Just throwing this out there . . . someone else can make something of it
When I went to see Dr. Dake in December I was actively having a flare-up. He ordered bloodwork including a d-dimer. My d-dimer was quite high, indicating a possible blood clot or embolism, and I had to go to the ER and get screened. Thorough screening showed no clots or embolism. Repeated d-dimers (over weeks) in which the flare continued showed the elevated d-dimer. When the flare resolved the d-dimer resolved.
Dr. Dake said he was tracking the d-dimer because he had seen an elevated d-dimer in other people as well without clots or embolisms. Now, this is me, not a doctor: I wondered if that could interact with narrowed veins during times of relapse and decrease blood flow to produce the MS symptoms.
So one question might be, if some people have narrowed or flattened veins, what happens periodically in a subset of people to trigger the thicker or maybe hypercoaguable blood that interacts with the problematic veins and causes a flare-up of symptoms? In some people. If you will.
Edited to add this little gem featuring diseased mice with high d-dimers:
I picture tiny hypo's and miniature alcohol wipes. The detail on the scoring of their little spastic backends almost made it worth squinting through this thing. Where is Tim Burton to animate this nightmare when we need him? Actually, what I want to know is, where is my spastic little tail?