Sheila McDonough kept a secret as she worked as a nurse in the Stanislaus County Jail, hoping no one would notice the slight limp in her right leg.
When she told her boss she has multiple sclerosis, surprise registered on her manager's face and then acceptance.
"I was afraid," McDonough says. "You think your job is in jeopardy if they think you can't perform at the top of your ability. ... They have been absolutely fabulous. They don't show me any favoritism, but I can let them know if I need some time off."
The 46-year-old Turlock resident works at the Public Safety Center on Hackett Road in south Modesto, taking care of people many nurses would avoid.
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On any given day, the vocational nurse may respond to a medical emergency in the jail, patch up prisoners who were injured in a fight or tend to a pregnant inmate going into labor in her cell.
She does it despite the numbness on her right side, as well as the pins-and- needles sensation in her hands and feet. At the end of an eight-hour shift, her legs often are swollen and sore.
"I think they can tell now that I have a little problem with my gait," she says.
About 400,000 people in the United States and 2.1 million worldwide are afflicted with multiple sclerosis, a disorder of the central nervous system most often diagnosed from the ages of 20 to 50.
It is believed to result when the immune system attacks the myelin, the insulating sheath covering the nerves of the brain and spinal cord, and the scar tissue that forms on the nerve fibers interferes with the signals transmitted through the nervous system.
The progressive disease affects people in different ways, causing blurred vision, numbness, paralysis, tremors, fatigue, or problems with speech and memory. Far more women are afflicted than men.
Disease comes, goes
McDonough is among the 85 percent of patients with the relapsing-remitting form of the disease, which means she may have debilitating attacks followed by prolonged phases where she can work and live her life without severe symptoms.
According to the National Multiple Sclerosis Society, two-thirds of people with MS are able to walk, although some may need a cane, while others rely on scooters or wheelchairs owing to problems with balance and fatigue.
Except in rare cases, people with MS have normal life expectancy. There is no known cause or cure.
McDonough's symptoms began in 2003, during a stressful time of planning the funeral and executing the will of a great-uncle, she says. She noticed numbness in one of her legs and was no longer able to take her dog on three-mile walks.
A magnetic resonance imaging scan revealed lesions on her brain and a spinal tap in January 2004 confirmed that she had MS.
Her doctors put her on disease-modifying drugs that can cost $2,000 to $4,000 a month. The drugs are intended to prevent the attacks, which can impair the vision or mobility of patients for days, weeks or months.
McDonough's last attack occurred in 2008, giving her extreme fatigue for two months and the right-side numbness that has stayed with her.
She says it's hard dealing with the unpredictable nature of the illness.
"Stress brings a lot of it on," she says. "Hot weather bothers it. I may have a lot of energy one day, and another day, my legs may feel like they weigh a thousand pounds."
McDonough started working full time in the jail out of necessity after her nursing job at Emanuel Medical Center in Turlock was cut during layoffs in March 2009. She was earning extra money as a part-time jail nurse, and to keep her medical coverage, was able to expand to 32 hours a week with Correct Care Solutions, a Nashville, Tenn.-based medical services firm that contracts with the county jail.
Lynn Philpott, a regional manager for the company, says she never saw any signs of McDonough's illness before learning she has MS.
"I had always seen the job she did, and was surprised she could do it so well and work as hard as she does and not complain," Philpott says. "I don't have to worry about things being done right when Sheila is around."
McDonough's work at the jail is in stark contrast to her job at Emanuel, where she took care of mothers who had just delivered babies.
The Public Safety Center houses male and female inmates who are waiting for trial or serving short sentences, and the population has a host of medical issues, whether it's inmates with heart problems related to drug use or prostitutes with sexually transmitted diseases.
When the police haul in 20 people from a sting operation, McDonough and other nurses are waiting to perform medical assessments. (The nurses work in conjunction with a physician and licensed nurse practitioner.)
Every day, she fills a cart to distribute medicine to prisoners who have untreated diabetes or hypertension.
McDonough tends to prisoners who are sick or drug addicts who need treatment for painful abscesses on their arms or legs. Recently, she noticed that an inmate who delivered her baby by C-section at a hospital needed to have the staples taken out.
"I took them out, and she was very appreciative," McDonough says. "That was one example where my maternity experience paid off."
She finds that people with criminal backgrounds are not so truthful about their health, so she looks for ways to ferret out information. It's not her job to judge patients, she says, but only to ensure they have basic medical care.
There also are incidents when inmates with mental issues spin out of control and need to be moved to a safe cell.
"If you are the nurse on the floor, you have to respond to the call," McDonough says. "Day by day, you never know what will happen."
She says the key to handling the job with her condition is knowing her limitations and being honest with her boss if she's having symptoms. The disorder has not kept her from performing her duties, she says, although it's a pain to climb the stairs and she hopes no one notices when she stumbles on words.
Every Tuesday, McDonough spends a quiet hour in a yoga class in Modesto funded by the Northern California chapter of the National Multiple Sclerosis Society.
The exercises help with strength and balance and dealing with the emotional strain of the disease, she says.
As background music creates a tranquil atmosphere, women with MS unroll mats on the floor and stretch.
Learning to balance
The women perform the tree pose by stretching out their arms and balancing on one foot, with the other foot touching the shin of the sturdy leg. Instructor Richard Parenti says the women could not balance on one foot before starting the class.
"If I fall at home, I need to have the strength to get back up," says April Guttierrez, a classmate who uses a walker. "I had a fall where I couldn't get up for hours."
Terri Lawson, who has lived with MS for 18 years, says she does yoga breathing before her infusion treatments at Doctors Medical Center in Modesto. It takes her to a peaceful place where she visualizes jogging again.
Like McDonough, the former graphic artist for Gallo Winery continued to work after her diagnosis in 1992. When Lawson's attacks gave her double vision for four to six weeks, a co-worker drove her to and from the office.
The company also gave her the flexibility of working at home.
"I stopped working when I had a bad attack in January of 2002," Lawson says. "My mobility was horrific -- I could barely walk -- and at the time I was struggling with cognitive issues. I felt it was not fair to have them worry about my condition."
She says many people with MS don't tell their employers because they're afraid of how the situation will be handled. Some are unable to work because of paralysis or blindness or safety issues in the work environment.
McDonough, who is divorced, draws emotional strength from her two grown children and members of her support group.
Last year, she started a chemotherapy treatment at the University of California at San Francisco Medical Center that is designed to slow the progress of the disease. She is due for blood tests next month to see how it's working.
She is the ambassador for the 2010 fund-raising walk of the National Multiple Sclerosis chapter April 24 at Modesto's Downey Park.
She volunteered to help raise money for MS research and programs, and to show the public that life goes on after diagnosis.
The 350-member chapter believes there are 735 people with multiple sclerosis in Stanislaus County. With the latest medical imaging technology, doctors are able to diagnose the disorder more quickly so the patient can begin treatment, McDonough says.
As she continues her journey with multiple sclerosis, her courage impresses co-workers who know the stresses of working in the jail.
"Sheila amazes us on an everyday basis," says Jennifer Webster, an administrative assistant for Correct Care Solutions. "She excels at all aspects of the job."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.