Best medications for MS symptoms

in this video I'm gonna share with you my personal opinions on my favorite medicines to manage common MS symptoms tune in because I'm gonna start right now learn about MS with be Erin boss tur I started this channel to help my own MS clinic patients learn between visits and it's my hope that through these videos I can help you learn to I use easy-to-understand language to bring you accurate and approachable multiple sclerosis education so if you are impacted by MS and you end up your game subscribe to the channel right now and please ring that notifications bell so that you're alerted to all of my upcoming educational content I divided the management of multiple sclerosis into three separate categories the first is managing acute MS attacks the second is disease modification slowing the disease down the third is managing chronic symptoms now allow me to explain when someone with multiple sclerosis suffers a clinical attack we give them medicines to help them recover unfortunately they don't always fully recover and they can be left with a residual deficit I'll use an example of an attack that results in left leg burning in this example we give the person steroids and they recover 80% they're left with a residual burning sensation in their leg which now becomes a chronic and bothersome symptom symptoms in ms can you Road the quality of our lives they can impact our daily functioning our performance at work and our ability to enjoy ourselves and we must if we're going to do the best job possible address chronic symptoms now I have made several videos on behavioral measures to improve a myriad of symptoms but what I have not done very much is talk about medicines I'm an allopathic doctor an MD and I use lotions and potions to help people feel better I have to throw out a couple disclaimers in this video I'm going to be talking to you about my personal opinions on my favorite medicines to manage common MS symptoms I am NOT providing you with medical advice this video is intended to be a form of medical education I'm not talking about how well the drugs work and the risks associated with them or the monitoring that's necessary for them or anything like that that's a conversation that you have to have with your medical provider and this video certainly doesn't replace that so let's get started the first symptom I wish to tackle is spasticity which manifests clinically as limbs that are very hard to bend spasms and bouncing of limbs and painful cramps now in order to properly manage spasticity we have to have a multi-modal approach we do multiple things at once exercise stretching heating the limbs staying adequately hydrated all of these things are critically important and I've talked about them in other videos today I want to focus on medications in my favorite medicine when managing mild plasticity is oral baclofen oral baclofen is one of many anti-spasmodics and it's my favorite for a couple reasons reason number one I find it to be the least sedating of all of those medications this is a medicine that oftentimes people have to take during the work day and I can't have them feeling groggy and sleepy number two it's easy to titrate I can start people at five milligrams a day which is a pretty low dose and I can slowly over multiple weeks increase them and I tend to go up on baclofen very slowly like five milligrams a day for a week and then five milligrams twice a day for a week and so on and so forth until we get up to a therapeutic level that works for that patient baclofen can be taken to mirror the needs of the patient and so if they only needed a night they can take it at night some of my patients actually have to take baclofen four times a day right when they wake up around lunchtime around dinner time and then before bed and this is a medicine with which we can do that and so I find that very helpful now let's turn our attention to depression depression is exceedingly common in multiple sclerosis it's actually twice as likely to occur in people with MS as compared to the general population on this YouTube channel I have multiple videos talking about different tricks and tips to optimize people with depression and if you haven't seen those I recommend that you check them out when it comes to medication management for depression I like wellbutrin the best it's my favorite antidepressant and I want to explain why number one it's not sedating many of the other antidepressants I find can cause some degree of sedation which is just not very tolerated and people that are trying to live active lives number two it does not cause weight gain many of the antidepressants can and people with MS are at risk of having difficulties maintaining their weight and so I don't want to give them a medicine which could contribute to that in fact sometimes wellbutrin is known to curb your appetite and so in some ways it can kind of help with the weight management number three it can be used to help decrease the desire to smoke cigarettes as many of you who follow my channel know smoking is a no-no in the setting of MS and using wellbutrin can actually be very helpful in moving towards quitting smoking number four wellbutrin can be taken with an extended-release dosing so you only have to take it in the morning and that's kind of lovely because that way you're not being asked to remember to take it multiple times a day number five wellbutrin does not worsen sexual function it's my opinion that if you're depressed and I give you an antidepressant which makes you have trouble with sex you're going to be more depressed and so wellbutrin is one of the only antidepressants that doesn't tend to worsen sexual function now wellbutrin is not for everyone if you have a seizure disorder wellbutrin is a no-no and sometimes wellbutrin can worsen anxiety and so obviously this is not a medicine for everyone but if given the opportunity this is my go-to medicine when treating depression in multiple sclerosis heat sensitivity and motor fatigue are very very problematic for many people with multiple sclerosis it's kind of a unique symptom in the setting of MS where someone starts walking and as their body heats up from the exercise they short-circuit and their legs become weak in the can't keep going or in the setting of August in Ohio when it's really hot outside they have cognitive and pathologic fatigue to the extent where they really can't function heat sensitivity is a problem and there's one medicine which has been fda-approved to help with heat sensitivity and I really like it it's called ampere or for amino pyridine and period is it twice a day medicine which only seems to help about 1/3 to maybe 1/2 of people with MS now we're not smart enough to figure out ahead of time which people with MS will respond in which people don't and so oftentimes I have to put someone on it for about a month taken twice a day before we can really determine if it helps or not I'll share with you anecdotally that in my experience using impurity one of two responses after a month on drug I either see what I call a Lazarus effect which is a wow this is really awesome or I see it yeah and if I give it and then it didn't really work and we have to take the person off of this now amperi is not okay for everyone and if you have problems with kidney function or if you haven't known seizure disorder this drug is a no-no what about neurogenic bladder I'm talking about urinary urgency we have to sprint to the bathroom for fear that you won't make it in time and urinary frequency where you feel like you're getting up and going way more often than you need to and maybe sometimes getting up multiple times at night and urinary accidents so what do we do about that my favorite medicine to manage this is a drug called century century XL is a once-a-day pill and that's awesome so you're not being asked to take pills multiple times a day in the reason that I like Centura as opposed to other common medicines like ditropan and detrol is because of cognition this class of medication risks clouding cognition and creating COG fog which is something that many people with MS struggle with and we don't want to give a medicine that worsens it the reason that Santeria is my favorite is it has the least number of cognitive side effects now staying on the theme of bladder what about urinary retention I'm talking about where you need to go and you go to the toilet and nothing happens and you sit there and strain and push on your bladder and maybe a little comes out you finish going to the bathroom and as soon as you step away you gotta go again urinary hesitancy and other symptoms of retention are very common in multiple sclerosis and so from a pharmacologic standpoint I have great success using flomax now flomax was invented to help men with enlarged prostates because it can open up the bladder neck and allow them to get the urine out in men and women with multiple sclerosis flomax can have an excellent benefit in opening up the bladder neck to allow them to empty air and all the way it's a medicine that I often times ask people to take before bed because it can cause a side effect of lightheadedness and so if you're asleep than you're not bothered by that the other option in managing bad urinary retention is a urinary catheter which actually is an awesome option but many people are reluctant to go there right away and so I like to start with flomax neuropathic pain is unfortunately all too common in the setting of multiple sclerosis it's one of these invisible symptoms which can literally erode the quality of someone's life and we use off-label medicines that stabilize cell membranes typically we're using anti-seizure medicines and antidepressants for their effects on pain now there's no one-size-fits-all but if I had to pick one medicine that I like the best it would probably be gabapentin or neurontin gabapentin was invented to treat seizures and it stabilizes cell membranes in the brain to stop seizures it can also stabilize cell membranes to decrease abnormal firing that causes neuropathic pain and it can be quite successful why do I like neurontin well number one it comes in lots of different doses so I can use a very small amount if I need it or I can use real big pills and use a large amount if I need it and I have a lot of room to titrate number two it's well tolerated by most people most of the patients that I put on the lots and don't suffer from a lot of side effects and so I really like because the goal of giving them the medicine is to make them more functional not sleepy and tired and dizzy which would be in counterpoint to that I also like neurontin because I can dose it as frequently as I need to I can give it just before better just upon waking or up to four times a day now neurontin is not the only medicine and just to share a little bit there are many times where I might reach for another one for example if I have a patient that's suffering from neuropathic pain and depression I really like using a medicine called cymbalta because it can treat both if I have someone that has really bad insomnia and they're having neuropathic pain I like to use a tricyclic antidepressant such as elavil or pamel or because it's somewhat sedating and it can help them fall asleep at night in patients with neuropathic pain that are struggling with weight gain I sometimes reach for a medicine called topamax because one of the side effects of topamax is it can cause weight loss my point here is that treating neuropathic pain pharmacologically is very involved and we have to consider the whole human being but if I was to reach for one medicine it would probably be neurontin what about a rectal dysfunction unfortunately some men with MS can suffer from erectile dysfunction and given that sex is a massively important aspect in quality of life if a man is bothered by that I want to give them a little blue after-dinner mint to improve Friday night I'm talking about viagra now there are many medicines in this class and they're outstanding to be blunt I have the most experience using Viagra and I find that it can be very very helpful I also like the fact that nowadays there's generic viagra and so sometimes we can get it at a lower cost point many people with MS suffer from constipation this is a terrible symptom and we don't talk about it enough I have a video on this channel talking about many different ways of managing constipation and I do not recommend starting with medicines only but that's what this video is about now what's my fave miralax now I don't start with me relax I oftentimes will have people use suppositories and other things but if we're really struggling me relaxes my go-to it's a liquid that doesn't have a taste and I like to recommend that patients mix a half a cap in with their morning coffee and I have them take a half a cap or a full cap every morning until they can start to become regular now a tip about me relax you can't keep taking it if you continually take me relaxed without stopping you're gonna have what my wife refers to as blood but fatigue is a monster in multiple sclerosis it is the most common symptom of MS and one of the two major reasons that people with multiple sclerosis leave the workforce fatigue presents in many different ways this can be a pathologic fatigue where you literally are trying desperately to stay awake it can also be a cognitive fatigue making it harder to process and think as the day goes on I have many videos on tricks and tips to improve fatigue and today I want to talk about my favorite medicine provigil it's not a traditional stimulant but it can be remarkable in its ability to help people with on a stay awake and to stay thinking clearly it doesn't have the same dependence and the same tolerance that I see with traditional stimulants like adderall and it can be used with a half a pill in the morning if necessary it can be reduced around noon now provigil like all medicines has side effects and we have to worry about insomnia and anxiety and high blood pressure but provigil has helped many of my patients continue to stay working and continue to stay active one last tip about provigil I find that if you take a drug holiday one day or two days a week it tends to work better what about insomnia I'll share with you my own personal opinion that I don't like sleeper agents I sort of think it's like Bugs Bunny coming up and hitting you on the head of the hammer and that can cause a lot of different problems one of my biggest gripes with sleeper agents is that patients literally become dependent upon them so after you've taken them for a while if you don't take them it's really really hard to regulate your sleep I also find that sometimes peep wake up groggy when I give them a sleeper agent and so I don't like that what do I like melatonin now Lehtonen is a natural substance is actually the way your brain tells you that it's time to go night-night I find that taking a decent dose of melatonin right before bed can be very helpful along with behavioral measures in trying to induce a natural and healthy form of sleep there you have it my own personal opinions about my favorite medicines to manage common MS symptoms again we don't only take care of people with a pill it requires a multiple modality approach in order to be successful and managing chronic symptoms I hope that this video gave you some insights into how we might apply pharmacology as one of the many tools to improve function optimize people's lives and make them the most awesome version of them possible thanks for learning about ms with me Erin boster and until my next video take care

Channel: Aaron Boster MD

Views: 34,621

Rating: 4.9544539 out of 5

Keywords: top meds ms symptoms, best drugs ms symptoms, Best Medications for MS Symptoms, top drugs ms symptoms, best meds multiple sclerosis symptoms, Dr Aaron Boster, learn about ms with aaron boster, best medicines ms symptoms, top meds multiple sclerosis symptoms, top medications multiple sclerosis symptoms, best medications for multiple sclerosis, multiple sclerosis educational video, ms erectile dysfunction, multiple sclerosis depression, Pain multiple sclerosis

Id: cbcs8rU_3So

Length: 16min 43sec (1003 seconds)

Published: Sun Jul 29 2018