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Tuesday, February 12, 2013

Coping With MS and a Secondary Disease

People living with MS often find themselves coping with a second or third health condition at the same time. But with a positive attitude and the right planning, it's possible to manage multiple diseases.

Medically reviewed by Lindsey Marcellin, MD, MPH

Being diagnosed with multiple sclerosis (MS) can feel overwhelming.  Some people become so caught up in managing their MS that they stop getting routine health screenings and believe that nothing worse can happen to them, says Rosalind Kalb, PhD, vice president of the Professional Resource Center for the National Multiple Sclerosis Society. This can have dire consequences.
Kalb points out that having a diagnosis for one disease will not prevent you from ending up with a second disease or even a third. “Get preventative care so that you are better prepared to handle other health conditions as they arise,” she suggests.
It's also important to notice when a new symptom appears or a “normal” symptom suddenly changes. Don’t assume it’s being caused by your MS, and if the symptom persists mention it to your neurologist. He or she will be able to determine if the symptom is aside effect of new medications or treatments you're trying.

And If your neurologist determines the symptom isn’t caused by MS, it’s time to visit your primary care doctor to locate the source.Migraine headaches and MS are a frequently seen combination, and secondary autoimmune disorders like rheumatoid arthritis aren’t uncommon.

Create the Best Medical Team

Because MS can be an all-consuming disease that requires frequent visits with a neurologist, some people come to rely heavily on that one specialist, mistakenly believing they no longer need a primary care physician. This is not the case, cautions Kalb, because "your primary care doctor watches all different aspects of your health.” And when you have more than one health condition, it’s even more imperative to have a primary care doctor helping to coordinate care with your neurologist and other specialists. For example, you'll need to see a rheumatologist if you develop rheumatoid arthritis
Zoe Koplowitz can vouch for the necessity of a well-coordinated medical team. Diagnosed with MS in her twenties, Koplowitz is now 64 and thriving thanks in large part to her medical team — a primary care physician, neurologist, rheumatologist, internist, and endocrinologist. They work together to help manage symptoms of MS and her two other conditions, diabetes and Sjogren’s syndrome, another autoimmune disorder characterized by chronic dry eyes and dry mouth.
Many hospitals and doctor's offices have electronic medical records stored in a central computer system that enables medical providers to easily communicate with one another and track patients’ treatment plans. If your health care providers are not electronically connected, you need to make sure you report each and every medication and treatment to all of your doctors or follow up to make sure the information is passed along among offices. Ask your primary care doctor to help you and your providers stay up-to-date.
Keep track of all symptoms and any over-the-counter medications you take and provide all of this information to your doctors as well. Koplowitz uses e-mail to make sure her team has all pertinent data — one group e-mail and the information gets where it needs to be.
If managing multiple health conditions becomes overwhelming, consider hiring a professional care manager as a team coordinator. A care manager is a health professional who coordinates care between your medical team, pharmacists, and even your insurance company. Ask your health care provider or insurance company to see if this is an option.

Create a Triage System for Care

“What will this do to my MS?” is a common reaction after being diagnosed with a secondary disease, even one as serious as cancer, says Kalb. It is important to remember that MS is rarely life-threatening, so you want to prioritize your health concerns and treat them accordingly. Your medical team should direct a treatment plan so that the most serious conditions are taken care of first. If none of your conditions are life-threatening, your medical team will work with you to prioritize the symptoms that should be treated first.

There may be instances when medications for MS should not be taken if you are on drugs for another health condition. For example, prednisone, taken to relieve the inflammation of MS, makes it more difficult to manage blood sugar and weight — side effects make it harder for Koplowitz to control her diabetes.

Koplowitz depends on her medical team to identify these types of interactions. She also uses one pharmacy for all medications because its database will alert the pharmacist if there's a potential interaction that she should be aware of. Any time she starts a new medication, she takes it separately, at a different time of day than her other medications — something that she says helps her to identify any changes in symptoms or side effects that she needs to report to her medical team.

Stay Positive No Matter What

When Koplowitz was first diagnosed with MS in 1973, she thought it would eventually kill her. She was prepared for defeat from the beginning. Her outlook changed when she choked on a pill one day and had the realization that, even with MS, she was subject to the same randomness as everyone else. She thought of activities that seemed impossible for someone with MS to accomplish and set out to do them.

Since then, Koplowitz has completed 25 New York City marathons, finishing last every time, but finishing. She has also gone snorkeling and parasailing. She sets goals for herself and figures out how to make them happen using modifications and sheer determination. Planning ahead (while staying flexible), being prepared, and maintaining a positive attitude keep her moving forward and actively participating in life. “Don’t cash in your chips,” she says. “You can either have a disease or be one.” 


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