Scenarios

Chapter 9: Long-term conditions

Millie was diagnosed with relapsing remitting multiple sclerosis 12 years ago at the age of 28. She lives with her husband and two children in a ground floor flat.

Multiple sclerosis (MS) is a disease of the central nervous system (CNS), the brain and spinal cord. MS is an auto-immune disease, where the immune system gets confused and instead of attacking an infection or virus, it turns on itself and attacks nerve cells. The CNS cells are covered in a protective layer of fatty protein called the myelin sheath (a bit like insulation on an electrical cable). It is these cells that are attacked by the faulty immune system and the damage that results is called demyelination. During demyelination, messages from the brain are disrupted causing them to slow down, become distorted or not get through (MS Society, 2013).

Millie recently had a relapse and although physically she has improved, she describes feelings of exhaustion, anxiety and isolation. Millie has been invited to attend a self-management programme.

• 1. What might be the specific problems Millie may have in relation to her MS?

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  Correct answer:
  Balance; bladder and bowel incontinence; fatigue; mood swings, depression and anxiety; muscular weakness, spasticity, tremor and spasm; pain; speech problems; swallowing difficulty; visual disturbance.

• 2. What might be an approach to self-management for Millie?

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  Correct answer:
  This would cover dealing with symptoms, making informed choices about medication, working with health professionals in making decisions about treatment. Specific issues relate to symptom management, diet, exercise and activity, pain management, medication management and fatigue management.