Patrick: Thanks for that Karen. And the fourth question is from someone called Clare and she asks, I have suffered no symptoms since diagnosis two years ago. I now feel exhausted with pain, numbness in the upper body. Would steroids or other drugs help?
Karen Vernon, MS Nurse: I think this question in some way, a lot of what I said, I’ve already said it in the previous question on the drugs. But, again, it’s getting that history. So it’s getting the history of what’s going on and I always say to people, have you done anything different. Most of the times people haven’t, but sometimes, again, is there any infection going on. So typically, for people with MS they can be at higher risk of urinary tract infections, so we would ask that that is checked out by the GP, or if the service is set up so if a patient like Clare rings in with these symptoms we would see in either a relapse clinic, or it could be called different things, you know, depends upon the service, and go through that history with them. So we would check urine there. Obviously if there is an obvious infection, what we would advise is that we wait until the infection has cleared, because often, infection will trigger an increase of your symptoms, but hopefully that they will settle down after that infection has settled. So that would be the first point.
Patrick: Okay, thanks for that. So it sounds like at first you’d like to rule out other things.
Karen Vernon: Yeah.
Patrick: And once you’ve ruled out other things and you think it might be a relapse, what would you recommend from there? Steroids, other drugs?
Karen Vernon: It depends again. I mean all steroids do is speed the recovery of the relapse up, they don’t actually, you know, determine the amount of recovery or outcome. I think if you’re thinking it’s a relapse it’s one… an assessment is extremely important of patients and although we try and do it face to face, I know for people in the UK that live in very rural areas or central London, sometimes that isn’t possible. So it can be a telephone assessment. But I think it’s important that how are the symptoms impacting on the person. So, you know, is it a clinically significant relapse that is disabling and stopping the person doing something, so stopping them working, causing them problems caring for family, some sort of practical element to it as well. And I think it’s having that discussion with the person as to what is the treatment option.
Sometimes, like Clare was saying, it’s increased fatigue and pain and numbness. There is some debate over whether steroids are the best treatment for a sensory type disturbance. So in that case it may be symptom management, so it may actually be suggesting one of the medications that are used for neuropathic pain, particularly because sometimes it can be quite an intrusive and a horrible pain and so it may be treating the symptom first. But often, as I say, if you take how it’s affecting the person, what it’s restricting them doing, then it would be, you know, steroids potentially would be an option if there was no infection there.
But as I say, I think it’s also important to point out to people that they’re not doing their MS any detriment not having them. You know, we have patients who don’t want them, because they’ve had them once, don’t like the side effects. Whereas others who do want them, but sometimes that may not be the appropriate option. But it’s also referring through to the wider team, so actually if it’s mobility, would them seeing a physiotherapist be the best option. You know, if it’s bladder problems, getting a continence adviser in. So it’s actually trying to break down what’s causing the problems and the best approach to that.
Patrick: Okay, thanks Karen. Sounds like there’s similar themes throughout about how it is for the individual.
Karen Vernon: Yeah.
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