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    Flare vs Exacerbation

    This is my impression of the difference between a flare and an exacerbation:

    Flare
    Disease progression and additional demyelination and nerve damage resulting in new or significantly worse disability / symptoms.

    Exacerbation
    An exacerbation of existing symptoms, as a result of excessive heat, stress, eating something disagreeable, or other activity that triggers existing symptoms.

    In January, an optic neuritis caused temporary blindness in one eye. There was demyelination, resulting in a bruised optic nerve. The inflammation has healed and the nerve is back to about 66%. This incident was a flare.

    In July, there was debilitating neuritis pain in that eye when we had a lot of smoke happening in our area, and air quality was really bad. The pain was gone in a day or two. I considered this to be an exacerbation.

    If a person is on disease modifying therapy and they have an exacerbation, this does not mean the overall disease is progressing - it just means symptoms are exacerbated by whatever you're doing. This is also why eating a good diet is good for reducing symptoms but it does not necessarily stop progression.

    Does all of this sound correct?
    All the best, ~G

    #2
    Hi gargantua.

    An exacerbation, relapse, attack, flare-up, all mean the same thing; A worsening of old symptoms and/or new symptoms lasting continuously for more than 24 -48 hours.

    Information from the National MS Society:
    https://www.nationalmssociety.org/Tr...aging-Relapses

    If a person is on disease modifying therapy and they have an exacerbation, this does not mean the overall disease is progressing
    Unfortunately, a DMT doesn't guarantee an exacerbation won't leave residual symptoms Remissions are either complete (no symptoms) or partial (residual symptoms), with partial being the most common ~ this is true on or off DMT.
    Diagnosed 1984
    “Lightworkers aren’t here to avoid the darkness…they are here to transform the darkness through the illuminating power of love.” Muses from a mystic

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      #3
      I had no idea of the difference or that there was a difference. YAY for no real Dr for over a year.

      I am hoping this new one is good. I already feel positive. I wanted an earlier appointment and they have called me 3 times with cancellations. Sadly I was at work twice and once I slept until noon because it was the first day of my vacation.

      15 days though until I see him. So at least his office staff is 100 times better than the staff for my old one.

      Comment


        #4
        gargantua:
        An exacerbation of existing symptoms, as a result of excessive heat, stress, eating something disagreeable, or other activity that triggers existing symptoms.
        This would be referred to as a pseudo-exacerbation. Pseudo-exacerbations is a worsening of old symptoms and/or new symptoms due to a cold/virus, the flu, getting overheated, an infection, overdoing it, and exercise. Pseudo-exacerbations are self-limiting; once you no longer have the flu, cold/virus, infection, cool down, and rest your symptoms will usually return to what is normal for you.

        Information about pseudo-exacerbations:
        https://www.msfocusmagazine.org/Maga...-Exacerbations
        Diagnosed 1984
        “Lightworkers aren’t here to avoid the darkness…they are here to transform the darkness through the illuminating power of love.” Muses from a mystic

        Comment


          #5
          Originally posted by SNOOPY View Post
          Hi gargantua.

          An exacerbation, relapse, attack, flare-up, all mean the same thing; A worsening of old symptoms and/or new symptoms lasting continuously for more than 24 -48 hours.

          Information from the National MS Society:
          https://www.nationalmssociety.org/Tr...aging-Relapses

          Unfortunately, a DMT doesn't guarantee an exacerbation won't leave residual symptoms Remissions are either complete (no symptoms) or partial (residual symptoms), with partial being the most common ~ this is true on or off DMT.
          Thanks Snoopy. I'm trying to get down to the difference between a relapse and situations when symptoms are felt more intensely, but there is not disease progression, for example when it is hot, or after a lot of activity when exhaustion sets in. For me, if I cool down or rest I recover pretty quickly, which makes me think it's not a flare but rather activity that may be taxing already-damaged pathways.

          "Heat or high humidity can make many people with multiple sclerosis (MS) experience a temporary worsening of their symptoms. Doctors believe that this occurs because heat causes nerves (whose myelin covering has been destroyed from MS) to conduct electrical signals even less efficiently...It is important to remember that while climate may worsen the symptoms of MS, climate changes do not produce more actual nerve damage. The adverse effects of temperature and humidity are generally temporary."

          https://www.webmd.com/multiple-scler...ct-temperature

          If I can tell the difference between a flare and a "temporary worsening of symptoms," I'll feel even more positive about living with this.
          All the best, ~G

          Comment


            #6
            This might help you...

            https://secure.nationalmssociety.org..._msattackornot

            Comment


              #7
              Exacerbation or Flare:
              From https://www.nationalmssociety.org/Tr...aging-Relapses
              An exacerbation of MS (also known as a relapse, attack or flare-up) causes new symptoms or the worsening of old symptoms. It can be very mild, or severe enough to interfere with a person’s ability to function at home and at work. ...
              To be a true exacerbation, the attack must last at least 24 hours and be separated from the previous attack by at least 30 days. Most exacerbations last from a few days to several weeks or even months.

              PseudoExacerbation:
              The difference is that a true exacerbation is an actual worsening of the disease and lasts from several days to several weeks—or longer. A pseudoexacerbation is a temporary aggravation of MS symptoms, symptoms that have occurred before. The episode comes and goes fairly quickly—usually within 24 hours.
              InsideMS: Is It an MS Attack or Not? - National Multiple Sclerosis Society
              https://secure.nationalmssociety.org...gename=HOM_LIB...

              Originally posted by gargantua View Post
              If I can tell the difference between a flare and a "temporary worsening of symptoms," I'll feel even more positive about living with this.
              The link that Marcos gave you was to an excellent article that I have often referred people to in the past, and my link is to the same article. Unfortunately, NMSS seems to have changed the web address and I can no longer find it. I did post a quote from it, though, that I found on google.

              Hopefully, these explanations, plus Snoopy's post, will help you to determine the difference between a flare and a temporary worsening of symptoms.

              I did find this article from MS Focus Magazine. Although not as comprehensive an article as the previous one, it might provide some additional insights.
              https://www.msfocusmagazine.org/Maga...-Exacerbations
              ~ Faith
              MSWorld Volunteer -- Moderator since JUN2012
              (now a Mimibug)

              Symptoms began in JAN02
              - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
              - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
              .

              - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
              - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

              Comment


                #8
                Originally posted by Mamabug View Post
                **** Exacerbation or Flare ****
                From https://www.nationalmssociety.org/Tr...aging-Relapses
                To be a true exacerbation, the attack must last at least 24 hours and be separated from the previous attack by at least 30 days. Most exacerbations last from a few days to several weeks or even months.

                **** PseudoExacerbation ****
                The difference is that a true exacerbation is an actual worsening of the disease and lasts from several days to several weeks—or longer. A pseudoexacerbation is a temporary aggravation of MS symptoms, symptoms that have occurred before. The episode comes and goes fairly quickly—usually within 24 hours.

                https://secure.nationalmssociety.org...gename=HOM_LIB...

                https://www.msfocusmagazine.org/Maga...-Exacerbations
                Thanks Mamabug, that's exactly what I was looking for, the term for the thing that isn't a real exacerbation

                Knowing the difference between actual disease progression and times that MAY not require expensive medical attention is helpful too.
                All the best, ~G

                Comment


                  #9
                  Originally posted by gargantua View Post
                  Thanks Mamabug, that's exactly what I was looking for, the term for the thing that isn't a real exacerbation

                  Knowing the difference between actual disease progression and times that MAY not require expensive medical attention is helpful too.
                  Actually, that is a conversation that everyone should have with their neuro. You should ask what types of things warrant a phone call and/or appointment and what type of response and in what timeframe should you expect one?

                  It is always better to have that conversation before you need to call.
                  Kathy
                  DX 01/06, currently on Tysabri

                  Comment


                    #10
                    [QUOTE=pennstater;1514270]Actually, that is a conversation that everyone should have with their neuro. You should ask what types of things warrant a phone call and/or appointment and what type of response and in what timeframe should you expect one?

                    These are good questions noted for my next 6 month visit. To be frank, out of 3 doctors including neuro, all have a hard time to committing to - or even speculating - what kinds of things might occur that would constitute another flare. But if it's my eyes, I call a certain doctor and they know exactly what to ask me, and where to refer me. My neuro is phone-only except for every 6 months, though he does have nurses who would likely bring me in. It's decent overall coverage.

                    Very generally I like to know enough to be able to be proactive but not clog the queue.
                    All the best, ~G

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