February 16, 2023
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Collage design by Ryan Hamsher; photograph provided by Ardra Shephard
While a neurologist can help diagnose and manage MS itself, your PCP can help you manage day-to-day symptoms.
Welcome to Ask Ardra Anything, an advice column about life with multiple sclerosis from blogger Ardra Shephard. Ardra has lived with MS for 2 decades and is the creator of the award-winning blog Tripping on Air, as well as the host of AMI-tv’s new series, Fashion Dis. Got a question for Ardra? Reach out on Instagram @ms_trippingonair.
During the touch-my-finger-touch-your-nose portion of one of my first multiple sclerosis (MS) examinations, I told my neurologist that I had new symptoms to report. I was feeling anxious. I couldn’t sleep. I wondered if I was depressed.
My neurologist dismissed me with the advice to follow up with my primary care practitioner (PCP). It seems naive to me now, but at the time, I’d thought my anxiety needed to be treated by my MS doctor because it was MS that was causing my anxiety.
In fact, the MS disease process can cause emotional changes, and I was right to report my concerns, but a primary care practitioner is better equipped than a neurologist to assess and treat symptoms like anxiety and depression.
Typically, the role of the MS neurologist is to diagnose and manage the course of MS rather than manage day-to-day symptoms. MRIs and disease-modifying therapies (DMTs) are the responsibility of the neurologist, while any number of medical professionals may be tasked with treating MS symptoms.
This is actually good news; MS neurologists are in short supply. My own clinic in Toronto currently has 8,000 active patients. It has an exhaustive list of specialists like occupational therapists, speech-language pathologists, urologists, and others who can address the most complex symptoms of MS. But primary care practitioners, also known as family doctors or general practitioners, can have an important role in managing some basic MS symptoms. Here’s how.
Depression and anxiety are common in people with MS. One of the responsibilities of a PCP is to assess and monitor mental health. A PCP can be your first resource for identifying concerns and forming a treatment plan.
Your doctor can prescribe medication when necessary, tell you what kinds of support are available, refer you to a specialist when necessary, and monitor your treatment and progress. Oftentimes, your PCP can provide counseling and other resources as well.
Actress Christina Applegate told the New York Times that she gained 40 pounds after her MS diagnosis in 2021. During the first 8 months following my MS diagnosis, I, too, wracked up 40 pounds. Steroids and comfort food led to my personal weight gain, but MS can present a number of factors like fatigue, weakness, and depression that can limit physical activity and make it more difficult to stay fit.
MS isn’t your fault. While excess weight didn’t cause your MS, a high body mass index (BMI) and obesity are known risk factors for more rapidly progressing MS. Your PCP can help you identify reasons for any unexplained weight gain. If weight loss is indicated, your family doctor can offer medication, recommendations for lifestyle modifications, dietary and exercise supports, and even referrals for bariatric surgery when appropriate.
Smoking can make MS worse. On average, smokers have more relapses, bigger lesions, and become disabled faster. Like body weight, smoking is a modifiable risk factor for MS progression.
Smoking is a powerful addiction, and you may need recovery assistance from a medical professional to help lower your risk of worsening MS. Your doctor can offer encouragement and support in addition to medications and other resources.
Last year, I fell and fractured my back, which led to the discovery that in my early 40s I have secondary osteoporosis. Steroid use, low vitamin D levels, and insufficient weight-bearing exercise can make people with MS more susceptible to osteoporosis, which is particularly concerning if you’re also at an increased risk of falling due to problems with balance, weakness, or mobility.
If you have MS, bone health should be on your radar. Osteoporosis takes years to develop. Ask your PCP to test your vitamin D levels regularly, and get routine bone density scans to detect and mitigate problems early.
MS is associated with increased risk to your heart health. February is Heart Disease Awareness Month, which makes now a good time to check in with your doctor to find out your blood pressure and cholesterol numbers. Your doctor can assess and treat any concerns, and provide you with lifestyle interventions and support.
MS affects the sexual health of both men and women. This is a medical issue that should be prioritized as such. Your sexuality is not a luxury, but an important function that affects your quality of life.
Your PCP can assess your current medications to see if they may contribute to sexual dysfunction. Family physicians can order additional testing, prescribe medication, assess the need for pelvic rehabilitation, and refer you to a specialist if necessary.
Feeling like a professional patient is exhausting, and I sometimes neglect the non-MS areas of my health. I used to joke that you can only get one disease at a time, believing that the universe had dealt me my fair share of bad luck. I told myself I could put off non-urgent appointments like the dentist or routine mammograms.
The reality is that MS increases your risk of comorbidities. Living well with MS is not just about responding to symptoms. Protecting your overall health is key, and your PCP can help monitor the risks that should be on your radar if you have MS.
Whenever I see my family doctor, she comments on how often my name comes across her desk. Whether I have had an MRI, lab monitoring, or any number of appointments with a specialist, a copy of all my assessments is sent to her. Continuity of care is important, but access to the whole picture can also equip your doctor with the information needed to support an insurance claim or to request workplace accommodations on your behalf.
Disability paperwork is often time-sensitive. Your PCP will likely be able to help with this more quickly than your MS neurologist. Maintaining a good relationship with regular check-ins can help ensure your doctor has a solid understanding of your limitations so she can provide accurate feedback to employers or insurance providers.
New MS symptoms and suspected relapses should always be reported to your MS clinic or neurologist without delay.
There’s no cure for MS, but the tools for managing MS symptoms are constantly evolving. Managing MS can feel overwhelming. Cultivating a strong relationship with your family doctor can provide you with a powerful resource and ally.
Medically reviewed on February 16, 2023
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