More MS news articles for Mar 2002

MS follows slow path that's tough to predict

http://www.nationalmssociety.org/articles.asp?SMContentIndex=0&SMContentSet=0

February 26, 2002
Josephine Marcotty
Star Tribune Company

If Sen. Paul Wellstone's doctors are right, he will be a lot like Phil Cognetta.

Cognetta, 56, earned a master's degree and a doctorate, worked 32 years for the Minneapolis school system, raised a son, coached baseball, soccer and basketball, and took care of 150 shrubs in his yard.

In those 32 years, despite having multiple sclerosis (MS), he took only one day of sick leave.

Like Wellstone, he has a type of MS that progresses over the years. However, doctors say one of the hallmarks of the disease is its unpredictability. Cognetta's condition has worsened slowly since his MS was diagnosed more than 20 years ago. Now, he has given up the shrubs and moved into a townhouse, but he is still fighting his doctor's recommendation that he get a scooter to get around.

"That's succumbing," he said. "I hate to succumb."

Wellstone's neurologist, Dr. J.D. Bartleson of the Mayo Clinic in Rochester, said he is confident the senator's disease is progressing slowly as well.

Wellstone's condition was diagnosed only a month ago, but doctors have been observing him for five years.

And Wellstone, 57, has been experiencing a gradual weakening in his right leg for at least 15 years, Bartleson said, that is now causing a noticeable limp.

"He used to run marathons," Bartleson said. "Then he cut back to 10Ks [kilometers], then 5Ks. That's what leads us to believe it is slowly progressive."

Wellstone's condition probably will continue to change very slowly and should not interfere with his ability to run a campaign or work as a senator, Bartleson said.

However, other doctors said his type of MS is defined by its name -- primary progressive MS. That means it gets worse, said Dr. Randall Schapiro, a University of Minnesota neurologist and director of Fairview Hospitals' multiple sclerosis center. And its course is uncertain, he said.

"Progressive is progressive," he said. "And there are many gradations and patterns in people who have the disease."

The issue has come into focus because Wellstone is in a neck-and-neck political race against Republican Norm Coleman, former mayor in St. Paul. The real-life politics are imitating entertainment. The scenario -- a liberal politician whose MS has become a political issue in a reelection campaign -- mirrors that of President Bartlett, the president on the TV drama "West Wing."

Wellstone made his condition public for the first time Sunday. He said he is fit and ready to pursue the Senate seat he has held since 1991, and he said the illness was largely confined to his leg.

In an interview Monday, Bartleson said that Mayo doctors made their diagnosis based not only the progression of Wellstone's weakness, but also on the results of medical tests and evaluations. Physicians can never guarantee 100 percent certainty for a disease such as MS because there is no precise biological test.

But the doctor said the illness probably will continue to affect only Wellstone's leg, rather than move to other parts of his body.

MS is a neurological disorder. For reasons that are not understood, the body's immune system attacks the sheaths that surround the nerves, causing inflammation and scarring, and disrupting nerve signals. It is not fatal, and most people with MS live a normal lifespan.

But it can severely restrict a person's life. It causes numbness, vision problems, and a lack of coordination, and eventually many patients must resort to using a cane or wheelchair. It can also result in severe bouts of fatigue, doctors and patients said.

There are four sub-types of the disease. The most common is marked attacks of symptoms, which are often how the disease is diagnosed. Most people return to normal after an attack, but the progress of the disease is unpredictable and varies from person to person. Eventually, however, many begin to develop permanent disabilities.

Scott Wells, 57, of Minnetonka, said his first attack 20 years ago was so severe that it put him in the hospital and on permanent disability. He suffered numbness, blurred vision, slurred speech and couldn't walk. He recovered from that attack, but never really got back to normal, and he never returned to working full time, he said. Though his attacks have been infrequent, each one has set him back. The last one, five years ago, persuaded him to move out of a house and into a townhouse.

Today, he uses a cane, plays pool at the Minnetonka senior center, manages his portfolio of investments and is head of his condominium association.

"You don't want to sit in front of the TV," he said. "There is a potential for self-esteem problems."

The progressive type that both Wellstone and Cognetta have can take longer to diagnose, doctors said, because there are no tell-tale attacks.

Cognetta said it took some time before his symptoms were diagnosed. Even then, he said, he was able to work 9-and 10-hour days and then go to the library to work on his dissertation.

"And life went on," he said. "I had some blurred vision, but I played sports and did all the normal things."

Over time his symptoms got a little worse, and he thought maybe he should pay some attention to it.

"In the meantime we had a son, moved a couple of times, and life went on," he said.

He retired from his job as head of counseling services for the Minneapolis school system a few years ago -- not because of his disease, but because, after 30 years, he could. Today, he teaches at the University of Minnesota and is a consultant for both the Minneapolis and St. Paul school systems. However, he has to budget his energy more often.

"Part of that is aging, and part of it is MS," he said.

How the disease affects Wellstone will play out in the years ahead, but his doctors and others say there is no reason why he should not pursue his ambitions.

"I am not surprised by his view -- I encourage it," Schapiro said.

Bartleson said Wellstone revels in his work, and the disease should not slow him down.

"I'm sure he can handle it," he said. "We are describing it honestly. The Mayo Clinic would not want to be wrong."

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