Indeed, many people leave the hospital with a diagnosis of multiple sclerosis when symptoms like numbness, vision changes, weakness, loss of balance, or vertigo have prompted them to seek emergency care. But if you’ve already been diagnosed with MS, what constitutes a true emergency, and what problems could be better handled in an office visit with your primary care physician or neurologist, or with a visit to an urgent care center?
3 Reasons to Seek Urgent or Emergency Care
Generally speaking, there are three situations that might require urgent or emergency care for people with MS, says Brandon Moss, MD, a neurologist at the Mellen Center at Cleveland Clinic in Ohio. “First, there are issues that are direct consequences of multiple sclerosis, specifically relapses. Additionally, side effects of certain medications used to treat MS can sometimes require urgent attention,” says Dr. Moss. There can also be issues that are indirect consequences of MS and MS-related therapies, he says. “Most commonly, that’s going to include infectious complications, though those aren’t the only things.” In addition to those MS-specific problems, any symptoms that could indicate a heart attack or stroke require an immediate 911 call and should send anyone to the emergency room right away, says Moss.
Your MS Provider Can Help You Decide if Urgent Care Is Necessary
“Your MS provider’s office should be — most of the time — the first stop if you have a question about whether or not your symptoms are severe enough to seek emergency care,” says Moss. Even if you don’t get your doctor on the phone, you should be able to talk with a nurse who can discuss your symptoms with you, he says. “They have been trained to give people advice on whether emergency care is necessary.” But if you think you might be experiencing a medical emergency such as a heart attack or stroke, call 911 before you call your MS provider, says Moss.
When Should You Seek Urgent Care for an MS Relapse?
An MS relapse is the occurrence of new or worsening symptoms that are related to inflammation involving the brain or the spine, says Moss. “They can be in one location and produce very focal or specific symptoms related to that area of the brain or the spine, or they can be in multiple areas of the brain or the spine simultaneously,” he says. Symptoms that temporarily worsen and subside within 24 hours are called pseudoexacerbations and are often caused by heat, stress, or fatigue. In a true relapse, symptoms last for longer than 24 hours, possibly even for weeks. “If you have a relapse, it’s important to get in to see your doctor quickly, because treatment can speed recovery and limit the damage,” says Moss. “More severe relapses could involve loss of vision, especially in both eyes, severe weakness, or poor balance that can interfere with a person’s ability to move around or their safety or their ability to care for themselves,” he says. People with this type of relapse are usually treated with a short course of high-dose steroids, he says. Depending on the healthcare facilities in your area, even a severe MS relapse doesn’t automatically mean you have to go into the hospital, says Moss. “We try to keep people out of the emergency room if at all possible,” he says. Many healthcare systems, including the Mellen Center at Cleveland Clinic, have an infusion center. “If we determine that a person is having a severe relapse and needs to be treated with high-dose steroids, we can give them IV treatment in our infusion center,” he says. In some cases, a high dose of oral steroids (rather than IV steroids) can be given to treat a relapse outside of a clinical setting, says Moss.
Medication Side Effects Can Be Serious and May Require Intervention
Before you start taking any disease-modifying MS medication, your provider should have a detailed conversation with you about the potential risks or side effects so that you are prepared and know what to look for, says Moss. “Although most drug side effects can be managed over the phone or in an office visit, some more serious medication-related side effects require further intervention and evaluation. For example, some people who are getting an IV treatment may have an allergic reaction,” he says. This type of reaction would usually happen while the person is in the infusion center, but sometimes it can be delayed, he explains. “In this case, if you have a severe reaction like throat swelling, shortness of breath, or a rash that involves a large part of the body, then it would be appropriate to seek immediate medical attention,” says Moss.
MS Medications Can Increase Your Risk of an Infection
Medications used to treat MS can lower a person’s immune response to viruses, bacteria, and fungi and increase the risk of infection, says Moss. There’s also evidence that people diagnosed with MS have more infections — particularly urinary tract and kidney infections — than people without MS even before they begin disease-modifying medications, according to a study published in October 2020 in Multiple Sclerosis and Related Disorders. If you have symptoms of an infection, such as fever, it’s a good idea to call your MS provider so they can help you decide what your next steps should be, says Moss. “For example, a milder UTI or viral upper respiratory tract infection might just warrant calling your doctor’s office to decide what needs to be done; those usually wouldn’t require a trip to the urgent care or ER,” he says.
Serious Infections May Require Urgent Medical Attention
It’s common for people with MS to have infection complications that are related to consequences of their MS, says Moss. “For example, if someone isn’t moving around much and is in a wheelchair on a regular basis, they might be predisposed to developing pressure ulcers. The pressure ulcers may get infected, and that could lead to a hospital admission,” he says. Some people with MS can have something called neurogenic bladder, which is caused by neurological damage, which can make them more prone to get a UTI, says Moss. “If that goes untreated, it can lead to a more systemic infection called sepsis and that would need urgent attention,” he says. A viral infection that’s causing more severe symptoms could require an evaluation in the emergency department, says Moss. “For example, if you’re having high fevers or whole-body shakes, coughing up colored phlegm, or producing phlegm that has blood in it, that’s more serious than a run-of-the-mill cold and should be checked out right away.”
When to Call 911
Symptoms that could indicate a stroke or heart attack should be taken seriously, says Moss. “A stroke can cause similar neurologic deficits to what you can see in MS relapses, but the key difference is timing. Any symptoms like numbness, weakness, or confusion that come on suddenly — by that, I mean seconds to minutes — that’s not characteristic of an MS relapse.” If stroke-like symptoms do come on suddenly, you need to go to the hospital right away to get treatment, says Moss. “That can make a huge difference in people’s long-term outcomes, or even the difference between life and death. I caution my MS patients to not always attribute symptoms to a relapse.” It’s also critical to seek evaluation for symptoms that could indicate a heart attack, such as new-onset chest pain or pressure, especially if it gets worse with exertion or exercise, says Moss. “That would be something that you should seek medical attention right away. Don’t wait to talk to your MS provider,” he says. People don’t always realize the importance of timing when it comes to interpreting or describing their symptoms, notes Moss. “They are usually pretty good at describing what they are feeling and where it’s located, but they often don’t think too much about the timing of symptom. Take note of when your symptoms first started, says Moss, “when they reached their maximum, and whether they getting better or worse.”
Don’t Be Afraid to Seek Emergency Care Because of COVID-19
The COVID-19 pandemic has kept many people — not just people with MS — from seeking emergency care, says Moss. “In a situation where you’re concerned about heart attack, stroke, or severe infection, it is far worse to stay home and do nothing. We are seeing fewer people going to the hospital for the evaluation of stroke or heart attack, and it’s leading to worse outcomes and even death,” he says. Healthcare systems have protocols to make sure they are not contributing to the spread of COVID-19, says Moss. “There can actually be a greater risk for transmission in places where everyone isn’t following CDC guidelines, such as a grocery store,” he points out. Additional reporting by Tammy Worth.
