Multiple Sclerosis: A Self-Care Guide to Wellness.

Multiple Sclerosis: A Self-Care Guide to Wellness

Holland NJ, Halper J, eds. Washington DC 20006, Paralyzed Veterans of America, 1998, spiralbound, 150 pp, $9.

This book is a tremendous overview and source of information for patients with multiple sclerosis (MS) who want to "read more about it" and learn what they need to do in order to live and function optimally with this condition. It explains how MS affects the lives of both the family (or caregiver) and the patient and offers help to patients with MS who need to be informed consumers in this time of managed care. It emphasizes wellness and preventive care, which is a slightly different orientation from that of many of the resources available on MS. The audience for this book is clearly patients with MS and their caregivers. In addition, this book could also be a helpful resource or review for interns or medical students who are working with patients with MS for the first time.

This book provides a thorough and detailed overview of MS and all the problems and issues that might concern a patient with MS. Seven of the book's 18 chapters list resources showing where the reader can get additional information, but there are no references listed for any chapter. The resources are very helpful, but further references or documentation would help give this book more validity from the practitioner's point of view, even though it was not written primarily for that audience.

The first chapter is an excellent and informative overview of MS. It includes excellent diagrams and charts and a fine review of symptoms, causes, and diagnostic tests. The tests were described in detail concerning what they reveal, but these descriptions said little about the actual procedure, the pain level, the preparation involved, or whether the test was invasive.

Chapter 2, on fatigue and pain, and chapter 4, on cognitive problems, were helpful, described the problems in a well-organized manner, and offered constructive approaches to dealing with these issues. Chapter 3, on joint flexibility and mobility, contains a good description of the impact of loss of motion. The descriptions of all exercises in this chapter included the subject's position, the role of the person assisting, and the movement required. Many of the exercises involved the extremities and a few trunk activities. However, I feel that a little more information on trunk activity would have been helpful, because much of the current literature documents the importance of mobilizing the trunk to allow for better mobility in the extremities. Chapter 3 also discussed assistive devices.

Chapter 5, on bowel and bladder management, gave a superb explanation of the normal function of these systems, describing the major problems and symptoms that can occur in MS and some practical approaches. It provided a good explanation of the required diagnostic tests, including the patient preparation and experience. The figures and diagrams were very helpful. Chapter 6 covered skin care very well, using fine diagrams and an extensive outline of the stages of pressure sore development. It made clear and very practical suggestions for prevention.

Chapter 7, on exercise options, was a little disappointing because it basically presented the theory and a general description of types of exercise, such as aerobic, strengthening, aquatic, and open and closed chain exercises, but did not describe or show any specific exercises. It mentioned the importance of having a physical therapist assess the patient's needs and prepare a program. However, because the book is a self-care guide, I expected to see some exercises, perhaps just a few for gait or balance, that would help it fulfill its self-care mission. This chapter also addressed the importance of monitoring heat sensitivity in any workout.

Chapter 8, on coping and stress management, and chapter 9, on nutrition in MS, were complete and outlined the requirements in these areas and options for achieving them. Chapter 10, on the lungs and heart, had fine diagrams, clear explanations of the anatomic systems, and fine self-care strategies.

One of the most important and honest chapters in this book was chapter 11, on sexual changes in MS. This topic is rarely addressed in the professional or consumer literature, and it was handled superbly. Any self-help book dealing with a condition such as MS should discuss this topic. The chapter was extensive, well illustrated, and well outlined. It presented an excellent overview of normal sexual functioning and response, and a clear description of problems that can develop because of MS. The symptoms and the solid suggestions for approaching them were discussed in detail with honesty and compassion. The end of the chapter contains an excellent list of resources and organizations.

Chapter 12 addresses early detection of gender-specific cancers such as breast and testicular cancer. Even though these are not associated with a greater risk for MS, patients should know how to check for these conditions. The chapter provides fine diagrams and instructions on the subject. Chapter 13 discusses alternative medicine and treatments, and it cautions the patient to be a wise consumer and to ask questions.

Chapter 14, on work and productivity, has some excellent guidelines and a fine description of the most important employment provisions of the Americans With Disabilities Act. Chapter 15 deals with driving and driver training. It includes a self-appraisal form and describes how the patient can work with the state licensing agencies. Suggestions and resources for vehicle adaptations are covered in detail. Chapter 16 provides a superb overview on accessible home designs and includes detailed suggestions with technical drawings for bathrooms and kitchens. Chapter 17, on leisure activities, also includes a wonderfully detailed listed of sources for travel, transportation, and sports activities that accommodate patients with MS. Chapter 18 is a finely written chapter on obtaining personal assistance. It includes a job description for the assistant, a list of suggested major duties, and a sample employment agreement for help at home.

The appendixes include a list of federal resources for patients with MS; an extensive glossary of terms associated with MS; and an excellent drug index that lists 43 medications used to treat MS and their action, precautions, and side effects.

This important book is relevant to physical therapy because of its comprehensive approach to the topic and its lists of organizations and other resources, which could help the patient and the therapist find important medical information. This book truly empowers the patient by offering a solid base of knowledge on every aspect of MS.

Overall, Multiple Sclerosis: A Self-Care Guide to Wellness is a fine and important source for the patient with MS. It is thorough, clear, honest, and includes some wonderful resources tot all aspects of preventive care and continuing a productive life with MS. I highly recommend this book as an important resource guide for any clinic, patient, or family dealing with MS. As the introduction mentions, in this time of managed care and limited visits, the consumer must be "armed" and well read. This book will enable patients and their caregivers to do that. It is an extraordinarily empowering resource for any patient with MS.

Barbara S Oremland, PT Baltimore, Md

Ms Oremland is currently a consultant in the area of movement disorders, training health care professionals in the specialized treatment of patients with Parkinson syndrome, dystonia, and Huntington disease.