Buddy has been a source of strength to Mrs. Romney and helped her recover as she was in remission from MS. We wish him the best of luck in London.

Katerina Trinko has a nice article today at NRO about Ann Romney’s battle with Multiple Sclerosis. She writes:

Looking back, Romney views the Utah sojourn with gratitude. It was one of “the greatest blessings in our life,” she says. Moving to Utah “was the best decision I ever made . . . because during those three years, I completely regained my strength, went into remission with MS, [and] had this enormous love of horses renew my soul.”

Ms. Trinko’s article nicely illustrates a family that, when faced with a chronic illness, rises to the occasion and rallies around the family member.

Dr. J., not the most touchy, nor the most feely of the Gormogons (that would be The Czar and Puter, respectively), is here to discuss Multiple Sclerosis with you, so that you may better understand this frustrating and challenging neurologic disorder.

Multiple sclerosis (there are actually a few flavors, but Dr. J. will lump them together for simplicity) is a disorder where the immune system attacks the myelin sheaths that surround the axons of nerves in the central nervous system. Not all nerves have myelin sheaths. The purpose of myelin sheaths is to act as insulation for axons, allowing for faster electrical impulses down long axons with a minimum of signal degradation.

From www.ms-symptoms.net – These are pictures of myelinated neurons with and without MS. Below the nerves is the conduction velocity and amplitude of said neurons. You can see without myelin, the nerve impulses are slower and weaker.

MS is a tough disease to diagnose because symptoms can be separated in space (parts of the nervous system that are nowhere near each other) and time (your right big toe goes numb today lasting a week, your left arm is weak 3 months from now lasting a day, your speech is slurred 4 months from that lasting hours). So it takes an astute clinician and a two separate parts of the body affected to for the disease to be suspected. A lumbar puncture demonstrating ‘oligoclonal bands’ of protein on protein electrophoresis, or an MRI demonstrating two separate demyelinating plaques somewhere in the brain and/or spinal cord can confirm the diagnosis.

Symptoms can come and go, might never be the same thing twice, or may persist. The weakness caused by an attack may last until physical therapy can help bring the strength.

There are a number of therapies available to help with the disease:

• Steroids – which suppress the immune system is used for acute attacks.
• Plasmapheresis – where you dialyze off immunoglobulins sometimes helps in attacks as well.
• Copaxone – an amino acid polymer which is made up of amino acids that are a part of myelin basic protein can prevent relapses.
• Interferon Beta-1a – a recombinant cytokine is useful but has side effects.
• Mitoxanthrone – an anthracycline chemotherapeutic (typically used for leukemia) is an option with significant side effects.
• Natalizumab – a monoclonal antibody that targets a cell surface molecule, but can increase risk of PML, a neurological disorder caused by an opportunistic infection due to immunosuppression.

Nevertheless, this disease can be debilitating, but because it comes and goes, with clean living and careful management, individuals can live very productive and otherwise healthy lives while they are in remission.

Dr. J. wishes Mrs. Romney nothing but the best of luck in the future with this disease, and admires the grace and strength with which she and her family have battled it together.

Dr. J.