Diagnosis Can Be Difficult

Diagnosis is rarely straightforward with MS, requiring that the multitude of other causes of the symptoms be ruled out. Tools such as magnetic resonance imaging (MRI) can help diagnose the disease earlier than in the past, but a great deal of clinical judgment is required.

“There’s not a single blood test; there’s not a single X-ray that can diagnose it,” Haselkorn emphasized. “It really is a physical exam and a consideration of all the other things that could be causing it.”

To help healthcare providers deal with the complexity of the disease, the VA’s MS Centers of Excellence have developed a handbook that can be used by facilities nationally. The centers also work closely with VA pharmacies to ensure that medications for MS are available and that the effects of the drugs are closely monitored.

Two Centers of Excellence were established by VA nine years ago to improve quality of care for MS. The Eastern center is based in Baltimore, and the Western center in Seattle and Portland.

“The centers were really designed to improve the clinical care of veterans with MS by developing a supportive network of care,” said Haselkorn. “It’s not that veterans diagnosed with MS come to one or the other center, it’s that, as centers, we are mandated to really develop this integrated hub-and-spoke model and to really support with education and training a national program for providers and veterans and their support systems so that they get better care.”

The centers also have been involved in setting up telemedicine programs for MS patients, allowing them to receive advice and care as close to their homes as possible. Specialists are able to monitor both a patient’s physical and mental health via video.

An electronic survey tool also has been developed to help track all the medications veterans have taken, including those prescribed by private doctors before the patient entered the VA system.

“Some people who come into the VA have been treated for a long time in the private sector,” Haselkorn said.

Physicians and others who treat MS can tap into a network of benefits for their patients, including drugs which could cost $50,000 a year in the private sector but are provided to veterans for as little as $8 per month, she added. Some veterans may qualify for grants to adapt their homes and automobiles to accommodate their disabilities. They also can qualify for home care and extended nursing home care.

VA seeks not only to improve care for veterans with MS but also to attempt to fight the disease on another front. Research is being conducted to determine if deployment and battlefield conditions increase the risk of developing MS. It already is known that stress can aggravate the symptoms of the disease.

 “We’ll know more about that in a few months,” said Haselkorn. “We don’t know too much about that right now.”

1. LaVela SL, Prohaska TR, Furner S, Weaver FM. Chronic diseases in male veterans with multiple sclerosis. Prev Chronic Dis 2012;9:110121. DOI: http://dx.doi.org/10.5888/pcd9.110121

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