“MS-itis”
My 3.5-year-old son recently came down with what I assume was gastroenteritis. No one likes gastroenteritis making its way into their home. There’s sick, and then there’s gastroenteritis. If there is anything that I truly hate doing as a parent, it is cleaning up vomit. I can’t see or smell vomit without feeling nauseous. After about a dozen loads of puke-covered laundry, a couple instances of being barfed on, and one particularly gnarly clean up of the bathroom, my little guy was feeling back to his usual cheerful self, but this Mama was about to experience a visit from “MS-itis”.
This picture was captured during the brief reprieve between when my little guy started to feel better and when I was plunged into the depths of the worst fatigue that I have ever experienced.
What is “MS-itis”? Well, first, it’s a made-up word that I am using to describe the unique experience of illness (all the various “itis-es”, e.g., gastroenteritis, bronchitis, laryngitis… you get the idea) that can occur for a person with MS. It’s also a lot of different things to a lot of different people, but for me it was extreme fatigue, headaches, body aches, and aching behind my left eye (the eye that has previously endured an attack of Optic Neuritis and never fully recovered). I am fortunate that I don’t ordinarily experience the notorious “MS fatigue” that many people living with MS experience on the daily. However, when illness makes its way into our lives, all bets are off. I literally slept for 21 hours of a 24-hour span of time. I kept waking still exhausted and wondering how it was possible that I was still tired after all that sleep. At one point, I got out of bed in order to transfer into storage containers some chicken broth that I had whipped together in the crock pot just before the fatigue struck me down. This wouldn’t ordinarily have been a big job, but I had to bring a chair into the kitchen and sit down several times to rest during this process. I didn’t want my broth to go to waste, so I powered through… barely.
My fatigue has finally subsided (as evidenced by my ability to even write this post). I’m still battling a headache and pain behind my left eye, but fortunately these symptoms also seem to be in retreat. Thankfully, I was able to take a day and a half of sick time off from work, and my husband stepped up to the plate in a big way to get our family through my period of extreme fatigue. My husband told me that he always knows when I really don’t feel well, because its one of the things that makes me cry. Yes, there were tears. I hate feeling useless.
So, what caused this flare up? First, it’s unlikely that it was an MS attack or relapse because it was short lived. I turned a corner after roughly 24 hours. The terms “attack” or “relapse” are usually used to refer to longer lasting symptoms, generally (though not always) coinciding with new lesions visible on MRI. Most MS attacks or relapses last from a few days to several weeks or even months. This is because inflammation doesn’t generally resolve quickly. Think of the last time you sprained your ankle. Was it all better the next day? Heck no! It was probably sore and swollen for days, or even weeks. That’s because localized inflammation usually takes days or longer to resolve. That’s true whether the inflammation is in your brain or in your ankle. The terms “pseudo-relapse” or “pseudo-flare” are often applied to the more transient symptoms that people with MS tend to experience. These pseudo-flares can often be connected to environmental triggers. What I believe was a pseudo-flare coincided with exposure to a virus and exposure to a stressful situation (my little guy being sick). These are environmental triggers that can cause both true attacks and pseudo-flares.
When the body is fighting an infection, it activates the immune system. In the setting of MS, the immune system is prone to “friendly fire”, attacking the myelin sheath that surrounds nerve axons in the Central Nervous System (CNS), leading to inflammation and damage to the nerves. When the immune system is activated to fight an infection, it may also attack the myelin sheath, leading to a worsening of MS symptoms. Basically, people living with MS have hyperactive and confused immune systems. Additionally, when the body is fighting an infection, it releases certain chemicals, such as cytokines and chemokines, which can promote an inflammatory state. These chemicals can cross the blood-brain barrier and enter the CNS, where they can contribute to MS-related inflammation and damage. In addition, getting sick can cause a general increase in stress on the body, which can itself exacerbate MS symptoms.
The relationship between stress and MS is complex, but stress is thought to play a role in triggering and/or exacerbating MS symptoms. One theory is that stress causes an increase in the body's production of certain hormones, such as cortisol and adrenaline. These hormones can activate immune cells that are involved in inflammation, as well as the destruction of the myelin sheath surrounding nerve axons in the CNS. Another theory is that stress can trigger a temporary worsening of MS symptoms by affecting the ability of nerves to conduct electrical impulses. This may occur because stress causes a release of certain chemicals that interfere with nerve function. It is also possible that stress does not directly trigger MS symptoms, but instead exacerbates existing symptoms, making them more pronounced.
Given that I started to see relief from these symptoms after just 24 hours, this was likely a temporary exacerbation or pseudo-flare, and not an MS attack. My neurologist has instructed me to report any new symptoms that last longer than 48 hours immediately, and to track any symptoms that appear for shorter time periods in an MS journal that we can review during our regular visits. This one is getting logged in my journal.
Not all illnesses will trigger MS attacks or pseudo-flares. However, it is generally recommended that people with MS take steps to avoid illness, including practicing good hygiene and getting vaccinated against preventable illnesses. This is thought to minimize the risk of MS attacks and pseudo-flares. Having just experienced a likely pseudo-flare, I will definitely be continuing my efforts to avoid illness, because being bed-ridden for 24 hours is not a good time.
