Delivering a MS diagnosis

Dr. April Erwin is a Baton Rouge neurologist and an LSU graduate. She completed her medicine internship and neurology residency at Georgetown University Hospital in Washington, D.C. In addition, she holds a master’s degree from New Orleans Baptist Theological Seminary and has done missionary work in India.

Dr. Erwin: It’s tough with moms. They are diagnosed with MS at such a young age, and a lot of them have never heard of it. They want to be able to go on with all of the things that they want to do. And their obligation is all of the things they have to do to raise their families. So we encourage a balance. We don’t do them any favors when we say, ‘Sure, go do what you usually do,’ and then they have symptoms and they can’t do those things, and then they feel like they have failed.

We help them understand the disease process and what it involves, the waxing and waning features of the illness. You can be well one day and not well the next. People take for granted that you’re doing fine, where, inside, you are exhausted or have bladder and vision malfunctions. It involves education, writing letters and making phone calls to work supervisors. It should also include additional counseling and support to the patient as she first determines what activities she is continuing and what needs to be cut back.

Patients are typically very frightened for their children. It’s that mother lion protecting her cubs. What burden is this going to put on my family? Are my children at risk for later developing this disease? That’s that motherly instinct.

And then, on a daily basis, it’s how can we deal with a disease that is capricious? We don’t know when an MS relapse could occur, so you have to already have planning in place for that. It’s almost like a fire drill. Every family has to have their fire drill.

There was a time not very long ago where we had absolutely nothing to offer, aside from steroids. No disease-modifying medicines were FDA-approved. Now, we have eight and several more in the pipeline. We have many options for treatment.

Any disease disrupts a person’s core understanding of themselves. In areas like stroke, brain tumors and end-of-life issues, a lot of seminary training informs my part of those conversations, as well as those dealing with MS.