No surprise the world can be a dangerous place to live, but the challenges can be even greater for those with multiple sclerosis. According to a 2014 study published in the journal PLoS One, folks with MS are twice as likely to fall accidentally as those who don’t have the disease. And falls aren’t the only risk. Multiple sclerosis presents all sorts of safety concerns – from driving a car and keeping track of medications to avoiding certain circumstances that could trigger a relapse of symptoms.
It’s easy to understand why multiple sclerosis can make maneuvering in the world especially challenging. An autoimmune disease, MS damages the myelin sheath (covering) around the neurons in the brain and spinal cord responsible for sending signals to other parts of the body. That can lead to symptoms such as brain fog, depression, muscle spasticity, imbalance, extreme fatigue and vision issues – all of which can contribute to an increased risk of falling, as well as other kinds of accidents and misjudgments.
One way to reduce potential problems is by paying attention to the most common issues that can trip you up, such as:
“Many multiple sclerosis patients suffer with cognitive issues (especially with memory), as well as extreme fatigue, and both these conditions can interfere with sticking to a medication schedule,” says Victoria Leavitt, clinical neuropsychologist and Director of the Multiple Sclerosis Cognitive Neuroscience Laboratory at Columbia University Medical Center in New York. A 2013 review of MS patients and their adherence to medications supports Leavitt’s view. The study showed that less than 64 percent of patients take their MS drugs as prescribed. Fatigue and forgetfulness were among the top reasons for missing medication.
There’s another reason why MS patients may not take their medicine. “Some patients make a conscious decision to stop taking drugs because they start feeling better and figure they’re no longer needed,” Leavitt explains. “This is especially true for people with relapsing remitting MS, which is a type of MS where symptoms come and go. In some cases, it can be months or years before a problem returns,” Leavitt says. “But for safety’s sake, before patients decide to stop taking their medications, they always need to discuss it first with their doctor. There can be serious consequences if a drug is abruptly abandoned, including the return of symptoms.”
“As many as 75 percent of MS patients will be affected by balance problems sometime during the course of their disease, so their homes need to be safety-proofed for possible falling,” says Dr. Devon Conway, staff neurologist in Cleveland Clinic‘s Mellen Center for Multiple Sclerosis. “MS patients can arrange for a physical or occupational therapist to make a home visit. An assessment will be made, along with suggestions on how to make the patient’s home safer,” Conway says.
Several common adjustments the National Multiple Sclerosis Society recommends, include:
- Putting grab bars in the tub, shower and near the toilet.
- Removing throw rugs.
- Creating an unobstructed path throughout the house.
- Keeping night lights on to lead the way in darkened hallways.
- Getting rid of clutter.
- Making sure furniture is sturdy and easy to use.
- Putting pots, pans and dishes where they can be reached easily without climbing or standing on tiptoe.
On-the Job Issues
Even after you’re diagnosed with MS, there’s a good chance you’ll still be able to keep your job. But there could be an exception if your employment requires the use of heavy, or potentially dangerous machinery. “Because MS can interrupt signals between your brain and body, you may develop symptoms such as visual blurriness, dizziness, extreme fatigue and weak limbs. Dealing with any of these problems while working with heavy machinery can create a potentially dangerous situation,” Conway points out. What can you do? According to the Americans with Disabilities Act, you have a right to keep a job. The law requires your employer to make possible accommodations, including the use of special devices or equipment. That said, if your MS makes it unsafe for you to do your job, you might have to look for other work or apply for disability benefits.
“Driving is an incredibly complex cognitive activity and can be hazardous if you get somebody behind the wheel who has sudden numbness, vision or scanning issues, or if they have executive function impairment,” Leavitt says. “Just getting in and out of a car can create a risk for falling.” But driving isn’t an easy issue to tackle. “I wouldn’t want to tell someone they shouldn’t drive because it’s a huge part of independence,” she adds. But keep in mind that studies show there is a higher rate of accidents in drivers who have MS.
What’s the answer? “It’s probably best to err on the side of caution,” Leavitt says. “If you’re not sure, speak to your doctor who can refer you for a driving evaluation.” The National Multiple Sclerosis Society says that this test includes office-based and behind-the-wheel assessments. Special adaptive equipment may be available to help you adjust for deficits that interfere with your driving such as mechanical hand controls to operate the gas and brake, or a spinner knob to turn the steering wheel, among other adjustments.
In a study published in 2011 in the journal Bio Med Central Neurology, Swedish researchers found that more than 70 percent of 256 MS sufferers experienced some sort of heat sensitivity. The study also pointed to the most common symptoms of overheating: fatigue, difficulty concentrating, pain and visual blurriness.
“Rising body temperature is a big concern because it can make MS symptoms temporarily worse. This phenomenon is called Uthoff’s Syndrome,” Conway explains. “A healthy body cools off on its own because the hypothalamus regulates core body temperature, but with MS, signals to that area of the brain can misfire and the body doesn’t know it’s supposed to cool down.”