One of the most common complications of physical disability is the formation of pressure sores, also known as "bed sores" or "decubiti." This occurs when a small patch of skin experiences prolonged pressure and blood flow in the area becomes restricted, causing a break in the skin that may become infected.
An individual without a physical disability constantly shifts his or her weight while sitting or lying down. These are unconscious reflex actions that react to mild skin sensations of pain or pressure. These sensations signal the time to make a slight adjustment to one's position, thereby protecting any area of skin from being overly exposed to pressure.
People with MS sometimes lose this reflex action to shift weight, either because of decreased sensation or difficulties in movement. Pressure sores appear most frequently on thighs, buttocks, tailbone, heels, or other area of the body that is in constant contact with a surface, such as a wheelchair or bed.
A pressure sore often begins with redness or blisters on the surface of the skin. With little or no pain, a sore can silently appear. Pressure sores are easily infected and require a long time to heal. Left untreated, a pressure sore will rapidly advance to a large hole which can extend clear to the bone. Infection in the decubitus may also spread to the underlying bone.
Immediate attention is vital to the treatment of a pressure sore. If the pressure is discovered soon enough, the skin and muscle can recover simply by removing the pressure. This is referred to as "healing by primary intention." Redness and heat at the site is a sign of this rebound response.
When a sore is in an early stage, care must be taken to see it heals properly and does not progress. The first step is to completely eliminate pressure from the area. The sore must be kept dry and clean; this may be accomplished by irrigating the area with peroxide or saline.
Exposing the clean sore to a 100-watt electric light bulb, approximately two feet away from the sore for about 10 minutes, can aid with healing. After the wound is dry, it may be dusted with cornstarch or even sugar; or an aeroplast dressing may be applied.
Healthy skin around the wound may be toughened with a product called Benzoin®. A polyurethane film dressing, such as Tagaderm®, creates an "artificial skin" and can also be very useful for a minor skin breakdown.
When a sore advances, "healing by secondary intention" is necessary, involving surgery. Early treatment consists of trimming away dead tissue, a procedure known as "debridement." Antibiotics are given if an infection is present.
Without this procedure, infection develops at an accelerated pace. After or between debridements, dressings need to be changed frequently. A wet-to-dry fluff gauze which has been soaked in saline works well for removing dead tissue.
If more involved surgery is required, the tissue surrounding the entire wound cavity must be removed along with any bony edges which may become affected. Skin grafts are usually performed to cover the sore, protecting it and allowing it to heal.
Caring for a sore after surgery is critical. An ulcer can become life-threatening if permitted to advance to a large size. Keeping any irritation away from the wound is important, as well as ensuring that the area is clean, dry, and protected according to the physician's instructions.
Prevention and management are the keys to winning the battle against pressure sores. Good nutrition plays a role in not only prevention but also the recovery of pressure sores. The individual needs to maintain adequate calories and vitamins; supplements should be given to those whose intake is not sufficient. Certain medications can also increase an individual's susceptibility to developing pressure sores.
Special beds are available to aid in the prevention and management of pressure sores. These include waterbeds, air mattresses, foam-rubber mattresses, plastic sectional mattresses, alternating-pressure mattresses and beds with circulating tiny beads. These all work to disperse weight over larger areas, to minimize and vary pressure from one area to another, and to reduce both shear (parts of the body rubbing against each other) and friction.
Foam pillows are useful in alleviating pressure, as well as putting sheepskin under vulnerable areas or across the mattress to cushion the entire body. Sheepskin not only reduces pressure and friction but also aids in absorbing moisture, keeping the person dry. Properly padding a wheelchair is also useful for relieving pressure.
Turning a bedridden patient every two hours is very important in preventing and treating pressure sores. For those severely impaired, care partners must check daily for trouble spots, especially in vulnerable areas. Bladder incontinence must also be cared for meticulously, as dampness contributes to sore formation and infection.
Although pressure sores cannot always be avoided, prevention and management are the best treatments. Proper nutrition, dispersing pressure (by special beds, turning patients, and cushioning pressure areas), along with keeping the patient clean and dry, can certainly minimize the risk of pressure sores as well as aid in the healing of any that do develop. Careful daily examination and immediate medical attention for sores are crucial for the comfort and good health of a physically disabled patient.
Depression is a very common symptom of MS. It is often found in conjunction with other MS symptoms, and depression may also contribute to these same symptoms, which may include fatigue, bowel problems, and sexual dysfunction.
Additionally, individuals with MS who become depressed may stop following their treatment regimens, they may have difficulty performing their jobs, and their personal relationships may suffer. Some may even consider or attempt suicide.
Fortunately, effective treatments are available for people with MS who experience depression. These treatments always include two components: medication and psychological counseling. The first helps to turn around feelings of sadness and hopelessness, while the second allows individuals to explore their emotions and develop better ways to cope with the challenges they encounter.
The first line of medications include the "selective serotonin reuptake inhibitors" (SSRIs). Serotonin is a compound found in blood platelets and the tissues of the intestinal wall and CNS. It acts as a neurotransmitter and may be involved with inflammation, migraine headaches, and sleep. Serotonin also tends to elevate mood, but its effects are only temporary, as cells "take up" (or absorb) serotonin once it becomes available. SSRIs inhibit the reuptake of serotonin, so it remains in the system longer, and its positive effects may be experienced for longer periods of time.
Fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft), and venlafaxine (Effexor®) are all SSRIs that are commonly used to treat depression in MS. Side effects of these drugs may include headache, sexual dysfunction, difficulties with sleeping, and anxiety or sedation. Other antidepressants that are considered to be a "first line of treatment" for depression are bupropion HCL (Welbutrin®), nefazodone (Serzone®), and trazadone (Desyrel®).
All of these agents may be given alone, or various combinations may be prescribed. Attending physicians will start a patient with one medication, and depending on the results, may change the dose, switch to another drug, or possibly add a second medication. The optimal drug and dose combination depends on each individual and his or her response to a particular treatment regimen. Antidepressants do not have an immediate effect, and typically require six to eight weeks before reaching their maximum level of benefit.
The predecessors to these drugs were the anticholinergics or tricyclic antidepressants. These were formerly the first treatment choice, but with the introduction of SSRIs and other agents, medications such as imipramine (Tofranil®), amitriptyline (Elavil®), and nortriptyline (Pamelor®), and now considered as an option should first-line treatments fail. The side effects of these drugs include dry mouth, constipation, and blurred vision.
Although manic-depressive behavior is uncommon in MS, medications are available for those whose mood fluctuates between depression and happiness with hyperactivity. Medications include carbamazepine (Tegretol®), divalproex sodium (Depakote®), and lithium carbonate (Eskalith®). For those who suffer from depression and standard drug therapies are ineffective, electroshock therapy has been refined to a level that it is now considered to be both safe and effective. For individuals with MS, however, it may potentially have some negative effects on the blood-brain barrier.
Psychological counseling is the second and equally important component for treating depression. Individuals suffering from this condition need to work with a psychiatrist, psychologist, or social worker to discuss their thoughts, behaviors, and outlooks. These medical professionals assist patients with their coping skills and help individuals to better adjust to their situations, so they may feel better about themselves.
In addition to one-on-one counseling and therapy, group sessions may also be beneficial. Support groups and peer counseling help people to see that they are not alone in their feelings, and may find comfort as well as direction by talking with others who face the same challenges.
Seeking treatment for depression is extremely important for the health and wellbeing of any individual, especially those who must cope with the added burden of a chronic condition. Anyone who suffers from depression should consult his or her physician and take immediate steps toward starting a treatment and counseling program. Such therapies have shown dramatic results, sometimes in as little as a few weeks, but long-term treatment is needed to provide long-term relief from this debilitating symptom.
MS was originally thought to be a disease that produced only physical symptoms while not affecting mental abilities. Any cognitive difficulties exhibited were thought to be the result of depression. In more recent times, the medical community has found this not to be the case; MS can have an impact on cognitive capacity and functioning in about 40 percent of people with MS.
Fortunately, cognitive difficulties are usually not severe for those with MS. When mental functioning is affected, the demyelination occurs along cerebral tracts which link sensory areas (sight, hearing, smell, taste, and touch) to the movement, language, and integration areas of the cerebrum. This demyelination may cause changes in thought, memory, judgment, ability to concentrate, mood, and emotions. Some people with MS experience difficulty managing multiple tasks simultaneously.
Most people with MS who are experiencing cognitive changes may simply be more forgetful than they were in the past, taking a little more time to recall a name or thought. Concentration and organization may also become more difficult. Such problems are often minor and typically not noticed by anyone other than the patient and perhaps members of the immediate family.
Rehabilitation therapists and psychologists are developing cognitive retraining programs. They are looking into specific memory problems in people with MS and are prescribing appropriate therapies.
Drugs for Alzheimer's Disease are being tested for cognitive problems with MS. So far, results are mixed and additional studies are needed.
Steps may be taken to manage shortfalls with memory and planning. Many people with MS are devoted to making lists that may be recorded on paper, journals, calendars, cassette tapes, or computers. Noting thoughts, activities, reminders, messages, and appointments is very helpful to combating forgetfulness. Additionally, maintaining organized and uncluttered surroundings allows for fewer lost items and clearer thinking. Doing one thing at a time is also good advice to follow.
Difficulties in concentration may be addressed in a number of ways. When speaking to others, maintaining good eye contact helps to hold one's attention. Repeating or writing down any vital information assists greatly with memory.
Individuals with MS who are tackling heavier subjects, such as for work or school, may need to pace themselves and take breaks periodically. Whether reading, speaking, or participating in any other activity that requires thought or attention, the atmosphere should be kept quiet and comfortable. Minimum distractions will promote maximum concentration.
People must also take into consideration that no one's memory is without fault. Forgetfulness or difficulty in concentration is certainly not unique to those with MS.
Other factors, such as medication, depression, stress, or fatigue may all have an impact on cognitive abilities. These factors should be addressed before treating problems with memory or concentration as symptoms of MS.
Rarely, someone with MS may experience more severe cognitive disability. In such instances, the person is typically unaware of his or her mental deficiencies. At times such a patient may become emotionally uninhibited or insensitive to others. MS may even provoke certain psychosis to surface or worsen, but this normally occurs only if the individual is already prone to such disorders. Such conditions should always be brought to the attention of a neurologist by the care partner.
Sexual dysfunction is another common symptom of MS, although MS itself is not always to blame. Changes in sexual performance and enjoyment may often be brought on by medications, other medical conditions, spasticity, and depression, along with other contributors. Treatment for sexual dysfunction in MS begins with an understanding of all potential factors.
Sexual difficulties experienced by women are frequently overlooked. Impotence in men is a clearly defined symptom, while sexual problems in women are not as obvious. Typical symptoms for women include difficulty in reaching a climax, dryness from reduced vaginal secretions, reflex pain during intercourse, and increased spasticity, especially in the legs.
Treatments should include education, psychological counseling, and possible changes in medication (always under the guidance of a qualified physician). On a more intimate level, lubrication and enhanced stimulation through the use of sexual devices can be very helpful. Additionally, studies are underway to evaluate the effects of Viagra® for women.
The most common sexual complaint for men with MS is impotence. Previously, injections and vacuum devices were the only choices for men experiencing difficulties in sexual performance. While they both work, Viagra®, an oral medication for impotence, has quickly become the preferred treatment.
Like women, men may also benefit from education, counseling, and possibly a change in medication. Men may particularly need to redefine their own sexuality, often discovering that sexual enjoyment need not be limited to intercourse. Emotional intimacy, touching, kissing, and finding other ways of pleasing one another can easily compensate for a physical problem.
Those who experience any type of sexual dysfunction should always first consult their physician – so all possible factors may be considered and treated. Understanding the problem, seeing a counselor, and learning about different options and treatments will help to ensure that MS does not get in the way of a full and satisfying personal relationship.
Speech disorders in those with MS are not as common as other symptoms, and medications for this are usually ineffective. Speech therapy is the only treatment used at this time to treat such a condition. This type of approach may be beneficial, but the sooner the problem is discovered and therapy begun, the better the outcome.
Initially, speech disorders in MS may be so slight they go unnoticed. As time passes, problems with speech may eventually become more distinct and treatment is advisable.
Dysarthria is a type of speech disturbance that affects a person's pronunciation and speech rhythm. This condition may cause speech to be slurred, as though the person has been drinking liquor. The rhythm is also changed, making words rapid, weak, or choppy. Dysarthria may be caused by other illnesses that should be ruled out before assuming MS to be the cause.
Not everyone who encounters individuals with speech disorders understands the situation, and they may misinterpret the cause. Carrying a card or putting a sign on the dashboard briefly explaining the condition can avoid a misunderstanding. This could be particularly helpful if emergency personnel or police happen to stop someone with this problem.
Scanning is another type of speech disorder found with MS. Those afflicted may talk in an abrupt or jerky fashion; words may be voiced in an explosive manner. This disorder is not typically found in other conditions; therefore it is often indicative of MS.
An individual who experiences tremor may find his or her speech to be affected. Loss of control of the lips, tongue, jaw or even the throat and breathing will interfere with the person's ability to pronounce sounds and control loudness.
Although speech disorders produced by MS may disappear on their own, a speech therapist should be consulted if the problem persists for more than a couple of months. A therapist may help both dysarthria and scanning by having the person slow their speech while being very conscious of enunciation. Repeating a number of specific mouth exercises may prove to be beneficial, thereby sustaining coordination of those muscles.
Other therapies include exaggerating speech to slow it down. To improve rhythm, therapists often employ a paceboard that is used by a patient to point to specific spots on the board and to speak at the same time. In severe cases, a communication board with letters, words, and pictures, as well as more advanced electronic systems, are available.
MS-related speech difficulties are often associated with swallowing disorders, medically known as "dysphagia." This is a rare complication of MS, and for many, may only be present during an exacerbation.
People who have trouble swallowing often are experiencing a delay in the swallowing reflex. Food may be difficult to get down, requiring extra effort to do so. The patient may feel congested in the throat area while eating. This may result in choking, spitting, persistent throat clearing, or coughing during or after a meal. Some may also exhibit a weak voice.
Swallowing difficulties may eventually lead to a loss in weight or even pneumonia. A physician should evaluate a patient's swallowing deficiencies if either of these events occur.
Three deficiencies involved with MS cause trouble with swallowing:
A speech pathologist or an ear, nose, and throat specialist should be consulted when a swallowing problem arises. In order to precisely identify the problem, a "videofluoroscopy" may be performed. This procedure enables the doctor to view how the throat is functioning when the person swallows.
Many steps may be taken to make swallowing easier. For instance, a speech pathologist will teach people exercises for the mouth and throat aimed at "retraining" muscles and improving coordination. Posture may also be adjusted to help with the movement of food – a person should always be sitting up while eating.
Different food choices must be considered as well. If weight loss is involved, a diet with better nutrition needs to be designed to maintain good health and proper weight. Taking smaller bites, having smaller meals, and eating more frequently may be of benefit as well. Alternating between drinking and eating helps to keep food from slowing down while swallowing.
Food preparation is equally important. Textures can be changed by moistening the food with gravy, broth, or juice. Conversely, food may be made heartier with a thickening agent. Foods that tend to remain in the throat – such as milk products – may aggravate a swallowing condition. Foods and drinks of different temperatures can also assist swallowing by stimulating the swallowing reflex.
In addition to nourishment, meals have traditionally been a time for relaxing and socializing. Having a swallowing disorder, however, can interfere with a person's enjoyment of a meal. Consulting a speech pathologist for such a problem is vital to restoring comfort while eating. Although a person's swallowing may be helped through such therapies, family members and care partners are encouraged to learn the Heimlich Maneuver just as an added measure of safety.
Swollen ankles are a common symptom for those who have had to limit their activity. In most instances, the swelling is actually lymphatic fluid which builds up around the ankle when inactivity prevents the fluid from circulating within the body.
Lymphatic fluid normally flows along lymphatic channels, delivering nutrients and other important substances to the body's organs. Swollen ankles may worsen during the summer as heat causes these channels to dilate (expand).
Diuretics, also known as "water pills," do not affect this type of fluid buildup. The standard treatment is to elevate the ankles above the hip level while sitting during the day and keeping them above the heart level throughout the night. This will pull the fluid back toward the body. Additionally, support stockings may help to prevent further fluid accumulation.
Anyone who experiences swollen ankles should always contact a physician to confirm the exact diagnosis. Other conditions, such as heart trouble, thrombophlebitis (blood vessel inflammation), or nutritional deficits, should first be ruled out before blaming inactivity.
People with MS frequently experience cold feet. This condition is thought to be brought on by the incomplete flow of nerve impulses in an area that controls blood vessel constriction and sensitivity to temperature.
Cold feet is normally a harmless condition and is often alleviated through the use of warm socks, an electric blanket, or other method traditionally used to warm the feet. Occasionally niacin (one of the B complex vitamins) or a medication will be prescribed to dilate blood vessels.
People naturally gain weight when they continue to eat the same size meals as they always have, but are unable to exercise or be as active as they were previously. Whenever activity is reduced, food intake should be appropriately adjusted.
A medical professional should be consulted to design a diet plan which best suits each individual – according to individual needs. Caloric intake, dietary restrictions, nutrition, fat, fiber, and other important components such as lifestyle, activity, and fatigue levels are all taken into consideration when creating a proper diet.
Many people find eating several small meals throughout the day to be not only satisfying but also advantageous in terms of maintaining an optimum weight. An exercise program should be used in conjunction with the diet to derive the most benefit, and a "small-movement" exercise program – such as one recommended to office workers while at their desks – may be helpful.
The majority of MS symptoms are not unique to the disease and seeing a doctor should never be overlooked. With any MS symptom, a physician should be consulted to identify the cause and to prescribe an appropriate treatment plan. The services of physical therapists, speech therapists, speech pathologists, social workers and therapists, as well as other medical professionals are vital to the treatment and management of MS symptoms.
Any MS symptom has the potential to worsen when a person is experiencing stress, anxiety, depression, lack of sleep, illness, or poor nutrition, including vitamin deficiencies or an unbalanced diet. Seeking appropriate help where and when needed, following through with treatments and therapies, and generally taking good care of oneself will ensure success with treating this disorder in the best way possible.
Anyone familiar with MS knows that the only predictable aspect about the disease is the unpredictability. Every person
with MS differs with respect to types, duration, and severity of symptoms experienced. In some cases, a patient may wake up one morning with a brand-new symptom or may be suddenly rid of a symptom that had been present for a long time.
While researchers work toward finding a cause and cure for MS, those involved – people with MS, families, friends, care partners, and medical professionals – find comfort in the knowledge that much is available for symptom relief. In most cases, these treatments and therapies allow MS patients to lead a comfortable, active, and manageable lifestyle.