The heart of the matter: cardiovascular wellness and multiple sclerosis (MS)
People with MS are not immune to health problems that accompany a sedentary lifestyle. High blood pressure (hypertension) and high cholesterol (hyperlipidemia) are found in more than 10% of people with MS, increasing with age. High cholesterol profiles, particularly high LDL-cholesterol and total cholesterol levels have recently been associated with more disease progression and more activity on MRI in MS.
Canadian investigator, Ruth Ann Marrie, PhD, has reported that MS carries a higher risk of dying from heart disease and that people with MS who have vascular conditions including heart disease are likely to develop reliance on a cane for walking, to develop visual impairments and to develop brain atrophy.
Canadian investigator, Ruth Ann Marrie, PhD, has reported that MS carries a higher risk of dying from heart disease and that people with MS who have vascular conditions including heart disease are likely to develop reliance on a cane for walking, to develop visual impairments and to develop brain atrophy.
Obesity and smoking are two cardiovascular risk factors that may carry additional risks for those with multiple sclerosis. Obesity is reported to affect 24% of people with MS in North America. Recent studies have shown teenage obesity as a MS risk factor and predictor of MS onset at younger age. In one study, females with Body Mass Index (BMI) > 27 were at twice the risk of those with BMI <27. One study found that higher baseline BMI predicted a more progressive MS disease course.
Obesity tends to lower vitamin D levels and vitamin D deficiency is itself a risk for MS. Smoking has been associated with a 2-fold heightened risk for developing MS. Smoking after MS diagnosis has been found to increase the risk for developing progressive MS, as well as risk of more severe brain atrophy and brain lesion load.
The underlying links between obesity and smoking with MS are unknown, but of growing interest. Obesity and other cardiovascular risk factors may affect certain hormones that interact with the immune system in ways that are harmful in MS. Adipose tissue (fat cells) produces hundreds of hormones, peptides, and cytokines, collectively referred to as adipokines. Some are pro-inflammatory, including leptin. Leptin crosses the blood brain barrier.
Mice that are genetically engineered for leptin deficiency are resistant to the experimental version of MS. Calorie restriction also has a benefit on the experimental version of MS in mice. An ongoing study is looking at calorie restriction as a stand-alone treatment for MS. The method being studied is intermittent fasting (2 days per week). Why tobacco smoking is bad for MS is unknown, but the explanation is probably not related to the nicotine content of tobacco.
There is intriguing evidence that Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) that lower cholesterol levels may have beneficial effects in MS. In secondary progressive MS, a 2-year randomized controlled trial of simvastatin 80mg daily in England found a 43% reduction in brain atrophy and significant differences on measures of disability progression and symptom impact favoring the statin. More work needs to be done to determine the role of statins, if any, in managing MS.
What does all this mean for someone with MS? To put it simply, what is good for your heart is probably good for MS. Having MS is another good reason to quit smoking tobacco. Don’t hesitate to talk to your doctor to get help in quitting smoking. If you are obese or overweight, getting to a lower weight will reduce cardiac risk and may improve your blood pressure and lipid profiles. Many patients report improved sleep and bowel regularity with weight reduction.
Achieving weight reduction requires discipline. Body fat will decrease with an increase in energy utilization (increasing physical activity) or a decrease in energy intake. Combining exercise with dieting is the most effective way to keep the pounds off. Everyone with MS needs regular physical activity. For exercise, the key is keeping a program going over many months or years. That means finding something that is manageable in your lifestyle and it should be enjoyable, too. Physical therapists are a great resource in establishing an exercise program that is right for you, especially in the presence of fatigue, spasticity, reduced balance or weakness.
The National MS Society and the MS Foundation can support exercise by funding personal needs for gym memberships or exercise equipment. At Evergreen, we sponsor physical exercise programs for people with MS, including a neurological exercise group, yoga and laughter therapy. We have a monthly nutritional workshop led by a certified dietician and intended for people with neurological diseases. This summer, we’ll be having our second annual ½ day nutritional seminar for people with MS- mark your calendars for Aug. 1.
Laughter is the best medicine: Introducing laughter therapy at Evergreen
Copyright: daynamore / 123RF Stock Photo
By Ted Brown, MD
There is a growing body of research supporting the therapeutic value and health benefits of laughter. Some of these benefits are:
- Stimulation of organs, such as heart, lungs and muscles through your intake of oxygen.
- Increased production of endorphins, which are hormones that make you feel good.
- Stress reduction: Like exercise, laughter increases your heart rate and blood pressure and stimulates circulation. This results in relaxation of ones muscles and relief from many of the symptoms of stress.
- Strengthening of the immune system through the reduction of harmful stress hormones and promotion of stress reducing neuropeptides.
- Relief from pain through muscle relaxation and the production of natural painkillers.
- Promotion of social connection and reduced feelings of depression and anxiety.
So what is Laughter therapy? It is the brainchild of Dr. Madan Kataria, a doctor and visionary in Mumbai, India. Dr. Kataria devised simple exercises using child-like playfulness, eye contact, and chanting “ho-ho-ha-ha-ha.” A session begins with simulated laughter which soon turns into real laughter. There is no need to rely on comedy, jokes, or sense of humor to reap the benefits of laughter. That is great news for those of us who can never tell a joke! It is based on the theory that our bodies can’t differentiate between real and fake laughter; just performing the physical act of laughing is enough to send our healing hormones into maximum overdrive.
Today, Laughter Yoga is practiced in more than 65 countries at thousands of Laughter Clubs. It allows people of all ages and physical abilities to laugh and play together. I did a YouTube search and found 30,000 videos on the topic of laughter therapy. One video that does a nice job exploring the treatment is found on the MyNewNormals blog of Nicole Lemelle, who is living with MS.
Laughter therapy has been taught at yoga studios, nursing homes, business corporations, prisons, and any place where people wish to gather and experience the benefits of laughter. It has been used to treat people with cancer, Alzheimer’s disease, and Parkinson’s disease.
I first became intrigued with the therapeutic potential of laughter when I attended a “Caring for the Caregivers” workshop for medical staff only. Along with talks about stress management, meditation and nutrition was a presentation on laughter therapy. At first, I felt a little out of my comfort zone and silly. As the speaker led us through a series of laughter activities, we all started to loosen up - why not have fun and start laughing with gusto? It was exhilarating, and a pretty good workout, too.
Fast forward nine months, and EvergreenHealth Medical Center has the first laughter therapy workshop that is dedicated to people with neurological diseases in the State of Washington. This workshop is led by a certified laughter therapy instructor and is open to anyone with multiple sclerosis or other neurological condition. There is no need to stand; people with wheelchairs are quite welcome. Currently, this free laughter therapy workshop still has space available and is held every Monday from 10:00-11:00 am at EvergreenHealth. You can call 425-899-3000 to register. We’ll have a second session starting in February. We hope that some of our readers will give it a try. It is definitely good for a laugh!!
If you’d like to learn more about the benefits of laughter and laughter therapy, here are some interesting articles on the topic:
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| Copyright: daynamore / 123RF Stock Photo |
There is a growing body of research supporting the therapeutic value and health benefits of laughter. Some of these benefits are:
- Stimulation of organs, such as heart, lungs and muscles through your intake of oxygen.
- Increased production of endorphins, which are hormones that make you feel good.
- Stress reduction: Like exercise, laughter increases your heart rate and blood pressure and stimulates circulation. This results in relaxation of ones muscles and relief from many of the symptoms of stress.
- Strengthening of the immune system through the reduction of harmful stress hormones and promotion of stress reducing neuropeptides.
- Relief from pain through muscle relaxation and the production of natural painkillers.
- Promotion of social connection and reduced feelings of depression and anxiety.
So what is Laughter therapy? It is the brainchild of Dr. Madan Kataria, a doctor and visionary in Mumbai, India. Dr. Kataria devised simple exercises using child-like playfulness, eye contact, and chanting “ho-ho-ha-ha-ha.” A session begins with simulated laughter which soon turns into real laughter. There is no need to rely on comedy, jokes, or sense of humor to reap the benefits of laughter. That is great news for those of us who can never tell a joke! It is based on the theory that our bodies can’t differentiate between real and fake laughter; just performing the physical act of laughing is enough to send our healing hormones into maximum overdrive.
Today, Laughter Yoga is practiced in more than 65 countries at thousands of Laughter Clubs. It allows people of all ages and physical abilities to laugh and play together. I did a YouTube search and found 30,000 videos on the topic of laughter therapy. One video that does a nice job exploring the treatment is found on the MyNewNormals blog of Nicole Lemelle, who is living with MS.
Laughter therapy has been taught at yoga studios, nursing homes, business corporations, prisons, and any place where people wish to gather and experience the benefits of laughter. It has been used to treat people with cancer, Alzheimer’s disease, and Parkinson’s disease.
I first became intrigued with the therapeutic potential of laughter when I attended a “Caring for the Caregivers” workshop for medical staff only. Along with talks about stress management, meditation and nutrition was a presentation on laughter therapy. At first, I felt a little out of my comfort zone and silly. As the speaker led us through a series of laughter activities, we all started to loosen up - why not have fun and start laughing with gusto? It was exhilarating, and a pretty good workout, too.
Fast forward nine months, and EvergreenHealth Medical Center has the first laughter therapy workshop that is dedicated to people with neurological diseases in the State of Washington. This workshop is led by a certified laughter therapy instructor and is open to anyone with multiple sclerosis or other neurological condition. There is no need to stand; people with wheelchairs are quite welcome. Currently, this free laughter therapy workshop still has space available and is held every Monday from 10:00-11:00 am at EvergreenHealth. You can call 425-899-3000 to register. We’ll have a second session starting in February. We hope that some of our readers will give it a try. It is definitely good for a laugh!!
If you’d like to learn more about the benefits of laughter and laughter therapy, here are some interesting articles on the topic:
'I gotta go…but not now'
A discussion of multiple sclerosis and bladder problems
By Ted Brown, MD
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| Ted Brown, MD, MPH |
There is a lot of neurological input into the process of storing urine in the bladder, signaling the brain of need to empty and then coordinating contraction of the bladder muscle with relaxation of the bladder outlet to achieve complete and timely emptying. The complex process of urination is prone to fail when there is damage to the brain and spinal cord in multiple sclerosis (MS).
Just how common is it? Bladder problems are present from disease onset in 35% of people with MS and over 80% will eventually have some urination dysfunction. Urinary problems have a major psychological impact, and are among the most socially disabling manifestations of MS. Types of bladder dysfunction include problems of storage, problems of emptying, and a combination of both. Storage problems are the most common, typically caused by an “overactive bladder,” where the bladder begins to contract prematurely with a small volume of urine.
Symptoms of an overactive bladder are urgency (feeling pressure or need to empty soon/hard to hold on to it), frequency (urinating more often than normal (>7x/day), including during the middle of the night), and having incontinence (bladder accidents). Problems of emptying (urinary retention) in MS are usually caused by inadequate signals to make the bladder outlet relax and let the urine flow.
With combined dysfunction, there is simultaneous bladder overactivity and trapping of urine at the outlet. The symptoms of combined dysfunction are urgency, hesitancy, frequency and incontinence. As if these symptoms are not enough, bladder dysfunction may lead to skin care problems, bladder infection, bladder stones and damage to the ureters and kidneys.
So, what can be done about it? The first step to figuring out what is wrong is to bring up the issue with your healthcare provider. He/she may want to run tests such as a blood test for kidney function, urine analysis for infection and checking a residual bladder volume by ultrasound. An urologist may run additional tests. Once there is some sense what kind of bladder problem is present, the treatment follows course.
For overactive bladder, treatment options are behavioral changes (e.g. avoiding caffeinated beverages, wearing pads), pelvic floor exercises (a.k.a. “Kegel exercises”), pelvic physical therapy, and medications. There are several drugs for this including a host of anticholinergic medicines, botulinum toxin injections, and mirabegron.
For urinary retention, there are also some behavioral techniques (double voiding- or making a second void a few minutes after the first), use of intermittent or indwelling catheter, or medications to help relax the bladder outlet (e.g. tamsulosin).
It is best to start treating bladder dysfunction early, before the problems have become severe. So, don’t hesitate to bring this up with your MS care team. Treatments really can help most people and prevent potentially dangerous complications, so you can pursue your daily activities with comfort and confidence.
Where can I get more information? A good starting point is with your healthcare provider. Contact the National MS Society (1-800-344-4867, nationalMSsociety.org) for the educational pamphlet “Urinary Dysfunction & MS.” If you are interested in participating in a research study involving treatment of overactive bladder in MS, please click here for the research flyer.
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