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Coping with dual diagnoses -- How to prioritize when MS is only one of your health concerns.

by Aviva Patz
Lisa Emrich and her husband, Rob Osberg.
Lisa Emrich, a musician, with her husband, Rob Osberg, manages the coexisting health conditions of Multiple Sclerosis and rheumatoid arthritis. Photo courtesy of Lisa Emrich
Just two years after being diagnosed with Multiple Sclerosis, 47-year-old Lisa Emrich, a professional musician in Falls Church, Virginia, suddenly was unable to play the piano. “My fingers on both hands curled into fists, and I cried during the night because of the excruciating pain,” she recalls. “I fantasized that someone would chop off my arms just so I might get some relief.”
Emrich, who had already lost control of two fingers on her left hand the previous year due to MS, figured the new symptoms were just the next chapter in her struggle with the disease. But after several months and referrals to many other medical professionals, her finger issues turned out to be due to a whole other diagnosis—rheumatoid arthritis (RA).
“I was devastated,” Emrich says. “As if it wasn’t bad enough that I had previously lost my vision, lost the use of my left arm, even lost strength and dexterity, all due to MS, now I was faced with the possibility of further pain and disability from the RA.” Once her RA was diagnosed, however, Emrich worked with her team of physicians to pursue a course of treatment and learn strategies for managing it alongside her MS.
Dr. David E. Jones
Dr. David E. Jones says it’s important to identify the condition that may be causing new symptoms in
someone with MS.
 Photo courtesy of Dr. David E. Jones
Untangling the web
Like Emrich, many people with MS develop other seemingly unrelated health conditions such as cancer or diabetes, another autoimmune disease such as psoriasis or RA, or a potentially temporary issue like headaches or anemia.
“More than 50 percent of people with MS are estimated to have another chronic health condition,” says Dr. Ruth Ann Marrie, professor of medicine and community health sciences at the University of Manitoba, Canada, and director of the Multiple Sclerosis Clinic at the Health Sciences Centre in Winnipeg.
However, like Emrich, many people with more than one health condition may simply blame the new or Worsening symptom on their MS—especially if the symptom is consistent with MS, like pain or weakness. “Part of the problem is that MS is different for different people, so you can’t just pick up a book and say, ‘This is exactly what you’ll have,’” says Dr. David E. Jones, assistant professor of neurology at the University of Virginia and chair of the MS section at the American Academy of Neurology. Attributing new symptoms to MS may also provide some sense of comfort, Dr. Jones says. “People may think, ‘Phew—it’s just my MS and not another diagnosis.’ ”
But as awareness of dual diagnoses grows, it’s becoming increasingly clear that for people with MS, any new symptoms should be evaluated through a wider medical lens. “If there’s another condition that’s causing the [new] symptoms, it will not be treated successfully unless it’s identified,” Dr. Marrie says.
Dr. Ruth Ann Marie
Dr. Ruth Ann Marrie has found that depression and anxiety are common disorders that occur alongside MS. Photo courtesy of Health Sciences Centre Winnipeg
Common comorbidities
Dr. Marrie recently led an international committee of MS experts in an investigation into which coexisting health conditions, known medically as “comorbidities,” are most common among people with MS. The goal of the ongoing research, called The Comorbidities Project (which is supported by the National MS Society and the European Committee for Treatment and Research in MS), is to understand how other health conditions may affect the course and treatment of MS, and how best to manage all of the various symptoms.
After reviewing 249 earlier studies on MS and other medical conditions, Dr. Marrie’s team published seven papers in the MS Journal in 2015. Key findings include:
The five most prevalent disorders that occur alongside MS are depression, anxiety, high blood pressure, high cholesterol and chronic lung diseases like asthma. Depression and anxiety are so common, in fact—affecting about 24 and 22 percent of people with MS, respectively, per Dr. Marrie’s analysis—that researchers are beginning to suspect they may actually be caused by the disease process itself. “In some cases, structural and functional changes in the brain due to MS likely play a role, and inflammation may also play a role,” explains Dr. Marrie. But she’s quick to add that depression should not automatically be attributed to MS. “Any of the stressors and circumstances that increase the risk of depression in people without MS—divorce, illness in family members, financial difficulties—can also cause depression in people with MS, and genetic factors are likely relevant in other cases.”Some autoimmune disorders—in which the immune system attacks its own body rather than predatory invaders like viruses—appear to be more common among people with MS. According to Dr. Marrie’s findings, more than 7 percent of people with MS have psoriasis, over 6 percent have thyroid disease and nearly 3 percent have RA. In the general population, only a total of 5 to 8 percent of people have any type of autoimmune condition.On the whole, cancer is less common in people with MS than in the general population. However, certain types of cancer may occur more often in people with MS—including cervical and digestive-system cancers.Heart disease, congestive heart failure, stroke, arthritis, inflammatory bowel disease, irritable bowel syndrome (IBS), seizure disorders, bipolar disorder, sleep disorders and alcohol abuse are found more often in people with MSClick here to read the complete article 


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Saturday, 04 July 2020

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