What do the principles of patrolling have to do with multiple sclerosis?
A columnist applies an Army abbreviation to everyday activities
The U.S. military loves abbreviations and acronyms. So many of these are learned during a soldier’s first year that, to civilians, a conversation between service members might sound like a foreign language. It can be amusing, but the intention of this method of condensing words is not to confuse. It’s actually the opposite: It’s a sort of mnemonic device that helps people quickly recall things.
I still remember many of the acronyms and abbreviations from my time in the Army, despite not using them for years. One that sprang to mind recently is the abbreviation PRSCC. This one from my time as a Ranger is a list of the five principles of patrolling: planning, reconnaissance, security, control, and common sense.
I don’t slip through the woods at night anymore as my platoon makes its way to an objective. With multiple sclerosis (MS), I can still slip, just not through the woods, and my objectives are a bit different these days. PRSCC can still apply, though, even when I’m just patrolling to the grocery store or a restaurant with my platoon of five.
Mission cleanup
MS has a way of turning the most mundane task into a daunting mission. The following is how I apply the five principles of patrolling, not to a week’s vacation in a foreign country, but rather to something as simple as taking a shower in my own home.
First comes planning. Before multiple sclerosis, I never imagined I’d have to plan a shower. I never thought I’d have to rest after one, either, but here we are. Because of my symptoms and disability level, I use a shower chair and need assistance from my wife during the entire operation. Nothing about this is spontaneous anymore. Schedules are consulted, time is allotted, and resources are procured. I do bathe regularly, so this is a routine mission, but not as quick as it once was and never spur of the moment.
Next is reconnaissance. It’s my house, so the route to and from the shower is familiar, but my wife still has to scout it out prior to launch. Dog beds, sleeping cats, and children’s toys must be cleared before we head that way. The roll-in shower has to be checked for any obstacles that might compromise our ability to, well, roll in.
Third is security. A shower chair user must consider potential dangers, but these pale in comparison to my Army days. Bathroom rugs, wet floors, and the placement and sturdiness of grab bars are all hazards to mitigate. The patrol is over before it began if security isn’t considered and managed.
Fourth is control. On a patrol, having control includes spacing, staying on the right route, concealment, and communication. For a shower in a familiar setting, the route is set and my wife assists me, so proper spacing between individuals is moot. There is also no concealment — at all. Instead, communication is key. If you’re more independent than me, this might mean a phone or other means of summoning nearby assistance. I have an actual person to communicate with. The importance of communication between caregiver and care receiver cannot be overstated.
Last is common sense. For people with multiple sclerosis, I interpret this as being honest about one’s ability to do the task at hand. Being too fatigued to take a shower (especially a hot one) is a genuine concern. The same is true for every patrol that is planned for the day. I’ll ask myself if I have the energy to do something. If the answer is no, then common sense means giving myself grace and sitting this one out.
As if you didn’t have enough MS-specific acronyms to keep up with, I offer yet another in the form of PRSCC. Feel free to discuss it in the comments below or at our MS forums.
Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to multiple sclerosis.
About the Author
Merlene Cook
I too am challenged by the shower routine. I rest on the bed before and after. I have eliminated large bath towels and use only hand towels for drying. Slow and methodical with the process. The handheld shower head is my savior. I have permanent handhold items that I rely on.....never to stand without one hand supporting my balance.
Another savior is a bedee feature that is installed on my toilet seat. Use every time to refresh. I used to shower every day but with this feature I don't have too. Others like it too. Does not look like a handicap device. I pick my day to shower. Never push myself when I am fatigued.
Benjamin Hofmeister
Thanks for reading Merlene! One day when I have the perfect accessible house built, I'll have a wet room with roll under sink, large shower with multiple heads, and a chair height bidet with a warm water spray.
....some day
Lisa Harte
You can get a Toto seat to put on top of your toilet to give you that warm water spray you want. I have it and love it!
Benjamin Hofmeister
Adding that to my list Thanks!
Merlene Cook
That is what I have. An upgrade to the toilet seat. A cheaper way to go rather than a stand alone bedee where more energy has to be expended to move and operate.
Sean
Mr. Hofmeister,
Thank you very much for another insightful article.
I first want to say that I do not have MS myself, but have done market research in this space (so, that's my connection and the way in which I've come across your articles). In my previous role, we've done a lot of work with health plans, PBMs, health systems, medical groups, and HCPs, but I've always been very curious about the patient's perspective. So, when a new therapy comes out, or is being developed, how may it improve a patient's prognosis? Or, if a payer changes access to a specific drug, what does that mean for the patient? I'm saying all of this because, while my work has allowed me to better understand MS from the clinical and access sides, there's so much more about the patient experience that I do not know.
Thank you and keep the articles coming!
Sean
Benjamin Hofmeister
Sean, I owe you a bigger reply than what's possible here. Everything you mentioned is a factor. I'm giving a lot of thought to those and other possible factors of the patient's perspective. I'll contact you via email for the rest of my thoughts if that's ok.
Pamela s harden
What a great read and a good way to look at it. I have SPMS but am mobile. At one time I was using a shower chair and walker and it definately took a great deal of planning and resting before, during and after. Now, most of my disability is internally effected, with some externals. But one thing I've learned is that while it feels great to get right up in the am and get my day started, my MS doesn't always agree. Therefore, I typically spend my am starting slowly with meds and coffee while I rest and watch a show, giving my meds a chance to kick in so that my spasms and tremors are better controlled and I can move about more independently w/out my kids worrying over me. I've also learned boundaries and a little grace for myself over the past 12 months and that has been HUGE, esp from someone who is a people pleaser and nurse by trade!! This has been one of my hardest lessons, saying NO. For me, NO, doesn't get followed up with "But I will later or let me go ahead and tell you when I can", it's just no. This puts control back in my hands and head. Then I'm not getting anxious about needig to fulfill something for someone else "as soon as I can get rested up enough or calm down my tremors or muscles" so I can help someone else. I wish you the best in your journey:)
Maria Muddell
I can relate to your comment Pamela ... I get up in the morning, prepare my breakfast and sit on the lounge and watch the morning news to finish waking and to prepare myself mentally for the day. I call it "I'm finishing resting" haha
Benjamin Hofmeister
Thank you for reading Pamela! It's true, being able to say no is so important because it is something we can still control with a disease that seems to take control away.
Similar to nursing, in the Army we were always told that "no" wasn't an answer. When you were given a choice, you always said "I'll try".
Now, I often feel like saying no, I'm not going to try that today. Maybe tomorrow and even then if asked if I gave it my all, I find myself saying no, I didn't give it my all. I gave it my enough.
DIANA PULLOS
I love PRSCC ! That's how i live my life now. My husband now knows never to ask "would you like to go out for lunch?' instead he asks "have a think about going out for lunch'. I then go through my PRSCC and see IF 1. I have the energy today 2. will not need the toilet urgently in the next couple of hours 3. where would we go - can i fit my scooter in without crashing into the tables 4. can i get into the place without him if he has to go park the car and 5. Am i hungry enough to bother ?
Spontaneity is a foreign word to us now :(
Thank you for your articles, i love them.
Benjamin Hofmeister
Thank you for reading them Diana.
I was never very spontaneous before multiple sclerosis. However, I took great pride in the fact that I could be. Now, that isn't even a choice.
Thank you again for reading. And for the comment
Tom A.
Hello Ben- Yes, being aware of this stuff becomes part of the routine. I don’t have the military experience to make an analogy, but for me it is all about considering a combination of the discomfort and risk that is associated with what you will do. And the discomfort level of something, is always a reminder of the risk. I think about risk now all the time. Can’t remember what it was like to not think about it. You don’t want to trip/fall. Grabbing something for balance can turn to twisting your arm as you go down because you don’t want to let go (like I did with my garage door frame a few weeks back). Walking too swiftly around the corner of your garden can cause you to fold your ankle 90 degrees and go down. So then are the pain and mobility issue you already had, going to increase? You thought maybe it was subsiding, now is it increasing, and why? Neuropathy or fallen arches you already had causing the pain now, or is it from a new sprain? Perhaps time will tell.
Do you really want to do anything if it doesn’t have to be done right now? Just getting up and doing something without a thought, those days for the most part are long gone. So for the reader thinking about starting a DMT, think about that. And always keep in mind, “be careful”. Enjoy your freedom.Try not to add to "the mess". Sounds sad. Bit it’s OK, I get by. Could be worse.
DIANA PULLOS
Hi Tom, yes it can get worse if you're not careful. I am supposed to concentrate on EACH step i take but of course i had 3 steps to the computer and i was thinking about what i had to do so down i went and broke the top of my tibia behind the knee. It will never heal properly so i can no longer kneel. hurts too much. Just makes it that much harder to get up off the floor when i do fall. sooo, now i concentrate on every step i take and make sure i have support with each step. The only time that I'm not thinking of the risk of a fall is if I'm reading or watching tv/computer. And yes, I'm the same, i can't remember what it was like before just getting up and going somewhere. Even just to the bathroom or kitchen for a glass of water. But we're still here and still fighting!
Benjamin Hofmeister
Thank you as always Tom. PRSCC is just the name the Army gave to something most people do every day without realizing it. MS just seems to bring the subconscious to the surface.
Even when we could be spontaneous, were we really, or were we just considering risk/benefit quickly rather than methodically?
I guess with MS we have to adopt a sort of methodical spontaneity for anything that can't wait.
Heidi Sandgathe
Makes me upset in todays age with ADA Act the Planet Fitness club in my area does not have handicapped electronic entrance? Costsv toon much? not a big draw for the handicap community? Are we going back to the days sick people are to just say in bed? Finally diagnosed in 1991. Many doctors and many meds later, still walking YEAH!
Merlene Cook
If you have the stamina, this might be a goal to get this institution to make the necessary changes. Will boost your spirits knowing you have made positive results for others who share your concerns.