Nurse Practitioner Jollene Shirley, CNP, says it was always her “dream job” to work at a center that treated patients with multiple sclerosis. On May 1 that dream came true when she became the newest clinical team member of the Waddell Center for Multiple Sclerosis at the University of Cincinnati (UC) Neuroscience Institute. Ms. Shirley, who was recruited to UC Health from a neurosurgery practice in Lake Charles, La., will assist Waddell Center Director Maria Melanson, MD, in the management of the center’s 1,700 patients.
MS is a chronic, incurable disease of the central nervous system that affects more than 400,000 individuals in the United States and more than 2 million worldwide. MS, which is usually diagnosed in young and middle-aged adults, can cause transient or permanent neurological symptoms, including numbness, weakness, and problems with vision, balance and memory.
Ms. Shirley said there is something special about people who have MS. “It’s very rewarding to work with them and help them find ways to stabilize and improve their disease. Patients with MS are generally proactive. They educate themselves about their disease, and they want to know how they can get better. Holistically, they are looking for ways to eat healthy, to exercise more, and to take care of their whole body.
“Patients with MS know there is no cure. Fortunately, we have good modifying drugs to stabilize or calm the disease, and more are on the horizon.”
While many patients are resilient and self-reliant, others benefit from working with the Waddell Center’s psychologist, Peggy Crawford, PhD, who helps them come to terms with their disease.
Ms. Shirley was working in Lexington, Ky., with a neurologist who specializes in treating patients with multiple sclerosis when she first met Dr. Melanson, who was in town to give a presentation about MS. “I thought the world of her,” Ms. Shirley said. “I thought she was wonderful in the way she interacted with everyone. I had also been told by her colleagues that her patients loved her.”
Ms. Shirley’s role will involve seeing new and established patients, taking pertinent histories, ordering diagnostic tests and reviewing previously ordered tests. In taking a patient’s history, Ms. Shirley said, she will often learn of unexplained neurological symptoms such as optic neuritis (painful eyeball movement) and unexplained numbness and tingling that occurred years before the patient was diagnosed with MS.
After a patient’s history and diagnostics have been compiled, Dr. Melanson and Ms. Shirley meet with the patient and prescribe the appropriate treatment, which could be determined by many factors, including the type of multiple sclerosis the patient has and how far the disease has advanced.
Treatment options, which include injectable, IV and oral disease-modifying therapies, are increasing for people with MS. A newly approved oral medication is Gilenya, which is taken in pill form daily and is available for those patients who have failed to benefit from injectable therapies. Gilenya is the first oral form of disease-modifying medications for treatment of MS.
Three new MS medications are expected to become available in the next year or so, Ms. Shirley said. One of these new medications, currently known as BG-12, is expected to become available in January 2013.
Tysabri, which is given intravenously once a month, is a good option for some patients, Ms. Shirley said. A neurological condition called progressive multifocal leukoencephalopathy (PML) is a rare side effect of the medication. PML is caused by the JC virus, which lies dormant in 50 percent of the population and can be detected by diagnostic testing prior to the initiation of Tysabri.
– Cindy Starr