Friday, 27 March 2015

ClinicSpeak: MS comorbidities

A focus on MS comorbidities; at least it is something we can target in progressive MS. #ClinicSpeak #MSBlog #MSResearch

"I  have just arrived in Toronto to attend, and speak at, the NMSS-ECTRIMS Comorbidities meeting. The programme below may be of interest to you. What is a comorbidity?  The following is a reasonable working definition:


'In medicine, comorbidity is the presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases. The additional disorder may also be a behavioral or mental disorder.' Source Wikipedia

Please note the definition defines it as the presence or additional disorders or diseases. Implicit in this definition is that it affects health; i.e. comorbidities makes you less healthy or unhealthy. This then brings up a debate about what is health. In preparation for this meeting I did a lot of background reading on what constitutes health or poor health and again there is no agreement. For example the World Health Organisation (WHO) defines health 'as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity'. As a clinician this definition is unworkable. As part of preparation for my talk, which I am finding impossible to prepare, I read a very good series of article in a the latest issue (#7) of the NewPhilosopher; the whole issue is dedicated to the philosophy of health. For example, the best debate was on whether or not we should classify ageing as a disease and whether or not getting old causes you to become unhealthy. A quote from the issue that I plan to use in my talk later today is from David Seedhouse (New Philosopher 2015;7:97-99): 'Health is more than the opposite of disease'. This worldview and some of the other intellectual meanderings in the NewPhilosopher make me realise that health is more a state of mind that something that can be defined by the medical profession. Why can't you have MS and be healthy? A medicalised worldview is that disease and poor health or synonymous; this is clearly not the case. You can attend any one of my large MS follow-up clinics and you will see that a significant number of MSers are healthy or at least describe themselves as being healthy. " 


"I have also come to realise that the medical profession, clinicians and scientists, have a lot to learn from the philosophers. How to define illness, sickness, disease and health is a starting point. If we understand the impact of labelling people as ill, sick, diseased or unhealthy we may think twice about what our objectives are as neurologists treating MSers. Is it to simply relieve suffering? Do we have a responsibility to maximise health? Are we responsible for trying to help MSers age healthily? These are the sorts of questions that have been percolating in my mind. What is clear that I doubt I will be able to answer them at this meeting. What is clear we can't shirk our responsibilities when it comes to comorbidities; if want to treat MSers we need to approach MS holistically."

"I only give my talk late morning so any suggestions would be welcomed. As usual once I have given my talk I will share the slides with you on SlideShare." 




CoI: multiple

8 comments:

  1. I think the connection between the comorbidities and worsening MS needs to be spelled out soon after diagnosis. It surely all comes down to time and resources. A good GP will be doing this anyway - far too many will not.

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  2. Re "Why can't you have MS and be healthy? "
    I'd have to agree with this overall as I would describe myself as mostly being so at the moment. However, MS has had and will continue to have impacts on my overall health, as MS increasingly affects my abilities to do all the things I used to. This is not only in relation to physical health such as fitness, muscle tone etc, but also my mental health, as my reducing physical capacities make each day just that little bit harder to get through. Apart from MS I have no other health issues that I am aware of, but I am not the same person I was two, three or five years ago. This is depressing in itself, and knowing that my decline will continue makes it even worse, no matter how hopeful or optimistic I try to be.

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  3. I would define biological health as free from any underlying pathological condition that is detrimental to the individual. Since MSers have an underlying pathological condition they are not medically healthy even though they may perceive they are healthy (i.e. no apparent neurological deficits). We can be healthy as we age, normal physical decline with age (loss of bone density, muscle mass, etc.) is not a state of disease. The goal for physicians is to treat the disease with the ultimate goal curing the disease.

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    1. Anon of 1.29pm back again
      Steve S - you make some valid points especially in relation to MSers having an "underlying pathological condition". However, my concerns stem from the fact that the impacts from MS limit my capacity to do things that are known to keep people healthy. I have plenty of neurological deficits which limit my ability to be active - potentially leading to additional problems such as weight gain, hypertension, lack of fitness etc from a more sedentary lifestyle which is effectively forced upon me by MS. So it's an awkward situation in many ways - the impacts of MS could lead me down a pathway towards additional comorbidities which I may not have suffered from if I did not have MS.

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  4. Although I suffered early on with my MS I lived my life in the best way I could. I suffered some depression not just because I had MS. I resolved my problems with short periods of counselling, no medication Always a struggle, but I kept healthy. I my lifestyle was good diet exercise no smoking. I was so healthy doctors didn't really believe that I had cancer a few times, all primaries. There was no crying, no depression, nothing.
    I still don't understand my reaction and never will. I treated every stage of the process separately. After years of worrying about what the future held, I didn't look beyond the next appointment. I must have been healthy else how could I fight it? The SPMS has set in now and it's a bit of a problem getting the support.

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  5. I love this conversation because you touch on what was most devastating to me about my diagnosis 3 years ago. It was a huge blow to my identity! Sometimes I forget and think of myself as pretty healthy for my age, and I start feeling optimistic. Then someone online says something about how sorry she feels for her uncle with MS, and how fortunate she and her friends are not to have it. At a party, someone says that her worst fear is getting MS. Or a well-meaning relative puts my name on her bib in an MS bike ride. And so on. I guess I'm realizing now (I mean as I write) that if I want to self-identify as healthy with MS, I'll need to do more than work out, take my shots, eat healthy, and get good sleep. I'll also have to fight against public perceptions in a world that clearly prefers to see me not as healthy but rather the subject of their Schadenfreude.

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  6. Re " If we understand the impact of labelling people as ill, sick, diseased or unhealthy ... ":

    Do you think any MSer who reads this blog can avoid thinking of herself as sick or diseased?

    This is not a complaint. I understand why the blog must present all news, good or bad. And I understand why it must be honest about dementia and other bad stuff.

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  7. I am sorry, but I cannot see the slides :-(

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