mashed banana, yogurt, buttermilk, ground flaxseed or chia seed, and more.
4. Nuts
Many schools are nut-free due to the common allergy to them—the top nut allergies are towards peanuts, walnuts, almonds, cashews, pecans, and pistachios. If you still crave that crunch, you can try replacing them with seeds like pumpkin seeds, sunflower seeds, hemp seeds, chia seeds, and more.
5. Soy
Many individuals have issues with soy allergies and sensitivities, which is why they are another food to be eliminated in this diet. Soy is found in many items, such as infant formulas, canned broths, soups, canned tuna, baked goods, processed meats, energy bars, and more—be sure to check the labels of every food before consuming.
6. Shellfish
Lastly, shellfish is another common allergy and sensitivity that can cause undesirable reactions. Foods that fall under the category of a shellfish allergy include shrimp, crabs, lobster, squid, oysters, scallops, and snails, making it a good idea to avoid seafood almost entirely during the SFED diet.
The six food elimination diet was proposed by a gastroenterologist due to limited access to allergists that perform food allergy evaluations for eosinophilic esophagitis. The diet was so successful that it resulted in an 88% resolution of diseases in children with the condition. However, you should keep in mind that the diet is quite challenging to follow as major changes in eating habits will need to occur. Before beginning the SFED diet, be sure to speak to your healthcare team to make sure it’s right for you.
