Medical Officer Nurse: From Vol. 2, No. 4
Nurses work with people who have multiple sclerosis (MS) in all outpatient settings, ranging from neurology and ob-gyn to family practice and pediatrics. In working with such patients, how would you answer the following questions?
1.Your patient was diagnosed with MS two years ago but is in remission. She and her husband want to get pregnant. She plans to discuss this with her neurologist and ob-gyn. What does the current research show about the effect of pregnancy on MS?
2. The patient with MS comes in for her annual checkup and tells you she takes echinacea and vitamin C (1,000 mg a day) to prevent colds, which she fears could trigger her MS. What would you tell her?
3. What are known as the ďABCĒ drugs for treating MS? What new drugs have been approved recently to treat MS? Are there any new drugs to help prevent further neurological disability in patients whose MS is on a steady, downhill course?
4. Whatís one of the most important roles a nurse in any setting can play in helping the patient with MS who is on long-term medications?
5. Whatís the current thinking about the effect of an infectious agent in the development of MS?
Answers to Test Yourself
Nancy Holland, EdD, RN, vice president of the professional resource center and clinical programs for the National Multiple Sclerosis Society, provided the following answers.
1. The news is much better today for women diagnosed with MS who are considering pregnancy. Pregnancy does not have an impact on the long-term course of the disease. There is less disease activity in pregnancy (fewer relapses) but an increase following the pregnancy, which is what gave pregnancy a bad name. But in the long run, over a decade, patients who have been pregnant donít fare any worse than those who have not.
2. Vitamin C is believed to enhance immunity to some extent, and patients with MS must be careful about taking anything that boosts the immune system. The same is true for echinacea. The patient should thus check with her physician before taking any supplement in terms of the effect it might have on the immune system.
3. Patients now have four immunomodulating drugs for treating relapsing MS. There are the ďABCĒ drugs, e.g., Avonex, Betaseron and Copaxone. The Food & Drug Administration recently approved a fourth one called Rebif. These are all injectable drugs that are recommended early in the disease course for anyone who has the relapsing form of MS, which is the most common. In addition, Avonex has been studied in people with a single demyelinating event and has been shown to delay onset of a second attack. So itís a clinical judgment call and up to the person and his doctor whether to try this drug [at the time of the first attack]. There is a drug (Novantrone) recently approved for people with secondary progressive MS, the form of MS where the patient no longer has periods of remission and appears to be on a steady downhill course. Or Novantrone can be used for patients who havenít responded well to the other drugs. (For more information about this drug, go to novantrone.com.)
4. Nurses are important in helping to instill hope in the patient with MS. Treatments are available, and most people do not become severely disabled from this disease. People need to be taught to have realistic expectations when taking the drugs and not stop them because they have a relapse. Itís known that the drugs donít stop all relapses, but the drugs have been shown to reduce the frequency and severity of relapses.
5. Medical scientists continue to look for the role of
an infectious agent in at least triggering MS. They are
studying Chlamydia pneumoniae because that bacterium
has been found in the spinal fluid of people with MS, so
thereís some speculation it may have an effect. Viruses
have been suspected for years ó most recently the herpes
(HHV-6) virus. (MS is, however, believed to be caused by
a combination of factors, including genetic, environmental,
and what may be any variety of potential viral triggers.)
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