What Is The Treatment For Multiple Sclerosis

CONSIDERING THE IMMUNE-MODULATING THERAPIES

• Because MS is likely to progress without treatment, and irreparable damage can occur even early in the disease course, treatment should be considered for any person with relapsing MS even if a person is relatively symptom-free and "feeling fine."
• Early treatment improves a person's chances of reducing the attack rate and slowing disease progression over the long term.
• All of the approved treatments are beneficial; the evidence indicates that some may be stronger than others; together, your physician and you can determine the best treatment option for you. 
• While every treatment may have side effects, 90% of people can learn how to manage the treatments comfortably. If you are having difficulty with your immune-modulating medication (or any other that has been prescribed for you), do not stop taking it without talking to your physician; most problems with treatment can be successfully resolved. 

What Is The Treatment For Multiple Sclerosis

Many people with MS use various types of alternative treatments in an effort to manage their symptoms - sometimes instead of mainstream medicine, but more commonly as an adjunct to the treatments prescribed by their physicians. Alternative therapies include a broad range of treatments (i.e., dietary supplements, homeopathy, chiropractic, and many others). It is extremely important that you let your physician know about any treatments you are using, including over-the-counter medications and nutritional supplements, so that he or she can alert you to potential drug interactions or other risk factors.
 
Bringing a family member or friend to your doctor's visits can often be quite helpful. People sometimes feel anxious while talking to the doctor and find that they have difficulty focusing on what is said, and even more difficulty remembering it afterward. You might ask your relative or friend to jot down notes for you during the appointment so that you can go over them again later. This person might also be able to remind you of problems or symptoms that have sipped your mind. A family member may have questions of his or her own pertaining to your symptoms or to family issues relating to the illness. In addition to, or instead of, bringing someone with you to the appointment, you might want to tape record the conversation for later review or to share with family members.

You may hear or read about a treatment that seems relevant to your MS or to a particular symptom you are having. It is appropriate to ask your doctor whether this treatment might be helpful for you. If your doctor is not familiar with the particular treatment, it is reasonable for you to ask that he or she look into it further and give you an opinion about it. Doctors who are not MS specialists should be willing to investigate possible MS treatments or make a referral to a specialist who might be more familiar with them.
 

No matter which topics are covered in a particular visit to the doctor, you should leave feeling that you have conveyed and received whatever information is needed for you to continue managing your MS symptoms and day-to-day activities as comfortably and effectively as possible. If, at the end of your visits, you wonder what has been accomplished, it is time to think about what needs to change in order for those visits to be more productive. If every visit to the doctor is a search for "the cure," the visit is not likely to be a fruitful one. If, however, you are working with your doctor to keep your life comfortable, active, and productive, you have a much higher likelihood of success. To find out more, you can check out What Is The Treatment For Multiple Sclerosis.

Multiple Sclerosis Clinics

Taking Responsibility for Optimizing Your Medical Care
 
Choosing Your Physician And Healthcare Team

WHETHER OR NOT your choice of physician is restricted by your health plan, the most important factors in your selection should be (1) your comfort level in working and communicating with this doctor, and (2) the physician's knowledge and experience in MS. Centers that specialize in MS care are often in a position to offer a wider range of medical and psychosocial interventions. However, even the most sophisticated MS center will not meet your needs if you do not feel able to communicate and work comfortably with the healthcare team.

Multiple Sclerosis Clinics

If your healthcare plan requires you to select a primary care physician (most likely an internist, or a general or family practitioner) to act as gatekeeper for your medical care, look for a physician who currently treats other MS patients and is familiar with the complexities of the disease. He or she should be willing and able to help you manage your symptoms and knowledgeable about existing treatment options. The primary care physician should also be willing and able to refer you to a specialist when the need arises. If you are unable to find a physician within your network who is experienced in the care of MS patients, your next best option may be to find one who is willing to learn.
 
Staying Informed
 
PEOPLE WITH MS and their family members need to educate themselves about the disease and existing treatment options. In particular, those patients whose care is provided by non-MS specialists need to take responsibility for staying informed and up-to-date about MS management. This is the most effective way to ensure that you are receiving optimal care. Today, more than ever, there are numerous avenues for obtaining this kind of information, including books, newsletters, information lines sponsored by pharmaceutical companies, the Internet, and the vast array of publications offered by the MS societies. Keep in mind, however, that some sources are more authoritative than others, and that you cannot believe everything you hear. This educational process will enable you to be an active and informed participant in your own care.

TIPS FOR MAKING THE MOST OF DOCTOR VISITS

• Make a list of questions and concerns before the visit.
• Prioritize the list and discuss your most important issues first.
• Make sure that your doctor has a complete list of all the medications you are taking, including any that have been prescribed by another physician for non-MS-related conditions, and any over-the-counter drugs or supplements. 
• Bring up all your concerns - even the ones that may be difficult to talk about (e.g., bladder and bowel problems, sexual changes, cognitive changes). 
• Discuss any medication side effects you are experiencing. 
• Ask for a referral if' you would like a second opinion on any aspect of your disease or its management. 
• Consider bringing a family member or friend to your visit if you feel the need for a "second pair of ears"; consider tape recording the visit for later review. 
• Ask for more time or another appointment if you have not addressed your issues fully. 

Use Your Visits to the Doctor Effectively
 
THE DOCTOR-PATIENT collaboration is at its most active during the office visit. This is the time to give your physician the information he or she needs in order to help you manage your MS. Be prepared for your visits.
 
Because most people find it difficult to remember all the things they want to talk about, particularly when they are trying to listen to what the doctor is saying, it is a good idea to bring a list of topics and questions. Let the doctor know how current medications are working for you and what, if any, problems or side effects you are having with them. This is particularly true in relation to the approved immune-modulating therapies - the interferons (Avonex, Betaseron, and Rebif), glatiramer acetate (Copaxone), and mitoxantrone (Novantrone). 

An effective collaboration between you and your healthcare team will help to ensure that you initiate treatment at the time that you and they feel is most appropriate, and that you can continue comfortably with the treatment for the foreseeable future. 

Describe your symptoms, taking care to let the doctor know which of them are causing you the greatest difficulty. Patients are sometimes hesitant to bring up certain issues that they find embarrassing. Unfortunately, some physicians may be reluctant to bring up the very same topics. People living with MS need to know that bladder and bowel symptoms, sexual difficulties, and cognitive and emotional changes can all be significant problems related to their disease. Do not hesitate to talk about them, and do not hesitate to think about looking for another physician if you feel that you are not getting adequate help with these important problems. To find out more, you can check out Multiple Sclerosis Clinics.
 

Multi Sclerosis Treatment

The Implications of Managed Care in MS 

HOW DOES THE comprehensive model of MS care fit with the healthcare reform that is currently happening throughout the United States? Interactions between doctors and their patients are being re-defined in the face of the growing need for cost containment. Managed care is a system for organizing large numbers of healthcare providers within a single corporate structure, with the goal of providing quality services to patients while simultaneously controlling costs.
 

Multi Sclerosis Treatment

There are major differences between traditional and managed healthcare. In traditional healthcare, the patients choose the doctors they want caring for them, and the insurance company pays for all or part of the visit. In managed care, the health organization contracts with healthcare providers to provide services to patients who are enrolled in their insurance plans. The patient must abide by the rules of the plan or face the possibility of not being reimbursed for services provided. Although these rules vary from one insurance plan to the next, they typically require patients to choose from a list of participating providers and use their primary care physician as the "gatekeeper" for access to specialty care. 

As a result, the primary care physician, rather than the patient or family, decides when consultation with an MS specialist is desirable or necessary. Referrals to specialists are usually for a specific number of visits or a limited time period. In other words, specialists do not provide ongoing care for people in many managed care programs. In addition, services once covered by insurance are gradually being shifted outside the traditional healthcare environment. Thus, although counseling, rehabilitation therapies, and education are still important, the new emphasis is on how to provide care at a lower cost. Financial responsibility for many services is being shifted from the insurers to the healthcare providers, their patients, and the patients' families.
 
Patients and families with reduced access to MS specialists need an even greater understanding of the issues related to MS and its management, and must work closely with primary care physicians to make certain that their needs are addressed. Primary care physicians who traditionally have not provided neurologic care need to expand their expertise in areas such as MS.
 
A likely outcome will be that the ongoing or "maintenance" care of a person with MS will be provided in the primary doctor's office, with referrals being made to specialists for a difficult diagnosis, immunologic therapy, and the management of difficult problems or complications. The patient and family may need to depend more on information from publications, lectures, the Internet, voluntary health organizations (e.g., National MS Society, the Multiple Sclerosis Association of America, United Spinal Association), and other resources, to make certain that they are aware of the latest developments in MS. Prepared with this information, it is appropriate (even important) for a patient or family member to ask the primary care physician for a referral to a specialist when they perceive that he or she is unfamiliar with available treatment strategies or is unwilling to pursue additional treatment options.

Is managed care good or bad? Medical treatment managed in this way may initially reduce overall healthcare costs. It is yet to be determined whether it will reduce costs in the long run, or how it will affect the quality of MS-related care. Although managed care seems to provide adequate and cost-effective preventive medicine and treatment for acute illnesses, managed care has yet to demonstrate its effectiveness in chronic diseases, including MS. Specialists in MS care have concerns about the quality of care given to MS patients by healthcare providers who lack experience and expertise in the management of disease symptoms and who may not understand the potential complications of the disease or the side effects of various medications.
 
The new immunosuppressive treatments in MS have provided an interesting point of contrast between managed care and MS care provided in comprehensive specialty centers. Once patients with MS have been started on disease-modifying medications such as Betaseron, Avonex, Copaxone, or Rebif, their ongoing care is typically provided by physicians who are not MS specialists. These physicians are often less familiar with the subtleties of treatment, patients' emotional reactions to medications or the injection process, and the management of side effects. Not too surprisingly, one study demonstrated that the dropout rate for one of the medications was much lower for patients who are followed by MS specialist physicians and nurses than for those patients who were being followed by other healthcare providers. 

This clearly has significant implications for the health and well being of people with MS. The effectiveness of the new immuno-suppressive therapies will ultimate|y be determined by the ability of patients to use and tolerate them over a long period of time. Simply prescribing a treatment is not enough; teaching patients how to use it and supporting their efforts to continue doing so are essential.
 
In the long run, the effectiveness of managed care for people with MS will depend on the degree to which patients and families believe that they have access to the kind of treatment and support they need in order to manage their symptoms and live comfortably with MS. A close working relationship between primary care doctors and MS specialists has proved quite successful in the past. The question will be whether this kind of collaboration can continue to flourish under managed care.

An alternative to the comprehensive model in MS care, known as "principal care," is currently gaining momentum. In this model, the MS specialist provides ongoing care, while referring the patient to the primary care physician for non-MS medical care. Some managed care insurance plans are becoming more amenable to specialists providing the comprehensive care.
 

Whichever approach takes hold in the days ahead, it will be important for individuals who have MS or other chronic illnesses to make their needs and feelings known to their insurance companies. Since people live to an older age and survive for longer and longer periods with diseases like cancer and AIDS, chronic illness is becoming much more prevalent. In order for insurance companies to be able to survive, they must meet their clients' needs and become responsive to this growing segment of the population. Although the pendulum of healthcare management and insurance reimbursement is unlikely to swing back very rapidly, it will eventually respond to the demands of educated and assertive consumers. Consumers will be the ones who educate insurance companies about the unique and ongoing needs associated with chronic illness. To find out more, you can check out Multi Sclerosis Treatment.

What Are The Treatments For Multiple Sclerosis

The "Comprehensive Care" Model in MS 

A MORE COMPREHENSIVE approach to treatment grew out of the recognition of the complexity and chronicity of the problems caused by MS, as well as its impact on the entire family. The effects of MS are not only medical, but also social, economic, and emotional. The idea of a solitary medical practitioner working to find a cure or manage all the problems no longer seemed feasible. Rather, the far-reaching impact of the disease required the intervention of a multidisciplinary team, working in a coordinated fashion to help the patient and family cope with the ongoing stresses of MS.
 

What Are The Treatments For Multiple Sclerosis

MS centers that provide this type of comprehensive care for patients and their families have emerged in the United States and Canada over the past 30 years. In addition to the physician, this type of team might include a nurse, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, recreational therapist, and nutritionist. Although the members of the team each tend to focus on different aspects of patient and family care, they share the important goals of education, disease management, and support.
 
Although individual healthcare practitioners have tended in the past to be reactive, responding only to losses and negative events, the role of the healthcare team in MS is a proactive one. As soon as the diagnosis is known, the team begins to educate the patient about ways to slow disease progression, manage the symptoms and prevent unnecessary complications. Thus, for example, the person who has MS (and family members) will learn the indication for a specific treatment, the expected result, and the possible side effects. Realistic expectations for a treatment form the foundation for its success, as well as the success of the doctor-patient relationship.

In addition, the team begins to help the entire family with the coping and adjustment process. During these early months, team members assess the family's existing strengths and resources. The family's ability to cope with the stresses of chronic disease will depend on the internal and external resources they bring to bear on the problem. The healthcare team helps patients and families recognize, appreciate, and utilize all their existing strengths to cope with the challenges that arise. 

Families also need to learn about resources available in the community. What is helpful for one family may not be helpful for another, but the goal is to provide a menu of options so that families can choose what is most useful for them. The educational process needs to be ongoing in order to meet the changing needs within the family. Information that would have been irrelevant to a family in the early stages of the disease may suddenly take on new meaning as significant medical, economic, or social changes occur.
 
The family clearly has a central role in this comprehensive model of MS care. The family experiences its own reactions to the diagnosis of MS in one of its members. From the outset, family members are encouraged to express their own sadness and anger over this intrusion into family life. They will be unable to support the patient in any effective way over the course of the illness if they are overwhelmed by their own reactions.
 
The healthcare team can help families assimilate MS into their lives without allowing personal and family needs to be totally submerged by the disease. Family members are encouraged to pursue personal goals and maintain satisfying outside interests and activities so as not to feel like hostages to MS. Spouses and elderly parents, in particular, can experience guilt over their own good health and their feelings toward the family member who has MS.

The healthcare team can lessen this guilt by supporting people's efforts to maintain an independent life beyond the MS. This, in turn, will have reciprocal benefits for the team and the person with MS. Over the course of the illness, family members serve as a valuable extension of the healthcare team. To the extent that they continue to feel good about themselves and satisfied with their own lives, family members can be more effective in their care of the person with MS.

This, in turn, helps promote the long-range goal of the healthcare team, which is to promote quality care for individuals with MS, free of unnecessary hospitalizations or treatments, and free of the threat of premature or inappropriate long-term placement. 

While the comprehensive, multi-disciplinary team approach to MS care is ideal, it is not always available, especially outside of large cities. Your National MS Society chapter, which can be reached by calling 800-FIGHT-MS (800-344-4867), can refer you to an MS center or to MS-specialist clinicians in your area. The challenge is to find ways to access this multi-disciplinary expertise even if you cannot find it within a single center. There are two primary strategies for accomplishing this:
 
The first strategy is to locate the MS center that is nearest to you, and consider the possibility of using their expertise on a consultative basis. There are many people with MS who visit a comprehensive center once every year or two for a thorough evaluation and recommendations on treatment. The center then forwards its recommendations back to the person's local physician for implementation. While some physicians might resent the input from the MS center doctors, there are many that find this type of collaboration very helpful, particularly since it may not be possible for them to keep up with all of the latest research and information about available treatments.
 

The second option is to create your own team of specialists and ask them to communicate with one another about your care. In other words, you make every effort to ensure that your family doctor, neurologist, urologist, physical therapist, and whatever other specialist you might use, know what care you are receiving. Some people accomplish this by asking each practitioner to send reports to the other practitioners; other people maintain a file of their own records, including a complete list of all their medications, and bring them to each doctor's visit. Since the MS nurse is often the person who is most familiar with you and your care needs, she or he may be in an ideal position to help you coordinate your care. The goal of these efforts is to ensure that the various aspects of your medical care are working in some coordinated fashion to help you manage the challenges of MS. To find out more, you can check out What Are The Treatments For Multiple Sclerosis.