DEAR DR. ROACH: I was diagnosed with relapsing-remitting multiple sclerosis (RRMS) at the age of 46. The course of the disease was mild for me with only three identifiable MS attacks (in both my spine and brain). Although I initially resisted treatment, I took Copaxone shots for seven years before my neurologist believed that it was safe to discontinue treatment. Since this time, I haven’t had any new attacks, only some occasional balance issues and lingering weakness in my left leg.

My concern is secondary progressive MS (SPMS) and the possible consequences of an occurrence. I’ve recently read about therapeutic plasma exchange as a disease prevention option. It’s an extremely expensive treatment, so I’m curious about your thoughts regarding its effectiveness for the possible prevention of SPMS. — S.G.

ANSWER: MS is a disease where the immune system attacks the myelin coating that protects the nerves in the brain and spinal cord. There are different patterns of disease activity, with RRMS being the most common.

People (much more often women) have acute attacks of symptoms that stop, and a person recovers partially or completely until the next flare-up. The major symptoms of MS include sensory changes in the limbs, visual loss or double vision, gait changes, weakness, and bladder problems, although there are many other symptoms that any given person with MS might have.

Primary progressive MS (PPMS) only represents about 10% of MS cases and is equally likely to happen to men or women. In these cases, the disease is progressive, although there may be some relapses or temporary minor improvements. Some people who initially have RRMS will eventually convert to progressive MS, most commonly about 10 years after their diagnosis.

I completely understand why you’d be interested in treatments that might reduce your risk of developing secondary progressive MS, as this has a worse prognosis. Plasma exchange is useful for acute relapses in symptoms, but unfortunately, the data on plasma exchange don’t show effectiveness at preventing the conversion of RRMS to SPMS.

Therapies that have been proven to reduce the conversion to SPMS include the medication that your neurologist prescribed you — glatiramer acetate (Copaxone). This was shown to reduce the conversion rate by roughly 30%, compared to no treatment. The most effective treatments were fingolimod (Gilenya and others), natalizumab (Tysabri), and alemtuzumab (Lemtrada).

Roughly speaking, these other therapies ranged between being 52% to 71% effective at preventing conversion. Other highly effective treatments included rituximab, although it wasn’t included in a landmark trial. However, starting any therapy early (within five years) is important to reduce the conversion risk.

DEAR DR. ROACH: I’m a 75-year-old active male who recently wore a heart monitor for two weeks. The results showed atrial fibrillation of 9% with my bpm ranging from 49 to 230. I’m waiting for an appointment with a cardiologist and wondering what to expect. My preference would be to alleviate symptoms with medication, such as diltiazem, and avoid a blood thinner beyond low-dose aspirin, which I’ve been taking for 20 years. But I realize that this may not be realistic. — R.B.

ANSWER: In people with AFib, an irregular heartbeat that is often too fast (230 is way too fast, especially in a 75-year-old), the goal of treatment is to alleviate symptoms and reduce stroke risk. Diltiazem may be an excellent choice to keep your heart from going too fast, but I’m afraid that at age 75, your stroke risk is high enough that aspirin alone isn’t recommended. Your cardiologist will recommend an anticoagulant such as apixaban, which has the lowest risk of bleeding of all the drugs in the class.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.

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