It’s not so long ago that a diagnosis of MS led your doctor to tell you to quit work and go home and rest. Many people did this, but they got bored.

MS affects people in different ways. Some have a relatively mild form of MS and may never experience any symptoms which prevent them from working. Others may have to cope with varying degrees of disability from time to time, whilst some people may become severely disabled quickly. It is only a small proportion of people with MS who are so severely affected.

However, there are many reasons why people leave the workforce ranging from problems with fatigue and cognitive dysfunction to embarrassing problems such as bowel and bladder difficulties. But many people are not aware of the treatments available and the accommodations that can be made to allow them to stay “on the job”.

While well meaning friends, family and healthcare workers could be encouraging you to reduce stress and give up work, there is only a tentative link between MS and stress and the stresses of unemployment with its financial burdens are not a good solution.

So let’s start with working outside the home.

There are many benefits for an employer who supports the employee with any kind of disability

• Maximising on their investments in an employee with MS, for example by not losing prematurely the skills and experience of a well trained member of the workforce
• Avoiding potential difficulties by adopting a proactive approach to intermittent medical condition policy issues now, instead of waiting for a situation to arise
• Confirming that existing/new policies and procedures comply with current or upcoming legislation
• Capitalising on the expertise and support provided by the MS Societies
• Promoting a positive perception/image of the organisation to both employees and external audiences.

For the employee there are reasons to keep going.

• Financial security: The longer you remain in the workforce the higher you benefits are likely be if you need to leave and the longer you can pay into savings.
• Fringe benefits such as health insurance may be one of  your most valuable assets.
• Your identity is often defined , at least in part, by the kind of work you do.
• A sense of self worth comes from  feeling productive and contributing to your family, your community and even society as a whole. Thus voluntary work can have just the same benefit.
• Being a role model for others feels good. A model for your kids, others with disabilities and even anyone else who’s paying attention.

If you want to stay in the home there are options you can look into.

There may be many reasons why people struggle to secure employment outside of the home, and disability and ongoing illness may be one cause. Problems overcoming physical limitations, in the workplace, or employer reluctance to hire you and give you the chance to try may arise despite laws that forbid discriminating against disabled applicants. Ongoing or frequent illness may mean that you miss a lot of work, or are unable to keep up with the required working pace. Working in the comfort of your own home ensures that all areas are accessible and safe, and any specialist devices that you may need such as computer screen readers for the blind are available to you.

Some home working may involve being employed as an at home agent of a larger company, whilst others may involve you being self employed; your own boss, answerable to no one but yourself. You may have to try several different things before you find something that is suitably flexible to work for you, or that meets your other needs and your likes.

The internet is a great, big equalizer and it can work to your advantage. The internet does not care if you are disabled – it only requires that you can deliver the work you promise.

Self employment can start very easily and if you are using social networks like Twitter and Facebook you will have a readymade audience to work with. Be careful not to sign up with some of the called “gurus” who claim you can make huge amounts of money in very little time. There is no such thing as a free lunch but by working consistently you can achieve your goals.

Look into things like MY AUTO CASH GENERATOR by Joey Smith and Devon Brown or investigate scriptlance.com or elance.com article writers, web designers, software programmers, audio transcriptionist, proofreaders, video creators, et cetera are all used by these companies. Or check out a directory site like wahcheck.com . Start advertising yourself with a free advertiusing service. There is no end of wasy to keep the costs down.

There is no requirement to stick to only one option you can do as many as you like but don’t dilute your focus by trying to do too many.

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In  the fourth part of this series I will be addressing secondary causes of sexual dysfunction.

While life changes affect everyone, changes from MS can directly and indirectly affect sexuality.

Sexual changes in MS can best be characterised as primary, secondary, or tertiary.

Primary sexual dysfunction has been dealt with in parts 2 and 3. In this article I am going to deal with secondary sexual dysfunction but I am simply going to lay out the symptoms. A more advanced course is available which covers possible courses of action to take given the symptom.

Secondary sexual dysfunction

MS changes can affect sexual response by making sexual activity difficult physically and emotionally. Symptoms common to MS, such as fatigue or changes in muscle tone, lack of coordination or pain, can frustrate sexual expression and extinguish desire. Bowel and bladder dysfunction can inhibit and cause embarrassment. Cognitive changes challenge the most devoted couple, yet in the presence of any of these symptoms; it is possible to find creative ways to keep the physical expressions of love alive.

Fatigue

This is perhaps the most common symptom reported by people with

MS, and it can be the most disabling.

Weakness

Muscle weakness may necessitate alterations in sexual practices.

Lack of coordination and tremor

Lack of coordination may make sex and sexual expression feel clumsy, as can tremor. But besides being awkward, these symptoms may also interfere with the couple’s style of having sex.

Bowel and bladder problems

Another source of anxiety and distress can be bowel and bladder disturbances. These problems go hand in hand with sexual dysfunction, since nerve pathways are shared or close to each other. Incontinence, or even fear of having an accident, can cause a person to avoid sex entirely, thus depriving them of the closeness it brings.

Pain

This can impact significantly on interest in sex as well as performance ability. Understanding the type of pain can influence the best way to manage it. Muscle tightness, intense itching and spasticity may all be called “pain”. Also, medications used to relieve pain may add to sleepiness or fatigue.

What you can do

Medications that bring relief must be well prescribed for the type of pain they treat and used in just the right dose and frequency to give relief with the least disadvantageous side-effects. An extra or well-timed dose before intimacy can often provide effective symptom management and reassure the partner that he/she is not adding to discomfort.

It is also important that a symptom such as adductor spasms (which cause involuntary pulling together of the legs) is not seen as an indication of the person’s interest or willingness to have sex. Again, communication is the key to avoiding misunderstanding and hurt feelings.

Water soluble lubricants can make intercourse more comfortable, without predisposing to urinary tract infection.

Sensory issues

Changes in sensation can also interfere with sexual pleasure. Non-genital symptoms such as numbness and tingling can distract and discourage either partner. Impaired genital sensations can diminish pleasure, while heightened sensitivity may make even the lightest touch unbearable. What feels good at one time may be excruciatingly painful on another occasion

Mobility

Mobility devices used to compensate for loss of function can also damage your confidence and self-image. They may be seen as less than sexy. Canes, wheelchairs, braces and walkers are often identified with being “sick” or “old”. Spontaneity can be a problem if great effort has to be made to get about.

Cognition

Cognitive changes can be amongst the most potentially damaging to the relationship, since they can undermine the person’s sense of who he/she is. A partner may feel this is no longer the person they once knew. Changes in attention and concentration may be perceived as lack of interest or love, and may irreparably strain the relationship. Changes in mood, memory loss and depression can be frightening, frustrating and sometimes infuriating. All interfere with intimacy. Individual or couples counselling may be advised.

Conclusion

Sexuality is an important aspect of human life and must not be neglected when considering the impact of MS on an individual.

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DREW IS KNOWN AS “PRETTY BOY” — a 12-year-old palomino who used to perform in western pleasure shows. Now, the gentle horse is helping people improve their health.

He is one of three horses used at RideAbility Therapeutic Riding Center, a nonprofit organization in Florence that helps people with disabilities through supervised horseback riding.

“We work with those who are battling a lot of different things – from autism to cerebral palsy to multiple sclerosis,” says Christy Henderson, executive director and certified instructor at RideAbility. “Part of our motto is body, mind and spirit, and we truly believe that therapeutic riding helps in all those areas.

“Riding can improve your body. It can help your self-esteem when you can talk to this 1,000-pound animal and get him to do what you ask. And your spirit can be lifted by being outside and around other people.”

Henderson is a member of NARHA, an association in the United States and Canada that teaches equine assisted activity and therapy programs. The organization was founded in 1969.

One of Henderson’s riders is 46-year-old Preston Wade, a resident at Community Place, a skilled nursing home in Jackson. Wade is battling multiple sclerosis. He must use a wheelchair and has limited use of his arms and hands.

“I don’t ever see Mr. Wade ‘yee-hawing’ down the side of an arena on a horse,” Henderson says. “But he has a progressive disease, and our goal is to improve his core strength, upper body strength and keep his body flexible.

“When you’re sitting astride a horse, the warmth of the horse massages your thighs. And the way a horse moves is very similar to the walking gait of a person. So it helps stimulate those muscles that haven’t been moving normally in a while.”

After 10 lessons with Henderson at his side and a volunteer slowly leading Drew around an arena, Wade says, “I can tell it’s helped my trunk and hips … I always look forward to riding Drew. And my goal is to be able to walk again.”

The 90-degree heat has forced Wade’s once-a-week workout to move from late afternoon to early morning.

“Since it’s been so hot, we’ve seen a slight regression in Mr. Wade,” Henderson says. “But that’s consistent with multiple sclerosis patients. They have a hard time dealing with extreme temperatures. Sometimes he can ride for 45 minutes, sometimes for only 15.

“But I do believe it’s helping him with his posture and balance. I tease him a little. He was in the military, so if I see him slumping I’ll say ‘Sit up, Marine!’ He gets a kick out of that.”

Wade learned about horse riding therapy through Michelle Daniel, administrator and CEO at Community Place.

“My 5-year-old nephew (David Lockwood) in Texas has seizure disorders, and he’s been doing horse therapy for the past two years,” Daniel says. “David can’t walk. But we have noticed that he has much more trunk control, so he’s able to sit up better. He’s not consciously doing that. It’s happened through muscle memory and riding three times a week.”

While visiting with Davis one day, Wade mentioned that he used to ride horses.

“I started talking to him about horse riding therapy, and he was all for it,” she says. “He loves it, and I can definitely tell a difference. What we’re hoping is that the riding slows the progression of the disease and provides him a longer quality of life.”

Lessons at RideAbility are usually $25. Wade’s are paid for through a grant Daniel helped him acquire through the Mississippi Health Care Foundation.

Henderson was chief nursing officer at Rankin Medical Center in 2004 when she and her husband, Harold, vacationed at a ranch in Colorado. “We spent almost the entire week on horseback, and I absolutely fell in love with it,” she recalls. “I came back and took riding lessons. I came across something about NARHA, and I could see myself doing that one day. So when I retired in 2006, I started working on getting our nonprofit status.”

RideAbility opened in 2007. Henderson works with about 15 riders.

“The most prevalent diagnosis of my riders is autism,” she says. “A lot of those kids are socially isolated and have communication issues. Just sitting astride that animal can be very beneficial in improving their communication skills. I’ve heard stories where children have not spoken, and the first word out of their mouth is the name of the horse they’ve been riding.”

According to NARHA, Mississippi has four therapeutic riding centers in addition to Henderson’s. They are in Caledonia, Kiln, Starkville and Senatobia. Complete information is available on the Web at www.narha.org.

To comment on this story, call Billy Watkins at (601) 961-7282.

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