Is the flu shot ok for MS?

The inactivated flu shot is appropriate and helpful for people who have a history of Multiple Sclerosis. 

There is a potential interaction between interferons (Avonex, Beta Seron, Rebif) and the flu shot.  Both of these can cause flu like symptoms.

The FluMist nasal spray, which contains a live virus, is not recommended.

How long does the flu last?

The seasonal flu is caused by an outbreak of the influenza virus.  This tends to occur during the winter.  The flu normally causes symptoms of fever, muscle pain, fatigue, weakness, and sometimes, coughing, sneezing, or sore throat.  The flu is normally transmitted from person to person via sneezing or coughing.

The time between onset of the illness and exposure is normally 2-4 days.  People with simple flu infections recover in 2-5 days, although durations as long as one week are not uncommon.  In some people, the symptoms may last longer.  These are people who are children or older adults, people with chronic illnesses or immune suppression.

A complicated course of the flu may include associated viral pneumonia, bacterial pneumonia, changes in heart rhythm, confusion and meningitis, or other serious infections.  These conditions are more serious, and they tend to have a longer duration.

Does Prevagen Work?

Prevagen has been touted as a dietary supplement that helps to improve memory.  Does Prevagen work?

Prevagen is a dietary supplement made by Quincy Bioscience, a company based in Wisconsin.  It contains apoaequorin, a protein derived from a jellyfish.  Evidence cited by Quincy Bioscience that Prevagen is effective is reported in a study in 2016.  This study was not published in any journal.

The goal of the study was to determine whether the active ingredient of Prevagen, apoaequorin, improves cognitive function in older adults who have normal or near normal memory function.  In this study, healthy adults ages 40-91 with memory concerns were examined by cognitive tests over a period of 90 days.  People with neurological diseases and other conditions were excluded from the study population.

The authors reported that there were significant improvements in cognitive function in people treated with the study chemical compared to those who were not.

Limitations of this study include:

The study duration was 90 days.

Only participants with minimal or no cognitive impairment were studied.   Results for people with mild or greater memory impairment were not reported.

This study examined a small number of study participants.  Of the 211 people enrolled in the trial, only 100 were included in the final analysis.  Only 37-60 received the test chemical.

With respect to the majority of cognitive tests, the study reports there is a trend to significance.  This is the same as saying there was no change.

They authors state there are significant improvements in the control group compared to the placebo group in three tests.  These are the Groton Maze recall, the Detection test, and the One Card Learning test.  The statistical analysis shows a lack of significant results.  Examining the numbers reported in Tables 3 and 4, there was no significant improvement in either the control group or the placebo group over the time of the study.

The background evidence for the in vitro efficacy of the active ingredient of Prevagen was published.  These include two meeting abstracts and one article in PLoS One.

It would be wonderful if Prevagen improved memory in normal people or people with memory problems.  Although the evidence presented in this study was limited, we are hopeful that better evidence will be reported soon.

Note that The Federal Trade Commission and the State of New York have accused the manufacturer of Prevagen of false advertising.

Erectile dysfunction


Male sexual dysfunction has many causes and symptoms.  It has different subtypes, including reduced sexual drive, ejaculatory dysfunction, or erectile dysfunction.  Erectile dysfunction is the inability to have or maintain an erection to have intercourse.  This can be caused by nerve damage, problems with blood flow, hormones, or psychological function.

ED is associated with diabetes mellitus, coronary artery disease, drug side effects, spinal cord disease, MS, back injury, injury to the pelvis, or prostate surgery or sometimes hormones.

Ejaculatory disorders are a group of conditions that interfere with release of semen.  This may be premature ejaculation (release before or within one minute of intercourse)

Drugs that may cause ED include: Hydrochlorothiazide, ketoconazole, spironolactone, clonidine, cimetidine, and antidepressant medications.

Libido is often used to describe sexual drive.  Low libido has been reported to be associated with recreational drugs (incl nicotine and alcohol), fatigue, low testosterone, depression, medications, behavior and wide spread illnesses.


Prostate Cancer

Prostate cancer is a condition that affects men.  The symptoms of prostate cancer may be frequent or night time urination, difficulty controlling or feeling changes in the urine flow, a pain with urination, or problems with erectile function or ejaculation.  These symptoms are also caused by other conditions that affect the prostate and the urinary system.

Prostate cancer can be diagnosed using a variety of tests.  These may be blood tests for PSA, ultrasound or other imaging tests of the prostate anatomy, or a biopsy.

Prostate cancer can be treated by surgery, radiation, or chemotherapy.

Radical prostatectomy is a surgery that removes the prostate gland and surrounding tissue.  It can be done using different approaches.   The different approaches may be chosen to help reduce the time to heal, to access the prostate gland, or to reduce the risk of side effects.

With every intervention, there are possible risks.  Prostate surgery has a risk of causing urinary leakage or incontinence, erectile dysfunction, swelling, or surgical sterility.


Removal of the gall bladder is a common surgery for people who have gall stones.  The gall bladder stores bile, a physiological fluid that helps us digest fats in the small intestine.  About 500000 cholecystectomies are done in the US each year.  These cost about $24000.  Most cases are done by laparoscopic surgery.  When cases are complicated, such as when the gall bladder has ruptured, an open or abdominal approach is taken.

Tests that are useful to help diagnose problems with the gallbladder are normally done before a cholecystectomy.  These may be an ultrasound (helps to show evidence of stones in the gall bladder) and ERCP, a test that shows the anatomy of the bile ducts.  The ERCP is done with an endoscope.



The hysterectomy is removal of the uterus and sometimes the fallopian tubes and the ovaries.  This is most often done for symptoms of excessive uterine bleeding, and sometimes for symptoms of fibroids or uterine cancer.  The cost of hysterectomy is normally about $13000.  Every year, about 600000 hysterectomies are done in the U.S.


Circumcision is a surgery to remove the skin that covers the head of the penis.   This surgery is often done for religious reasons, but it is not medically necessary.  Having this surgery is known to reduce the risk of infection.

The cost of this procedure is $250.  There are about 1 million circumcision surgeries every year in the U.S.

Joint replacement

Every year there are about 750000 knee replacements and 330000 hip replacements in the US.

A damaged joint can be replaced with an artificial one.  This is often referred to as an arthroplasty.  This replacement may be the entire joint or just part (one side) of one.  This procedure is done more often for people with osteoarthritis or other joint diseases.  These procedures cost from $16000-32000

A total knee replacement is a procedure where the two ends of the knee are replaced my metal or plastic parts. This is done when the knee has severe arthritis or a severe injury.  A total knee should last 10-20 years, although they may break down earlier than that.

A total hip replacement affects the ball and socket of the hip, at the top of the upper leg bone (the femur) and the pelvis.  Most hip replacements function for more than 10-20 years.

A total shoulder replacement replaces the top of the upper arm bone (humerus) and the socket for the arm bone (the scapula).


Caesarean section is a common surgical method for delivery of newborn babies.  This surgery is normally done if there are complications during pregnancy or for safety.  It may be related to the mother’s blood pressure, the size of the baby, or changes in the position of the placenta or umbilical cord.  A c-section is normally done by an incision over the lower abdomen, from side to side, about 15 cm long.   There are several variations of the C-section, such as how and where to do the incision, the choice of tools used, fetal extraction and removal of the placenta.

A c-section costs about $18000-27000

In the U.S. there are about 1.28 million cases of c-section per year (Centers for Disease Control 2015).

There were about 2.7 M vaginal deliveries each year in the U.S.