Pain with eye movement typically occurs before or during vision loss or other symptoms, which tend to worsen for several days before improving.

“As an MS symptom, visual impairment is usually temporary and can be worsened by stress, fatigue, infection, certain medications or an increase in temperature,” said Jocelyn H. McGuire, APRN, a nurse practitioner at the Norton Neuroscience Institute Hussung Family Multiple Sclerosis Center. “Managing these external factors may improve the associated visual symptoms.”

How MS causes vision impairment

MS is an autoimmune disease that causes the body to mistakenly attack myelin, an insulating coating around nerves in the central nervous system, including the optic nerve. The brain itself and spinal cord also have myelin coating nerves.

Visual information is transmitted along the optic nerve to the brain. When myelin is damaged, inflammation results, and nerve signals from the eyes can be altered or stopped completely, causing vision loss.

Optic neuritis is often the first symptom of MS, but the condition alone does not necessarily mean someone has or will develop MS. Other potential causes of optic neuritis include other neuroimmune disorders like neuromyelitis optica spectrum disorder or MOG antibody disease as well as cytomegalovirus, Lyme disease and herpes. Optic neuritis affects about 70% of people with MS at some point in their lives. Most with optic neuritis experience a full or partial recovery of vision in four to 12 weeks.

Double vision and involuntary eye movement

MS also can result in other eye symptoms, including double vision (diplopia) and shaking or involuntary eye movement (nystagmus).

Unlike optic neuritis, which affects the optic nerve, MS damage in the brain causes double vision and involuntary eye movement. Diplopia results from weakness in the muscles controlling the eyes, causing double vision as the eyes move out of sync. Nystagmus causes a lack of muscle control.

So-called floaters, specks or spots that appear to float in front of everything, are another symptom common in MS patients, but MS may not be the cause. These appear during the normal course of aging when tiny strands of the gel-like fluid in the eyes stick together and cast a shadow on the retina at the back of the eye.

If floaters appear suddenly or are accompanied by light flashes or vision loss, they may signal an emergency that requires immediate attention from an eye specialist.

With MS eye symptoms, simply waiting for the inflammation to go down can be enough, especially if the symptoms occur as part of a relapse of the disease. For more severe attacks, a doctor may prescribe steroid treatments. Disease-modifying therapies can be used to address multiple sclerosis as a whole, including visual issues. An eye patch or yellow lenses also can help people cope with visual changes.

Because MS symptoms vary so much between individuals, everyone will experience vision issues differently. Those with MS should have regular evaluations by an ophthalmologist.

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MS is an autoimmune disease. The body’s immune system mistakenly attacks the myelin sheaths that surround and protect nerves. Symptoms include numbness, tingling, blindness and paralysis. The symptoms of MS range from very mild to severe and vary from person to person. There is virtually no way to predict the progression of MS, and there is no known cure.

What is Epstein-Barr virus?

According to the Centers for Disease Control and Prevention, EBV is one of the most common human viruses in the world. Spread through saliva, EBV can cause other infections, such as mononucleosis (mono). EBV often is spread among children and young adults, since it is easily passed from person to person and often has no symptoms.

Children are often infected with EBV with no symptoms, or symptoms that resemble any mild childhood illness.

How is EBV linked to MS?

“This is one of the more promising discoveries linking the two diseases,” said Geeta A. Ganesh, M.D., MPH, neurologist with Norton Neuroscience Institute Hussung Family Multiple Sclerosis Center. “Other viruses have been studied, but EBV seems to have the strongest prevalence associated with MS.”

MS has been associated with people who’ve had mono, which is caused by EBV. A 2007 study found that risk of MS can increase soon after a mono infection and persist for at least 30 years.

Indeed, the more recent study suggesting EBV as the leading cause of MS found that people infected with EBV were 32 times as likely to develop MS as those who hadn’t been infected. Other viruses, including a very similar virus, did not increase the risk of MS.

The study found that as many as a quarter of MS patients have antibodies that latch on to a protein from EBV as well as a protein in the myelin sheaths. Essentially, the immune system attacks the EBV, but mistakes the similar protein in myelin and winds up attacking that as well.

Having EBV itself isn’t enough to trigger MS. The virus is thought to work in conjunction with certain genetic factors.

Which types of MS are associated with an Epstein-Barr virus infection?

While the discovery clears up some of the mystery around the cause of MS, there are still many questions. It is not known if EBV causes relapses or affects the progression of MS. Though EBV is a trigger, MS is fueled by a combination of genetics, environment and other factors. Research has yet to establish a link between EBV and any particular type of MS.

More encouraging news lies in the potential of an EBV vaccine that would prevent the disease and possibly could protect those who already have a higher risk for MS. That includes people whose close family members have MS.

There are about 200 genes that each add to the risk of developing MS. In identical twins, if one twin develops MS, the chances of the other twin getting the disease is about 1 in 4. The risk of developing MS in the general population is about 1 in 334.

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Signs of MS

“MS mimics many other less serious conditions,” said Jocelyn H. McGuire, APRN, nurse practitioner with Norton Neuroscience Institute. “It’s one of the reasons MS is difficult to diagnose. The symptoms of MS vary from person to person, vary in intensity and make it tricky to diagnose sometimes.”

MS can appear anytime in someone’s life, though it is most often diagnosed between the ages of 20 and 50. Specialists believe symptoms go on for years before they get bad enough for someone to seek and receive a diagnosis.

Symptoms of MS include, but are not limited to:

• Fatigue: The most commonly reported and persistent sign of MS is feeling tired without exertion or lack of sleep. 
• Dysesthesias: This refers to a group of symptoms related to feelings in the body such as numbness, tingling, burning or sensitivity to touch.
• Tremors: Many MS patients report shaking in the limbs, and sometimes the head. 
• Vision issues: Eye pain and partial vision loss are common symptoms of MS.

Risk factors for MS

“We don’t know exactly what causes MS, and anyone can get MS, regardless of age, sex or race,” Jocelyn said. “There are a few possible factors that increase someone’s risk.”

These include:

• Genetics: While MS is not passed from parents to their biological children, 1 in 5 MS patients have people in their family with MS.
• Infection history: There is a strong correlation between a history with certain viruses and the onset of MS. For instance, Epstein-Barr virus (EBV) is the cause of mononucleosis (mono). EBV raises your risk for developing MS by more than 30 times.
• Certain environmental and lifestyle factors: Geography, low vitamin D levels in the body, smoking status and obesity all may contribute to the development of MS.

Getting help for MS

There are many resources to support MS patients and their families in the Louisville area. Norton Neuroscience Institute Resource Centers focus on bridging the gap between managing care and improving quality of life. The team at the resource centers provides educational, therapeutic, support and exercise programs, and can assist patients with:

• Access to medical care
• Social Security Disability Insurance resources
• Nutritional counseling
• Financial challenges
• Referrals to community resources and home health agencies

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I still remember his words: “The good news is that I didn’t see any signs of cancer. No polyps or anything like that. But I’ve been doing this for over 20 years, and I don’t know what I’ve just seen. I took a couple of biopsies.”

I left the surgical center with some pictures and a lot of questions. 

It took doctors just 10 days to determine this 50-year-old man had both lymphoma and leukemia — on top of my already diagnosed multiple sclerosis (MS). 

These days, we sometimes hear how “broken” the American health care system is. But the truth is that you have scores of victories at Norton Healthcare every day. I know because I’m one of them. And I didn’t have to leave Kentucky to receive this superior care.

My story began in January 2017 when I entered Norton Brownsboro Hospital’s emergency department with “stroke-like” symptoms. Through testing and the expertise of your physicians, I was diagnosed with multiple sclerosis and have been a patient of Norton Neuroscience Institute neurologist Geeta A. Ganesh, M.D., MPH, ever since. 

The next two years were challenging as I worked to recover from that episode. Unbeknownst to us all, a more sinister condition was developing inside my body. And by early 2019, I was nearly incapacitated with gastrointestinal problems that I was convinced were rare symptoms of MS. Only through Dr. Ganesh’s advice and care was I put on a path to ultimate healing.

Dr. Evans, who is now with Norton Gastroenterology Consultants of Louisville, referred me to Terence Hadley, M.D., who has since retired as an oncologist from Norton Cancer Institute. He diagnosed me with small B-cell lymphoma and chronic lymphocytic leukemia. While both of these diagnoses are sadly quite common, my particular case was anything but that. Dr. Hadley informed us of the rarity of my case and that it was a presentation he had never encountered in his career. He was able to find four documented similar cases. Sadly, none of those four had survived. 

Only through his intelligence, compassion, curiosity, persistence and humility am I here today to share this remarkable story. My case was presented to the tumor board. The consensus was that demographically I was a candidate for the standard treatment. But Dr. Hadley thoroughly understood my prognosis. He did not believe I would survive the rigors of that treatment. Though my condition was “unstageable,” and a suitable course of treatment was not immediately apparent, he was determined to find the best path forward. My family and I had full faith in his ability, but the following six weeks were torturous. Mentally and psychologically, I was preparing to die. I am one of the most optimistic people you might encounter. I had even told Dr. Hadley that I would not enter treatment if the treatment itself would kill me.

At his retirement, Dr. Hadley referred me to Khuda D. Khan, M.D., a hematologist and medical oncologist with Norton Cancer Institute. Dr. Khan knew the complicated nature of my case, and it demanded his expertise and care. It was a seamless transition. I am proud to share with you that I am in remission today. 

So many patients seek the expertise of nationally renowned hospitals and centers of excellence, and rightfully so. But I have received superior care right here at Norton Healthcare and in the comfort of my hometown with my family, friends and loved ones by my side. At every juncture, I have been treated as a person with dignity and as an equal partner in discerning the best path. 

We often hear stories of miracles in this world, but I truly believe the care, the science and the doctors and staff that have provided me with such excellent care are miracles in and of themselves. My hope is that my story will stand as a testament to the world-class care that Norton Healthcare provides.

Before my retirement, I spent my career working in higher education and nonprofit fundraising. In that time, I learned that organizations that can most clearly and concisely tell the stories of how their mission is making a difference in this world are the most successful and effective. I am a firm believer in a principle that guided the late Ed Sabol, founder of NFL Films: “Tell me a fact, and I will learn … tell me a truth and I will believe, tell me a story and it will live in my heart forever.”

My hope is that my miraculous story will provide hope, knowledge, and awareness for other patients and for Norton Healthcare.Mike Goetz, who works in collegiate athletics, lives in Louisville.

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Bladder issues and MS

MS prevents the brain and muscles from communicating normally. The muscles of the human urinary tract can be affected by MS, resulting in incontinence (inability to hold urine), difficulty fully emptying the bladder and frequent need or urgency to urinate.

What can I do about bladder issues if I have MS?

There are some medications available for some bladder issues. There are also many lifestyle interventions and techniques you can try:

• Limit bladder irritants including coffee, tea, citrus juice, caffeine and alcohol.
• Practice pelvic floor exercises either at home or with a physical therapist.
• Restrict fluids two hours before bed.
• Drink enough water that urine is a pale yellow color or almost clear.
• Timed voids: Urinate every two hours while awake.

RELATED: Hormone replacement therapy is different from over-the-counter supplementation

Sexual issues and MS

Sexual dysfunction comes from a variety of sources. Neurological issues include erectile dysfunction, decreased libido, difficulty reaching orgasm and premature/delayed ejaculation. MS symptoms can affect a patient with fatigue, muscle spasms, and bladder/bowel control issues. Another kind of sexual dysfunction deals with body image and one’s perceptions of one’s body, as well as changes in one’s roles between partners.

What can I do about sexual dysfunction if I have MS?

Depending on the source of the dysfunction, there are many ways to address sexual issues in MS patients, including:

• Medication — either starting or stopping medicines that affect your symptoms
• Tools such as lubricants, vibrators or other methods
• Cognitive behavioral therapy, couples counseling or other method of “talk” therapy
• Managing MS symptoms — for example, taking medications to reduce muscle cramps

The most important step to take is talking to your doctor.

For sexual dysfunction, you could answer this questionnaire and give it to your doctor as a starting point for a conversation.

The post Managing bladder and sexual health with MS appeared first on Norton Healthcare.

“I didn’t know what it was. I didn’t know anything about it,” Pat said. “I started having issues. MS started saying, ‘Hey, I’m here.’ Next thing you know, I’m in rehab.”

Eventually Pat, who coached youth football for decades, found himself needing a wheelchair or mobility scooter just to get around. When a person has MS, the immune system causes communication issues between the brain and the rest of the body.

While medication can help, doctors also recommend people living with MS practice a healthy lifestyle.

“People living with MS can consider physical activity and diet as another kind of medicine,” said Geeta A. Ganesh, M.D., neurologist and MS specialist with Norton Neuroscience Institute. “Wellness is essential to modifying the disease course, treating relapses, managing symptoms and promoting safety and independence.”

Pat was motivated to improve his health, so he started physical therapy at Norton Healthcare last fall. By that time, he could barely get out of his chair.

“Fatigue doesn’t even do it justice on how tired you are,” Pat said. “You can’t even raise your arm.”

Putting in the work and getting results

When physical therapist Abby Scinta first saw Pat at the specialty rehabilitation center, she knew there was a lot of work to do. She also quickly realized Pat was willing to put in the effort.

“The more I worked with him, the more I knew how hard he worked at home; then I raised my expectations a little bit,” Abby said.

For months, Pat and Abby worked together. The therapy was difficult, but they quickly saw improvement. In fact, Pat had a goal. He wanted to walk a 5-kilometer (3.1-mile) event.

“I felt if I worked hard enough, I could make it happen,” Pat said.

It wasn’t easy. When Pat started training at the Big Four Bridge in downtown Louisville, he could do only a portion of the walking bridge. But he kept coming back, and eventually willed his way to doing the entire bridge.

The training culminated in his first 5K in April 2022, just six months after beginning therapy.

He even took the medal he received from the 5K to his next therapy appointment to show Abby.

“I probably didn’t think he would be doing 5Ks within six months,” Abby said. “But it shows Pat’s determination and his desire to put in the work.”

“Everybody has to find their why,” he said. “Why do you do something? Why, why am I doing it? Because I like to stand up. I like to walk. I like to go.”

Though Pat will have to continue living with MS, his efforts in physical therapy and exercising at home have helped him reclaim independence. He continues to walk regularly is and hoping to get back into coaching.

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MS is an autoimmune disease that causes the body to attack the central nervous system, damaging or destroying the myelin tissue around the nerve fibers. Depending on where MS strikes, the symptoms can vary widely.

No one knows what triggers MS, although it is likely the product of several factors including genetics and exposure to certain viruses and the environment. There is no known cure for MS. Treatment focuses on easing symptoms during a relapse, addressing the disease itself and rehabilitation therapy to better manage symptoms.

MS is a complex disease. While MS sometimes can be seen in the form of lesions on the myelin that surrounds nerves, the diagnostic process can be lengthy and may require eliminating other possible conditions.

Early symptoms of MS

Norton Neuroscience Institute patients tend to show the following early symptoms of MS:

• Dizziness or the feeling of being off balance
• Intermittent numbness or weakness in the feet, one whole side of the body, or legs
• Optic neuritis, inability to gauge distance, and double vision
• Changes in sensitivity to heat or cold
• Slurred speech or stroke-like symptoms such as slackness or paralysis on one side of the face or body

Approximately 1 miliion people are living with Multiple Sclerosis in the US,  and MS is as much as three times more common in women than men.

Diagnosing MS

When a patient develops early symptoms of MS, diagnosis isn’t as simple as a blood test. The complexity of the disease requires MS clinic experience and training to pinpoint the condition.

“Since this disease is so variable, we have to look at the whole person. The big picture, including past neurological symptoms,” said Jocelyn H. McGuire, APRN, a nurse practitioner and neurology specialist at Norton Neuroscience Institute. “Is it just numbness? Is it numbness and double vision? Are these symptoms consistent? What other medical conditions exist? We also do many tests, both to confirm an MS diagnosis and to rule out anything else.”

Tools in diagnosing MS based on early symptoms or a more progressed case of the disease include:

• Physical neurological exam
• MRI
• Spinal fluid evaluation
• Blood tests
• Family health history

“It can be a frustrating process,” Jocelyn said. “There are so many different tests, and sometimes the symptoms come and go so unpredictably; it might take several months and several specialists before we pinpoint the real illness.”

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Every MS patient’s triggers are going to be different. Understanding what can cause your MS to worsen will help you and your health care provider devise strategies to avoid setting off a flare-up.

“Multiple sclerosis can be an overwhelming disease to live with. Taking care of your whole self can help you live your best life,” said Jocelyn H. McGuire, APRN, a nurse practitioner at the Norton Neuroscience Institute Hussung Family Multiple Sclerosis Center.

The top five things not to neglect if you have MS are:

• Heart disease
• Obesity
• Smoking
• Age-appropriate cancer and other screenings
• Mental health

Cardiovascular risk, which includes high blood pressure, high cholesterol, diabetes and obesity, is linked to higher risks of relapse and disability progression. There also may be a link between cardiovascular risk and brain function.

Obesity itself can contribute to worsening MS symptoms and disability. One study found that excessive weight can contribute to worsening inflammation, fitness, and increase fatigue and depression.

Smoking can increase neuroinflammation and demyelination. It also can increase the likelihood of developing secondary progressive MS, a shorter time to transitioning to secondary progressive MS, and a higher disability score and disability progression. Finally, some MS treatments may not work as well in smokers, compared with nonsmokers.

For patients with MS, it’s important to continue to see a primary care provider at least once a year to make sure you have completed age-appropriate screenings for diabetes, hypertension, cancer and other health conditions, according to Jocelyn.

Your primary care provider can oversee the management of other diseases and health conditions, such as heart disease, diabetes, high blood pressure, thyroid disorder, depression and anxiety.

People with MS are more likely to experience depression and anxiety. Symptoms of depression, such as fatigue, decreased activity and mental changes, can overlap with symptoms of MS, which can make it hard to tell the difference between the two, according to Jocelyn.

Jocelyn lists five key components to wellness:

• Healthy food choices
• Exercise
• Not smoking
• Attending to mental, emotional and spiritual health
• Addressing other health conditions

Small changes can reduce MS triggers and have a significant impact on your overall health, according to Jocelyn.

For example, to improve your diet you could swap one sugary drink a day with water, or choose whole wheat bread or pasta, or brown rice, or eat a sweet potato rather than a regular baked potato.

To improve your physical activity, you could walk a little each day, gradually adding more as you are able. You could attend a yoga, tai chi or aquatics class offered through the Norton Neuroscience Institute Resource Center, or you can meet with a physical therapist to learn a strengthening or stretching program.

If you’re ready to quit smoking, you can discuss methods of quitting with your primary care provider or MS specialist. Norton Prevention & Wellness offers a free smoking cessation course.

Addressing mental, emotional or spiritual health can relieve MS triggers. Deep breathing exercises, meeting with a clinical psychologist or talking with a spiritual or religious leader can help.

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That’s why Andrea Rogers, R.N., BSN, is the multiple sclerosis nurse navigator at Norton Neuroscience Institute Resource Center.

She educates MS patients and helps them find MS clinic care and the resources they need.

“I just want to be able to make a difference in somebody’s life and make their journey a little bit easier,” said Andrea, who joined the three physicians, a dedicated pharmacist and two nurse practitioners on the multiple sclerosis team at Norton Neuroscience Institute in October 2021.

According to Andrea, people newly diagnosed with MS are often anxious. The news can be upsetting. To help the patients, Andrea hosts MS 101, a virtual, on-demand program that covers the basics of MS: where it comes from, why it happens, how it impacts people’s lives and what can be done about it.

Education that includes medication advice

In addition to educating newly diagnosed patients about the disease, Andrea helps relapsing, remitting and primary progressive MS patients decide which of the 24 MS medications now approved is best for them.

Usually, according to Andrea, they will choose among the two or three medications the doctor has decided will work best with the patient’s disease, considering the side effects and how they might impact that person’s life.

Each of the medications is a little different in how it is administered, how effective it is, how well it is tolerated by the patient and how much it costs. If the drug’s cost is an issue for a patient, Andrea will work with drug companies and other resources to try to find financial assistance.

Help living with MS

Because MS medications suppress the immune system, Andrea also works with patients on when they should get vaccines and on other issues related to medications. And she coaches

patients on how to cope with MS fatigue and other symptoms when patients are having a flare-up.

“The big thing is knowing your limits and not pushing yourself too hard,” Andrea said.

For example, if someone needs to do laundry in the middle of a flare-up, they should pace themselves, taking a break between each step of the process. If they need to chop vegetables in the kitchen, they can sit, instead of standing. They also can delegate to other members of the household.

Andrea, who has lived in the Louisville area most of her life, has always been interested in science and medicine. She began college studying pre-med, but decided she wanted a position in health care that was more hands-on and switched to nursing.

She received her bachelor’s degree at Murray State University in Kentucky and is close to completing a Master of Science in nursing, executive leadership concentration, at Northern Kentucky University.

“I love learning. I’m all about personal growth,” Andrea said.

When she’s not working or studying, Andrea likes spending time at her Oldham County home with her 6-year-old daughter. She also likes gardening, cooking and hiking.

Before becoming the MS nurse navigator, Andrea worked with heart patients in the medical/surgical and cardiac progressive care units and in the neurological intensive care unit. She was also a clinical instructor at Bellarmine University.

As a nurse navigator, Andrea serves as the point person for patients when questions or concerns come up.

“If I can’t help them, I can at least point them in the right direction,” Andrea said.

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Wellness is essential to modifying the disease course, treating relapses, managing symptoms and promoting safety and independence.

People living with MS can consider physical activity and diet as another kind of medicine, said Geeta Ganesh, M.D., MPH, neurologist and MS specialist at Norton Neuroscience Institute.

Dr. Ganesh spoke at the 2020 Neuroscience Expo. The upcoming  2021 Neuroscience Expo will be held Oct. 22 and includes an MS track.

Physical wellness includes regular physical activity geared to individual abilities, weight control, MS care and primary care, according to Dr. Ganesh. Quitting smoking and limiting alcohol use also can help.

To understand how lifestyle can affect MS, the National MS Society brought together a group of experts in the fields of MS, exercise, rehabilitation and physical activity.

The group came up with recommendations for those living with MS, including at least 150 minutes per week of exercise or physical activity — 30 minutes a day, five days a week. This can be broken up into smaller blocks of time throughout the day.

People with MS should set goals with their health care provider. If disability increases and physical activity becomes more challenging, the goals should be reevaluated. Some may need to work with exercise specialists trained in MS to ensure safety.

Once the goals are set, strive for gradual progress, based on abilities.

In addition to physical wellness, living with MS can include other aspects of wellness.

Wellness and living with MS

• Emotional wellness. Develop coping strategies to enhance problem-solving, manage stress and foster a positive outlook. Develop resilience in the face of unpredictable changes while paying attention to mood changes, including depression, that may require treatment.
• Occupational wellness. Engage in meaningful and rewarding activities that promote a sense of purpose and accomplishment, including opportunities to contribute one’s unique skills, talents and knowledge to others at home, at work or in the community.
• Spiritual wellness. Develop a worldview that provides a sense of peace and harmony, and enables you to cope and adapt throughout life with the ultimate goal of finding meaning and purpose in the face of personal challenges.
• Social wellness. Develop positive healthy relationships that nurture interconnectedness with family, friends and community. Promote active engagement in a social network of meaningful and rewarding friendships and intimate relationships.
• Intellectual cognitive wellness. Engage in mentally stimulating and challenging activities that lead to personal growth, enhanced creativity and new learning, while developing the ability to think objectively and independently.

Improving overall wellness can be challenging, and it’s important to seek out the assistance and encouragement of health care professionals, friends and family along the way.

Talk to those close to you about your goals and ask for their support as you seek to eat better, get exercise, stop smoking get out of the house more or whatever you want to change, according to Dr. Ganesh.

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