I'm 22, and I have some of the symptoms of MS, and I still didn't do anything in life…. I think I'm doomed to never amount to anything if I get MS now… how long before I'll be mentally disabled???

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Although there is no known cure for multiple sclerosis, several therapies have proven helpful. the primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects. at the same time different alternative treatments are pursued by some patients, despite the paucity of supporting, comparable, replicated scientific study.

Management of acute attacks

During symptomatic attacks administration of high doses of intravenous corticosteroids, such as methylprednisolone,[83][84] is the routine therapy for acute relapses. the aim of this kind of treatment is to end the attack sooner and leave fewer lasting deficits in the patient. although generally effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery.[85] Potential side effects include osteoporosis[86] and impaired memory, the latter being reversible.[87]

Disease modifying treatments
Disease-modifying treatments are expensive and most of these require frequent (up-to-daily) injections. Others require IV infusions at 1-3 month intervals.
Disease-modifying treatments are expensive and most of these require frequent (up-to-daily) injections. Others require IV infusions at 1-3 month intervals.

The earliest clinical presentation of relapsing-remitting MS (RRMS) is the clinically isolated syndrome (CIS). several studies have shown that treatment with interferons during an initial attack can decrease the chance that a patient will develop clinical MS.

As of 2007, six disease-modifying treatments have been approved by regulatory agencies of different countries for relapsing-remitting MS. three are interferons: two formulations of interferon beta-1a (trade names Avonex and Rebif) and one of interferon beta-1b (U.S. trade name Betaseron, in Europe and Japan Betaferon). a fourth medication is glatiramer acetate (Copaxone). the fifth medication, mitoxantrone, is an immunosuppressant also used in cancer chemotherapy, is approved only in the USA and largely for SPMS. Finally, the sixth is natalizumab (marketed as Tysabri). all six medications are modestly effective at decreasing the number of attacks and slowing progression to disability, although they differ in their efficacy rate and studies of their long-term effects are still lacking.[91][92][93][94] Comparisons between immunomodulators (all but mitoxantrone) show that the most effective is natalizumab, both in terms of relapse rate reduction and halting disability progression;[95] it has also been shown to reduce the severity of MS.[96] Mitoxantrone may be the most effective of them all;[97] however, it is generally considered not as a long-term therapy as its use is limited by severe cardiotoxicity.

The interferons and glatiramer acetate are delivered by frequent injections, varying from once-per-day for glatiramer acetate to once-per-week (but intra-muscular) for Avonex. Natalizumab and mitoxantrone are given by IV infusion at monthly intervals.

Treatment of progressive MS is more difficult than relapsing-remitting MS. Mitoxantrone has shown positive effects in patients with a secondary progressive and progressive relapsing courses. it is moderately effective in reducing the progression of the disease and the frequency of relapses in patients in short-term follow-up.[94] On the other hand no treatment has been proven to modify the course of primary progressive MS.[99]

As with any medical treatment, these treatments have several adverse effects. One of the most common is irritation at the injection site for glatiramer acetate and the Interferon treatments. Over time, a visible dent at the injection site due to the local destruction of fat tissue, known as lipoatrophy, may develop. Interferons also produce symptoms similar to influenza;[100] while some patients taking glatiramer experience a post-injection reaction manifested by flushing, chest tightness, heart palpitations, breathlessness, and anxiety, which usually lasts less than thirty minutes.[92] More dangerous are liver damage of interferons and mitoxantrone,[ the immunosuppressive effects and cardiac toxicity of the latter;[105] or the putative link between natalizumab and some cases of progressive multifocal leukoencephalopathy.

Management of the effects of MS

Disease-modifying treatments only reduce the progression rate of the disease but do not stop it. As multiple sclerosis progresses, the symptomatology tends to increase. the disease is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Management of these deficits is therefore very important. both dr

TV presenter Nigel Farrell tells how a bizarre exchange led to him being diagnosed with pancreatic cancer

It had been a gruelling couple of weeks filming, yomping through the ice and snow with heavy cameras and tripod in one of the remotest places in Britain  -  Barra, one of the most southerly islands of the Outer Hebrides, 60 miles off the wild north-west coast of Scotland. 

We’d been shooting for a BBC documentary series called Island Parish, and now my cameraman Aidan and I were sitting in the tiny airport terminal beside the sandy beach where the planes land from Glasgow, heading home to London for a few days’ break. 

All clear: Nigel Farrell, with partner Sally Ann, has been told all traces of cancer have disappeared

Suddenly, I noticed Aidan was leaning forward and looking at me in an odd way. ‘I hope you don’t mind me saying,’ he said awkwardly, ‘but your eyes seem to have turned slightly yellow.’

I checked in the loo mirror, but it was quite gloomy in there and I couldn’t see anything wrong. At home in my Islington flat that night, the lighting was low and my partner Sally Ann didn’t notice anything.

That all changed dramatically the next morning.

‘My God, you’ve turned completely yellow!’ Sal shouted in alarm when we awoke. it was weird staring back at my new, totally yellow self in the mirror; I had assumed I was in the peak of health, and had felt no aches or pains at all.

Things then moved incredibly rapidly  -  and never again will I curse the NHS.

‘You’ve got jaundice,’ said my GP an hour later. it was a Saturday, and they’d sent me straight in to his surgery.

‘It’s often caused by gallstones. not a huge problem, but you need attention immediately. I’ll make an appointment for you to see someone at UCLH.’

University College London Hospital is my local general hospital. this was my first big piece of luck. I didn’t know it at the time, but UCLH is a world leader in treating the liver and pancreas.

‘What, some time this week?’ I asked.

‘No,’ he said, looking at me kindly.

‘I mean now. Right now.’

A few hours later I was in the ward being examined by a surgeon. it all seemed slightly surreal. I’d never felt better in my life.

Early warning: Cameraman Aidan noticed that Nigel’s eyes had ‘turned slightly yellow’ while they were shooting a BBC documentary series called Island Parish

One of the common causes of jaundice is blockage of the bile duct, which normally carries bile from the liver to the gut. The liver extracts potential toxins from the blood, modifies them and passes them into the bile so they can reach the gut and be excreted from the body.

if they cannot escape, the toxins ‘leak’ back into the bloodstream, and one  -  bilirubin  -  produces a yellow colouration, usually visible first in the whites of the eyes, and later in the skin.

An endoscopic camera examination revealed that, in my case, the blockage was the result not of gallstones but of a tumour in the pancreas. Sal and I were horrified, well aware that it could be cancer. A quick trawl of the internet revealed that pancreatic cancer has an appalling prognosis for most people.

We passed the three-week wait for the operation in a kind of dizzy dream, heightened by the fact that still at no stage did I feel remotely ill.

As it turned out, my swift diagnosis was my second big piece of luck. Early symptoms of pancreatic cancer disguise themselves behind less alarming problems such as weight loss or diabetes, and are notoriously hard to identify. often it is simply too late by the time doctors realise what it is.

The fact that my tumour had blocked the bile duct, making its existence obvious, was a blessing in disguise. of every 100 patients diagnosed with pancreatic cancer, only ten can be operated on. I was already in the ‘lucky’ ten per cent.

The operation is called a Whipple procedure, and in my case it lasted seven hours. Led by an outstanding surgeon, Charles Imber, the team removed not just the tumour but part of my pancreas, gall bladder, and parts of the bile ducts, bowel and stomach, in an attempt to prevent any potential spread of the tumour.

I was in intensive care for a few days, then moved to the ward. The registrar broke the news from the pathology lab. ‘I’m afraid your tests reveal that the tumour was cancerous,’ he said. ‘But we have managed to cut out the whole growth.’

I suppose we had been wildly hoping against all the odds that the tumour was benign so, knowing that this form of cancer has a high chance of recurring, this was, in a way, the lowest point.

My imminent death now seemed a real possibility; most pancreatic cancer patients die within six to eight months of diagnosis. it was almost more of a worry trying to imagine how my friends and family  -  and particularly Sal  -  would take the news. In fact, whatever their private thoughts, everyone was unbelievably upbeat and supportive.

Having stared death squarely in the face, I decided to put it back in its box and focus on recovering from the operation. I’d been told it was vital to get out of bed and walking as quickly as possible  -  even though this was painful at first  -  to get the lungs working and so help stave off infection. I took a few more steps each day, eventually pounding the ward and later the stairwells.

Seeing the other patients, many of whom seemed to be in a far worse state than me, made me realise that I was, even now, lucky to be alive.

I met a man who had started to undergo the same operation as me, but the surgeons were unable to remove his tumour because of its proximity to a major blood vessel. later, I saw the delight on his face as his wife and young children arrived for a visit. he, too, looked the picture of good health.

Of the one in ten pancreatic cancer patients surgeons can operate on, in six cases they are unable to remove the entire tumour. I was now in the ‘lucky’ four per cent.

Hugely helpful was the fact that, even in the ward, I could keep working. if I was a teacher or employed in a bank, I would no doubt have been signed off for months. The offices of my TV production company are just down the road from UCLH, in Soho, so colleagues were able not just to visit, but to bring in scripts and DVDs of rough-edited programmes for me to work on in bed.

Within a month, I was back on the Outer Hebrides with Aidan, filming the main characters on our documentary series  -  Father John Paul Mackinnon, the Catholic parish priest on Barra, and his colleague in the next-door parish of South Uist, Father Roddy McCauley, who suggested celebrating my return to the islands with a wee dram, and promised to light candles and say prayers for me at Mass.

On my return, I started a six-month course of chemotherapy at a neighbouring North London hospital, the Royal Free, designed to attack any rogue, post-operative cancer cells that may still have been whizzing around my system.

I was on a trial regime; chemo pills every day for three weeks, along with a once-a-week, half-hour chemo drip, then nothing for the fourth week, to allow the body to recover.

Mercifully, there were few side effects. My hair thinned a little but not noticeably. The chemo tries to destroy cells that replicate (the principle characteristic of a cancer), so the palms of my hands and the soles of my feet (where the skin cells get worn quickly and automatically replicate themselves) suffered badly.

I had terrible blisters, which made walking difficult at times, and handshakes could be embarrassing. But I was able to function pretty much as normal, which I’m sure was a major contribution to my rapid recovery, both physically and mentally.

In late November last year, I had a CT scan, and this, along with the results of blood tests, showed that the chemo appeared to have done its job and there was now no evidence of cancer. The consultant was beaming as she gave us the results.

‘Go away and enjoy Christmas,’ she said, and we all laughed idiotically. I guess they spend a lot of time dishing out bad news in the oncology department.

‘We’ll be monitoring you every three months with a scan and blood tests. see you next February. Have fun.’

Outside the hospital, Sal and I hugged with relief. again, the next few days had a surreal quality. I had been in the hands of doctors since early February  -  nearly ten months  -  so I had handed over responsibility for my life to them. now I was on my own, feeling lost and lonely.

Talking to other ‘survivors’ helped. I had coffee with an inspirational woman called Ali Stunt, a mother of two young boys, who had surgery for pancreatic cancer three years ago, aged 41. Ali had experienced months of unexplained back pain, and was diagnosed only after a CT scan paid for by her private health insurance.

‘My surgeon said that had I waited four weeks for the scan I would probably not be here today,’ she told me. ‘Early diagnosis of this killer would help save so many lives.’

Ali went on to found a charity called Pancreatic Cancer Action to try to increase awareness among doctors and patients alike. She has become something of an expert. ‘The general population need to know about it, the symptoms and the risk factors  -  smoking, obesity and hereditary links.’

I am well aware there is a real risk of recurrence, but if you can get through the first two years, your chances of survival increase dramatically. Never has the cliche ‘take each day as it comes’ been more relevant.

It has been a joy to return to normal life. I wake each morning feeling more ambitious and vigorous than ever. And yes, those moments I used to take for granted, I now relish; the warmth of the winter sun on my hand, the sip of a fine wine, the smile of a stranger on a bus.

Has it changed my life?

No. I have a job I cherish and a family, friends and a partner whom I love. all I have ever wanted is the chance to continue as before. if I can function, I can be happy.

Has it made me appreciate life more? A hundred times. there is no past, there is no future, so the saying goes, there is only now  -  and you can either seize the moment, or not.

Island Parish is on BBC2 at 7.30pm on Fridays, starting this week.

DR ELLIE CANNON SAYS:

This is a classic, text-book case of how doctors are taught pancreatic cancer shows itself. Painless jaundice is what we call a ‘red flag’ for cancer and must be investigated immediately.

Jaundice can also be caused by gallstones, but patients normally experience pain with this.

Anyone with jaundice should see their GP straight away. if it is the weekend, you must go to A&E. Pancreatic cancer has a poor prognosis generally, but the earlier the diagnosis, the better the chances of survival.