Tuesday, 21 October 2014

The paralysed man walks again

An ode to the helpful MSer

Another new blogger – as a junior doctor with an interest in MS, my time with TeamG is predominantly spent researching new treatments and teaching medical students. This post is about the latter…

How many of you are regularly accosted by medical students when in clinics or hospital? Or have had a doctor like me rush round apologetically but no doubt somewhat intrusively asking “I understand you have MS – would you mind if some students came and examined you?”  

I often feel guilty when doing this as I am sure that for many of you it is not top of your wish list, hence I’m writing this to thank those of you that help out, encourage those of you who would rather not to speak up, and give you some insight from the students perspective. Any comments on your experiences would be much appreciated and will help to try and improve the situation for everyone.

At Bart’s, students only get two weeks out of a 5 year course studying neurology and neurosurgery – no time at all! Much of this is spent in lectures, hence it is not unreasonable to think that these doctors-to-be might only meet a couple of patients with MS during their whole course. Furthermore, it is well known that neurology is generally seen as a rather obscure and complicated subject that students are often inclined to shy away from.

Besides the obvious importance of increasing awareness of the condition, people with MS are often able to teach students much more than many other patients that they come across – as a group, my experience of MSers is that they are often younger and better informed about their condition than your average patient, and hence better able to impart this knowledge onto the students.

In addition to this, however, any chronic condition such as MS that involves regular clinic visits or trips to a teaching hospital can understandably lead rather quickly to “student fatigue” – the sight of yet another nervous group of 20-somethings, proudly sporting their new stethoscopes and eager to attack you with a tendon hammer may no doubt be a rather unpleasant prospect… (An under-reported risk factor of tysabri – when hooked up to a drip once a month you have a limited ability to escape the gaggle...) 

When you next find yourself in such a position, please therefore remember the following:

  1. Number 1 for a reason – please tell us to go away if you don’t want to see students! No excuse needed, and it certainly will not affect your treatment.
  2. In addition to the above, please also say if you would rather not be put through a full examination – I’m sure this can be tiresome (especially if it’s not for the first time that day…). A lot of the time if you are just happy to let the students ask you a few questions about your condition they will learn more than they would have done with a tendon hammer.
  3. Please do tell the student (and the teaching doctor) afterwards where they could improve – you will often be much more experienced than the students! This is especially important if you found anything uncomfortable.
  4. If you are kindly letting students talk to or examine you, try not to tell them that you have MS – it is really useful to make them try and work it out for themselves based upon what you tell them (and as a bonus you get to watch them squirm when they can’t work it out)
  5. Agreeing to be examined only on the condition that the students/doctor go and make you a cup of tea immediately afterwards is entirely acceptable – by that stage you probably deserve it.

It is just over 4 years since I first met an person with MS as a student. I can still remember it very clearly, and I’m sure their willingness to be interrupted by the likes of me had a significant contribution as to why I am pursuing a career in neurology now. 

A simple conclusion is therefore that we are very grateful to those of you who are able to help contribute to teaching medical students, and that this really does have a big impact upon them. 

At no point, however, should you be made to do anything that you don’t want to – whenever you don’t feel like it, please do tell us to go away!

Vitamin D trial

Bhargava P, Cassard S, Steele SU, Azevedo C, Pelletier D, Sugar EA, Waubant E, Mowry EM. The Vitamin D to Ameliorate Multiple Sclerosis (VIDAMS) trial: study design for a multicenter, randomized, double-blind controlled trial of vitamin D in multiple sclerosis.Contemp Clin Trials. 2014 Oct. pii: S1551-7144(14)00150-5.

BACKGROUND:Lower levels of vitamin D are associated with increased MS risk and with greater clinical and brain MRI activity in established relapsing MS.
OBJECTIVE:The VIDAMS trial (NCT01490502) evaluates whether high-dose vitamin D supplementation reduces the risk of MS activity.
DESIGN/METHODS:Eligibility criteria include diagnosis of RRMS, age 18 to 50years, and Expanded Disability Status Scale≤4.0. Disease duration and activity requirements depend on whether 2005 or 2010 criteria are used for diagnosis. Enrollment is restricted based on prior MS therapy exposure and recent vitamin D use. After completing a one-month run-in of glatiramer acetate, 172 patients will be randomized 1:1 to oral vitamin D3  5,000IU versus 600IU daily. Clinical visits occur every 12weeks for 96weeks.
RESULTS: Sixteen sites throughout the United States are participating in the trial. Complete enrollment is expected by late 2014, with follow-up through 2016. No interim analyses are planned. The primary outcome for the trial is the proportion of patients experiencing a relapse in each group. Other clinical, patient-reported, and MRI outcomes will be evaluated.
CONCLUSIONS: The VIDAMS trial will provide critical information about the safety and efficacy of vitamin D therapy in RRMS, with implications for MS patients worldwide
So paper for old rope. You write up the trial before you get any data......Mint. 

So we have mega dose verses supermarket multi-vitamin dose. Wonder what ProfG makes of this? This is a multi centre trial with 15 sites in USA taking Vitamin D and copaxone. I wonder how natural sunlight exposure will influence this I guess people in North with get low and high dose and people in south will get low and high doses I guess it adds "noise" into the system.