SPECIALIST SEEKS TO DISPELL MYTHS WITH THE LATEST KNOWLEDGE

David W. Giang, MD, who specializes in neurology, listens to the concerns of a patient who has been diagnosed with multiple sclerosis. Though the disease usually strikes when a person is between 20 and 30 years old, persons with MS have essentially the same lifespan of those who do not have the disease.

David W. Giang, MD, is chair of the graduate medical education committee, and associate dean and director of graduate medical education, School of Medicine.

Dr. Giang (pronounced "Jung") also has a busy clinical practice. Currently, he has over 200 multiple sclerosis (MS) patients in his caseload, some traveling to Loma Linda from as far away as the high desert.

Though they share the same diagnosis, symptoms and their severity are as different and distinct as each of his patients' fingerprints.

"When a person first hears the words 'multiple sclerosis' from their primary physician, they may become fearful or depressed," says Dr. Giang, who specializes in neurology. "At the beginning, they often do not have much information about their disease."

As he evaluates and manages a patient's case, Dr. Giang attempts to dispel myths while presenting facts which help the patient understand and manage the changes in their lives. For instance, many people do not know that the life expectancy of a patient with MS is essentially identical to the average lifespan of someone who does not have the disease.

In addition, many people are not aware that three quarters of the patients diagnosed with multiple sclerosis do not need to use a wheelchair.

As the disease many times strikes during the time a woman may want to have children, Dr. Giang is sometimes asked if a family should plan to have a child.

"Research has shown," he recounts, "that there are no long-term detriments to undergoing pregnancy after multiple sclerosis has been diagnosed."

In fact, there is often a masking effect during pregnancy, where the patient does not feel or experience any symptoms while she is pregnant. "It is thought," says Dr. Giang, "that this may be due to changes in womens' immune systems while they are pregnant. Often, symptoms appear soon after delivery--symptoms which may well have occurred during the last nine months if the woman had not been pregnant."

Dr. Giang keeps apprised of the latest medical research taking place in this field. "There are three new drugs that have shown favorable results," he declares.

Like other physicians, Dr. Giang works with patients who are hungry for the latest trends and treatments used to combat their disease.

Information is now available on the Internet to patients and their loved ones by typing a few keystrokes on a computer. The challenge is that good information, as well as misinformation, is available--and often both look equally appealing.

Type in "multiple sclerosis" on one of the major Internet search engines, and up to 753,258 sites--ranging from those posted by individuals, to those advertising support groups, to sites posted by health-care facilities--are available.

Some offer excellent information, but others prey on patients' hopes, and offer expensive, unproven therapies, some of which are harmful.

"It all depends on what site the patient 'hits' on," comments Dr. Giang.

"When patients come to me with new theories about how to handle their disease," he says, "I listen to what they have heard. If the treatment is not detrimental and is not overly expensive, I explain that there is no clear evidence showing the benefits, but that they may certainly try the treatment if they desire."

If the treatment may be damaging, however, or if it is astronomically expensive with no proven results, Dr. Giang warns them against trying it.

"One of the recent alternative treatments which has received attention in the media and on the Internet," he notes, "is the use of bee stings for treatment of Ms. Bees are usually available at no cost, and if the patient does not have an allergy to bee stings, I tell them to go ahead. I've found, however, that most patients do not stay with this type of therapy for long."

As he listens to patients' concerns and gives them control of aspects of their treatment, Dr. Giang's patients become increasingly knowledgeable about their disease.

Thus, his patients are better able to live with the symptoms of MS and are able to look to the future with hope.

What is MS?

Multiple sclerosis (MS) is a disease of the central nervous system in which a vital insulating material called myelin is damaged or destroyed. This process is referred to as demyelination.

Myelin serves as an insulation on nerve fibers much like the insulating material which covers an electrical wire. When the insulation on a wire is damaged or destroyed, the flow of electrical current may be interrupted and a short-circuit occurs. Similarly, in ms, when the myelin is damaged or destroyed, nerve impulses from the brain to the spinal cord are interrupted, resulting in various symptoms. MS patients may experience any or all of these symptoms:

• decreased vision
• fatigue
• pain
• weakness; coordination, or balance problems
• numbness and/or tingling
• speech or swallowing problems
• tremor
• bowel or bladder difficulties
• dizziness
• blurred vision
• thinking or memory problems
• extreme fatigue
• decreased sensation
• spasticity (a firm resistance as a limb is raised, followed by sudden relaxation)

Facts about multiple sclerosis:

• Symptoms may be mild, moderate, or severe.
• Between 250,000 and 500,000 persons in the U.S. today have MS.
• Ten percent of people diagnosed with the disease experience symptoms that are progressive, some to the point of incapacitation.
• Seventy percent have symptoms that appear and disappear at varying intervals.
• Women are diagnosed with MS two-thirds more frequently than are men.
• The cause of MS is not known, though a combination of heredity, the immune system, and a virus may play a role in a person contracting the disease.
• Multiple sclerosis is not contagious.

Excerpted from Living Well with MS: a guide for patient, caregiver, and family by David L. Carroll and Jon Dudley Dorman, MD. HarperPerennial, 1993.

[Scope, Autumn '97 contents]

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