Not All Symptoms Are Due to MS
A patient with MS recently came to my office complaining of a pain and tingling in her hand and wrist. It had been going on for several months and at times was a minor nuisance, but it became especially severe at night when it woke her from sleep. When this happened she had to shake out her wrist to alleviate the pain. The patient merely assumed that this was her MS acting up again and since she did not want to take steroids, there was little that could be done for it. In fact, she said that she almost decided not to mention it to me at all as another doctor had already told her that she was right about this being her MS.
After listening to her symptoms and examining her hands, I decided that this was more likely carpal tunnel syndrome. I sent the patient to a specialist in the peripheral nerves who performed electrical studies of her nerves and confirmed that indeed the patient had carpal tunnel syndrome. She was given a wrist brace to wear at night which provided almost immediate and permanent relief of her symptoms. Treatments such as this, which are cheap, risk-free, and effective, are the best kind of treatments medicine has to offer.
The point of this is to remind patients that having MS does not protect them from other conditions. There is a tendency amongst patients and doctors alike, to attribute every symptom an MS patient experiences to her MS. As this case illustrates, this is often a mistake. Had this patient not had MS, she would have likely sought medical attention much sooner, and the diagnosis would have been much easier to make.
Just because a patient has MS does not relieve the doctor of the responsibility of searching for other causes of their symptoms. When an MS patient complains of a symptom like fatigue, for example, it is still important to do routine lab work to check and see if the patient is anemic or if she is hypothyroid. I have also seen rare cases where patients may have another very serious condition in addition to her MS, such as amyotrophic lateral sclerosis. Most of the time, of course, when a patient has MS, her symptoms are likely caused by it. But patients and doctors alike need to be alert to the possibility that something else might be going on.