When the body’s immune system attacks its own tissues

Dear Doc,

What is multiple sclerosis?

Ali, Nairobi

Dear Ali,

Multiple sclerosis is a chronic condition affecting the brain and the spinal cord and can potentially cause disability. In multiple sclerosis (MS), the immune system attacks the protective lining (myelin) of the nerves and the nerves themselves, causing damage to the nerve cells and interfering with communication between the nerves and the rest of the body.

The symptoms of multiple sclerosis (MS) are different from person to person, depending on which nerves or which part of the brain or spinal cord is affected. Symptoms may include;

a) Fatigue. b) Pain. c) Dizziness. d) Weakness on one or both sides of the body

e) Numbness and or tingling sensations

f) Electric-shock sensations when moving the neck. g) Lack of coordination or unsteady gait when walking. h) Visual problems: blurred vision, double vision, reduced or complete loss of vision in one eye. i) Slurred speech. j) Heat intolerance

k) Muscle cramps and spasticity

l) Weakness and/or twitching of the facial muscles. m) Bladder and bowel dysfunction. n) Sexual dysfunction. o) Mood changes: depression, anxiety, bipolar disorder. p) Cognitive changes: poor concentration, memory, judgement and reduced attention span; dementia.

In addition to the symptoms being different from person to person, the course of the disease also varies. Most people have the relapsing-remitting type, where new symptoms develop over days or weeks then resolve partially or completely,  followed by a quiet period of disease remission for months or years. There are those who get the initial symptoms and the disease gradually progresses from there, with no remission. This is called primary progressive MS. Among those with the relapsing-remitting type, at some point the disease becomes progressive with no remissions, which is called secondary progressive MS. And among those with progressive disease, some may have instances of new symptoms developing, which is called progressive relapsing MS.

Multiple sclerosis develops when the body’s immune system decides to attack its own nerve cells, and there is no known cause for this. There are higher risks for developing MS for:

a) Females.

b) Those between age 20 to 40 years.

c) Those with certain genetics on chromosome 6p21.

d) Those with a family history of MS.

e) Those with vitamin D deficiency and reduced exposure to sunlight

f) Certain infections such as Epstein Barr Virus that causes mononucleosis

g) Those with other auto-immune disorders such as pernicious anaemia, thyroid disease, type 1 diabetes, psoriasis and inflammatory bowel disease

h) Those with obesity, especially females with obesity in childhood and adolescence.

In addition, smoking increases the chances of an initial episode becoming progressive instead of remitting.

Anyone with symptoms of MS should be followed by a doctor, preferably a neurologist. There are tests done to check for the presence of any other illnesses that can cause these symptoms, and an MRI scan may show the lesions where the myelin and nerves have been damaged. There is no cure for MS but there are treatments to slow the progression of disease, to reduce the severity of an attack and address specific symptoms.

Some measures to manage MS at home include eating a balanced diet, exposure to sunlight, getting adequate rest, appropriate exercise and stress relief. Any illness should be treated and high temperatures should be managed quickly since a rise in body temperatures can cause worsening of MS symptoms for some individuals. There is also a great need for psychological and social support, both because of the chronic and debilitating nature of the disease, and also because of the mental challenges that may be part of the illness. Enrolling in a support group and/or follow up by a mental health specialist would be beneficial.

Dear Doc,

I have been having pain when passing urine for the past week. Yesterday I noticed some blood in the urine. All this started after I had unprotected sex with a colleague after a party. Could she be the cause of this? What can I do? I’m embarrassed to go to hospital.

Jude

Dear Jude,

The pain when passing urine and blood in the urine most likely indicates that you have a urinary tract infection. It is very likely in your case, that this infection was sexually transmitted. It may be due to organisms like gonorrhoea, chlamydia, trichomonas, among others.

If it is not treated, initially the symptoms worsen, then they may actually reduce with time, though the infection is still present. The danger with this is that the infection can spread to the testicles and the rest of the reproductive tract and in the long run lead to infertility. The infection can also spread to the rest of the body, causing serious illness. Any time you have unprotected intercourse, you can spread the infection to your partner. In women, this can lead to infection in the reproductive tract and pelvic organs, and can also lead to fertility problems.

You need to see a doctor for examination immediately. A sample of the urine and any discharge will be taken for analysis and culture. You also need a Chlamydia test and, if possible, a HIV test. You will be given antibiotics to treat the infection, depending on the results. Abstain from sexual intercourse until you have completed treatment and you have been retested and found to be cured. Any partners you have had in the past three to six months also need to be treated, for their own health’s sake, and also to prevent re-infection to you.

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