"I have multiple sclerosis, it does not have me," declares Jan Dury. Diagnosed six years ago, Dury refuses to let living with a chronic illness get in the way of living her live.

"There are some things I can't do as well as I used to," she admits. Stairs are problematic so is heat.

"I love to vacation anywhere there is a beach, but I can't take the heat anymore. I guess that's why they invented air conditioning."

Her easy spirit may stem from having a partner who is fully engaged in living life with her — ups and downs included.

"When I found out I had MS, my husband said, 'We have MS.' We have always been in this together."

Dury describes the routine she and her husband, Jay, have built around her Friday night injections as proof of their fun-loving spirits.

"I come home from work and take some Tylenol. Then my husband does the wave, and I take my shot. We top it off with a glass of wine and dinner. You need a support system," Dury explained.

She admitted that she hasn't been shy about her illness.

"Some people want to keep it a secret, but you need a support system everywhere," she said.

As a special education teacher, Dury was seeing students on three levels of a sizeable building. "I explained that if we could coordinate my students on two floors rather than three that would be very helpful."

Typically, Dury pointed out, all you need to do is ask to get the help you need. That philosophy holds true even in her doctor's office.

"If I had scripted a doctor for me, I could not have scripted a better one than Dr. Rauchway," Dury said. "She listens. She cares. She doesn't make light of my concerns. And she leaves her recommendations up to me, so that I have the final say. It's more of a friend relationship than that of a doctor and patient relationship."

Amy Rauchway, D.O., of the West County Multiple Sclerosis Center, a Mercy Health affiliated practice, was flattered by Dury's compliment, but also said it speaks to the heart of what a doctor-patient relationship should be.

"We work with our patients very closely," Dr. Rauchway said. She pointed out that, when dealing with MS or any chronic illness, the most important thing is to get the diagnosis right.

"When a person comes in with a problem and articulates symptoms, the most important thing is to be able to talk freely and frankly with the patient to diagnose the cause of the symptoms. Education and understanding is critical to providing individualized care. The patient knows themselves very well, so its my job to gather all the knowledge I can from them and to respect what they are saying."

MS, diabetes, heart disease ... the list of potential chronic illnesses is long, but as Dury so emphatically stated life is not about the illness.

"By providing personalized care, we are empowering the patient to take charge of managing their illness."

Physicians can serve as leaders and guides, but the day-to-day management of the illness and of life in general is up to the patient.

When living with a chronic illness, a good attitude is paramount to success.

"We participate with some of the resources in the community, but none of them are gloom and doom. We have fun," Dury said, explaining that she and her husband meet with other MS patients on a regular basis for dinner, drinks and lots of laughs.

Living with Multiple Sclerosis — a Q&A with Dr. Rauchway

Q. It seems that chronic illnesses, such as MS, often sneak up on people disguised as something else, thus making acceptance of the diagnosis particularly difficult. And when symptoms are not particularly bothersome it may be hard for patients to accept that treatment is necessary; however there is value in being treated consistently, even when symptoms are mild.

Why is that?

A. In a way, your comment hits to the heart of many medical conditions. For example, hypertension is considered a silent disease, which if not addressed leads to severe problems. This is because the underlying disease process continues until the damage becomes noticeable. Multiple sclerosis is a complex disorder of the central nervous system, the brain and the spinal cord, that is understood to have an immunological basis. For about 85 percent of affected individuals, it presents in a relapsing remitting course. Early in the disease inflammatory processes are prominent. As the disease continues over decades, a more degenerative process occurs within the CNS. The symptoms may be mild, such as tingling that is sometimes erroneously attributed to a pinched nerve or carpal tunnel syndrome, and then resolve or remit. Often symptoms are ignored when they are attributed to a coincidental event. I think people in general, are optimistic, and seek medical help only when problems start to interfere with their daily activities.

There are several keys to the care of chronic disease from both the patient's and the physician's perspective. Immunologic activity in MS, particularly early on, may be hidden with symptoms that manifest in a mild manner. The goal of disease modifying medication is to decrease ongoing inflammation that later leads to the development of disability. Consequently these medications are considered preventative. Use of FDA approved therapies as directed by an MS specialist provides the best opportunity for reducing and targeting the underlying disease activity.

Q. What can drug treatments do to affect the course of MS and improve the quality of life for individuals and their families?

A. Large-based clinical trials have shown that treatment with FDA-approved disease modifying therapies reduce the frequency of relapses in MS. In conjunction with neurological examinations, MS specialists follow changes on magnetic resonance images (MRIs) to assess disease progression. By reduction of relapses, the principal expectation of drug treatment is the reduction of irreversible disability. As mentioned, some relapses may be mild, of short duration, and the individual experiences a full recovery. In contrast, a person may be left with functional disability including difficulties with problem solving, walking or balance. With use of medications, the goal is to provide the best quality of life possible by avoiding those types of deficits. Because MS is primarily a disorder of young adults that usually occurs between the ages of 20-50 (although is recognized in pediatric and older populations), the goal is to keep those affected by it vibrant at their home and work environments. There are now a variety of agents available that target the relapsing phases of MS. The choice of medication is individualized and based upon a number of factors discussed between the patient, his or her family and the patient's doctor. In addition to disease modifying medications, there are medications that target symptoms of MS such as spasticity, fatigue, and pain. One such medication is specifically approved to improve walking speed in MS.

Q. Are there any non-drug interventions (lifestyle adjustments, complementary therapies, etc.) that are helpful in treating MS?

A. Yes. Comprehensive care of patients with MS means addressing the many aspects of a patient's life. Access to a diverse array of interventions is important including rehabilitation therapies, mental health counseling, assistive devices, and interventions that address bladder and sexual dysfunction. Complementary therapies that may be effective in improving fatigue and enhancing the quality of life include yoga and exercise. Tai Chi has been reported to improve balance. Vitamin D may have a role in immune regulation, however, its use should be discussed with the physician. There are also a variety of dietary supplements that are thought worthy of investigating further in MS.

The ideal approach in treating any chronic illness is for patients to have enough understanding about the illness and their own bodies, health and individual needs so that they can bring their concerns to their physicians where they can share them openly and honestly to determine the best plan of action on an individual basis.