Coping With MS on the Job

When your doctor says you have multiple sclerosis, you may wonder if you'll be able to continue working. After all, MS is an incurable autoimmune disease that damages nerves and can trigger cognitive changes, fatigue, numbness and tingling in the hands, trouble walking, bladder and bowel problems, weakness, vision problems and sometimes depression, according to the National Multiple Sclerosis Society.

But those problems can often be managed on the job, suggests Dr. Barbara Green, a neurologist with Mercy Hospital in St. Louis. "Many of my patients work for a very long time after an MS diagnosis and in the face of accompanying disability," Green says.

[See: 10 Lessons From Empowered Patients.]

Encouraging Evidence

Green notes that before there were effective medications for MS -- as recently as the late 1990s -- most people with the disease would leave the workplace within 10 years of a diagnosis. "Now the numbers are lower," Green says.

A 2014 study of MS patients, published in PLoS ONE, found that 45 percent of study participants were still employed up to 19 years after diagnosis. People were more likely to continue working if they had the most common form of the disease, called relapsing-remitting MS. That type of MS causes flare-ups of symptoms periodically, which then go into remission and disappear, according to Johns Hopkins Medicine. The institution also reports that about 10 to 15 percent of people with MS have primary progressive MS, with symptoms that continually worsen over time and don't go into remission.

It may be possible to continue working with either type of MS, says Dr. Lawrence Samkoff, associate professor of neurology at University of Rochester Medical Center. "Progressive disease may be more challenging, but I wouldn't say you need to stop working," Samkoff says.

Addressing Challenges

Some challenges of MS are a little easier to accommodate at work than others.

For example:

-- If MS causes an overactive bladder, you may be able to move to a workstation closer to the bathroom, or your doctor may be able to prescribe a medication that reduces your urge to go.

-- If walking is difficult, it may help to park closer to the office door. Use an assistive walking device such as a cane, or ride a motorized scooter.

-- If vision problems keep you from seeing a computer screen clearly, it may help to use a larger font size, request a larger monitor or wear an eye patch to reduce double vision.

-- If typing is difficult because of numbness in your hands, consider a voice-activated computer program.

-- If you need routine medication infusions to decrease the frequency of MS flare-ups, you may be able to arrange some flexibility in your work schedule to accommodate doctor visits. For example, the drug natalizumab (Tysabri) is given by infusion once every four weeks, Samkoff notes.

[See: 10 Questions Doctors Wish Their Patients Would Ask.]

More Complicated Challenges

Other conditions or symptoms can be more difficult to navigate at work. For example:

Fatigue: About 80 percent of people with MS experience fatigue, according to the National Multiple Sclerosis Society. "This is one of the most disabling symptoms at work," Samkoff says. "The key is periodic rest so you can recharge. Not a nap, just a 20-minute break. Most employers are amenable to that."

Another solution is changing your work schedule. A later start time or earlier departure may help manage fatigue. "Many times we're advocating for restricted hours or working from home a few days a week to accommodate fatigue. A lot of my patients work from home now," Green says.

Medication is another way to fight fatigue in the workplace. Some drugs stimulate the central nervous system and help give people more energy or alertness. "We may prescribe methylphenidate or modafinil," Samkoff says, "and a lot of people use caffeine."

Memory and thinking: As many as 70 percent of people with MS have difficulty with thinking skills, such as attention, information processing, decision-making and memory, according to the Multiple Sclerosis Association of America. In the workplace, these may cause problems with multitasking, running a meeting, remembering how to work a machine or learning to use a new computer system.

It may help to ask for additional time to complete tasks or tutoring to learn something new. "Maybe you can't write things down fast enough or you can't remember what someone said. Recognize this early on and have discussions about it with your doctor or your employer. I've had patients who've asked to be demoted so they can go back to a job that's simpler," Green says.

"We'll perform detailed neuropsychological testing to see if we can isolate issues and ways patients can adapt, such as using a phone or calendar reminder and using to-do lists," Samkoff says.

Depression: A 2005 review of numerous studies published in the Journal of Neurology, Neurosurgery & Psychiatry suggests that in any given year, 20 percent of people with MS will be depressed, and that over a lifetime, 50 percent of them will experience depression at some point. "Unrecognized depression is a source of dysfunction and impacts cognition," Samkoff points out.

"It affects your ability to focus and interact with people," Green explains. "But effective treatment can make cognition better and make you less moody and less fatigued." She says treatment includes counseling and possibly medication and exercise.

[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]

What You Can Do

It may feel overwhelming to consider the impact of MS on the job, so it's important to share your concerns with your doctor. Samkoff says it may be possible to reduce some symptoms by detecting underlying conditions that make MS worse, such as sleep or thyroid disorders and medication side effects. "Remove the conditions that can be reversed, and you'll have a jump-start," he explains.

Green recommends asking your doctor and other health care professionals for guidance to overcome MS-related work challenges. "You know what your job entails, but you may need other experts to get you assistance so you can stay in the workplace," she says.

Green also suggests having a frank discussion with your employer. "You aren't obligated to reveal that you have MS, but it may benefit you to ask what your options are," she says.

The Americans with Disabilities Act requires most businesses with 15 or more employees to help people with disabling conditions (such as MS) obtain reasonable accommodations, provided that you meet the requirements for your job (such as education or experience) and that you can perform the essential functions of your job with or without accommodations.

But regardless of whether you reveal that you have MS, Green says it's important to be proactive. "The patients who are most successful," she explains, "are the ones who can figure it out or advocate for themselves."

Heidi Godman is a freelance health reporter for U.S. News. Her work has appeared in dozens of online and print publications, including the Harvard Health Letter (where she serves as executive editor), the Chicago Tribune, Baltimore Sun, Orlando Sentinel and Cleveland Clinic Heart Advisor. Heidi also spent more than 20 years as a TV news anchor and health reporter. She's interviewed surgeons in operating rooms, scientists in laboratories and patients in all phases of treatment. Heidi has earned numerous awards for outstanding health reporting and was the first TV broadcaster in the nation to be named a journalism fellow of the American Academy of Neurology. Email Heidi at health@heidigodman.com.