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Archive for the ‘Reasons for Hope’ Category.

Multiple Sclerosis, Wheelchairs and Lifespan

June 8, 2008, 9:40 am

My wife made a comment last week that I’ve thought about a lot since she said it. It was said in passing in the middle of a conversation that I cannot remember (apparently, my wife’s not the only person in our family with poor memory). In this case, though, I think I fail to remember the rest of the conversation because her comment stunned me.

“I don’t think I’ll live a long life.”

I knew if I talked to her about it then I would become too assertive about how wrong I thought the statement was and that she had no right to think that way. (Actually, she has the right to think any way she wishes … and usually does … even if when I don’t like it!)

I knew, though, I wouldn’t be able to listen to what she was really saying. So, a week later, yesterday morning, I asked her about her comment.

“I imagine you said it because you have MS, but having MS doesn’t mean you’ll have a shorter life. Are you thinking you’ll have a shorter life because of something you’ve read? Or is it just a hunch?”

She’s a realist and a pragmatist. “I need the cane to walk around on and it’s getting worse. I’m headed for a wheelchair in my future and I don’t think people confined to wheelchairs live as long,” she explained simply.

I know her gait is worsening. And I won’t be surprised when she requires a wheelchair. But I’m not ready to believe it will shorten her life. I said, “Unless you’ve read some significant study, I wouldn’t assume being confined to a wheelchair automatically shortens one’s life.”

She countered, “people in wheelchairs get less exercise, hearts grow weak, muscles grow weak. I don’t think they live as long.”

Ever the optimist, I responded, “Yes, perhaps that could be true, but I know people confined to wheelchairs who are in great shape. They even make racing wheelchairs for athletes!”

Her eyes said, “but I’m not an athlete.” She looked at me like I wasn’t understanding her. The fact is, I didn’t want to understand. I didn’t want to think that being confined to a wheelchair will shorten her life.

It’s obvious neither of us knew the real impact a wheelchair has on lifespan. So it was time for a little online research.

I’ll share what I’ve found about life span and wheelchair confinement. Interestingly, I’ve not been able to find a single study of the impact of wheelchair confinement on lifespan for MS patients.

So I’m approaching it from a different angle. I’ll start with the basic question, “Is MS fatal?”

According to the National MS Society the answer is: “No, MS is not a fatal disease, except in rare cases. People who live with MS can be expected to have a normal or near-normal life expectancy.”

I like that answer except for the “except in rare cases” part. But from all I’ve read, those rare cases are indeed rare and consist primarily of MS patients in whom the neurological damage is done to areas of the brain and nervous system which control breathing or regulate heart beat.

A more complete answer seems to be available on the Medscape Today website in “Aging With Multiple Sclerosis“, an article published in the Journal of Neuroscience Nursing (J Neurosci Nurs 36(5):245-251,259, 2004. © 2004 American Association of Neuroscience Nurses)

The authors write, “The disease (Multiple Sclerosis) causes demyelination of the central nervous system and results in symptoms such as extreme fatigue, mobility impairment, optic neuritis, weakness or paralysis, abnormal/painful sensations, and loss of balance. Although these symptoms can result in considerable disability for the person with MS (Finlayson, Impey, Nicolle, & Edwards, 1998), overall life expectancy is not dramatically altered for these individuals (Weinshenker, 1995). Of those with MS, 85%-90% can expect to live as long as their age peers (Minden, Marder, Harrold, & Dor, 1993). Currently in the United States, life expectancy estimates range from 74 years for men to 79 years for women (Centers for Disease Control, 2001).”

The authors did not separate the MS patient population into two groups, Those in Wheelchairs vs. Those Without Wheelchairs. The statistics include all MS patients.

So I’ve found an answer to my wife’s statement that she’ll not live a long life. I think she will live long.

Here’s why: 85%-90% of MS patients can expect to live as long as their age peers. (I don’t think I’m doing any funny math here, but the following works for me). Statistically, the bulk of MS patients will be found toward the average (inside the bell of the bell-shaped curve for those of you who like statistics and graphs). The 10%-15% of MS patients who do not live as long as their age peers are in the population that are outliers, they are a standard deviation or two away from the norm.

Based on her symptoms to date I believe she is having an “average” experience of MS. So, to extrapolate that into the future, I think she’ll find herself well within the 85% to 90% who live as long as their age peers … with or without a wheelchair.

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Tags: life expectancy, lifespan, multiple sclerosis, wheelchair
Category: Living with MS, Reasons for Hope | Comment

Prozac/Fluoxetine, Multiple Sclerosis, and Reduced Lesions

May 2, 2008, 11:29 am

Here’s news that gave me reason to create a new category: Reasons for Hope

Driving home for lunch yesterday I caught just enough of Paul Harvey’s broadcast to hear something about Prozac, Multiple Sclerosis and reduced number of lesions on MRIs. I mentioned it to my wife when I arrived home and then searched the web for more information. (I started at PaulHarvey.com, but didn’t have time to relisten to the broadcast. It would be great if the broadcast transcripts were available on Mr. Harvey’s website - and maybe they are, but I couldn’t find them.)

Here’s what I found:

In Fluoxetine Show Promise in Multiple Sclerosis on the Medscape.com web site, the author describes the results of a small study which were presented at ECTRIMS 2007: 23rd Congress of the European Committee for Treatment and Research in Multiple Sclerosis. The article is dated October 16, 2007, so we’re not dealing with “new” news.

I think the reason Paul Harvey’s broadcast mentioned it is because the study is about to be printed in Journal of Neurology, Neurosurgery and Psychiatry.

The study conducted by Jop P. Mostert, MD, and his colleagues at the University of Groningen in the Netherlands, showed a reduction in new gadolinium-enhancing lesions in the study’s patients with relapsing-remitting or relapsing secondary progressive MS who received Fluoxetine (the generic name for Prozac).

Read the article for the study’s details or search the web for Prozac + “Multiple Sclerosis” for additional information.

Here are some of the reason I created the “Reasons for Hope” category for this article:

This study was not funded by any pharmaceutical firm. Funding wasn’t an influence.
Fluoxetine/Prozac has been around for a long time and is generally well-tolerated (unlike other MS treatments).
This isn’t a “new” new thing - Dr. Mostert’s report mentioned that, as early as 1991, psychiatrists were reporting that fluoxetine/Prozac was having a positive effect on MS patients.
A list of Multiple Sclerosis Drug Treatments indicates the medication is already prescribed to MS patients for “depression without anxiety“. And, as mentioned in the study report, psychiatrists were reporting positive effects of Prozac on MS as early as 1991.

Remember, I’m not offering (nor am I qualified to offer) medical advice, merely reporting what I’ve heard on the radio and read of Mostert’s study. Talk about this with your neurologist.