b'Medicine & Researchand bothersome symptoms affecting peoplepublished series that have reported the success with MS. The researchers did nd that normalof SNM in patients with MS with incontinence. vitamin D levels were linked to fatigue reduction.The article was published in the International I would suggest speaking with your MSJournal of MS Care. healthcare team about vitamin D. There is noThrower -Problems with bowel and bladder standard dose of vitamin D since the dosingfunction are common in people living with depends upon your blood levels. Vitamin DMS. A loss of ability to control the bladder and is available as both vitamin D2 (ergocalciferol)bowel may result in the person having accidents and vitamin D3 (cholecalciferol). We typically(incontinence).Thiscanbeembarrassing, prefer the vitamin D3 formulation as this islead to decreased quality of life, and social the animal version, while vitamin D2 is theisolation. Areas of MS demyelination interrupt plant version. The latter must be converted tothe normal pathways of the spinal cord and vitamin D3 after consumption. It is best tobrain that regulate bowel and bladder control. dose your vitamin D with guidance from yourSometimes, lifestyle changes or medications healthcare team as excessive amounts canmay be sufficient in managing these issues. have health risks, such as kidney stones.When these measures are not effective, sacral Implant shows successnerve modulation may be the next step. SNM in addressing incontinenceinvolves the surgical implantation of a device Aretrospectivemedicalrecordreviewin the skin under the ank. Small electrodes run consisted of six patients at the Continencefrom the device to the sacral nerve, essentially Center of Nevada Surgical who sought treatmentrestoring control to the bladder or bowels. In this for urinary and fecal incontinence. The patientsstudy, episodes of urinary and fecal incontinence all received a sacral neuromodulation implantwere reduced by SNM. In my experience, SNM after not responding to medications or pelvicis used more commonly for bladder symptoms oortherapy.TheMichiganIncontinencethroughconsultationwithanexperienced Symptom Index and the Fecal Incontinenceurologist. Those dealing with fecal incontinence Severity Index were assessed before implantwould work with both a gastroenterologist and and about nine months after for all patients.a colorectal surgeon if SNM is being considered. All reported improved scores and that theBiomarker may indicate implant was successful for them based ondisease progression large reductions of incontinence scores andThis clinical trial, conducted in collaboration improved quality of life. Sacral neuromodulationwith researchers in the U.S. and Switzerland, has been approved by the FDA since 1997 andlooked at 1421 people with relapsing MS and has shown to be successful in many cases,596 people with primary progressive MS for however it historically had been incompatiblenearly nine years. The primary measure of with MRIs and not covered by the Centers forconrmed disability progression was taken at Medicaid and Medicare Services or manyweek 24 on the Expanded Disability Status private insurances. Newer MRI compatibleScale and measurements of neurolament devices are now available, and more researchlight chain, then compared at weeks 96, 144, is being published. The researchers of thisor 432 in the three different trials. Higher study note these ndings conrm with otherbaseline NfL was a sign of greater whole msfocusmagazine.org 54'