I am a 38-year-old male swimmer. Can I manage MS symptoms?

Question

Hello doctor,

I am a 38-year-old professional swimmer recently diagnosed with multiple sclerosis. I first noticed something was wrong during a competition. I lost all sensation on my left side mid-race and nearly drowned. Now, I am experiencing severe heat sensitivity during training. My vision becomes blurry, and my legs give out after just 10 minutes in the pool.

An MRI (magnetic resonance imaging) shows active lesions near my motor cortex and optic nerves. My neurologist suggested Lemtrada (Alemtuzumab), which might affect my training schedule. The team noticed that my core temperature rose faster during workouts. I am also experiencing strange electric sensations down my spine when I bend my neck forward (someone mentioned this could be Lhermitte’s sign). Additionally, I am having tremors in my hands during precision dryland exercises.

Should I switch to Paralympic swimming?
Would cold therapy before training help?

My balance is also terrible during platform dives now.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thanks for reaching out, and I understand your concerns completely.

I’m genuinely sorry to hear what you’re going through. It’s good that you’re taking the time to explore your options, especially since multiple sclerosis (MS) is such a complex condition, particularly for a professional athlete.

Heat sensitivity (Uhthoff's phenomenon): MS lesions affect nerve conduction, and as your core body temperature rises during workouts, those symptoms can worsen. To help manage this, consider using cooling vests, cold-water immersion, or ice packs before and during training. Shorter training sessions may also help. A cold shower before exercise and ensuring the pool temperature stays between 78 and 80 degrees Fahrenheit can make a difference.
Vision problems and weakness in the pool: These symptoms are likely due to heat sensitivity and possibly active lesions near the motor cortex or optic nerves. During flare-ups, corticosteroids can reduce inflammation. Talk to your neurologist about treatment options, including alternatives like 4-aminopyridine (Ampyra), especially if you’re considering switching from Lemtrada (Alemtuzumab).
Electric shock sensations (Lhermitte's sign): This symptom is typically caused by lesions in the spinal cord. Try to avoid bending your neck too much during workouts. Work closely with a physical therapist to modify your swim strokes or diving positions to reduce strain on your neck.
Tremors and balance issues: Tremors during dryland training and poor balance on diving platforms may indicate involvement of the cerebellum. A neurologically trained physical therapist can help improve your coordination, balance, and strength. Medications such as low-dose beta-blockers (Propranolol) or anti-tremor drugs like Gabapentin may help, check with your neurologist to find the proper treatment and dosage.

Managing active lesions and new symptoms will be challenging, but for now, the focus should be on controlling your symptoms and staying safe during intense training. If your symptoms begin to seriously impact your performance or safety during competitions, consider transitioning to Paralympic swimming, where you can continue to compete at a high level with support and adaptations suited to your condition.

Be open with your sponsors about your diagnosis; remember, your health always comes first.

I hope this information is helpful.

Please feel free to reach out again if you need more guidance.

Thank you.