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Health Matters: Evolving outlook for multiple sclerosis

Q. My sister was just diagnosed with multiple sclerosis. What can you tell me about this condition and her outlook?

A. Multiple sclerosis (MS) is a disease of the brain and spinal cord—what we call the central nervous system or CNS—where the body's immune system actually attacks some of the cells in the CNS. As the name implies, MS typically involves multiple locations in the brain over multiple time periods. Accordingly, symptoms typically wax and wane over time. Common symptoms include visual problems (due to involvement of the nerve going to the eye), weakness or problems with sensation in the extremities, double vision, and trouble with gait. The good news is that symptoms typically improve—at least for a while—after a few days or weeks. The bad news is that the disease typically is progressive starting 10 or 20 years after onset, and it is typical for long-term sufferers to end up in a wheelchair. Fifteen different medications are available to treat MS, and they may help reduce the severity and frequency of symptomatic flairs. And there is increasing enthusiasm for a treatment plan involving the transplantation of human stem cells, although only a small number of patients have been treated in this manner so far. However, the disease itself currently is incurable. The cause of MS is unknown, and for unclear reasons, three-quarters of MS patients are female. Many scientists are working hard to develop better treatments for this debilitating disease, and I would tell your sister that the future now looks brighter than it has before, with the likelihood of major scientific advances on the horizon.

Q. I have struggled with weight problems for as long as I can remember. Is there anything new to try?

A. As we've discussed in prior columns, obesity is a major problem in North Dakota and throughout the U.S. It is associated with high blood pressure, diabetes, and cardiovascular problems, leading to disability and an increased risk of death. It is affecting more people, leading to talk of an obesity "epidemic." While there are many reasons for the obesity problem, one important factor is the change in eating habits that has occurred over the past few decades. One habit that is especially problematic from the standpoint of obesity is the fast food fad, which is a diet rich in calories, fats, and salt. A variety of approaches (often used in combination) can result in weight loss, including special diets, medications, exercise programs, counseling, and even surgery. In fact, the combination of diet, exercise, and counseling/group support is probably the most effective approach short of bariatric surgery. And for those who cannot lose weight by diet and exercise, and who qualify, bariatric surgery can be life-changing and has proven durable benefits for most patients. But the bottom line is that consistently reducing caloric intake is perhaps the most effective way to achieve long-term sustained weight loss. For example, reducing one's daily caloric intake by only 500 calories per day will result in about a one pound weight loss over the course of a week, all other things being equal. The challenge is convincing individuals to do this, and to do so consistently.

Wynne is vice president for health affairs at UND, dean of the university's School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 1301 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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