Multiple Sclerosis Home Visit

**Reason for Home Visit:** Follow up Home Visit due to Complex Needs **Patient concerns:** Patient reports increasing fatigue and difficulty with mobility. **Diagnosis:** Diagnosed with Relapsing Remitting Multiple Sclerosis in 2018. Initial presentation included optic neuritis. MRI scans have shown new lesions in the brain and spinal cord. Last relapse was in June 2024, with symptoms including increased weakness in the left leg. Diagnosis confirmed by Dr. Eleanor Vance, Neurologist. **Relapse/progression:** Relapse symptoms: Increased fatigue, worsening mobility, and increased spasticity in the left leg. Symptoms started approximately 2 weeks ago. Severity is moderate, impacting daily activities. Reported to Dr. Vance. Timeline of events: Symptoms gradually worsened over the past two weeks. Current status: Symptoms are ongoing. No steroid use at present. Influencing factors: Possible correlation with recent viral illness. Progression: Mobility has worsened since last review. Symptoms started approximately 6 months ago. Impact: Difficulty with walking and balance, affecting ability to work. Seen by Physiotherapist. **Disease Modifying Therapy:** Currently on Ocrevus, started in January 2023. Infusions every six months. Side effects: Mild infusion reactions. No injection site reactions. Home delivery is not required. Last MRI was in April 2024, next MRI due in October 2024. **MS Related symptoms:** **Mood:** Patient reports feeling low in mood due to the impact of MS on her life. Coping strategies include regular exercise and support from family. Currently not seeing a therapist. Interventions/advice/referrals: Discussed the importance of maintaining social connections and offered information on local support groups. **Memory:** Patient reports some memory issues, particularly with short-term memory. Interventions/advice/referrals: Provided information on memory aids and strategies. **Vision:** Patient reports occasional blurred vision. Interventions/advice/referrals: Advised to schedule an appointment with an ophthalmologist. **Upper limbs:** Patient reports some weakness in the right arm. Interventions/advice/referrals: Referred to occupational therapy for assessment and support. **Lower limbs/Mobility:** Patient reports significant mobility issues, including difficulty walking and balance problems. Interventions/advice/referrals: Review of walking aids and referral to physiotherapy for gait retraining. **Bladder:** Patient reports some urgency and frequency. Interventions/advice/referrals: Provided information on bladder management techniques. **Fatigue:** Patient reports significant fatigue, impacting daily activities. Interventions/advice/referrals: Discussed fatigue management strategies, including pacing and energy conservation techniques. **Pain/Sensory:** Patient reports some neuropathic pain in the feet. Interventions/advice/referrals: Discussed pain management options and reviewed current medications. **Social Situation:** Patient is currently working part-time. Driving is becoming difficult. Support network includes family and friends. Carer assessment completed. Home adaptations are in place. Discussed the need to review benefits. Advanced directive in place. **Co-morbidities:** Hypertension, managed with medication. **Other:** Patient expressed concerns about the future and the progression of her MS. **Management Plan:** Referral to physiotherapy for gait retraining. Review of walking aids. Follow-up home visit in 4 weeks. Review of current medications. Referral to occupational therapy for assessment and support. Review of benefits. Discussed the need to review advanced directive. Advised to schedule an appointment with an ophthalmologist. Provided information on bladder management techniques. Discussed fatigue management strategies, including pacing and energy conservation techniques. Discussed pain management options and reviewed current medications.