Adapting Financial Planning For A Life With Multiple Sclerosis

The Elements of Life Planning
 
WHERE SHOULD YOU begin? Before diving right in, you should become familiar with some key concepts. In the face of disability or illness, the most important aspects of planning will involve anticipating your financial risks (as opposed to growing assets, for example) . The first principle of risk planning is that you must plan for the worst scenario. Otherwise, if the worst occurs, you will likely be unprepared for its potentially devastating effects. If, by planning in advance for them, you are prepared to meet the most difficult challenges head on, you will avoid having to cope with devastating financial loss at precisely the time when you are least emotionally equipped to do so.
 

Adapting Financial Planning For A Life With Multiple Sclerosis

In reality, every person has a life plan. The plan may simply be to take things as they come, to live from paycheck to paycheck, and to presume, therefore, that one will not become old, sick, or disabled. The life-planning process described in this post is, quite simply, a concerted effort to avoid such a non-approach. Nor is it too late to begin planning after the diagnosis. Some form of planning, whenever it occurs, is always better than having no specific agenda whatsoever.
 
Essentially, the life-planning process is designed to help a person reduce risk by (1) thinking through all possible contingencies, and (2) developing appropriate strategies to prevent life events from dictating catastrophic outcomes based on chance. The process includes four major types of planning:

• Life circumstances planning, or planning personal needs in major areas of life
• Planning for advocacy and directives by choosing professional and personal representatives or guardians in advance, as well as formulating advance directives
• Planning and implementing an ample financial portfolio or set of financial strategies designed to provide a financial portfolio, given the life goals that you have set, including provisions for adequate insurance against large financial risks 
• Preparing estate plans 

A fifth activity includes organizing all critical records into a health records file in order to permit continuity of administration of affairs throughout any period of disability, as well as after death. Regulations and penalties for medical providers who share medical information have become daunting. Such regulations also provide incentives for medical providers to dispose of older medical records. As a consequence, you may not be able to rely on your medical providers to keep a complete, long-term medical record for you. 

With the complexities of the information age, it is now in each individual's own interest to keep a thorough record of his or her own health history. You would be well advised, therefore, to create and maintain a complete, private medical record for yourself, including copies of imaging reports, lab reports, and any other record critical to your own long-term healthcare.

Perhaps the most important aspect of the life plan will be a comprehensive insurance plan. The traditional financial model in the United States assumes that an individual will begin working as a young adult and continue - essentially uninterrupted-until retirement age. MS can dramatically alter that model in several fundamental ways: the disease could cause your work life to be substantially shortened, thereby reducing the number of years in which you are able to accrue resources; the disease could also cause you to start drawing upon your savings at a premature age, and also cause you to have to draw upon those savings for a longer time than the typical retirement period; additionally, the disease could easily increase your overall expenses.
 

It is unrealistic to think that a typical middle-class person will be able to save sufficient resources to allow him or her to retire prematurely, stay retired longer, and have higher overall health related expenses for any length of time in retirement. Thus, the most critical element of the life plan will be construction of the risk or insurance plan as part of the financial plan. In fact, the insurance plan may drive all of the other components of the life plan; if there is a shortage of life, health, or disability coverage, the possible resulting limited financial resources if disability were to intrude could require a fundamental retooling of the entire life plan, including altering of life goals. To find out more, you can check out Adapting Financial Planning For A Life With Multiple Sclerosis.

Multiple Sclerosis Support Groups

EFFECTIVE LIFE PLANNING involves taking steps now to protect yourself and your family in the future. Although relatively few people who have multiple sclerosis (MS) become incapacitated enough to require long-term care, there is no way to predict with any certainty who will become severely disabled and who will not. Therefore, the optimal strategy is to implement plans now that will ensure your family's financial security regardless of the ultimate severity of the disease. It goes without saying that disability is a circumstance that no one would opt for. When it does occur, the key to a rich, fulfilling life, regardless of disability level, lies in planning.
 

Multiple Sclerosis Support Groups

The subject of life planning is one that most people find distressing. No one particularly enjoys thinking about potential problems or losses. However, engaging in the process of long-range planning and problem-solving will enable you to feel secure about your family's well-being, regardless of what the future brings.

This post highlights the principal components in the planning process. Because each family's situation is unique, and the complex laws pertaining to these issues vary considerably from state to state, the information provided here should in no way be considered comprehensive. You are well advised to consult an elder law attorney who specializes in disability-related law and/or a certified financial planner to discuss your family's particular needs. Your chapter of the National Multiple Sclerosis Society can recommend an appropriate professional in your area.
 
Selecting Planning Professionals to Assist You 

A STRONG WORD of caution must be offered here about selecting planning professionals to assist you. Only a few certified financial planners have the experience and expertise necessary to construct a rational and workable financial plan in the face of potentially career-shortening disability or illness. That is because most financial planners are, in fact, wealth planners, whose expertise is not designed for middle-class clients. Thus, most financial planners are not experts in assisting average or middle-class people to make sound financial decisions and deploying their resources most effectively.
 
This is particularly important to keep in mind when an individual needs to construct a sound financial plan in the face of potentially devastating illness or disability. Most typical planning strategies are inadequate in this situation; individuals who mistakenly rely on "traditional wisdom" are likely to face serious-but otherwise avoidable - financial disasters. As a consequence, it is critical that you exercise great caution when selecting financial experts or advice and screen for specific expertise in the area of disability planning.

Some key points include:

• A well-versed financial advisor assisting an individual with a potentially career-shortening disability will place a great deal of emphasis on the "risk" or insurance plan, and will pay particular attention to continuity of coverage problems that may arise with employer-sponsored coverage that disappears with the termination of employment.
• If the advice offered is simplistic, or relies solely on "traditional" insurance or savings strategies, that advice may well be inadequate to assist people with potentially career shortening illnesses to reach specific financial objectives.

What is Life Planning?
 
IN ITS MOST basic form, life planning is a process that encourages you to think about what you want in life (to set life goals), and to formulate a workable plan for ensuring that you are able to achieve those goals. The most important aspect of the plan is that it should be well executed and comprehensive. A well developed plan addresses all contingencies so that the possibility of its not being implemented approaches zero. In other words, a comprehensive plan should leave virtually nothing to chance. It should include many different aspects of formal individual planning, including financial, estate, and vocational plans. The planning process requires a consideration of everything that is important to the individual for whom the plan is being developed.
 
The life-planning process takes on special significance for persons with severe disabilities because their social and financial futures are so tenuous. Contrary to popular myth, it is not only the wealthy who must plan. The fewer resources you have, the more important it is that you plan wisely in order to deploy your scarce resources in the most efficient and effective manner possible.

Similarly, the greater the potential medical or vocational liabilities you may have, the more you need to ensure that you are adequately prepared for the expenses of illness, disability, or unemployment. To find out more, you can check out Multiple Sclerosis Support Groups.

Menopause And MS Multiple Sclerosis

Midlife and Menopause in Women
 
BECAUSE THE AVERAGE life expectancy for women is now more than 80 years, women can expect to spend at least one-third of their lives after menopause. In fact, one-third of the women in the United States have been through "the change." Learning what to expect from these hormonal and age-related changes is vital, especially for those who have MS, because certain peri-menopausal symptoms may be confused with a worsening of the disease.

Menopause And MS Multiple Sclerosis

Hormones have indeed been found to have some impact on MS. This impact is greatest during and after pregnancy. In addition, the symptoms of MS may increase at ovulation (midway through the menstrual cycle) when body temperature rises slightly and the estrogen level is at its peak. During the next 2 weeks until the period occurs, the temperature remains slightly elevated while the estrogen level gradually declines.
 
Estrogen, which declines during menopause, plays a major role in the health of the body, especially of the bones and heart. It is because of estrogen that women are much less likely than men to begin having heart attacks before the age of 60. When estrogen levels decline, bone density or thickness likewise decreases. Although bone density can begin to decline long before midlife, a truly dramatic decline begins at menopause. This trend is most often reflected in women's increased fracture risk (especially of the hip, wrist, and spine) after age 60. 

Women should, therefore, make every effort to arrive at menopause with the maximum bone density possible. Promoting healthy bones is best accomplished with weight-bearing exercise and calcium intake starting in childhood and continuing through the teens and twenties, when the body's maximum bone mass is developing. Once this bone density has been established, it needs to be maintained in the thirties, forties, and thereafter.

Adults with MS or other risk factors for osteoporosis (thinning of the bones leading to risk of fractures) should also have special screening tests done. While osteoporosis is common in women after menopause, especially if they are thin and of Caucasian or Asian ancestry, it can also occur in men and women of any age who use steroids or who have limited mobility. It is now possible to determine a person's bone density using a DEXA (dual energy X-ray absorptiometry) scan, which is a simple, painless, and safe test that predicts a person's relative fracture risk based on a computer-generated graph. 

There are also other methods of osteoporosis screening that your healthcare provider may recommend. Women or men who have osteoporosis may be prescribed a medication such as alendronate, which can increase bone density and help prevent fractures. As always, exercise and calcium must also he a part of the treatment.

Because menopause is the beginning of the rest of a woman's (long) life, the recommendations for preventive health care continue to apply during midlife and beyond. In general, physical exercise and a low-fat diet that includes the recommended 25-35 grams of daily fiber and adequate calcium continue to be essential to promote wellness. Routine preventive testing should include cholesterol screening, mammograms, Pap testing for cervical cancer, and screening for diseases such as colon cancer, high blood pressure, and diabetes.
 
Hormone replacement therapy is an important issue that all women of menopausal age need to consider. In years past, health practitioners routinely recommended hormone replacement for postmenopausal women because preliminary data suggested that estrogen supplements would decrease women's risk of heart attacks, strokes, cognitive problems, osteoporosis, and fractures. These preliminary studies were mostly of an observational variety, which could only suggest health benefits without truly proving them.
 
Proof depended on nationwide trials that would yield more definitive data by randomly assigning women to hormone replacement or to placebo medications, tracking outcomes over multiple years. When these long-term trials began to yield results, they showed that hormone replacement did not provide the expected preventive benefits. Not only did estrogen and progestin not prevent heart attacks, they indeed seemed to cause them.
 
The research also found that postmenopausal hormone replacement therapy increased the risk of breast cancer. Even though the studies found that hormone replacement prevented osteoporosis and fractures, relatively few physicians believe this benefit outweighs the increased risks of heart disease and breast cancer, especially since there are safe and effective treatments available for osteoporosis.
 
There are good reasons that some women may choose to use estrogen and progestin after menopause. Women bothered by hot flushes or other menopausal symptoms, for instance, might discuss with their physicians whether they should try hormone replacement for a period of time. Vaginal dryness or similar symptoms that may be MS-related, however, will not improve with hormone therapy. 

A woman's use of estrogen and progestin for short-term relief of menopausal symptoms should depend on discussions with her practitioner about the potential benefits and risks given her particular medical history, family history, and symptoms. Most physicians no longer recommend long-term use of hormone replacement therapy for the goal of preventing heart disease, osteoporosis or other medical problems.
 
Many over-the-counter remedies can alleviate perimenopansal symptoms. Vaginal moisturizers (KY Jelly, Astroglide, Replens and others) can increase comfort. Vitamin E (400 IU per day) has long been thought to reduce hot flashes. Soy products (soy milk, tofu) can result in healthier hearts and bones and can decrease hot flashes. Natural and health food stores encourage the use of dong quai, ginseng, black cohosh, wild yam root, and other products. Be careful, however, because acceptable studies are only now under way to assess the risk-benefit ratio of many complementary and alternative therapies.
 
We all want to make the right decisions about our health, knowing we will be living with them for a lifetime. Unfortunately, women (and men) are faced with decisions for which there are no guarantees and may be no obvious right answers. Medical recommendations vary from doctor to doctor and from study to study. The important thing is to be well informed, to discuss the issues thoroughly with your doctor, and to re-evaluate your choices as new research becomes available.
 
THIS POST HAS described some of the important health and wellness concerns of individuals with MS and their family members. Careful attention to health-promoting behaviors will make you an active participant in the teamwork that is required for you to enjoy the highest possible quality of life and be able to respond, "I am well, thank you" to all who inquire. It is important to make sure that the practitioners with whom you are working are sensitive to these concerns and attentive to problems other than those directly related to MS.

Although this discussion of general wellness has highlighted the health of the person who has MS, the same recommendations hold true for family members and friends. It is not only people who have a chronic illness who tend to forget preventive health care measures. Caregivers of very disabled individuals may find themselves so involved with MS-related demands that they neglect their own health or withdraw from healthy and relaxing activities that the person with MS can no longer share. 

On the other hand, people with MS who are able and willing to strive for wellness may find themselves becoming role models who inspire those around them. Whatever your own personal and family situation, it is essential to pay attention to your own health and well being. To the extent that everyone can adopt this approach, life's stresses - including the stresses of MS - will become smaller factors in what should be a happier and healthier family life. To find out more, you can check out Menopause And MS Multiple Sclerosis.

Causes And Symptoms Of Multiple Sclerosis

Preventive Health Care
 
IN ADDITIONAL TO proper diet and exercise, periodic health appraisals and screening tests are essential. Regular evaluations should occur once a year. Health maintenance evaluations should include a health history, physical examination, and laboratory tests depending on age and history. Beyond this basic, general testing, certain special screening tests should be done at regular intervals that depend on the person's age:

Causes And Symptoms Of Multiple Sclerosis

• Breast or testicular examination done by a healthcare provider
• Blood testing for cholesterol
• Rectal examination for men and women after age 40 years 
• Stool blood examination and other colon cancer testing for men and women after age 50 years, or if symptoms appear 
• Pap smear for women of reproductive age, usually once a year 
• Annual mammogram for women after age 40-50 years 
• For those with MS, blood testing for thyroid problems. 

Those with greater physical disability may worry that Pap tests, colon cancer screening, or mammography will be difficult to obtain. Many communities now offer accessible facilities for preventive health examinations. Some medical offices have special examination tables that lower to the floor. For pelvic examinations, the practitioner can use other adaptive equipment or techniques to increase comfort and avoid fatigue, it is certainly worthwhile to tell your practitioner in advance if you have any special needs.
 
People who have a chronic illness or disability may also have a tendency to neglect their dental health. Guidelines for accessing optimal dental care are available from the National MS Society.

Immunizations
 
ALTHOUGH WE MAY think of immunizations as interventions for children, even adults sometimes need immunizations to protect their health. The Centers for Disease Control and Prevention recommend these shots for adults:

• Tetanus and diphtheria (Td) booster every 10 years 
• Annual influenza immunization (flu shot) if you are over 50 or if you have certain medical indications (Most MS Specialist neurologists recommend a yearly flu shot for their patients.)
• Pneumococcal (pneumonia) immunization if you are over age 65 
• Varicella (chicken pox) immunization if you have not had the chicken pox. 

With or without MS, you may also need other immunizations, depending on your medical history and on whether you plan to travel abroad.
 
Safety Issues
 
THERE ARE MANY things you and your family can do to make your daily lives safer and healthier. Important safety measures include:

• Wearing seat belts every time you drive or ride in a motor vehicle.
• Using condoms to prevent sexually transmitted diseases if you are sexually active.
• Avoiding excessive sun exposure and applying protective sunscreen when you will be in the sun. 
• Keeping no firearms in the house, or at least keeping them securely locked. 
• Avoiding tobacco and drugs, and drinking alcohol in moderation if at all. 
• Protecting yourself and others from domestic violence. 

The media publicize reports of abuse against women, children and even elders. Many Americans do not realize, however, that younger adults with disabilities can also be abused or neglected in the home. If you are concerned about possible abuse or neglect in any form, contact your local protective services agency or police department. There are also community resources available to help with alcohol and drug problems. Smokers who wish to quit can ask their doctors about new medications and behavioral strategies, or dial 1-800-NO-BUTTS.
 
Stress Management
 
GOOD PREVENTIVE HEALTH care includes finding comfortable and effective ways to manage the stresses of everyday life. Stress management can take a variety of forms; the primary goal should be to identify activities or techniques that you enjoy enough to continue doing on a regular basis. While one person may unwind by attending a support group or an exercise class, another may read, listen to music, or write in a journal. Regular recreational activities, such as playing cards, going to the movies, or gathering with friends for dinner are also important strategies for easing the tensions of daily living. Keep in mind that although some people need time alone in order to relax and unwind, others seek group activities or social interaction as a way to relieve stress.
 

People who find themselves feeling overwhelmed and out of control of the stresses in their lives should not hesitate to consult a psychotherapist. A mental health professional can help you identify the sources of stress in your life as well as effective management strategies. A consultation may be all you need to get started on your own stress management approach. To find out more, you can check out Causes And Symptoms Of Multiple Sclerosis.