Eight ways to help your patients with MS

Stanley Cohan

Stanley Cohan, M.D., Ph.D.
Neurologist and medical director, Providence Multiple Sclerosis Center

March 3, 2014

Before the mid-1990s, there were no medications of proven value for managing multiple sclerosis, a degenerative disease more common in the Pacific Northwest than in nearly any other part of the country.

Today, however, safe and effective medications are significantly improving relapsing-remitting disease – the most common form of MS – reducing the attacks that affect vision, balance, muscle strength, sensation and concentration, and in some cases, reducing the progression of disability.

These advances have led to a fundamental change in the trajectory of this disease. Those who once had to resign themselves to a limiting disability are now maintaining active lives. With less fear of serious and inevitable life changes, many patients now can turn their attention to other issues that will improve the quality of their health and their lives.

Here are a few ways we can help our patients with MS:

  1. Treat specific symptoms
  2. When medications aimed at controlling MS fail to improve certain symptoms, other targeted treatments may help. For example:
    • Bladder and sometimes bowel control can be a problem for many people with MS, particularly when the spinal cord is affected. Fortunately, many effective medications and exercises are available, and some physicians, especially urologists and gynecologists, have developed special expertise in this area. 
    • Anxiety is another common problem that can be addressed, in most cases, with medication and counseling. 
    • Sexual performance problems, which can be an issue for some people, can be overcome with the help of medication and specialized counselors.
  3. Recognize and treat depression
  4. MS can cause depression by attacking areas of the brain that regulate mood and feeling. Many people with MS don’t realize their symptoms of sadness, irritability, fatigue and difficulty concentrating may be caused or worsened by depression. This is an important issue that deserves candid conversations between doctor and patient since most people with MS respond well to antidepressants and counseling.

  5. Emphasize a healthy diet
  6. Although research has found no direct benefit of a low-fat diet on patients with MS, we know that eating right and controlling calories helps to avoid additional serious problems, such as obesity, diabetes, hypertension and related diseases.

  7. Monitor vitamin D levels
  8. Recent scientific evidence suggests that vitamin D plays an important role in the development and function of the immune system. And MS is, in part, an immune system disease.

    Studies show that in populations where vitamin D levels are low, the risk of developing MS is higher. Babies born to women who have low vitamin D levels also appear to have a greater risk of developing MS. This is especially important in the Pacific Northwest, where less exposure to sunlight reduces the body’s ability to manufacture vitamin D.

  9. Explain how smoking affects MS
  10. Cigarette smokers have a much greater risk of developing MS than nonsmokers. Studies also suggest that people who smoke after they’ve developed MS have a more aggressive form of the disease. So in addition to all the other negative effects, the evidence is very clear: Tobacco use has a direct link to vulnerability for MS. 

  11. Prescribe exercise
  12. Physical activity reduces the risk of developing other diseases, improves sleep and mood, and helps keep weight under control, which can be very helpful for people with weak legs and balance problems. 

    Everyone should exercise to his or her fullest reasonable ability, and everyone can exercise to some extent. I have yet to see a patient, even with grave disability, for whom some physical activity, however limited, was not possible. There are buoyancy devices to help people walk in cool-water pools; upper-body exercises for those who can’t use their legs; and several devices that can be bought, rented or borrowed to help with home exercise programs.

    If physical limitations are keeping your patients from exercising, I encourage a referral to a physical therapist who can help them learn new ways to move their body and enjoy the benefits that come with some activity.

  13. Discuss pregnancy and parenting
  14. Multiple sclerosis should not stand in the way of any woman who wants to have children. MS does not prevent pregnancy, interfere with pregnancy or get worse during pregnancy. In fact, in the overwhelming majority of cases, MS actually gets better during pregnancy.

    Ideally, women who are planning a pregnancy should work with their neurologist and obstetrician to get their disease under control and to come off of their medications before conceiving, since some medications may affect pregnancy. A discussion about breastfeeding and medications is also important.

  15. Help them find help
  16. MS can be an isolating disease, but that can be remedied. Even for people who live in remote communities, help and support are readily available through organizations such as the National Multiple Sclerosis Society of Oregon and Multiple Sclerosis Society of Portland.

Each of these provides a home base for support and information on a wide variety of issues, from financial support and transportation assistance to information about doctors and medicines. MS care centers, such as Providence Multiple Sclerosis Center, are a major part of this supportive network, as well.