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NHE wrote:

willowford wrote:Great link - provides info on all the imaging modalities. I've heard docs explain that one x-ray has ABOUT the same exposure as flying across the country once, which is a good analogy. (could mean that one CT is approximately equivalent to 277 times! Hence the concern for flight attendants and pilots who could do this in a year).
CT is definitely up there in terms of risk, which is why its not routinely used unless they're looking for very serious conditions where the benefits outweigh the risks.

According to the post " A head CT scan is 2 mSy, a chest CT 8mSy. Annual allowable occupation dose limit is 50 mSy."

So definitely having 25 CTs in a year put one at a very high risk.

It seems to depend on the type of CT, e.g., head vs. chest. If you count chest CTs, then 6 scans puts you at the annual allowable occupation dose limit.


NHE

Yes, it seems so. I was looking at brain CT, since it's most relevant in this case. Interesting that the chest CT has more radiation... i wasn't aware of that. I wonder what the radiation level for abdominal CT is.

willowford i would be interested to see the studies showing that ms patients do not have urea cycle disruption and excess ammonia.

i don't personally have bloodwork demonstrating hyperammonemia, but i do have documented past low zinc, with years of low uric acid, and serious cognitive deficits (almost lost my drivers license), AND simultaneous MRI-documented lesion activity, which resolved with zinc repletion (the low uric acid normalized also).

the case study showing zinc levels at 7.65 and ammonia at ~750 is not to be taken lightly, in IMHO.

my zinc level at original baseline test was 8.6 umol/L and therefore if we are in any way comparable, you could expect my ammonia levels to be at least in the hundreds.

with the normal range for ammonia sitting at 15-45, i don't think zinc, the urea cycle, and ammonia toxicity ought to be swept aside.

willowford wrote:Yes, it seems so. I was looking at brain CT, since it's most relevant in this case.

[color=blue]LR1234[/color] wrote:Slightly worried about the CT radiation level for brain/neck and chest (to include azygous)

jimmylegs wrote:willowford i would be interested to see the studies showing that ms patients do not have urea cycle disruption and excess ammonia.

Well, any study looking at this won't be just looking for absence, they would also be looking for presence of this blood marker.

By this logic, we can list any number of potential findings and say that there is no evidence that they DON'T exist. This isn't the way things should be studied otherwise, we'd go around in circles forever because there are so many factors involved. There are MANY bodily functions and products; we can't conclude they EACH lead to MS related cognitive impairment until proven otherwise.

Are there studies that suggest that there is elevated ammonium or urea in patients with MS that is higher than the rates in those without? Case studies are important to generate more larger scale research but don't give conclusive answers since patients with MS are not immune from conditions like zinc-deficiency (or other deficiencies) that can affect others. For example, I met a patient with MS and Huntington's disease... totally separate diseases, but he just happened to have both.

iq don't personally have bloodwork demonstrating hyperammonemia, but i do have documented past low zinc, with years of low uric acid, and serious cognitive deficits (almost lost my drivers license), AND simultaneous MRI-documented lesion activity, which resolved with zinc repletion (the low uric acid normalized also).

the case study showing zinc levels at 7.65 and ammonia at ~750 is not to be taken lightly, in IMHO.

my zinc level at original baseline test was 8.6 umol/L and therefore if we are in any way comparable, you could expect my ammonia levels to be at least in the hundreds.

with the normal range for ammonia sitting at 15-45, i don't think zinc, the urea cycle, and ammonia toxicity ought to be swept aside.

Many deficiencies lead to cognitive impairment in MS and non-MS individuals. a few examples: iron, zinc, B12, folic acid...etc. the list goes on.
People without MS who have zinc deficiency of course experience symptoms. The only question is whether zinc is involved in most cases of MS cognitive dysfunction (40-65% of MS patients affected).

I was certainly not doubting or commenting on YOUR situation. I'm glad things are going well for you.
Certainly, if someone has a deficiency, whether they have MS or not, it needs to be treated. Just because someone has MS, doesn't mean they can't be affected by other common deficiencies in vitamins and minerals like anyone else.

I was commenting on the general relationship between ammonia/uric acid and MS-related cognitive dysfunction. Currently there is no direct evidence to suggest this is the case. That's all I was saying.

NHE wrote:

willowford wrote:Yes, it seems so. I was looking at brain CT, since it's most relevant in this case.

[color=blue]LR1234[/color] wrote:Slightly worried about the CT radiation level for brain/neck and chest (to include azygous)

I see your point. Didn't realize a chest CT would also be required. Either way, hopefully no more than 1 CT is required if at all.

jimmylegs wrote:willowford i would be interested to see the studies showing that ms patients do not have urea cycle disruption and excess ammonia.

Sorry jimmylegs. I know you like to disagree with anything I write. But I honestly have no intention of discrediting anything anyone says. I'm just trying to write my posts based on the available evidence on MS. So I'm not sure why the hostility I sense. I'm really just basing everything I say on the available evidence. Has nothing to do with my opinion about anything.

Either way, I wanted to note note that the studies you posted are very interesting and related to other diseases, like liver cirrhosis.
It's not a common practice to make conclusions from very different diseases because they have different causes and effects. Liver cirrhosis and renal failure (which lead to excess blood ammonia) lead to encephalopathy, which to someone who is trained to recognize these things, presents different than the cognitive problems that about half of MS patients face (unless the person with MS also has liver or renal disease).

There are many studies looking at these markers (and others) specifically with MS, which are more applicable to MS patients than findings related to other organ damage. So the issue is being investigated and of course, as I said, anyone regardless of having MS, with deficiencies or risk for deficiency should receive treatment. But the cognitive problems in MS are SO common, that these and other deficiencies/excesses do not underlie most cases. So the goal is to come up with the causes and hopefully find treatments/rehabilitations that help patients with MS related cognitive problems without other comorbid problems like the ones you mentioned.

low zinc is well documented in ms. also, low uric acid is well documented in ms.

here is a study exploring the links between cognitive issues, zinc, the urea cycle, and ammonia.

http://www.thelancet.com/journals/lance ... 4/abstract
ORAL ZINC SUPPLEMENTATION IMPROVES HEPATIC ENCEPHALOPATHY
"Short-term oral zinc supplementation probably improved hepatic encephalopathy by correcting the zinc deficiency that compromises conversion of ammonia to urea."

i recall a case study in which an ms patient recovered after liver transplant.

all this said, it would seem reasonable to ask a patient's zinc level when the question is asked about new lesion activity.

of course it is not wise to neglect all the other known nutritional issues that affect ms patients.

i encourage all ms patients to consider asking for bloodwork when they have symptoms that might be connected to a nutritional situation. if you find out zinc's in the high teens, then you're good. healthy controls in societies that don't really eat gluten have levels around 18 umol/L.

hth!

http://ajpendo.physiology.org/content/235/2/E203.short
Plasma ammonia and liver ornithine transcarbamoylase activity in zinc-deficient rats
"It is concluded that an increase in plasma ammonia may occur as a result of deficiency of zinc".

http://onlinelibrary.wiley.com/doi/10.1 ... 6/abstract
Zinc supplementation reduces blood ammonia and increases liver ornithine transcarbamylase activity in experimental cirrhosis
"Our results suggest that zinc deficiency may modify hepatic ornithine transcarbamylase activity and, therefore, ammonia disposal."

J Neurol Neurosurg Psychiatry 1982;45:691-698 Zinc and copper in multiple sclerosis.
Abstract
"Lower serum zinc levels were found compared to age- and sex-matched controls."

http://www.cpmc.org/learning/documents/ ... thy-ws.pdf
"Encephalopathy is a change in your mental condition in which toxins that normally circulate in the bloodstream are not cleared properly by the liver and result in altered brain function. Encephalopathy can cause mood changes, trouble with fine muscle movements, and trouble driving. Your doctor may tell you to stop driving."

i almost lost my license when i told the neuro about my driving trouble :S

hey LR and itaska, if either of you decide to get a zinc test, IIMA, please let us know what comes out of it!

jimmylegs wrote: http://www.thelancet.com/journals/lance ... 4/abstract
ORAL ZINC SUPPLEMENTATION IMPROVES HEPATIC ENCEPHALOPATHY
"Short-term oral zinc supplementation probably improved hepatic encephalopathy by correcting the zinc deficiency that compromises conversion of ammonia to urea."

This is exactly my point: if we apply every concept from other diseases to each other, then it's a slipper slope... why not say that MS is related to every possible disease out there in every patient. Why not use meds that are used for bacterial infection, HIV, liver disease, kidney disease, pneumonia, alzheimer's... just because one symptom happens to match. There are thousands of potential causes for cognitive dysfunction in the general population. There is no doubt that other conditions (like various deficiencies) lead to cognitive dysfunction. These individuals are not included in data showing that half of MS patients have cognitive problems (these are MS patients without comorbid illnesses).

As I mentioned, there are studies that are directly related to MS which are applicable.

IN CASE anyone is interested in learning more about cognition related specifically to MS (if you're not interested, just ignore this):

Cognitive function in MS is something I deal with everyday. It is important because first, it affects patients' lives, and second, it is a window into brain functioning. There is no doubt that these functions are driven by the brain. Anything that disrupts brain function sufficiently to overcome our normal brain capacity for compensation can disrupt cognition, but in DISTINCT ways. The list in the general population (non-MS) is long (I would say several thousand different diseases disrupt cognition in some way).

The patterns seen in MS are quite distinct and have been the topic of much research... thousands of studies since the 90s. The MAJORITY of them do not have comorbid conditions affecting other organs; if they do, it would not be possible to attribute the cognitive problems to MS itself and these individuals are not reflected in the research studies and data on this topic. So the patterns described in the literature are related as closely as possible to MS itself and not to other potential comorbid illnesses.

Of course if there are other diseases present in anyone, they are treated. But the information suggesting that half of MS patients experience cognitive problems is only referring to MS-related, not to problems arising from other conditions like encephalopathy. Therefore it is important to ensure that these individuals without other clear causes for cognitive dysfunction are not ignored as cognitive impairment occurs in the vast majority of patients who do not have treatable causes that can be detected via blood work.

Cognition is a huge area with a lot of facets. And it is often possible for a trained physician to differentiate between the cognitive and emotional problems that arise attributable to MS compared to those that are as a result of other disease conditions. The types of cognitive complaints and performances that someone with deficits due to MS has are quite distinct from encephalopathy-induced issues.

it all ties together and i rely on studies of nutrients in many conditions, not just ms. comorbidities and all. no harm in a zinc test to see if levels are suboptimal! what could be cheaper than testing zinc and correcting if necessary - even if it turns out to be unrelated to a specific patients lesion or cog fog, it would help with other diverse aspects of ms, given the zinc requirement for so many processes in the body.

jimmylegs wrote:it all ties together and i rely on studies of nutrients in many conditions, not just ms. comorbidities and all. no harm in a zinc test to see if levels are suboptimal! what could be cheaper than testing zinc and correcting if necessary - even if it turns out to be unrelated to a specific patients lesion or cog fog, it would help with other diverse aspects of ms, given the zinc requirement for so many processes in the body.

Certainly. Checking levels of other commonly deficient vitamins/minerals is also helpful. Iron-deficiency anemia, very common in women, and leads to fatigue and cognitive difficulties. B12, ...etc. These are normally done during a yearly check up in everyone if there is an indication depending on whether the person has risk factors for those deficiencies (the list of risk factors is long since there's so many possibilities but family docs know these).

Agree. I used to have testing done regularly, usually for ferritin and cobalamin, when I was a vegan. But I didn't even know to ask for a zinc test and I pretty much never got any testing other than what I learned of, researched, and asked for myself.

On that note, now I know that the ferritin and b12 levels which are considered okay to my doctor aren't actually good enough for me. I was so interested and actually appalled as everyone here knows, to discover once I got into it, how many groups of sick people are hanging out inside the 'normal' (ie stats normal data) range!

jimmylegs wrote:Agree. I used to have testing done regularly, usually for ferritin and cobalamin, when I was a vegan. But I didn't even know to ask for a zinc test and I pretty much never got any testing other than what I learned of, researched, and asked for myself.

On that note, now I know that the ferritin and b12 levels which are considered okay to my doctor aren't actually good enough for me. I was so interested and actually appalled as everyone here knows, to discover once I got into it, how many groups of sick people are hanging out inside the 'normal' (ie stats normal data) range!

That's one of the unfortunate features of having norms. Sometimes the person isn't represented by the norms. This happens a lot with women and iron deficiency.

Interesting note re: ferritin and B12; as long as your hemoglobin levels are nice and high and your red blood cell morphology is normal (this is all part of CBC, routine stuff), there isn't much consequences... If Hb is low, that's when symptoms start. The only reason we usually care about our ferritin and B12 is because of their effects on red blood cells/hemoglobin (and their oxygen carrying capacity). So if RBCs/Hb are fine, then severe symptoms can't be explained by this.
Low levels of B12/ferritin should still be treated to *prevent* anemia... but low levels of the former in and of themselves are not of much consequence. Many women have low ferritin levels but Hb and other blood markers (retic count, RBC size) are normal; so if they have any symptoms, we need to look for other causes cause low ferritin alone shouldn't cause problems without the anemia.

Yes. But we digress. If you start an anemia thread let's chat on that