By David Beasley

SEATTLE--Clinicians who treat the VA’s more than 30,000 multiple sclerosis patients face constant challenges in treating both the mysterious disease as well as the other chronic health conditions which tend to accompany it.

“It is a disease that doesn’t really have a known cause,” said Jodie K. Haselkorn, MD, MPH, co-director of the Multiple Sclerosis Center of Excellence (MSCoE) – West in Seattle. “And at this point, it doesn’t have a cure either.”

The age at which MS often strikes, between the ages of 20 and 50, makes it a special concern for the VA. “That’s a key age group for people who are involved in the military or have recently been involved in the military,” Haselkorn pointed out.

Increasingly effective drugs and rehabilitation are used to treat MS, with success varying greatly from case to case. “It may go away for months; it may go away for years,” said Haselkorn. “With disease modifying agents, what we really want to do is stretch out the time of those relapses and the severity of the relapses, if possible.”

Therapeutics can have serious side effects, which also need to be controlled or mitigated, she added. What further complicates treatment is that patients often have a host of medical issues unrelated to MS symptoms.

Jodie K. Haselkorn, MD, MPH, with Christopher T. Bever Jr, MD, MBA, (left) and Dennis N. Bourdette, MD, (right) of the VA’s Multiple Sclerosis Centers of Excellence.

New research indicates that male veterans with MS are more likely to have other chronic health problems as well. Hypertension, diabetes, coronary heart disease and stroke were “significantly more prevalent” among male veterans over the age of 50 than in the general population, a study by the Centers for Disease Control and Prevention found. Nearly half of the male veterans with MS had high cholesterol and hypertension, according to the study.¹              

All of those issues are compounded because of the unique demographics of veterans, which results in VA treating more severe cases of MS than private-sector facilities, Haselkorn noted.

“Men tend to have more severe disease than women,” she said. “Since we see a large proportion of men, we see more severe disease,” adding that MS in non-Caucasians also tends to be more severe, which affects the racially-diverse VA patient population.

In addition, patients presenting at VA facilities may have more advanced treatment because of delays in diagnosis, especially with the recently deployed. Servicemembers in war zones may delay getting a diagnosis because they are hesitant to get medical treatment about what seem to be minor early symptoms.

“Among the active-duty folks, there is reluctance to sort of step forward with some of their symptoms,” said Haselkorn. “People are unlikely in combat to complain about a numb toe that kind of comes and goes, or a little bit of weakness.”

Military personnel may also fear that they will be removed from active duty if they get an MS diagnosis. Whether that occurs is based on the severity of disease, she pointed out, because some patients have symptoms which mysteriously vanish and do not return for years, while others find themselves incapacitated much sooner.

“Anybody who has this disease has a certain amount of denial,” she explained. “There are times when you can be pretty sure you’ll be discharged from the military, and there are other times when people go to great lengths to keep people in.”