Case Study: Multiple Sclerosis
A 35-year-old male presented with the diagnosis of multiple sclerosis. He was admitted to a hospital in Florida three weeks prior to visiting The Raj with complaints of weakness and spasticity in the right leg, difficulties with balance, and fatigue and malaise. Tests performed at the Florida hospital revealed abnormalities in spinal fluid and MRI brain scan, which were consistent with a diagnosis of multiple sclerosis.
The patient complained of being severely depressed and anxious. One month prior to this he noticed aching and loss of vision in the left eye. Upon being discharged from the Florida hospital, his physician advised him that nutritional supplements and dietary approaches would not alter the course of the disease. He was discharged with a prescription for Xanax (a tranquilizer).
The patient arrived at our Ayurveda facility in a wheelchair. Initial examination revealed abnormalities of the left eye and optic nerve, abnormal reflexes in both legs, with weakness and lack of coordination in both legs and severe difficulty walking. The patient underwent a Maharishi Ayurveda program which included Ayurveda purification treatments, dietary changes, learning the Transcendental Meditation® technique, yoga, and specific herbal preparations. By the end of his stay, he could walk 800 yards unassisted.
Nearly twelve years after his in-residence program, he continues to follow our natural approach to MS, including diet, the Transcendental Meditation program and herbal preparations, and has not experienced any symptoms of relapse. He walks two miles daily, lifts weights and describes himself as having a positive attitude without depression or anxiety. His energy level is good and he is working full-time as a massage technician.
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Posted on 2/01/13
Joanna is a 40-year-old female who was diagnosed with multiple sclerosis (MS) 7 years ago after experiencing numbness in her legs and an MRI revealed characteristic brain lesions of demyelinating disease. She was prescribed an interferon (IFN)-beta formulation. Over the last 5 years, MS has affected every aspect of her life. Last year she began to experience increasing physical disability and difficulty driving. As a single mother of 2, she worries constantly that she may no longer be able to work and support her kids. She has not been faithfully adhering to her prescribed IFN regimen because she struggles with the injections. Recently, she experienced a worsening of symptoms including double vision and spasticity in her legs. After several days of experiencing these symptoms, Joanna awoke one morning to find that she could not move her arms or legs normally. She immediately called for an ambulance and was admitted to the hospital.
In the hospital, Joanna was seen by a case manager. After reviewing the patient’s medical records and speaking with her about the days leading up to her hospitalization, the case manager contacted Joanna’s health insurer and spoke with a managed care case manager. She updated the managed care case manager regarding the admission criteria and inquired about any insurance benefits that may be mobilized post-discharge. The hospital case manager learned that Joanna was eligible for up to 12 physical therapy (PT) visits post-discharge. She requested a PT consult in the chart, knowing that a hospital physical therapist would be in the best position to assess Joanna's current and near-future functional capacity and to mobilize a discharge plan for follow-up PT. The hospital case manager also advised the managed care case manager that Joanna indicated (although did not admit) that she was not faithfully adhering to her treatment regimen. The managed care case manager requested a post-discharge consult by the managed care pharmacist, with a goal to improve Joanna's adherence. Finally, the hospital case manager inquired about whether the health plan had a disease management program. This inquiry prompted the managed care case manager to investigate Joanna’s eligibility in the health plan's medication therapy management (MTM) program. Through the MTM program, Joanna would receive patient education resources by email and by mail, as well as regularly scheduled, periodic phone calls from a managed care pharmacist to assess her ongoing adherence.
Joanna represents a patient with MS who has experienced ongoing flare-ups of symptoms that affect her ability to carry on with her daily living activities. To effectively manage the disease, a multidisciplinary approach that incorporates a combination of disease-modifying medication, rehabilitation, and patient education can be used to improve the quality of care. In this approach, it is especially important for interprofessional team members to understand the patient’s concerns and various treatment options that may improve health-related quality of life and physical functioning. If left untreated, symptoms may worsen and become more difficult to manage. In addition, MS is often associated with physical and mental comorbidities, and lifestyle factors including smoking and obesity can adversely impact the disease. Due to the complex nature of the disease, case managers are ideally positioned to improve outcomes by coordinated care for patients and helping them to maneuver through the health care system.
Resulting in impaired physical, emotional, and cognitive functioning, MS compromises the quality of life for patients affected by the disease. Occurring in 85% of patients, the relapsing-remitting form of MS (RRMS) is characterized by the cyclical occurrence of relapses and remissions.1 Additionally, incomplete recovery following an acute exacerbation may worsen the condition. A multidisciplinary team of knowledgeable, specialized health care professionals dedicated to the continuity of patient care can be an effective strategy to slow disease progression and manage symptoms.
The management of MS can be challenging due to the presence of various comorbidities, its unpredictable nature, the need for long-term disease management, and patient-related issues including nonadherence. As the armamentarium of treatments for MS continues to grow, managing adverse events related to new treatments only adds to the complexity of disease management. However, the case manager can help to overcome some of these complexities and reduce barriers related to the management of MS.2
Case managers can educate patients with regard to symptom management, relapse prevention, and the importance of treatment adherence.2 Case managers also play an essential role as health care coordinators, ensuring that patients receive the comprehensive, multidisciplinary care that is required to improve outcomes. The case manager can help develop an individualized plan of care in which symptom management, social support, and containment of costs are all addressed.2 As patient advocates, case managers can assist patients in getting the appropriate treatments to help improve their quality of life and reduce costs for all stakeholders.
The increased complexity in the management of care for MS patients, in addition to barriers of treatment adherence, makes it necessary for the case manager to be interactively involved in all aspects of patient care. Case managers play a crucial role in improving patient outcomes by integrating the multidisciplinary team and promoting evidence-based decision making that incorporates the patient’s needs and wishes.
- National Multiple Sclerosis Society. How Relapsing-Remitting MS (RRMS) Differs From Progressive Courses of MS. Available at: http://www.nationalmssociety.org/about-multiple-sclerosis/relapsing-ms/relapsing-remitting-ms-rrms/how-rrms-differs-from-progressive-courses-of-ms/index.aspx. Accessed January 23, 2013.
- Halper, J. The evolving role of the nurse in the treatment of multiple sclerosis. Journal Neurosci Nurs. 2009;41(4):E1-E3.
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