Multiple Sclerosis and Career Prospects - Essay Example

Analyse a Case Study: Choice: Case Study# 3 - Multiple Sclerosis: Introduction: This case study concerns a 38 year old man, Max, who has been diagnosed by health care professionals, as having multiple sclerosis. This condition, affects his working life and thus, leads to changes in his career prospects and family life, and he finally comes to understand that although, his body has been weakened by the onslaught of this condition, his mind is still strong as ever, and would give him the strength and courage to withstand the progression of the disease and the sociological implications this would have on his future life and progress. Facts of the case: Although Max was not a good student in his schooldays, yet he excelled in sports and extra-curricular activities. He was career-oriented and led an active outdoor life, travelling long distances on company business and was also successful in his career. However, he was soon overtaken by health problems in the form of vision problems and tiredness, especially after long drives. Due to these reasons, he was constrained to shift to a desk job, involving less physical stress and strain, albeit at lower pay. He discussed these aspects with his Doctor, who, after a through examination, and questioning about his family life, confirmed the diagnosis that he was indeed suffering from Multiple Sclerosis. Although his present condition has left him with restrictions in movement, he is confident that, one day, there may be successful medical treatment for MS, and he hopes for the best for his future. Nature of the disease: “Multiple sclerosis (MS) is a chronic neurological autoimmune disorder which attacks the central nervous system (brain and spinal cord)” (Multiple sclerosis (MS). Multiple Sclerosis develops due to disorder in the brain and spinal cord, and is caused by the inflammation and destruction of myelin, or the white brain cells. “The symptoms of multiple sclerosis (MS) vary from person to person depending upon which part of the brain or spinal cord (Central Nervous System) are damaged. The loss of myelin and scarring caused by MS can affect any part of the central nervous system” (Multiple Sclerosis (MS). During MS conditions, due to destruction of myelin, the various neurons transmissions are rendered slow and sluggish, as a result of which the patient manifests spasmodic tendencies, shivering of hands, general lack of hand-eye co-ordination, and also, as the condition progresses, impaired vision, slurred speech, paralysis, ataxia and lowering of mental faculties, chiefly with regard to word recall and retentive memory. All these occur due to the impairment of myelin, which is chiefly responsible for allowing the nerves to transmit information to, and from the brain cell receptors. “Current research shows that the main determinant of the rate of cognitive decline is not the course of the disease but the extent of the development of brain lesions to the myelin” (Evers 2007). Under MS conditions, this transmission is slowed down and this leads to misinterpretation of brain messages. The brain responses in the case of advanced MS would be akin to that of traffic holdup and chaos, on a busy highway, with each driver wanting only his vehicle to proceed forward. In this particular case, the sociological aspects could be seen with relation to Mac’s career prospects and his family life. Career Prospects: It needs to be seen that MS is a progressively debilitating disease, which alters the functions of the central nervous system of the patient. However, the prognosis of the disease differs from person to person; it is also possibly that a person may live a healthy life with the disease present in his system, and yet not have any symptomatic manifestations that could warrant treatment and therapy. However, it is seen, that in this case, Mac has been diagnosed with MS, and has to undergo medication and therapeutic intervention for control and alleviation of his condition. In this case, the onset of the disease could have been caused by an overworked lifestyle and hard driving career demands. Over a period of time, the disease has remained dormant due to strong body constitution of Mac, but once the body weakened, the disease assumed full scale proportions and assumed its true colours. Family life: In this Case Study, it is seen that Mac’s wife, Ruby, had stood by him during his struggles with health ailments, and as a matter of fact, it was she, who first required him to visit a doctor to seek treatment for his ailments. She was most accommodating to his acquired moods, as a result of his condition, and tended to him during the various stages of his ailment. However, over a period of time, her patience wore thin, and finally, they parted ways. It has not been mentioned that Mac’s marriage floundered because of his health conditions, but it is believed that it occurred, due to economic reasons arising due to his inability to continue working, as before. From a study of the anecdotal narrative of Max the major striking point that comes to notice of any reader is that it is silent about his children and circumstances leading to the separation of his wife, Ruby are vague. All his episodes about his wife Ruby and cooperation from her in all the activities of Max’s life prompts the readers to ponder deep into the personal and psychological reasons leading to their separation. It is mentioned that Max started working for his uncle Jim at a young age as office junior and by mid age of 20 became head of the section. He got married at the age of 26, absolutely right age for reproduction for a healthy person, and he was physically and financially capable, then. His work as head of the section required intensive travel and working all time, for which his wife was not a hindrance. During spare time he participated in competitive racing as well. When he felt physically weak and thought it was due to frequent travel and overwork he opted for desk work, which was also acceptable to his wife. Another instance of his wife’s initiative, in helping him during crisis of physical rundown, is evidenced from the situation when she insists him to see a doctor. Thus, it establishes that his wife Ruby was very cooperative and caring; whatever the problems they may be encountering in their family life. The argument, that his complaining about the physical condition does not prove the reason for their separation, but it has to be construed as the failure to fulfil conjugal obligations. The narrative of Max states that the initial prognosis of the problem, in the opinion of the doctor, was ascribed to earlier sports injury. From this medical information it has to be presumed that Max had damaged Central Nervous Systems (CNS), out of sports injury or otherwise, leading to problems of sexual dysfunction. MS, a disease which damages central nervous system, can produce very wide range of symptoms and it is shown that when there is CNS damage, the normal function of muscles, tissues, and organs may compromise. “In multiple sclerosis, the demyelinisation of nerve cells may lead to bowel incontinence, bladder problems and/or sexual dysfunction” (Medline). Patients with MS are found to be suffering from erectile dysfunction, anorgasmy, retrograde ejaculation, and frigidity. It clearly indicates that Max’s family life was not a successful one, and his wife deserted him for his major problem of sexual impotency. Thus, though she was fed up with his complaining all the time, which also shows psychological stress imposed on her, the main reason for her separation has to be considered as his impotency and failure to give her a child. The diagnosis of Mac’s ailment came as a relief to him, since he was under stress to know the real ailment he was suffering from. Therefore, once it was confirmed, Mac felt more light-minded and became interested in knowing how it could be controlled and the symptoms become less pronounced. In the case of Mac, it is necessary to take up a neuropsychological evaluation in order to pinpoint the problems, which Mac is presently experiencing, and this would make the proposed treatment and therapy, more useful and beneficial to the patient. This assessment would entail conduct of series of interviews with the patient in order to assess the past and present social functions and capabilities of the person. He would be just put on a battery of tests including memory, attention span, problem solving, qualitative & quantitative analysis. This clinical assessment would be able to identify the exact problems faced by the patient and the weaknesses he suffers. Again, these clinical assessment tests would also focus on the strengths of the patient, and the attending health care professionals would find ways and means, by which these strengths could be utilized for alleviation of his present conditions.“ It will include encouraging the person to practice and improve weakened skills; make better use of strengths; learn alternative and compensatory techniques; cope with limited abilities practically and emotionally and offer counselling to relatives.” (Evers 2007). In the case of Mac, it is seen that past good health and active lifestyle have contributed to a lower symptomatic manifestation of the disease when compared with other persons with sedate lifestyle. He does not seem to possess the typical symptoms of the onset of the diseases like paralysis, slurred voice, sexual incompetence and depressive bouts. These would also reflect in clinical examinations and during the course of the interviews with the patient. Therefore, he stands an excellent chance of becoming well, over a period of time, since the progress of the condition has been slower, or steadier, as compared to other patients of his age group and income levels. Therefore, through a regimen of strict discipline and self abstinence, with regular exercises and dietary control it would be possible to arrest the growth of the disease in Mac, and also ensure his future good health, well being and welfare. Interpretation of the case based on literature review Literature review on the subject, Multiple Sclerosis, reveals that it is a complex disease affecting both physical and mental functions of the afflicted. Researchers are still trying to find out exact plausible reasons for the manifestations and it is difficult to pin point it. Medical practitioners often tend to diagnose it as either a physical complication or a mental disorder, as the symptoms tends to confuse and complicate them, and patients are also put to more dilemmas without a clear and confirmed judgment about their physical condition. In the case of Max, it seems that he had an impression of physical well being as he was an athlete and participated in competitive racing. He might have also ignored any past injuries or concussions occurred at young age as the symptoms of MS are not recurring. Majority of research out comes it is found that “in MS only the results of a properly randomized, double-blind, placebo-controlled trial can provide adequate evidence of efficacy. Measurement of treatment effect in MS requires a standardized schema of assessing neurologic dysfunction due to the disease as the criterion for change (better, same, worse)” (Kurtzke 1987). According to the behavioural theory of Lewinsohn (1985) and colleagues, disease (MS) leads to depression only if it interferes with the person’s normal level of functioning. Because MS is a disease that can affect multiple domains of functioning (e.g. occupational, physical), Lewinsohn’s model might be used to explain the development of depression among MS patients. MS is a disease accompanied by symptoms not easily distinguished from those of depression, as sleep abnormalities, sexual dysfunction, and concentration difficulties may also appear to be symptoms of depression as well as MS. Thus, symptom overlap creates problems in diagnosing and differentiating the cases between depression and physical disability found in MS patients. In the case of Max he shows physical disability and depression. Though he noticed his physical disability during his active life as manager he took it as a part of his frequent travelling and long drive as well as over work. The doctor he consulted also proved to be much failure in diagnosing the case. The reason may be that at the first visit the patient would not have disclosed all the problems encountered in normal life and he might be relying more on his physical capability as a sports person. So, the doctor naturally has the tendency to diagnose his case as a consequence of sports injury. Only on the second and subsequent visit the doctor was more inquiring and analyzing about his family life, which prompted to diagnose his case as psychological manifestations. In this context, when we rely only on the overall information provided by Max it will be much difficult to diagnose his case as he has the tendency to hide facts, and looks to be a psychological wreck, for which he is not to be blamed, because it is the general symptom of MS. Two commonly experienced psychological consequences of MS are depression and fatigue, of which depression is most common form of emotional disturbance. Major reasons for depression are learned helplessness, use of passive coping strategies, and intensity of stressful events, uncertainty, and inadequate social support. Fatigue is associated with increased physical disability. Clinical trials conducted by Penner, et al (2007) revealed that physical impairment was related to physical fatigue in MS patients. Depression and fatigue are common psychological sequels of MS-- the main factor influencing fatigue among both, MS patients and controls--and there is “correlation between fatigue and action control.” The study also indicated that “motivational disturbances might be specific for MS related fatigue” (Penner, et al 2007). Scientific evidence shows that identifying secondary factors that may influence cognitive performance in MS patients through neuropsychological tests is extremely challenging, because the multiple non-cognitive factors can interfere with a patient’s performance on these tests. According to Peter Arnett (1991), an MS patient with neurological problems could perform “poorly on demanding set of cognitive tasks not because of any primary cognitive difficulty emanating from the neurological condition, but because of the secondary effects of depression.” Neuropsychology is the study of fundamental relationships between cerebral activity and human behavior including cognition, emotion, and sensory and motor events. It helps researchers to understand brain functioning by examining the deficits associated with specific forms of brain injury. Another aspect of the case requiring correlation with the symptoms and physical activities of Max is his association with sports and participation in competitive race during young age and after marriage. It is found that concussions occurred during young age has major repercussions in adult life. Concussion is a relatively common occurrence in sports and concussion in sport is defined as “… a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” (McCrory et al 2005, p.196). Concussions involve physical, cognitive, and affective symptoms such as headache, dizziness, attention and concentration difficulties, depression, anxiety, etc. (Rosenbaum 2005, p.138) Since Mr. Max was active in sports the effect of concussions in such competitive athletes and link with his MS symptoms has to be analyzed in detail. The injuries sustained from sporting activities, during young age, might have been ignored and his present condition may be attributed to sports concussions. It is prevalent among most athletes that those who sustain low grade concussions either do not recognize that they have sustained a concussion or fail to report it for fear of being removed from competition. In the case of Mr. Max, he was actively participating in competitive racing during spare time, after his marriage at the age of 26, and till recognizing his physiological problem. It is found that frequent post-injury retest intervals and risk for “Second Impact Syndrome (SIS),” a condition where there is an irreversible increase in pressure in the brain, aggravate the condition and may turn fatal (Rosenbaum et al 2005, p. 138-140).” As such, the cause of sport injury sustained during young age, leading to Max’s physical condition of lethargy and particularly MS, may not be ruled out. The story is also to be interpreted with Max’s prediction of ‘tumour’ to another doctor, based on the knowledge he gathered from his reading on the subject. It is a good habit that patients suffering from any disease should be well informed about their condition and medical practitioners have the responsibility to keep them well informed. At the same time patients and relatives also have the responsibility to gather more information about the conditions ass well as latest treatment options available to them. It does not mean that the patient themselves should decide about their condition and arrive at a final decision that it is terminal. In addition, arriving at preconceived notions about a disease such as MS will be fatal, as its symptoms are varied and believing it as incurable is an unwise decision on the part of a knowledgeable person. Resorting to vegan food habits also shows his mental immaturity and disbelief in modern medicine. All these instances throw light on the part of Max’s inability to follow medical advice and he is living on the misconceived notion that there are no treatment options for his condition. It prompts for psychiatric counselling and developing resilience in Max. Mr. Max found it difficult to climb stairs and had breathing problems. He also had muscular cramp, though it is not specifically mentioned, establishing the fact that all the symptoms of multiple sclerosis are identifiable in his case. It is scientifically proved that problem encountered by patients with MS is spasticity, where the patient feels stiffness of muscles and involuntary muscle spasms. Spasticity can range from “mild spasms, or just tightness in the muscles, to painful, uncontrollable spasms, usually of the legs”. Sudden movements, extreme temperature and humidity, and infections and pressure sores can trigger spasticity. It is experienced that massage can increase range of motion, and massages by experienced professionals will relieve pain and help reduce spastic spasms. (Spasticity. 2005). In this case, Max could also benefit from good massage and physical exercise in a controlled environment to overcome his debility. Another incident in the narrative stating Max opted for fewer hours of work and lesser money at the same time getting financial assistance from Mr. Jim, his uncle and also his employer, shows that he had lost mental confidence in his capabilities. It is an example of personal submission to the physical inability and ultimate surrender of a sports person to his circumstances. In addition to this, he felt himself as a laughing stock before his fellow workers as the staff complained about ‘special privilege, and the occasional slurred speech and lack of coordination.’ It is an indication that Max was being isolated from his colleagues for his behavioural changes and overdependence on his employer. At the same time his employer though his uncle appears to be an understanding character and knowledgeable about the situation, as he provides financial support and suggests Max to have a break from work for a while. All this happenings indicate moral degradation and submission of a person undergoing mental and physical stress derived from the disease “MS.” Study results conducted by William D. Voss et al (2000, p.11) suggest that “spending time enjoying recreational activities may contribute to positive affect in MS patients.” If a reduction in recreational activities actually causes decrements in mood, then it might be possible to treat depression in MS patients by identifying, and then prescribing, alternate recreational activities than be enjoyed by patients regardless of physical or fatigue related difficulties. As Mr. Max was much interested in sports activities he should be inspired to indulge in light physical activities and psychological counselling to boost up his moral should also be initiated. Putting the blame on treating doctors in the case of MS, which shows multiple symptoms of physical and psychological manifestations, will be unwise. The patient and family members should be well informed about the options available and more advanced diagnosing tools and techniques should be employed to diagnose the case, at the same time effort should also be made to rebuild confidence in Max. Suggested course of treatment for MS: It has been established that the immune system plays a pivotal role, in the meditative aspects of treating MS, and hence the main functions of the medicines is to act as boosters to prop the immune systems. However, in the case of Mac, it needs to be a combination of both drug based and also non-drug based therapies. The drug would be based upon prescription drugs; other methods would involve family counselling, both with Mac’s carers and others, interview techniques and other psychiatric or psychological sittings with health care professionals to help Mac lead a happy, healthy and normal life, in the community, like other people. It is necessary that Mac need not be constantly reminded about being a patient and needs to be treated like any other normal and healthy human being, by others; This could give the necessary self confidence to him, to lead a normal life and could also help to improve his health for attending to his work and career. This combination of drugs and improvement therapies could put Mac, through sustained medication and supportive therapy, well on the road to recovery, and could also make necessary inroads for future rehabilitation plans, once the period of remission is over. The fear of relapse is high in the case of MS patients, and therefore, any medical intervention should take necessary precautionary measures in order to avoid relapses, since these could be more pronounced and severe than the early symptoms, and more significantly, it could negate all the good medication and therapies, already performed over a period of time, on the patients Medications for Mac The medication therapy to be applied on Mac should consider all aspects of his past and present conditions, and should take cognizance of the fact that his condition is mainly sports related, especially the aspect that a hectic and overstrained lifestyle, has been a fundamental cause for his present predicament. Due to supportive employers, namely his uncle Jim, he has been able to continue his employment, although this may not have found the favours of other employees, since he was working much below standards and established output levels. The medical counselling should also invoke his wife, Ruby, who has been a major source of mental support and guidance for him during his illness. It also needs to consider the work environment in his workplace, since this has been a highly significant contributory factor in the build up of his health problems, both physical and mental. However, medically speaking, it has been seen that when a patient suffers from an acute attack of MS, the attending doctors normally administer cortisone, and this is an accepted mode of treatment for this condition. In the event, that at later stages of Mac’s treatment, his condition worsens, it would be safe to administer cortisone with the consent of his attending doctors. It is however, interesting to note that the life spans of both normal healthy people and people having MS conditions are almost the same. The only difference would lie in their quality of life enjoyed by each of them, since the lives of MS conditioned patients would tend to be restrictive and the condition would not permit them to adopt lifestyles and living conditions, which a normal person would easily be able to adapt to. Moreover, it is also seen that MS patients need to take regular and proper care of their health and abide by their medication and therapy diligently, if they wish improvement in their health and their speedy remission from the illness that continues to weaken them. Mac should take heed from the fact that , although till now, no major breakthrough has been made in the medical sciences, seeking cures for this condition, a great deal of literature is available regarding the prospects that lie ahead for MS patients. In order to find suitable and effective curs for conditions or diseases, it is first of all necessary to understand the sources and leads from all possible perspectives. Although varying reports may be brought forth by various medical bodies, based upon their assumptions and presumptions, yet it has been definitely researched that MS is a neurodegenerative and metabolic disorder, with the predominant genes being on chromosomes 17” (Evers 2007). Use of resources: Having established the main cause for the condition, it is now possible for the medical world to seek a long term cure for this serious condition which would be most beneficial for long sufferers like Mac. As he has rightly concluded that he hopes that one day, during his lifetime, a breakthrough could be achieved which could be a boon for millions of people who have been afflicted with this disease all over the world. Till such time he has no other option, but to summon mental and physical resources that are at his command in order to combat the condition. However, Max needs to take maximum care in order to ensure that his condition, at any point of time, should not be out of control or incapable of being looked after. Every possible effort needs to be seen to arrest the worsening of the disease and it needs to be well controlled in order to be subject to a cure at a later stage. Bibliography ARNETT, Peter (1992). Research interest. [online]. Department of psychology. Last accessed 26 December 2007 at: http://psych.la.psu.edu/faculty/arnett.html EVERS, Clive (2007). Cognitive Dysfunction in multiple Sclerosis. Symptoms and Course. [online]. Alzheimer Europe. Last accessed 26 December 2007 at: http://www.alzheimer-europe.org/?lm3=CF7C9BDAC8BF EVERS, Clive (2007). Cognitive Dysfunction in multiple Sclerosis. Ongoing research: clinical trials. [online]. Alzheimer Europe. Last accessed 26 December 2007 at: http://www.alzheimer-europe.org/?lm3=CF7C9BDAC8BF KURTZKE, John F (1987). 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