12.3.10 Brochure LivingWithMS

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Living withMultiple Sclerosis

BY DEBRA FRANKEL, MS, OTR

WIT H HETT IE JA ME S

Debra Frankel, MS, OTR is Associate Vice President of Programs,

Services and Clinical Activities, Advancing the Region Teamat the National Multiple Sclerosis Society. Hettie Jones is a

professional writer.

This publication is supported by contributions to the National

MS Society from its members and friends.

Reviewed by members of the Client Education Committee of the

National Multiple Sclerosis Societys Clinical Advisory Board.

2010 NATIONAL MS SOCIETY. ALL RIGHTS RESERVED.

Kimberly (front cover), diagnosed in 2000.


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Newly Diagnosed | 2

Introduction

If this book has made it into your hands, the words multiplesclerosis (MS) may have been recently spoken by yourphysician.ese words can be incredibly scary if you havenever heard of MS before, or even if you have some personalexperience with MS in friends or family. is guide isdesigned to help ease some of those fears and educate you

about what MS is and what MS is not. Keep in mind thateach individuals experience with MS is unique, and thathaving MS today is dierent from what it was like in thepast. Today there are a number of eective treatments forthe disease with more in the pipeline. Be sure to educateyourself and dont succumb to myths and misinformation.

Clearing up misconceptions

Multiple sclerosis (MS) isnt entirely understood yet, sothere are many misconceptions about it. Here are somemyths you may have heard already:

MS is fatal.

It almost never is. Statistics show that most people with MShave a near normal life span and are likely to die of other

conditions unrelated to MS. Generally, deaths associatedwith MS are due to complications in advanced, progressivestages of the disease or the extremely rare case of malignantlyprogressive disease. Eective early treatment of MS shouldhelp to prevent those complications for most people.

Everyone with MS will bein a wheelchair sooner or later.

Not true. Many people living with MS remain able to walkwithout help. And, with the increased availability anduse of disease-modifying therapies and other treatments,more people are remaining mobile longer. People who are

able to walk may choose to use a wheelchair, cane, scooteror other device to conserve energy or prevent injury fromfalls. In a recent survey of people with MS, 12 percent ofrespondents used a wheelchair for mobility and about 20percent reported using a cane.

1 | Living with MS


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3 | Living with MS Newly Diagnosed | 4

Life in a wheelchair is a half-life.

People who use wheelchairs work, drive cars, travel,participate in sports, maintain meaningful family and sociallives, contribute to the community, and pursue their dreamswith as much passion as people who dont use wheelchairs.

You should stop working. The stress is harmful.

ere is no scientic evidence that the normal stress ofworking has any eect on MS. But symptoms such asfatigue and cognitive problems can cause problems on thejob. A recent Society-funded study indicated that about44% of people with MS are currently in the workforce.at number could be higher; the National MS Societyis working to inuence the attitudes of employees andemployers alike, as well as help them understand theirrights and responsibilities in the workplace.

You shouldnt have children.

Most women with MS nd their symptoms lessen duringpregnancy. en, the risk of an attack rises somewhat in the

rst six months after delivery. Overall, however, pregnancyand childbirth have no long-term eect on MS progression.MS is not directly inherited, but genetics play an importantrole in who gets the disease. ose who fear passing on thedisease to their children should know that the risk is actuallyvery small somewhere between 15 percent. But youshould consider what options you might have for help caringfor your children in the event that MS interferes with yourability to do so.

Diet can cure MS.

No dietary claim has yet held up in scientic studies.However, for general good health, people with MS arestrongly advised to follow the balanced, low-fat, high-berdiet recommended by the American Heart Association andthe American Cancer Society.

MS is the same as muscular dystrophy.

Muscular dystrophy (or MD) is a disease of the skeletalor voluntary muscles that control movement. Multiplesclerosis (or MS) is a disease of the central nervous system.e two diseases are completely unrelated to each other.MS damages the nerves that control muscles, not themuscles themselves.

What is multiple sclerosis?

MS is thought to be an autoimmune disease that primarilyaects the central nervous system (CNS). e CNS consists

of the brain, spinal cord, and the optic nerves. Surroundingand protecting the nerve bers of the CNS is a fatty tissuecalled myelin, which helps nerve bers conduct electricalimpulses.

In MS, myelin is lost in multiple areas, leaving scar tissuecalled sclerosis.ese damaged areas are also known asplaques or lesions.e nerve ber itself (called the axon)can also be damaged or broken.


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Myelin not only protects nerve bers, it makes their jobpossible. When myelin and/or the nerve bers are destroyedor damaged, the ability of the bers to conduct electricalimpulses in the brain and spinal cord is disrupted, and thisproduces the various symptoms of MS.

MS is not contagious; no one in your family will catch itfrom you.

What causes this disease?

While the exact cause of MS is unknown, most researchersbelieve that the damage to myelin results from an abnormalresponse by the bodys immune system. Normally, the immunesystem defends the body against foreign invaders such asviruses or bacteria. In autoimmune diseases, the immunesystem attacks the bodys own healthy tissue. It is believedthat MS is an autoimmune disease in which myelin is themain target of the immune attack.

Scientists do not yet know what triggers the immune systemto do this. Most agree that several factors are involved,including a genetic predisposition that may make someonemore susceptible to whatever stimuli or agent(s) in theenvironment cause the MS to become active.

What are thesymptoms of MS?

Symptoms depend on which areas of the CNS have beenattacked. Symptoms are not only dierent for dierentpeople, but dierent in the same person from time to time.

Symptoms may range from mild to severe. ey may go

away on their own or they may not. A person with MSwill usually experience more than one symptom, but notall of them.

Symptoms include weakness, tingling, numbness or impairedsensation, poor coordination, fatigue, problems with balance,visual disturbances such as blurred or distorted vision orinvoluntary rapid eye movement (also called nystagmus),tremors, spasticity or muscle stiness, slurred speech, bowelor bladder problems, unstable walking (ataxia), problemswith sexual function, sensitivity to heat , mood swings,increased susceptibility to clinical depression, and problems

with memory, judgment, or reasoning (cognitive problems).In severe cases, MS can cause partial or complete paralysis.

Remember, the majority of people with MS do not have allthese symptoms; some have very few of these symptoms.


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How is MS diagnosed?

Because no single test can diagnose MS, several tests andprocedures are commonly used to diagnose MS, including:

Q A medical history, in which the physician will look for

evidence of past neurological signs and symptoms.

Q A thorough neurological exam.

Q

MRI (magnetic resonance imaging), a noninvasive form ofimaging that produces detailed pictures of the brain and

spinal cord.

Q Blood tests that can test for certain uncommon illnesses

that can occasionally resemble MS (e.g. lupus, vitamin B12

deficiency and others).

Other tests that may be helpful where diagnosis is unclear are:

Q Lumbar puncture (or spinal tap), to look at the composition

of the fluid that surrounds the spinal cord (cerebrospinal

fluid or CSF) for signs of problems in the immune system.

Q Studies called visual evoked potentials that measure the

response of the CNS to specific kinds of visual stimulation.

Are second opinionsto confirm diagnosisa good idea?

If youve seen only one doctor, its certainly reasonable toget a second opinion. Your original doctor should not beinsulted or hurt because you want to conrm your diagnosis.You might ask your family doctor or call the National MSSociety for a referral to an MS specialist in your area.

What will happennext with my MS?

No one can know with certainty. You and your doctorshould talk over your particular situation. e words youwill hear most often are unpredictable and variable.

Living with this unpredictability is part of living with MS.

Many people go through periods ofexacerbation.eseare acute attacks, also called relapses, when new symptomsappear or existing symptoms become more severe.Exacerbations are usually followed byremissions, whichmay bring you back to your pre-relapse level or may leaveyou with some remaining disability. is form of MS iscalled relapsing-remittingMS.


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Some people never have attacks but instead experience slowand steady worsening of symptoms and disability over time.When this pattern exists from the outset, it is called primary-progressive MS. When this steady pattern follows an earlierperiod of relapsing-remitting MS, it is called secondary-progressive MS.

MS may stabilize at any time, regardless of pattern. If yourphysician has experience caring for other people with MS,

he or she may have additional insights about your situation.

Is MS inherited?

MS is not directly inherited, although studies do reveal afamily predisposition. is means that siblings or otherclose relatives are somewhat more likely to develop thedisease. However, 80% of people with MS do not have aknown relative with MS.

Who gets MS?

Women develop MS at a rate at least double that of men.Its estimated that in the United States some 400,000people are living with MS. Because it isnt contagious, thereporting of cases is not required. So the actual number ofpeople with MS can only be estimated.

MS is more common in those areas farthest from the equator.However, some ethnic groups, such as the Inuit, Aboriginesand Maoris, have few if any documented cases of MSregardless of where they live. is suggests that geography,ethnicity, genetics and other factors interact in somecomplex way that scientists have not yet determined.

MS occurs in most ethnic groups, including African-Americans,Asians and Hispanics/Latinos, but is more common in

Caucasians of northern European ancestry. ere is alsoaccumulating evidence that African-Americans may tend tohave more severe problems with MS than do other ethnicgroups.e variation in severity and type of MS amongdierent populations is an area of increasing research interest.

Are there anytreatments for MS?

Yes, there are many treatments, which fall into two generalgroups.e rst group the Food and Drug Administration(FDA)-approved disease-modifying drugs work to slow oralter the disease process itself. e second group includesmedications and techniques to improve or alleviate symptoms.Symptom management is vitally important for living wellwith MS. Weve provided a brief introduction on page 11,but there are many additional strategies.


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Because treatment for MS is changing so rapidly, its a goodidea to be in contact with your doctor for the most currentinformation.e National MS Society is also a source ofinformation on new developments. Call 1-800-344-4867or check our Web site often at nationalMSsociety.org.

What therapies

fight the disease?To date, the following medications have been approved inthe United States to help control MS Avonex, Betaseron,Copaxone, Extavia, Gilenya, Rebif, Novantrone, andTysabri. (Please checknationalMSsociety.orgfor updates.)ese medications are sometimes called the disease-modifyingtherapies. None of them cure MS. All of them reduce thefrequency of attacks and delay the onset of permanentdisabilities. And they all reduce the signs of new injurywithin the brain as seen on MRI scans.

Avonex, Betaseron, Copaxone, Extavia, and Rebif areadministered by injection; Novantrone and Tysabri aregiven by intravenous infusion. Gilenya is an oral medica-tion that comes in a capsule.

Avonex, Rebif, Betaseron and Extaviaare forms ofinterferon beta, a substance the immune system normallymakes to regulate itself. Avonex and Rebif are dierentformulations of interferon beta-1a; Betaseron and Extaviaare identical formulations of interferon beta-1b. Theinterferon drugs are all approved for treatment of relapsingforms of MS. Avonex, Betaseron, and Extavia are alsoapproved to delay the development of MS in individualswho have experienced a f irst episode of demyelination(known as a clinically-isolated syndrome-CIS) and haveMRI ndings that are typical of MS.

Copaxone is a synthetic protein derivative that works bydecreasing the number of destructive immune cells andincreasing the number of benecial immune cells. is drugis approved for relapsing-remitting MS. It is also approvedto delay the development of MS in individuals who haveexperienced arst episode of demyelination (known asa clinically-isolated syndrome-CIS) and have MRI ndingsthat are typical of MS.

Gilenya is a new class of therapy for MS that is taken bymouth. It binds to a docking site (sphingosine-1-phoshatereceptor, or S1P) on immune cells, including T cells and Bcells that have been implicated in causing nervous systemdamage in MS. e drug appears to force immune cells toremain in lymph nodes where they can do little harm andprevents them from migrating into the brain and spinalcord. Gilenya is approved to treat relapsing forms of MS.


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In the opinion of the National Clinical Advisory Board ofthe National MS Society, treatment with a disease-modifyingtherapy should be considered as soon as possible by anyone whohas received a conrmed diagnosis of MS and is experiencingactive disease (recent attacks or new lesions on an MRI scan).

Novantrone is the rst drug approved by the FDA to treatworsening forms of MS, including secondary-progressiveand rapidly worsening relapsing-remitting MS. is is a

powerful immune-suppressing medication with a limitedlifetime dosage to prevent heart damage that can be a resultof higher dosages of this medication.

Tysabri is a type of drug called a monoclonal antibody thatis designed to inhibit harmful immune cells from leaving thebloodstream and entering the brain. Tysabri, which is givenas an intravenous infusion, is generally recommended forpeople with MS who have not received sucient benetfrom, or been able to tolerate, one or more of the injectabledisease-modifying therapies. Because Tysabri increases therisk of a serious infection called progressive multifocal leuko-

encephalopathy (PML), it must not be used at the sametime as other disease-modifying treatments. In addition,the FDA requires that persons using Tysabri participate in asafety monitoring program called the TOUCHTM program.

Decisions about taking a disease-modifying therapy are bestmade through discussions with your physician, carefullyconsidering and weighing such factors as side eects, risks and

benets, lifestyle and cost. None of the disease-modifyingtherapies is approved for use by women who are pregnant,trying to become pregnant, or breastfeeding.

As of the printing of this publication, other medicationsand combinations, including oral therapies, are in variousstages of clinical trials or are under review by the FDA,potentially oering new options to modify the course of MS.

What therapiesrelieve symptoms?

Something can be done to moderate almost every MSsymptom, but getting the right therapy often requires trialand error. Good communication with your nurse and doctoris the key. And there is more to managing MS symptoms thantaking medication. Healthy living habits, stress management,spiritual life and psychological support all play a part in livingwell with MS.

Q Corticosteroids, such as prednisone or methylprednisolone

(Solu-Medrol), are used to shorten attacks (also called

relapses, exacerbations, or flares) and the discomfort

resulting from the symptoms that occur during attacks.

Q Spasticity or stiffness in the muscles can be managed with

stretching exercises and medications including baclofen

(Lioresal), tizanidine (Zanaflex), and dantrolene (Dantrium),

among others.


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Q Walking speed may be increased by a medication called

fampridine (Ampyra), which helps to enhance conduction

of nerve signals in nerve fibers on which the insulating myelin

coating has been damaged.

Q Fatigue may improve with aerobic exercise, energy-management

strategies, and medications including amantadine (Symmetrel)

and modafinil (Provigil).

Q Certain bladder problems respond to medication, including

tolterodine tartrate (Detrol), oxybutynin (Ditropan), trospium

chloride (Sanctura), or solifenacin succinate (Vesicare).Q Sometimes techniques such as self-catheterization or pelvic

floor exercises (Kegel exercises) are recommended. Prompt

treatment of urinary tract infections and adequate intake

of fluids are important to help prevent bladder complications.

An evaluation by a urologist is important for determining

the appropriate treatment strategies.

Q Bowel problems (such as constipation or loss of control) are

not uncommon. They are managed with diet changes, lifestyle

modifications, fluid changes, suppositories, or medications.

Q Burning, painful, or unusual sensations (called paresthesias)

may respond to carbamazepine (Tegretol), amitriptyline

(Elavil), gabapentin (Neurontin), pregabalin (Lyrica), orduloxetine hydrochloride (Cymbalta) and other therapies.

Q Cognitive problems may be managed with rehabilitation

and training.

Q Mood changes, including mood swings and depression,

are best treated with a combination of talk therapy and

medication. Significant mood swings generally respond

well to a mood-stabilizing medication like divalproex

sodium (Depakote); depression is treatable with the

newer antidepressant medications like sertraline (Zoloft)

and venlafaxine (Effexor), among others.

* NOTE: This information above was current at the time of

publication. Please visit our website, nationalMSsociety.org/meds

for updates about medications.

What can rehabilitation oer?

Rehabilitation cannot alter the course of MS itself, butmay improve tness, mobility, and cognition, and enhanceindependence and quality of life.

Physical therapy (PT) can help strengthen weakenedmuscles and improve balance and mobility. A PT regimenmight include range-of-motion exercises, stretching, helpwith walking, and training in the use of canes, walkersor other assistive devices. PT can also include exercises to

maintain or increase overall function and stamina, transfertraining (for example, learning how to move safely from awheelchair to a bed or toilet), and recommendations for aregular exercise program.

Occupational therapyimproves independence in dailyliving. An occupational therapist (OT) can help peoplewith MS attain maximum levels of independence andoptimal functioning. OTs are specialists in energy con-


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servation to combat fatigue and can teach techniques fordressing, grooming, eating and driving.ey can provideexercises for coordination and strength, and recommendlow- and high-tech equipment and strategies to adapt thehome or workplace to increase safety, productivity andindependence.

Speech therapyaddresses problems for those who have dicultyspeaking or swallowing due to weakness or poor coordination.

Techniques used by speech therapists (also called speechpathologists) might include oral exercises, voice training,the use of special communications devices if needed, dietmodication and altered positioning while eating.

Cognitive rehabilitation oers strategies to help improvememory, attention, information processing and problem-solving, which may become slowed due to loss of myelin inthe brain. A neuropsychologist, speech pathologist or OTcan teach methods to compensate for cognitive problemsincluding memory strategies, time management techniques,organization methods and the use of computers.

Does exercise help?

Yes. Exercise alone cannot alter MS, but it can improveoverall health and may prevent many complications that stemfrom inactivity. Because exercise contributes to a feeling ofwell-being and helps to regulate sleep patterns, appetite, and

bowel and bladder function, there are psychological as well asphysical benets. Yoga, swimming, tai chi and other forms ofmovement and body work may also be helpful.

You and your doctor or therapist can work out a programthat will benet you the most.

What do employersneed to know?

Its up to you whether or not to disclose your diagnosisto co-workers and your employer. Legally, youre notrequired to reveal this information. You can access anonline tool to help you with employment disclosuredecisions at nationalMSsociety.org/DisclosureDecisions.

Keep in mind that its not a good idea to make majordecisions about employment while youre in the midst ofa crisis either right after diagnosis, or during an attack

of symptoms. Give yourself time to recover from immediateproblems. Then gather information that will help youunderstand your options. MS varies from person to person,and so will its impact on work situations.

If you are interviewing for a new job, you are not requiredto disclose your diagnosis, and it is illegal for the potentialemployer to inquire about your health. A medical examinationmay be performed only after an oer of employment is


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made. If physicals are conducted, they must be conducted onall employees in that job category.e medical informationmust be kept separate from the personnel le.

If you need any accommodations such as extime, a modiedtelephone, or other equipment to do your job, you mustdisclose your disability to your employer. e Americanswith Disabilities Act (ADA) requires most employers toprovide reasonable accommodations.

e ADA contains many other provisions to protect you.Be informed before you do anything. Call the NationalMS Society for more information on your rights as a personwith MS.

Does MS affect sexuality?

Everything connected to MS from its physical symptomsto its emotional impact can aect sexual expression. Butthis doesnt mean that sexual problems cant be managed

successfully. People with MS can and do have fullling sexlives. Please consider these suggestions:

Q Work at sharing feelings honestly with your partner.

Q Be flexible about sexual expression.

Q Seek medical treatment for physical symptoms.

Q For non-physical problems, consider consulting a

psychotherapist or counselor.

Is depression common in MS?

Its certainly common to feel fear, confusion, loss of control,anger or grief at a diagnosis or worsening of MS. Beyondthat, at one time or another, approximately half of peoplewith MS experience what doctors dene as moderate tosevere clinical depression. Many others experience milderforms of depression. Depression can be a direct result of

MS damage within the brain or a side effect of somemedications or triggered by loss or life changes. Depression,whatever the cause, can be treated with medication andcounseling.

If you feel hopeless, sad, or despairing, and/or lose interestor pleasure in usual activities, and these feelings persist overseveral weeks, this may indicate clinical depression. Othersymptoms of depression include irritability, changes inappetite or weight, sleep problems, fatigue, feelings ofworthlessness or guilt, inability to concentrate, restlessness,and recurrent thoughts of suicide, violence or death. If

you are experiencing these symptoms, you should nd aqualied professional who can help.

If you feel depressed or overwhelmed, remember that askingfor help is not a weakness, but a strength. Your chapter oryour doctor can refer you to a knowledgeable professional.


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Can family counseling help?

e whole family lives with MS. It may change family routinesfor work, play almost everything and everyone isaected. Counseling may help the whole family to adjust.

Many National MS Society chapters oer family-orientedprograms. Contact your chapter for information or forreferral to counselors or support groups.

Whats the best way totalk to children about MS?

Young children easily sense when something is wrong.eyneed clear, age-appropriate explanations. Discussing issues,rather than hiding them, benets children of any age. Usuallytheyre more resilient and better able to accept challengingrealities than their parents assume. Children do need to be

consistently reassured that their parent will be there to takecare of them and that they will be safe and loved regardlessof what MS may bring.

e National MS Society oers a number of programs,brochures and special newsletters for children and teensof a parent with MS. Contact your chapter or visitnationalMSsociety.orgfor more information.

Does stress make MS worse?

eres no clear evidence that stress either causes MS ormakes it worse. Most people (with or without MS) dontfeel good when they are stressed out, and having anychronic illness can be stressful in itself. MS specialistsrecommend:

Q Keep as active as possible mentally and physically.

Q Manage time to conserve energy.

Q Simplify life set priorities.

Q Practice relaxation or meditation techniques.

Q Make time for fun and cultivate your sense of humor.

Q Set realistic goals and expectations.

Q Work on accepting what cannot be changed.

Q Ask for help if and when you need it.

Does smoking ordrinking affect MS?

Recent studies have suggested that smokers are morelikely to develop MS than non-smokers, and smokingmay accelerate disease progression.


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Smoking harms your health in general, which could add todisability. And because of weakness and poor coordination,people with MS who smoke may be at increased risk ofinjury.

Drinking in excess causes poor coordination, poor balanceand slurred speech. It also impairs judgment and altersbehavior. All this can add to existing symptoms, althoughtheres no evidence that alcohol makes MS worse.

How does heat affect MS?

Heat doesnt make MS worse permanently, but many peoplewith MSnd that hot, humid weather, a hot bath or shower,or a fever can temporarily make their symptoms worse.Although this temporary worsening (known as a pseudo-exacerbation) may feel like a real MS attack, the symptomswill improve as the bodys temperature returns to normal.Its a good idea to avoid heat in the middle of the day and

to bathe in warm rather than hot water. Many people withMS nd that cooling owith ice packs, iced drinks, coolinggarments (such as vests, suits, hats, and neck, ankle or legwraps), and cool baths helps to reduce symptoms and improvestamina in hot environments.

If you nd you are heat sensitive, an air conditioner may bean essential piece of equipment and is usually tax-deductibleif your healthcare provider writes a prescription for it.

What about vaccinationagainst the flu?

You should discuss your individual situation with yourdoctor. Based on recent research, it is the consensus of theNational MS Societys Clinical Advisory Board that theseasonal influenza vaccine is safe for people with MS,

including people who are taking a disease-modifying therapy.However, people with MS should only receive the seasonalinjectable vaccine containing inactivated or killed virus andavoid the nasal spray vaccine containing live or attenuatedu virus.

What about Vitamin D?

In the past, it was assumed that most people maintainedadequate vitamin D levels from their diet and exposure to thesun. Today, there is a growing concern that most children andadults have insucient levels of this important vitamin. Inaddition to its eects on calcium absorption and bone health,vitamin D exerts important actions on many other body systems,including the immune system. Adequate levels will help preventbone loss from reduced mobility and may improve musclestrength and prevent or decrease the severity of MS. Much


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additional research on vitamin D is needed. In the meantime,people with MS should discuss their situation with their healthcare provider to determine an appropriate vitamin D strategy.

Will complementary oralternative therapies help?

While complementary (used in conjunction with prescribedtreatments) and alternative therapies (used instead of prescribedtreatments) such as acupuncture, dietary supplements,massage, meditation, and hypnosis have not had a proveneect on MS, people sometimes nd that these therapieshelp them reduce stress, manage symptoms and feel better.But before deciding to pursue one of these therapies, investigateall potential risks, benets and costs, and discuss them withyour doctor.

Most alternative and complementary health practitionersare not MS specialists and cannot provide diagnoses. It isimportant to discuss new symptoms with your doctor andkeep him/her informed about all treatments or regimensyou may decide to use.

Whats the bottom line?

Your MS is unique to you, but it is not your identity. Youare still the same person you were, but a diagnosis of MSmay require you to make adaptations to your life and lifestyle.Here are some general tips on living well:

Q Take care of yourself. Eat well, exercise and get enough rest.

Listen to your body, and say no when you need to.

Q Take control of your emotional well-being. Find people

with whom you can talk and share feelings, and who will

offer support.

Q Try to act as a partner with your physician and other

healthcare professionals to manage your disease.

Q Connect with others who have the disease as you feel comfortable.

Sharing tips, information and feelings about coping with MS with

others can be reassuring and helpful. Your National MS Society

chapter can help you make that connection.

Q Examine your priorities. Try to make sense of MS within

your own worldview, according to your personal values and

insights. You might wish to seek support from clergy, spiritualorganizations or counselors.

Q MS poses uncertainties about the future. At some point, you

need to examine your financial plans, insurance coverage,

housing needs and other practical issues and to build a

network of informed advisors who can help you and your

family with long-term life planning.

Q Call the National MS Society for information, referral and

support.


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The National Multiple Sclerosis Society is proud to be a source

of information about multiple sclerosis. Our comments are

based on professional advice, published experience and

expert opinion, but do not represent individual therapeutic

recommendations or prescriptions. For specific information

and advice, consult your physician.

The Society publishes many other pamphlets and articles about

various aspects of MS. Visit nationalMSsociety.org/brochures

to download them, or call your chapter at 1-800-344-4867

to have copies mailed to you.

Early and ongoing treatment with an FDA-approved therapy

can make a difference for people with multiple sclerosis.

Learn about your options by talking to your health care

professional and contacting the National MS So ciety at

nationalMSsociety.org or 1-800-344-4867 (1-800-FIGHT-MS).

Some of our popular pamphlets include:

Q Preventive Care Recommendations for Adults with MSQ Fatigue: What You Should KnowQ Should I Work: Information for EmployeesQTaming Stress in Multiple SclerosisQ Clear Thinking about Alternative TherapiesQThe Disease-Modifying DrugsQThe Win-Win Approach to Reasonable Accommodations:

Enhancing Productivity on Your Job

Q Depression and Multiple Sclerosis

Ampyra is a trademark of Acorda Therapeutics, Inc.

Avonex is a registered trademark of Biogen Idec.

Betaseron is a registered trademark of Bayer Schering

Pharma Aktiengesellschaft.

Copaxone is a registered trademark of Teva Pharmaceutical Industries Ltd.

Cymbalta is a registered trademark of Eli Lilly and Co.

Dantrium is a registered trademark of Procter & Gamble.

Depakote is a registered trademark of Sanofi-Aventis Corp.

Detrol is a registered trademark of Pfizer.

Ditropan is a registered trademark of Alza Corp.

Effexor is a registered trademark of Wyeth Corp.

Elavil is a registered trademark of Zeneca, Inc.

Extavia is a registered trademark of Novartis AG.

Gilenya is a trademark of Novartis AG.

Lioresal is a registered trademark of Ciba Geigy Corp.

Lyrica is a registered trademark of C.P. Pharmaceuticals.

Neurontin is a registered trademark of Warner-Lambert Co.

Novantrone is a registered trademark of Immunex Corp.

Provigil is a registered trademark of Cephalon, Inc.

Rebif is a registered trademark of Ares Trading, S.A.

Sanctura is a registered trademark of Allergan, Inc.

Solu Medrol is a registered trademark of Pharmacia & Upjohn Co.

Symmetrel is a registered trademark of Endo Pharmaceuticals.

Tegretol is a registered trademark of Novar tis Corp.

TOUCH is a trademark of Biogen Idec and Elan.

Tysabri is a registered trademark of Elan Pharmaceuticals, Inc.

Vesicare is a registered trademark of Astellas Pharma.

Zanaflex is a registered trademark of Elan Pharmaceuticals Inc.

Zoloft is a registered trademark of Pfizer, Inc.


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