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One of the most common questions I get asked is what were the first signs or symptoms I experienced when I was being diagnosed with multiple sclerosis. Mine is an interesting story. It was 2005. I was working for a real estate developer in Boston at the time. My job required me to wear professional attire each day and with that I had to wear dress shoes. I worked long, hard hours oftentimes on my feet all day in stiff dress shoes.

Around the beginning of May 2005, I noticed that my pinky toe on my right foot would fall asleep. This happened consistently for a week, so I talked to my wife and we decided that I needed new, wider shoes. So that weekend, I went out and bought wider shoes. It still didn’t help. I asked my wife if she thought we should go by new bigger shoes.

However, there would be no third pair of shoes. By May 18, 2005, the numbness and tingling that started in my right pinky toe, had spread to everything south of my waist. The numbness and tingling was so severe that by this time, I could not walk or stand on my own. I also couldn’t go to the bathroom on my own. It was at this point that I knew something was seriously wrong with me and that I needed to seek medical attention right away.

Now, multiple sclerosis is unique in that the signs and symptoms are unpredictable and can affect each person in a different way. According to the research, most people will experience the initial onset of their MS symptoms in their 20s to 50s. The same research reveals that of the 2.3 million people in the world diagnosed with MS, 66 percent are women. While MS affects each person in a different way, there are certain common symptoms that are associated with the early onset of the disease:

• Vision problems are one of the first symptoms that are commonly reported. This includes blurry or double vision, loss of vision or color contrast, or pain while moving the eye. Vision problems can be very scary and affect your independence.
• Numbness and tingling can occur in your feet, legs, hands, arms or face. In my example, it started in my feet and then spread to my legs. I had a subsequent relapse where I experienced numbness and tingling from my face to my toes on my right side. The numbness and tingling can progress to be so severe that it affects your activities of daily living like dressing, eating, and bathing. Itching, burning, and other unusual sensations are common with the numbness and tingling.
• Fatigue is another commonly reported symptom that can be debilitating. While many of us may suffer fatigue, it may be hard to talk to your doctor about. For me, I was experiencing fatigue, but it wasn’t until I started experiencing the numbness, tingling, and walking problems that I decided to seek medical attention.
• Walking difficulties, along with vision problems, are the two symptoms that people without MS associate with MS. My aunt had MS when I was small and passed when I was only four. My only living memory of her was that she couldn’t walk and was in a wheelchair. When I was diagnosed 24 years later, I thought that was my fate. I couldn’t walk and was scared that I would never walk again. The most common walking problems with MS include: balance issues, sensory deficits from numbness and weakness when trying to lift and drop the leg to walk resulting in drop-foot.
• Bladder problems happen in 8 out of 10 MS patients, but is often the problem that is hardest to talk about. Bladder problems can mean feeling like you have to go often, or feeling like you never can fully empty your bladder. I had to learn how to use a self-catheter when my MS first happened because I could not go at all, or when I went, didn’t feel like I could empty my bladder. This happened for a short period of time and there were specialists to help. The hardest thing is just getting up the courage to talk to your doctor about it. I’ve been there, so I understand how hard it can be. Bowel problems are also common, especially constipation. Again, it seems like an awkward conversation, but you’ll feel so much better when you talk to your doctor about it.
• Sexual problems are common as well. Whether it relates to function, sensation, or desire, MS can affect the sex drive in both women and men. When you experience signs and symptoms of MS, it is difficult to feel attractive or be attracted to your partner. In addition to physical function, there can be a component of depression here as well. While this may be difficult to talk to your doctor about, your sexual health is a part of your overall well-being and should be discussed with your doctor.
• Cognitive or speech problems are common symptoms as well. Brain fog or fuzzy memory leads to slow thinking and poor concentration. Problems with word recollection or association are common, as well as, long pauses between word and missing words. Cognitive and speech problems can make it extremely difficult to complete daily tasks. These are part of the “invisible illness” symptoms that make MS hard to explain to others. Problems in these areas can become severe and must be brought to a doctor’s attention right away.
• Depression and emotional changes are associated with the onset of multiple sclerosis. Clinical depression is common with people living with MS. This can be associated with the emotional changes that happen with the diagnosis or neurological changes. Mood swings, uncontrolled laughter or crying at inappropriate times, and irritability can happen making it hard for family and caregivers. If you or your family members notice these changes or behavior, it is important to talk to a doctor right away.
• Muscle spasms and tremors are also commonly reported or associated with other deficits. These are typically associated with more progressive forms of MS, but can happen. Same with headaches and changes with hearing or hearing loss, but are less commonly reported as initial signs or symptoms.

If you, or a loved one, experience any of these symptoms, please see your doctor. If your doctor feels that your signs and symptoms are related to MS, then your doctor will refer you to a neurologist. It is important that you do not let these signs and symptoms linger and to see a medical professional as soon as possible.