Optic neuritis, nystagmus and the scary stuff!

Moving on, optic neuritis. Yes as you could have guessed, the eyes! This occurs when there is a relapse primarily affecting the part(s) of the brain that are involved in sight and vision.

The main symptoms that occur from this would be either blurred, double or complete loss of vision in either one of the eyes ( depending on which one gets 'attacked'). This too is usually one of the onset symptoms of MS and thus many (like me) MSers would be diagnosed after referrals from an ophthalmologist ( a medical doctor who specialises in eye care), an optician ( though the one I saw told me my glasses were dirty!) or even the GP to get further tests to check for nerve damage.

As discussed before, the nerve damage never completely recovers so this damage can leave a lasting damage with unclear vision and 'nystagmus'. This is basically when the pupils of the eyes randomly like to have a bit of a dance, Nystagmus most commonly causes the eyes to look involuntarily from side to side in a rapid, swinging motion rather than staying fixed on an object or person. Some nystagmuses, however, cause the eyes to jerk sideways or up and down.

The slightly scary stuff ( especially if your frightened of insects and horror movies!) is due to the nystagmus, your eyes may 'lie' to you, so with my experience; I thought there were beetles crawling all over my bedside wall and when I prepared to give them a whack, turned to see an empty plain wall as it was meant to be!

Not stopping there, if there is damage in other parts of the brain, it can lead to a transmission issue, so as when a human would see things, that message is sent to our brains to figure out what it is, and with damage in the right ( or wrong!) places, one could end up 'seeing' things because of the disruption and the 'short circuiting' analogy discussed earlier. So going past the pond near my house, the tree branches do look a bit like a scarecrow or a ghost on the initial look. Yes can be a bit frightening so the need to remind yourself your eyes are lying to you can be helpful! And focusing the eyes to see it's just a tree!

Last but not least, the makeshift medical advise to frighten you when you are already quite scared; because through my GCSEs and SATs and pretty much all my studies, I found online resources really helpful to revise and as you could probably guess, I am a bit of a nerd so I spent quite some time revising and because I used the computer, phone or even study without a lot of light so according to some, this was why my body decided to go AWOL. To add, the urge to itch the eyes were somehow making things worse along with the covering of the damaged eye with tissue being something supposedly problematic leaving me with old Indian remedies for 'relief' of symptoms which were laughed off and very much dis advised by the more professional doctors, and the need to learn how to ignore people after the many comments about wearing glasses meaning I should have perfect vision!

Whether you're enjoying things so far or not, we really are only getting started still! I think by the end you'd be experts at making caffeinated drinks!

Example of blurred vision on the left.

The lasting damaged vision difference between normal(left) and Optic neuritis (ON) eye.

A test given to check for vision issues, also used to test for colour blindness. 

Let's get started: symptoms.

What actually makes living with MS difficult, problematic and very abnormal? Quite obviously the symptoms. Simply put but far from that it if anything. Most people when seeing an MSer would see the condition from a more physical perspective, thus a very common stereotype of people with MS being wheelchair bound. But in reality the foundations of MS are physical, mental and emotional.

Based on the basic knowledge of the anatomy of the central nervous system and the posts covered so far ( be it even by background knowledge), one would presume physical symptoms are due to damage in the spine, mental ones the brain and emotional ones due to the change in social standing an MSer is left with.

However the symptoms all have their own specific damage source and some really minute physical ones may be due to damage in certain areas of the brain. For example, the 'drunkard walk' being due to damage in the base of the brain rather than just the spine or legs. Mental ones due to cognitive implications and emotional ones due the same reasons. Furthermore, the severity of the symptoms which may be another thing misunderstood but hopefully we'll share some light on that too.

Nevertheless, as we have been through the outskirts of MS, hope the mugs are warm and biscuits are ready! I know that joke is drying out now! I was previously told to apologise for my lame humour but if you find it an issue message me privately for an apology! If anything, associating humour with MS is quite something. We shall start with the more physical symptoms then move on to the others whenever we're done.

One of the common onset symptoms of MS - though not every MSer travels the same route - would be that of loss of sensation; Obviously you can't feel your limbs or part(s) of your body 'normally'. The feeling can best be explained like a permanent long lasting feeling of pins and needles or an itch that never seems to go away, this demonstrating a bit of damage to the nerve(s) and this can affect things like response to temperature. So yes needing a more 'colder' shower in the winter or vice versa in the summer due to the confusion that's present. On a more practical setting, this leads to lasting weakness in the muscle and issues with manual dexterity, so simple things like buttons on a shirt (or the equivalent for women if there is any) or even other things which may be covered later ( if need be). On a personal note, this occurred with me the night before my English GSCE exam so obviously these sudden abnormalities can result in a huge emotional distress! But it affecting other limbs like the legs, can result in an MSer being a bit 'slower'; I still had to sit the detentions for the lateness it caused me reaching school!

With a slight damage, it is bearable to live with but with more severe damage an MSer can be left in a wheelchair or even bed ridden as the muscles that keep a person up are not receiving the signals needed for this to function. Bearing in mind, this may be only one symptom but the basis of it has links to all the symptoms of MS. As we hope to see later on, the body is interlinked in many ways and on of the most vital ways, through the nervous system. To get a bit of how this may feel, wear a pair of thick gloves and try to make a cup of tea (don't do this alone!), write a sentence on paper or put your winter jacket on.

This taking place when I looked a lot normal, I must mention the range of comments I initially received, as people must give their two pence in all matters nowadays! Past being told I was not exercising enough or using the computer for too long, it even went as far as being accused of lying and 'crying wolf'. The more rather somewhat humorous one of it all being in our 'heads' which technically was spot on as frontal lobe damage ( front part of the brain, will be covered later) can lead to such symptoms in the hands and these similar parts of the body.

Till next week! Enjoy the creeping in of the cold!

Nerve 'recovery'.

As one would presume and hope, the nerves do recover after initial damage, well kind of. In the initial stages of the disease, the damage can be repaired to a near 100% state. Unfortunately, the reality is that once a nerve is damage, under the current understanding and treatments, it never recovers completely again. Hope you've already had the kettle boiling as here we go again!

I will try to explain my makeshift graph below, after the first 'attack' the nerve may be repaired but to about 98%, so an MSers will look 'better' and perhaps feel 'better' too, but as the disease activity continues, the symptoms will remain and almost stagnate to a certain degree. Over time, the repair work will decline in terms of productivity, I like to see it a bit like something like the Atkins diet and many others which are offered to those seeking weight loss, after going through a repetitive  cycle of improvement then a relapse ( back to step 1) psychologically we'd easily give up. The human body kind of does the same, the repair will only ever be done to a certain extent till the more secondary stages of the disease will take over ( secondary progressive multiple sclerosis) which as stated - a very long time ago I know- stereo typically takes the body and its' functions downhill! And with this there are currently no treatments available other than one's that offer 'relief' of symptoms that an MSer may be finding difficult to cope with.

The bars showing an estimate of the recovery after each relapse ( numbered)

I think the generals of MS have been discussed, if anything is misunderstood so far or even in the future, please leave a comment or leave a message. Hopefully We will now be jumping in the deep end with the symptoms, I suggest you keep the kettle, mugs and tea/ coffee nearby for next week! And packet of biscuits! See you then!

The first of cliff hangers; Dignosis.

Obviously to all medical  abnormalities in a human body, there is stereotypically a study then a solution and then treatment. MS also follows the same pathway, as easy as it may seem it can be very difficult for a definite diagnosis of Multiple Sclerosis. There are many possibilities to the initial complaints of an MSer in their more 'baby' days of the disease. Therefore certain forms of 'research' are carried out to eradicate any possibilities and find the concluding answer.

There are a handful of tests carried out which I'll go through below. Grab a nice warm drink and get comfortable!

Neurological examination: This being one of the easy ones, a neurologist ( a doctor specialising in nerve related or neurological conditions) will carry out a short assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. Simply put this can be things like matching your finger between your nose and their finger to see whether your perceptions are a bit 'off', give it a go with someone to see how it goes. Another could be when they pull out their medical hammers to give you a bit of a whack and see the automatic response the body will carry out.

Magnetic resonance imaging (MRI): This one being the scan that scares a lot of people hearing about it! Where the body is placed in an oven like machine which is very loud and in the case of MS the brain and spine is scanned, this shows healthy and unhealthy nerve cells ( see the example below). Either by first look or scans carried out over a period of time which show more/ worsened or odd looking nerve cells and linking them to complaints of the patient, it shows the medical team the likelihood of it being MS, it sometimes taking discussion with a team of even world renown neurologists (like in my case!) and radiologists (those who do the scans and know how to read the pictures that come out. Majority of MSers are diagnosed via the use of MRI scans.

Evoked potential test: electrodes being placed on the brain or spinal cord and the electric potential ( as the messages sent across nerves are a bit like electric currents) are analysed (the speed of the reaction) in response to a stimulus like loud noise or so.

Lambur puncture/ spinal tap: The brain and spinal cord are bathed in fluid. A spinal tap, also called a lumbar puncture, is a procedure doctors use to remove and test some of this liquid, called cerebrospinal fluid (CSF). If there is an abnormal amount of WBCs present this can be used as a cue to their being autoimmune activity. Just a warning to anyone who may have this procedure done, it is quite scary but professionals are so for a reason! Unlike the advice I was given beforehand about it being like an epidural given in childbirth and it hurting for the rest of my life ( a load of rubbish!). When told to rest after, really make the most of it, I jumped up after a few minutes only to almost pass out at home time and be given medical advice to go ahead and drink lots of coke, to which my dad had requested six cans of coke to be left at my bedside at home!

Blood tests: Last but not least, simple blood tests may be carried out, to eradicate the small possibilites like diabetes, because of my skin colour and genetic liking to diabetes, this was the initial thought by my GPs, but as the saying goes ; jack of all trades but masters of nothing!

The white dots on the brain indicating damaged nerves.

This is making me a bit 'nervous'. Nerve communication.

As MS is a condition affecting the nervous system, I thought I should clarify a few further things about the NS( nervous system).

Back to how they communicate with each other and send 'signals' to one another; when the action potentials (the initial signals) are passed over to another nerve, they must pass a small gap called the synaptic cleft, for this to occur they are transferred via chemicals called neurotransmitters. Take a deep breath!

These neurotransmitters play a huge role in physical, mental and emotional factors in a body. For example; levels of serotonin have been associated with affecting mood, social behavior, appetite, digestion, sleep, memory and sexual desire/function and things like excercise or erm chocolate showing to increase the levels of serotonin, that's why chocolate is loved very much! And excrcise more in others.

Thus why along with the turbulence MS may cause on a physical and cognitive playing field, there are also many mental issues easily associated with the condition and the treatments used for dealing with it also affecting or resulting in a further imbalance, which is a thought to why most known mental illnesses arise or why even families with a genetic make up resulting in neurotransmitter imbalance tend to have family histories of mental illnesses.

Just to clarify how the speed difference of signals make massive implications, I thought the pictures below would enlighten how it may do so and to show why MSers can be a bit 'slow'.

I know this is very sciency but it is needed, if you think MS is very long and confusing, just wait for the diagnoses process!

An 'autoimmune' condition.

What is the turmoil in a body that results in a sclerosis ( abnormal hardening of body tissues) in multiple places one may ask? To put things in context, the human body has two types of blood cells, white and red. Red being the obvious one, cut yourself and you'd probably see a lot of them if you're unsure! No don't do that just kidding, the other type being white (WBC) and these are part of the 'immune' system of a body, there being a specific one named the ' T killer cell' which attacks to kill foreign cells that enter the body presuming they would be things like bacteria which would lead to infections,viruses or the flu, not too sure if the infamous 'man flu' would count here but regardless that's the job of this group of white blood cells in the body and the immune system.

As by consensus MS is deemed an autoimmune condition by the this simply meaning the immune system is attacking the body it is in. It is thought that WBCs wrongly cross the blood brain barrier ( where the central nervous system is - the brain and spinal cord-  in the body) which is somewhere they are not really meant to be. Seeing many nerve cells which are 'foreign' to them as thinking back to school days, normal cells are a lot more simpler than nerve cells so the WBCs pretty much wage war and thus attack these cells, whichever of the billions that they may encounter, attacking the myelin sheath thus slowing or stopping signals that would've been sent across that specific nerve.

It being classified as an autoimmune condition has opened up the door to many conspiracies about things that cause these such conditions, from a reaction to gluten consumed, mercury in teeth fillings, genetically modified foods orvaccines given at their respective moments in our lifespan. Just to point, I'm on the fence with this, neither promoting or ridiculing any of these suggestions that have been or are being made!

I don't think the science would stop with me but I'll try not to cause an overload, have fun with this weeks one!

The nature of the nerve.

So yes I'm back, had an unfortunate passing in the family which kept me away.

So let's get started with the nerve, what does it do and how does it work? Well to make it easy, take the example of somebody touching you, that initiates a signal ( known as an action potential) from the sensory neurons, going to the brain via the spine then a response ( the realisation that someone touched me!).

In our body there are nerves which are myelinated ( the fatty layering around the nerves) and non- myelinated ( obviously, no myelin). This speeds up the signal in large quantities, like an formula one car to a baby crawling. A human body would naturally have these where needed.

When the myelin is damaged, it becomes the root of all the symptoms experienced with such neurological disorders like MS. Thinking of it to be like a electric cable, the rubber coating being the myelin and the copper beneath being the nerve fiber(s) where the signals are transferred. When the signals can't travel properly a 'short charge' would occur and the signals may jump to the wrong nerves just like a charge would transfer current to anything nearby that conducts electricity, and If the damage is to an extent the nerve cell is completely dead then as you'd expect nothing is registered or picked up so it is pretty much left like a vegetable.

Now as MS affects the brain and spinal cord, the nerves damaged are the ones based there which would be responsible for transferring messages to the 'peripheral' nerves leading to normal bodily responses.

I like to see a body with MS a bit like a game of minecraft by someone who wouldn't know how to play it, so metaphorically speaking, bombs sites all over the nervous system which are expected to worsen over time.

How this is all thought to happen we will wait till this science lesson is digested!