Five Advance Warnings of Multiple Sclerosis
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Five Advance Warnings of Multiple Sclerosis
First things first, a quick check-in with regard to how much you know about multiple sclerosis (MS):
- Do you know what causes it?
- Do you know how it happens?
- Do you know how it can be fixed?
If your answer to the above questions is “no”, then take solace in the fact that modern science doesn’t know either.
What we do know is that it’s an autoimmune condition, and that it results in the degradation of myelin, the “insulator” of nerves, in the central nervous system.
- How exactly this is brought about remains unclear, though there are several leading hypotheses including autoimmune attack of myelin itself, or disruption to the production of myelin.
- Treatments look to reduce/mitigate inflammation, and/or treat other symptoms (which are many and various) on an as-needed basis.
If you’re wondering about the prognosis after diagnosis, the scientific consensus on that is also “we don’t know”:
Read: Personalized medicine in multiple sclerosis: hope or reality?
this paper, like every other one we considered putting in that spot, concludes with basically begging for research to be done to identify biomarkers in a useful fashion that could help classify many distinct forms of MS, rather than the current “you have MS, but who knows what that will mean for you personally because it’s so varied” approach.
The Five Advance Warning Signs
Something we do know! First, we’ll quote directly the researchers’ conclusion:
❝We identified 5 health conditions associated with subsequent MS diagnosis, which may be considered not only prodromal but also early-stage symptoms.
However, these health conditions overlap with prodrome of two other autoimmune diseases, hence they lack specificity to MS.❞
So, these things are a warning, five alarm bells, but not necessarily diagnostic criteria.
Without further ado, the five things are:
- depression
- sexual disorders
- constipation
- cystitis
- urinary tract infections
❝This association was sufficiently robust at the statistical level for us to state that these are early clinical warning signs, probably related to damage to the nervous system, in patients who will later be diagnosed with multiple sclerosis.
The overrepresentation of these symptoms persisted and even increased over the five years after diagnosis.❞
Read the paper for yourself:
Hot off the press! Published only yesterday!
Want to know more about MS?
Here’s a very comprehensive guide:
National clinical guideline for diagnosis and management of multiple sclerosis
Take care!
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What is pathological demand avoidance – and how is it different to ‘acting out’?
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“Charlie” is an eight-year-old child with autism. Her parents are worried because she often responds to requests with insults, aggression and refusal. Simple demands, such as being asked to get dressed, can trigger an intense need to control the situation, fights and meltdowns.
Charlie’s parents find themselves in a constant cycle of conflict, trying to manage her and their own reactions, often unsuccessfully. Their attempts to provide structure and consequences are met with more resistance.
What’s going on? What makes Charlie’s behaviour – that some are calling “pathological demand avoidance” – different to the defiance most children show their parents or carers from time-to-time?
What is pathological demand avoidance?
British developmental psychologist Elizabeth Newson coined the term “pathological demand avoidance” (commonly shortened to PDA) in the 1980s after studying groups of children in her practice.
A 2021 systematic review noted features of PDA include resistance to everyday requests and strong emotional and behavioural reactions.
Children with PDA might show obsessive behaviour, struggle with persistence, and seek to control situations. They may struggle with attention and impulsivity, alongside motor and coordination difficulties, language delay and a tendency to retreat into role play or fantasy worlds.
PDA is also known as “extreme demand avoidance” and is often described as a subtype of autism. Some people prefer the term persistent drive for autonomy or pervasive drive for autonomy.
What does the evidence say?
Every clinician working with children and families recognises the behavioural profile described by PDA. The challenging question is why these behaviours emerge.
PDA is not currently listed in the two diagnostic manuals used in psychiatry and psychology to diagnose mental health and developmental conditions, the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the World Health Organization’s International Classification of Diseases (ICD-11).
Researchers have reported concerns about the science behind PDA. There are no clear theories or explanations of why or how the profile of symptoms develop, and little inclusion of children or adults with lived experience of PDA symptoms in the studies. Environmental, family or other contextual factors that may contribute to behaviour have not been systematically studied.
A major limitation of existing PDA research and case studies is a lack of consideration of overlapping symptoms with other conditions, such as autism, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, selective mutism and other developmental disorders. Diagnostic labels can have positive and negative consequences and so need to be thoroughly investigated before they are used in practice.
Classifying a “new” condition requires consistency across seven clinical and research aspects: epidemiological data, long-term patient follow-up, family inheritance, laboratory findings, exclusion from other conditions, response to treatment, and distinct predictors of outcome. At this stage, these domains have not been established for PDA. It is not clear whether PDA is different from other formal diagnoses or developmental differences.
Finding the why
Debates over classification don’t relieve distress for a child or those close to them. If a child is “intentionally” engaged in antisocial behaviour, the question is then “why?”
Beneath the behaviour is almost always developmental difference, genuine distress and difficulty coping. A broad and deep understanding of developmental processes is required.
Interestingly, while girls are “under-represented” in autism research, they are equally represented in studies characterising PDA. But if a child’s behaviour is only understood through a “pathologising” or diagnostic lens, there is a risk their agency may be reduced. Underlying experiences of distress, sensory overload, social confusion and feelings of isolation may be missed.
So, what can be done to help?
There are no empirical studies to date regarding PDA treatment strategies or their effectiveness. Clinical advice and case studies suggest strategies that may help include:
- reducing demands
- giving multiple options
- minimising expectations to avoid triggering avoidance
- engaging with interests to support regulation.
Early intervention in the preschool and primary years benefits children with complex developmental differences. Clinical care that involves a range of medical and allied health clinicians and considers the whole person is needed to ensure children and families get the support they need.
It is important to recognise these children often feel as frustrated and helpless as their caregivers. Both find themselves stuck in a repetitive cycle of distress, frustration and lack of progress. A personalised approach can take into account the child’s unique social, sensory and cognitive sensitivities.
In the preschool and early primary years, children have limited ability to manage their impulses or learn techniques for managing their emotions, relationships or environments. Careful watching for potential triggers and then working on timetables and routines, sleep, environments, tasks, and relationships can help.
As children move into later primary school and adolescence, they are more likely to want to influence others and be able to have more self control. As their autonomy and ability to collaborate increases, the problematic behaviours tend to reduce.
Strategies that build self-determination are crucial. They include opportunities for developing confidence, communication and more options to choose from when facing challenges. This therapeutic work with children and families takes time and needs to be revisited at different developmental stages. Support to engage in school and community activities is also needed. Each small step brings more capacity and more effective ways for a child to understand and manage themselves and their worlds.
What about Charlie?
The current scope to explain and manage PDA is limited. Future research must include the voices and views of children and adults with PDA symptoms.
Such emotional and behavioural difficulties are distressing and difficult for children and families. They need compassion and practical help.
For a child like Charlie, this could look like a series of sessions where she and her parents meet with clinicians to explore Charlie’s perspective, experiences and triggers. The family might come to understand that, in addition to autism, Charlie has complex developmental strengths and challenges, anxiety, and some difficulties with adjustment related to stress at home and school. This means Charlie experiences a fight, flight, freeze response that looks like aggression, avoidance or shutting down.
With carefully planned supports at home and school, Charlie’s options can broaden and her distress and avoidance can soften. Outside the clinic room, Charlie and her family can be supported to join an inclusive local community sporting or creative activity. Gradually she can spend more time engaged at home, school and in the community.
Nicole Rinehart, Professor, Child and Adolescent Psychology, Director, Krongold Clinic (Research), Monash University; David Moseley, Senior Research Fellow, Deputy Director (Clinical), Monash Krongold Clinic, Monash University, and Michael Gordon, Associate Professor, Psychiatry, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Ready to Run – by Kelly Starrett
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If you’d like to get into running, and think that maybe the barriers are too great, this is the book for you.
Kelly Starrett approaches running less from an “eye of the tiger” motivational approach, and more from a physiotherapy angle.
The first couple of chapters of the book are explanatory of his philosophy, the key component of which being:
Routine maintenance on your personal running machine (i.e., your body) can be and should be performed by you.
The second (and largest) part of the book is given to his “12 Standards of Maintenance for Running“. These range from neutral feet and flat shoes, to ankle, knee, and hip mobilization exercises, to good squatting technique, and more.
After that, we have photographs and explanations of maintenance exercises that are functional for running.
The fourth and final part of the book is about dealing with injuries or medical issues that you might have.
And if you think you’re too old for it? In Starrett’s own words:
❝Problems are going to keep coming. Each one is a gift wanting to be opened—some new area of performance you didn’t know you had, or some new efficiency to be gained. The 90- to 95-year-old division of the Masters Track and Field Nationals awaits. A Lifelong commitment to solving each problem that creeps up is the ticket.❞
In short: this is the book that can get you back out doing what you perhaps thought you’d left behind you, and/or open a whole new chapter in your life.
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One Cause; Countless Aches
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What Is The Cause?
Zac Cupples’ video (below) makes an appealing claim: 90% of movement issues and discomforts we experience daily come from one source: reduced joint space due to increased muscle tension.
For Cupples, this could be causing anything from knee pain to foot pain to ankle pain to hip pain to generalized joint pain to…pretty much any sort of pain.
So, why do we describe this as “appealing”?
Well, if there’s just one cause, that means there is only one thing to fix
Can This Be True?
Whilst we normally stray away from oversimplifications, we found Cupples’ example quite powerful.
Cupples defends his thesis by illustrating it with a simple wrist movement experiment: try moving your wrist in a circle with your palm open, and then do the same with your fist clenched.
Did you notice a difference?
When you clench your fist, movement (normally) becomes restricted and uncomfortable, illustrating how increased tension limits joint space.
It’s a powerful analogy for understanding our body’s mechanics.
So How Do We Fix It?
To combat issues with reduced joint space, Cupples proposes a three-step solution: reducing muscle tension, increasing range of motion in commonly limited areas, and enhancing movement efficiency. He delves into strategies for achieving these, including adopting certain positions and breathing techniques.
There are also some elements of strategic muscle engagement, but we’ll leave that to him to describe:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Egg Noodles vs Rice Noodles – Which is Healthier?
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Our Verdict
When comparing egg noodles to rice noodles, we picked the egg noodles.
Why?
It was close—these are both quite mediocre foods. They’re neither amazing for the health nor appalling for the health (in moderation). They are both relatively low in nutrients, but they are also low in anti-nutrients, i.e. things that have a negative effect on the health.
Their mineral profiles are similar; both are a source of selenium, manganese, phosphorus, copper, and iron. Not as good as many sources, but not devoid of nutrients either.
Their vitamin profiles are both pitiful; rice noodles have trace amounts of various vitamins, and egg noodles have only slightly more. While eggs themselves are nutritious, the processing has robbed them of much of their value.
In terms of macros, egg noodles have a little more fat (but the fats are healthier) and rice noodles have a lot more carbs, so this is the main differentiator, and is the main reason we chose the egg noodles over the rice noodles. Both have a comparable (small) amount of protein.
In short:
- They’re comparable on minerals, and vitamins here are barely worth speaking about (though egg noodles do have marginally more)
- Egg noodles have a little more fat (but the fats are healthier)
- Rice noodles have a lot more carbs (with a moderately high glycemic index, which is relatively worse—if you eat them with vegetables and fats, then that’ll offset this, but we’re judging the two items on merit, not your meal)
Learn more
You might like this previous main feature of ours:
Should You Go Light Or Heavy On Carbs?
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How To Really Look After Your Joints
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The Other Ways To Look After Your Joints
When it comes to joint health, most people have two quick go-to items:
- Stretching
- Supplements like omega-3 and glucosamine sulfate
Stretching, and specifically, mobility exercises, are important! We’ll have to do a main feature on these sometime soon. But for today, we’ll just say: yes, gentle daily stretches go a long way, as does just generally moving more.
And, those supplements are not without their merits. For example:
- Effect of omega-3 on painful symptoms of patients with osteoarthritis of the synovial joints: systematic review and meta-analysis
- Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator
Of those, glucosamine sulfate may have an extra benefit in now just alleviating the symptoms, but also slowing the progression of degenerative joint conditions (like arthritis of various kinds). This is something it shares with chondroitin sulfate:
Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis
An unlikely extra use for the humble cucumber…
As it turns out, cucumber extract beats glucosamine and chondroitin by 200%, at 1/135th of the dose.
You read that right, and it’s not a typo. See for yourself:
Reduce inflammation, have happier joints
Joint pain and joint degeneration in general is certainly not just about inflammation; there is physical wear-and-tear too. But combatting inflammation is important, and turmeric, which we’ve done a main feature on before, is a potent helper in this regard:
See also: Keep Inflammation At Bay
(a whole list of tips for, well, keeping inflammation at bay)
About that wear-and-tear…
Your bones and joints are made of stuff, and that stuff needs to be replaced. As we get older, the body typically gets worse at replacing it in a timely and efficient fashion. We can help it do its job, by giving it more of the stuff it needs.
And what stuff is that?
Well, minerals like calcium and phosphorus are important, but a lot is also protein! Specifically, collagen. We did a main feature on this before, which is good, as it’d take us a lot of space to cover all the benefits here:
We Are Such Stuff As Fish Are Made Of
Short version? People take collagen for their skin, but really, its biggest benefit is for our bones and joints!
Wrap up warmly and… No wait, skip that.
Writer’s anecdote: when I was young, my mother—her body already wracked with arthritis, along with post-polio syndrome—warned me that if I did not dress warmly, I would end up like her. In her mind, the cause of her arthritis was having spent too much time exposed to the elements. This is a popular myth, doubtlessly resulting from the fact that barometric changes can worsen the symptoms of already-extant arthritis, so it’s not a stretch to believe that wind and rain caused it. But, while it’s not a stretch, it’s also not scientific.
If you have arthritis, you may indeed “feel it in your bones” when the weather changes. But the remedy for that is not to try to fight it, but rather, to strengthen your body’s ability to respond to it.
The answer? Cryotherapy, with ice baths ranking top:
- Effects of an Exercise Program and Cold-Water Immersion Recovery in Patients with Rheumatoid Arthritis (RA): Feasibility Study
- Effectiveness of home-based conventional exercise and cryotherapy on daily living activities in patients with knee osteoarthritis: A randomized controlled clinical trial
- Local Cryotherapy, Comparison of Cold Air and Ice Massage on Pain and Handgrip Strength in Patients with Rheumatoid Arthritis
Note that this can be just localized, so for example if the problem joints are your wrists, a washing-up bowl with water and ice will do just nicely.
Note also that, per that last study, a single session will only alleviate the pain, not the disease itself. For that (per the other studies) more sessions are required.
We did a main feature about cryotherapy a while back, and it explains how and why it works:
A Cold Shower A Day Keeps The Doctor Away?
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Managing [E-word] Dysfunction Reactions
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
We had several requests pertaining to veganism, meatless mondays, and substitutions in recipes—so we’re going to cover those on a different day!
As for questions we’re answering today…
Q: Information on [e-word] dysfunction for those who have negative reactions to [the most common medications]?
When it comes to that particular issue, one or more of these three factors are often involved:
- Hormones
- Circulation
- Psychology
The most common drugs (that we can’t name here) work on the circulation side of things—specifically, by increasing the localized blood pressure. The exact mechanism of this drug action is interesting, albeit beyond the scope of a quick answer here today. On the other hand, the way that they work can cause adverse blood-pressure-related side effects for some people; perhaps you’re one of them.
To take matters into your own hands, so to speak, you can address each of those three things we just mentioned:
Hormones
Ask your doctor (or a reputable phlebotomy service) for a hormone test. If your free/serum testosterone levels are low (which becomes increasingly common in men over the age of 45), they may prescribe something—such as testosterone shots—specifically for that.
This way, it treats the underlying cause, rather than offering a workaround like those common pills whose names we can’t mention here.
Circulation
Look after your heart health; eat for your heart health, and exercise regularly!
Cold showers/baths also work wonders for vascular tone—which is precisely what you need in this matter. By rapidly changing temperatures (such as by turning off the hot water for the last couple of minutes of your shower, or by plunging into a cold bath), your blood vessels will get practice at constricting and maintaining that constriction as necessary.
Psychology
[E-word] dysfunction can also have a psychological basis. Unfortunately, this can also then be self-reinforcing, if recalling previous difficulties causes you to get distracted/insecure and lose the moment. One of the best things you can do to get out of this catch-22 situation is to not worry about it in the moment. Depending on what you and your partner(s) like to do in bed, there are plenty of other equally respectable options, so just switch track!
Having a conversation about this in advance will probably be helpful, so that everyone’s on the same page of the script in that eventuality, and it becomes “no big deal”. Without that conversation, misunderstandings and insecurities could arise for your partner(s) as well as yourself (“aren’t I desirable enough?” etc).
So, to recap, we recommend:
- Have your hormones checked
- Look after your circulation
- Make the decision to have fun!
Don’t Forget…
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Learn to Age Gracefully
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