Ask the Doctor

Q: I am not able to undergo an MRI because of my claustrophobia. I have tried a variety of sedatives which haven't worked. My doctor won't allow me to go totally under anesthesia, but I don't know why I couldn't do this. What options are available that you would suggest?

A: When doctors recommend a test (or treatment), they must weigh two issues: the potential benefits versus the potential risks. What are the benefits and risks of an MRI? While the MRI has been very helpful in diagnosing of MS, its role as a "routine" test to follow the progress of the disease is not uniformly accepted. In fact, one group of MRI and MS experts did not recommend "routine" MRI's for MS patients. Therefore, ordering an MRI may not be indicated unless the doctor is considering a change in treatment and MRI results would influence that decision.

Since the value of a "routine" MRI is not fully established, what are the risks? While the risks of an MRI are minimal, the risks associated with anesthesia are worrisome. Some MS patients do not tolerate anesthesia well. Therefore, why expose the patient to the risk of anesthesia unless the test results are going to be extremely valuable? Apparently, your doctor may not feel that the potential MRI value warrants your risk of anesthesia.

What are your options? An "open" MRI, which does not require being placed "in a tube," is an option. However, the MRI results from "open" MRI's are not as detailed as the regular MRI results. Therefore, the limited value of "routine open MRI" may not justify the test.

In my experience, sedatives are helpful in reducing anxiety caused by claustrophobia. I recommend that you have another discussion with your doctor (maybe in conjunction with an anesthesiologist), to assess the potential value of the MRI and the risks of anesthesia. The result may be another sedative that you have not yet tried (versus anesthesia) if your doctor believes that an MRI is crucial to your care.

Q: I was diagnosed with MS 13 years ago. Five years later, I suddenly developed severe allergies, mainly to food, that result in the itching of my eyelids; itching, swelling and welts all over my face and now my chest; as well as itching and peeling of skin on my fingers to the point that they bleed. After seeing many specialists, none can determine the cause or cure. Can this be related to MS?

A: Multiple sclerosis does not "cause" allergies. However, MS and allergies, are both autoimmune diseases and people with one autoimmunity are at greater risk for a second autoimmune disease. As you have discovered, food allergies are a common cause of skin reactions. I assume that you have consulted an allergy specialist and discontinued any of the foods that could aggravate your condition, and that you continue to monitor any other foods for possible reactions.

Environmental triggers are also common, and these may include pets, plants, molds, dust, laundry detergents, and soaps, to name a few. Through lab work (skin or blood-sensitivity tests) and sometimes testing each item separately (by removing and then bringing back the potential allergen), individuals suffering from these types of allergies need to make whatever modifications necessary to limit their exposure to such allergens.

Medications can also cause allergic reactions in certain individuals. These include both the disease-modifying treatments for MS, as well as medications used to treat the different symptoms of MS. If your physician suspects that medications may be the cause, he or she may have you stop and later restart each drug (if needed) to see if any are causing the reaction. Please note that any changes to one's treatment regimen should only be done under the advice and supervision of his or her doctor.

Lastly, when I evaluate MS patients with skin allergies, I test for systemic lupus erythematosus (lupus), especially in women. Blood tests can usually diagnose lupus, which can mimic MS symptoms.

Jack Burks, MD, is a neurologist who specializes in MS. He is vice president & chief medical officer for MSAA, as well as president of the Multiple Sclerosis Alliance. Additionally, Dr. Burks is a clinical professor of medicine in neurology at the University of Nevada School of Medicine in Reno, Nevada, and a member of the Medical Advisory Board of the National MS Society. He has edited two textbooks on MS, and in the 1970s, Dr. Burks established the Rocky Mountain MS Center in Colorado, one of the nation's first comprehensive MS centers.

To Submit Questions to Ask the Doctor

Many of these questions were submitted by readers. If you have a question that you would like to ask, please submit your question to:

MSAA
Questions for Ask the Doctor
Attn: Andrea Borkowski
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Cherry Hill, New Jersey 08002

Readers may also send in questions via email to aborkowski@msaa.com. Please be sure to write "Ask the Doctor" in the subject line.

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