Explaining MS Fatigue

November 6, 2014

Ninety percent of patients with MS suffer with fatigue. Fatigue is an extremely debilitating MS symptom and difficult to manage.

MS fatigue is more than being tired from a lack of sleep or a very busy day. It is a direct result of the disease itself, and is easily intensified by the other MS symptoms (such as extra energy required to walk), external factors (such as heat or dehydration), and health issues (such as colds/viruses, being overweight…).

Being an invisible symptom, fatigue is hard for people without MS to be aware of it, understand it, and realize the severe limitations it can impose on MSers.
I started an MS group discussion on LinkIn entitled “How do/would you explain your MS fatigue to people to try to make them understand it?” Over fifty comments were received to date, and here are some of the comments:

“I tell people that it is like the exhaustion you get when you have the flu- only multiplied by 20 and NEVER goes away…”

“I heard it explained once and it seemed exactly right. MS fatigue is using every ounce of energy in your body just to breathe.”

“Add 5 lbs. weights to both biceps, forearms, calves, thighs…etc.”

“There is no way to explain it properly. Everyone still thinks it’s just plain tiredness. They don’t get that fatigue is totally different. I once said “when I am fatigued and am in bed, sometimes I feel that peeing the bed is my only option.”

“I ask them to imagine they are coming down with a flu/cold, then recall how tired they are.”

“There is no explaining to others why my body needs to sleep when I have only been awake a short bit.”

“I liken it to hitting a brick wall so hard that you don’t bounce back but instead just slide to the ground and not able to pick myself back up.”

“People just don’t ‘get’ the difference between extreme fatigue and general tiredness – some think they are feeling the same as you are but they don’t know the half of it!!”

“Thank you guys so much for this discussion! I hear all the time “Well, I have trouble sleeping too… maybe you should just go to bed earlier.”Errrrgh! It’s not like that people!

“I tell them that my best day fatigued (tired) is like their worst day. Then they seem to get it.”

The truth is, most people don’t get it. But the upside is that our neurologists and peers DO get it, and that’s where we can get our comfort. And fortunately, fatigue is a symptom that is finally recognized by Social Security when applying for disability benefits.

For those that don’t get it, you can try handing them a copy of this post or a previous post of mine entitled “Fatigue and MS”. It never hurts to try.

www.DebbieMS.com
Author/MS Counselor/Living with MS

Where and How to get Your MS Information

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                                                  “Tips and Cautions”

The upside of the internet and social media is that mounds of information about MS are available immediately with the stroke of a few keys and searches. Folks need as much knowledge that they can get to help them understand and handle this complicated disease.

The downside of the net–besides being overwhelming–is that one has to be very careful with the validity of the source and information of what is read. I read discussions between MSers on Facebook, other social media, and MS Association sites and am concerned by how much info is misleading, incorrect, and cause for fear. Bad information causes bad decisions.

1. Understand which treatments/drugs help symptom improvement.

While it is gratifying that DMTs (Disease-Modifying Therapies) are reducing relapses for many MSers, participants in some discussions talk about how their symptoms improved when they were taking a certain DMT.

This is not true. Here is what one MS specialist-neurologist stated:

“The disease modifying medications do not directly help with symptoms in MS. these medications are to delay disability, slow progression and some can have improvements on MRIs. I can tell you that I have seen people in my clinic that had been doing well for years and so didn’t start any medications. But, then they had an attack that hit them quite hard. Then they wanted to go on a medication, “to get better. I told them that the medications are to keep from getting worse and not to make one better.”(see Source #1 below)

Now, there ARE drugs to directly and successfully treat symptoms (e.g. depression, bladder incontinence…), and relapses (e.g. steroids). These often improve symptoms and help a patient feel better, but not alter the disease course or direction of the disease itself.

2. No treatment exists today that will stop the disease activity/progression and damage completely, or reverses it. (see Source #2 below)

Recently, I followed a discussion on FB about stem cell treatments that miraculously accomplished this for them.  Most of the participants that had the procedure were diagnosed within the past two-three years. These participates probably did not know their personal pattern of relapses; it’s not uncommon to lose one’s sight or have impaired mobility for a long stretch of time in their initial relapses. Their recovery was more likely due to the relapse being over and they’re being back into remission with little residual, which is very common in the early years of the disease.

Furthermore, it takes a while for a patient to understand their own case of MS and how their body responds to a variety of things—both medicinal and non-medicinal. Nowadays, it is even more difficult since a newly-diagnosed person during their first couple of years are receiving DMTs and drugs for relapses and symptoms all at the same time. What is doing what?

3. Be careful with reading statistics, study results, etc.

I worked a number of years in my professional jobs doing financial analyses and market research. One of the things I know from that experience is that conclusions of studies can be misleading by what numbers are used and how numbers are presented. I’ve become quite the cynic about this.

For example, one might read “according this study, 50% of patients using XYZ showed a 38% reduction in…” How many people were used in the study, what were their characteristics, how long did they take XYZ, what were their side effects, who did the study, etc. You have to dig deeper, be cautious, use common sense and talk to your professionals when you hear something of interest and want to pursue it (like trying a new medication).

How would you feel if you discovered that a study was based on eight people?

4. When gathering information, consider the following:

• Use common sense and logic.
• If something sounds too good to be true, it probably is.
• Listen to your gut, not what you want to hear.
• There is no cure, and if something says you will be cured, throw it away. You can manage MS and even control it in many ways, but there is no cure yet.

5. What are good Sources of Information?

MS associations and Pharmas are good sources of information that can be trusted for acquiring basic MS knowledge about the disease itself, the symptoms, current research/events that are happening, and treatments that are available. They also can be helpful in providing programs and forums for people dealing with MS to get together and interact.

Where to use caution?

• When listening/reading information that MS associations, Pharmas, and neurologists present statistical information about study/treatment results. They all recommend DMTs as the first line of defense, and one has to be careful of taking this information at face value. Re-read #3 above, and know that numbers/statistics can be arranged to project just about anything. Dig deeper into what you are told. You may be surprised.

For example, a current starting point to get specific data on DMT’s is Source #2 below. And read closely. On Page 13, the colleagues point out that 50% of persons diagnosed will have “benign MS”. People with benign MS will have an Expanded Disability Status Score (EDSS)<3 after 10 years.  After 20 years they found while 51% remained benign, 21% had progressed to EDSS >6 and 23% had converted to SPMS.

The point? Stats like these could help a patient weigh their options more carefully.

• A standard line of advice is “consult with your doctor.” Do you trust your doctor? How experienced is your doctor with MS? Does your doctor listen to you and talk with you, respect your questions and doubts? If the answer is no to any of these, it’s a red flag. Remember that doctors get kickbacks, and truthfully are limited to prescribing drugs and giving referrals. Get second and even third opinions.

• Social media sites are wonderful for sharing information and feelings with other peers, but remember that two-thirds of effective communication is through body language. There is no eye contact, no voice to hear, etc. that can make judgment of people difficult. Learn the background of the people you engage with. If reading an MS blog, make sure it is a credible, respected and experienced person that is doing the writing.

Here is a link to my Resources/Links page on my website that is quite comprehensive, not overwhelming, and judged by many to be trusted http://debbiems.com/links-resources_271.html . (You can check out my background, experience and credentials in other sections of my site.)

(Sources)
#1 The NPR Diane Rehm Show (9/24/2012) aired “Diagnosing, Treating and Living with MS.” A panel of experts—neurologists/MS Specialists including a doctor who has MS—answered audience questions about diagnosing, treating and living with multiple sclerosis.

#2 The Use of Disease-Modifying Therapies in Multiple Sclerosis: Principles and Current Evidence http://bit.ly/1oEnTqY  September, 2012

www.DebbieMS.com
Author/MS Counselor/Living with MS

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Are Cognitive Problems Blamed Too Much on MS?

“What to Know—What to Do”

June 4, 2013

MS has many misconceptions associated with it, and cognitive impairment may be one of them. Lately, it seems that I read and hear more and more about how MS is the cause for memory issues that MSers experience–it is gaining a reputation for brain dysfunctioning. And along with the increased reputation comes the increased fear.

Although MS can cause cognitive issues, it is important to know that they are NOT the most typical symptoms of MS. It is estimated that 40-50% of people with MS experience mild to moderate impairment; severe cognitive decline like dementia are extremely rare (source: MSIF.org).

What are these impairments? Things such as:

• Long-term concentration; inattention; distraction
• Forgetfulness
• Planning or problem solving difficulties
• Loss in thought processes; word finding
• Not thinking quickly or clearly; “brain fog”

BUT, these types of difficulties can also be the result of other factors such as age, hormones, menopause, overload, stress, drugs, fatigue, depression and lack of sleep. For example, up to two-thirds of women report forgetfulness and other mental disturbances during hormonal shifts of menopause! So, maybe that 40-50% estimate is really lower in reality.

There is something called neuropsychological testing, and more people in the MS community are talking about them. These tests were designed to measure cognitive difficulties. However, unlike some other areas of measurement, with these tests 1) there is no single test that measures everything that the brain does, and 2) there are wide variations in how/what types of tests are done and their conclusions. Furthermore, the testing can be strenuous and expensive.

In the end, does knowing the test details make much difference in one’s life? Doesn’t it make more sense to learn about these cognitive difficulties and what can be one done to overcome them?

What to Do and Why

Exercise your brain. Practice brain games, crossword puzzles, and memory exercises that stress verbal skills.

Enrich your diet with plenty of omega-3 fats, low-glycemic index carbohydrates (e.g., whole grains) and antioxidants. Walnuts and fish high in omega-3 fatty acids (including sardines and salmon) fight artery-damaging inflammation. Antioxidants raise acetylcholine, which is an essential neurotransmitter for memory. Berries, especially blueberries, are loaded with anthocyanins – potent antioxidants that protect cells, including those in the brain. Blueberries may also have the power to create new pathways for connection in the brain.

Eat several smaller meals throughout the day. Eating small meals prevents dips in blood glucose levels, and glucose is the primary energy source for the brain.

Take walks daily and do stretching exercises. Increased cardio can make your brain actually grow, with more white matter and more neuron connections.

Do stretching/relaxation exercises and meditation to reduce anxiety and stress. Stress causes the body to release cortisol. Cortisol—the body’s stress hormone– has been found to shrink the memory/learning centers in the brain, which results in impaired memory.

Make sure your body is getting enough iron. Iron helps the neurotransmitters essential to memory function properly.

Make sure you are getting enough sleep. Anyone who’s ever stayed up all night recognizes that next-day brain fuzziness, when it seems like nothing really registers or is available for recall later. That is what’s happening. Different parts of the brain are responsible for creating different types of memories – a face, a name, or just the recollection that you met someone. Sleep is also needed to make long-term memories last.

Focus on one task at a time to keep a recollection of each one. When you do multiple tasks, the brain switches processing to another region that retains fewer details. For example, listening to the news while reading something will impair your ability to recall either later.

Check your cholesterol. The plaque buildup can block the blood vessels in your brain, deprive it of valuable nutrients, and cue memory problems.

Keep thin or lose weight. The brains of obese people work harder than those of normal weight people to achieve the same results, according to researchers at Carnegie Mellon University. High blood pressure and inflammation—both of which strike obese people hard–irritate the brain’s communication networks, making it more difficult for the brain to receive messages.

Many prescription drugs can affect your memory, and the older you are, the longer drugs stay in your system. Drugs that can cause memory lapses include antidepressants, anti-anxiety drugs, beta-blockers, sleeping pills, painkillers, antihistamines, and statins.

Easy Memory Tricks

1. Repeat yourself. To help get a routine activity lodged in your brain, say it out loud as you do it. “I’m getting the stamps” – fends off distraction as you go to get them. You may sound crazy, but rehearsal is one of the best tricks for memory. Memory experts also advise that you repeat a person’s name as you are introduced.

2. Bite off bigger pieces. Since your brain can process only so much information at a time, try chunking bits together. By repeating a phone number as “thirty-eight, twenty-seven” instead of “3, 8, 2, 7,” you only have to remember two numbers, not four.

3. Give words more meaning. When you’re introduced – let’s say to Elton – connect the name to someone (“Elton John”), a place, etc. Or you can use rhymes—“Dennis plays tennis.”

4. Create unlikely connections. For example, switching a watch to the other wrist when you need to remember something. The oddity of not finding the watch where it should be triggers recall.

5. Practice paying attention. What was your neighbor wearing this morning? Even if you’ll never need the information, forcing yourself to observe and recall the details of your day sharpens your memory.

6. Do something mentally challenging. Working a crossword puzzle, or learning an instrument or foreign language creates fresh connections in the brain. It can actually generate new cells in the brain’s hippocampus (i.e. the brain’s learning/memory center). Those new cells build cognitive reserves that are important for creating new memories and may protect against memory loss – even dementia – later in life. A timed game like Boggle or Simon will force you to pay attention, work quickly, and think flexibly.

In summary, if a MSer is experiencing some type of cognitive problem, it may be prudent to initially think through the possible causes and try commonsense solutions to improve it.
www.DebbieMS.com
Author/MS Counselor/Living with MS

Fatigue & MS

“What it is—What to do”

“People look at me and just cannot understand why I get so tired.” (MSer comment, March 2011) This is a quotation I used in a chapter about fatigue in my book, Managing MS: Straight Talk….”

During a brief conversation with my sister last night, she remarked that she had no energy, she couldn’t think clearly, and all she wanted to do was lie down because she felt so exhausted. She has a virus. I got it—I knew exactly how she felt.

I often describe MS fatigue to people that it is like having a cold or virus—that you feel so exhausted all you want to do is lie down. Out of all the symptoms I and others have experienced with MS over all these years, I truly believe this is the one symptom that is the most difficult one for everyone involved to understand and know what to do about it.

But fatigue is extremely difficult for a non-MSer to understand because you can’t always see it—there is no stuffed up nose, swollen eyes, or sneezing. Or, someone may say “you look tired, maybe you should take a nap.” Okay, a nap may help, but fatigue isn’t only due to being sleepy.

It doesn’t matter if the MS case is mild or advanced. It doesn’t matter if one had a good night sleep or if the MS is not currently active. Fatigue is almost always present with MS, 24/7. Why? Fatigue exists because it is caused by MS–a disease, a chronic illness–and it causes other symptoms such is walking problems to intensify.

Fatigue is the hallmark symptom of MS. It is a universal complaint by 80–90% of MS patients. And it is finally being recognized as a serious obstacle for employment by the Social Security Administration when applying for disability benefits.

• A MSer will get fatigued easily, whether other symptoms are present or not. Simple activities like making dinner or talking on the phone too long can be exhausting. The slightest thing can make it worse, such as not eating, drinking enough fluids, or being overheated.

• Fatigue is compounding and escalates quickly if MS becomes active due to a relapse, or the amount of disability has increased over time. For example, sleep disturbances due to bladder problems at night, or extra effort required to walk because of spasticity or other gait problems, will impact fatigue significantly. Energy is reduced, weakness increases. This causes stress, frustration, and depression that will then lead to even greater fatigue.

• Fatigue is often caused by medications taken for other MS symptoms.

Often we can combat fatigue by pacing our activities, taking frequent rests, or letting others do things for us. Yesterday I came across an article entitled What You Can Do About Fatigue From MS, and is worth a read. It is from a blog I subscribe to called Stu’s Views & M.S. News; the source of this article was WebMD. Here’s the link http://bit.ly/Wrk8M9 .

There ARE many ways we can help to manage fatigue, and even if some do not work, other things may. At least we can try and keep on hoping.

www.DebbieMS.com
Author/MS Counselor/Living with MS

The Sensitivity of MS Symptoms

“It’s only a Pay Day”

November 5, 2012

Two days ago I participated in two events that lasted all day with only a two-hour break between them. I normally only plan one outing per day, but both events were very important to me and just happened to fall on the same date.

When I planned for the events, I knew I would be fatigued and my MS symptoms would be whacked out afterward. So I made sure I got a good night sleep the night before, planned to lie down for an hour between events, then do absolutely nothing else the rest of that day when I returned home.

The fun and adrenaline enabled me to sail though the day. And sure enough, I returned home exhausted but fulfilled. The mental and emotional satisfaction was worth the physical stress I endured. After some Chinese take-out, I went to bed.

Yesterday, after nine hours of sleep, I woke up still feeling wiped out. It felt like I had a virus. My muscles ached all over, I felt nauseated and dizzy, and all I wanted to do was lie down. Not only did I have overwhelming fatigue, but many of the symptoms I handle with my own case of multiple sclerosis were intensified. The spasticity flared to the point that my legs were “frozen” straight, the pain in my back was unbearable, and the bladder medication wasn’t working. My mental faculties were off– I couldn’t concentrate and I kept forgetting things. Both hands were exceptionally tingly and weak.

It was a “pay day”.

I knew from experience not to freak out. A couple of days of mostly rest and minimal activity would calm the symptoms; I would revert back to my “normal” state. It was just a temporary worsening of symptoms triggered from the excess stress. And I also knew from experience that I didn’t do any permanent damage to my nervous system.

Neurologists like to use a fancy term for this, and call it a pseudo-exacerbation. I don’t like that term because to me it is misleading, implying an actual flare-up or attack. But it’s not! I was “paying” for overdoing it on the previous day, which is why I call it a “pay day”.

It’s like a hangover after a night of too much wine! Rest up, drink plenty of water and eat well. All will pass. Once in a while it’s okay to do this; but if you over indulge everyday then it become a chronic problem.

Any stress can intensify symptoms, as well as other things such as heat, hormones, or even forgetting to eat. I know from experience what causes my symptoms to temporarily worsen, and I know how to manage to call them down.

Aggravating and annoying? Yes. Cause for worry or calling the doctor? No.

I’m still extra fatigued and not quite my “normal” self after that long day I had. But it was worth over indulging and I will do it again.

www.DebbieMS.com

MS: Invisible Symptoms & Fatigue

“But you look so good!”

September 4, 2012

I was invited to be a guest on a radio talk show to discuss multiple sclerosis and living with it. This was the first time I ever did a radio talk show, so I was a bit nervous. There was no audience to speak to directly, and I had to keep in mind newly learned instructions about cues, minutes, red lights, etc. so at times it was a challenge to stay focused.

As the saying goes, hindsight is 20/20. When the show was over, which flew by quickly, I was dissatisfied with myself that I did not give adequate attention to fatigue and those invisible symptoms during the discussion.

When someone looks at me, I look terrific and normal even though I am sitting in a scooter. A guy in the studio was shocked when I told him I couldn’t walk at all. It got me thinking that when it comes to a person with MS being disabled, the impression is that “you don’t look disabled” which then sometimes implies why are you on disability?

After returning home and thinking about this, I took out my webcam and created a video about how disabling fatigue and other invisible symptoms are. Here is the link: http://www.youtube.com/watch?v=rnd1MrkH0vE&feature=plcp  It shows my true colors at a down moment—quite a contrast from my usual upbeat self.

In an earlier column, (April 30th) I talked about invisible symptoms. It’s worth repeating parts of it again:

On the outside so many of us look good unless we have some kind of walking aid to indicate otherwise. We’re not bleeding, we have good color in our faces, and we are not coughing or blowing our noses. When we look good, people automatically assume that we are good. I’m in a wheelchair, but I still look good and completely normal. If I would use a store’s scooter instead of my own, I would get dirty looks. I’m misunderstood.

But very often we are not good because so many of the symptoms are invisible. Pain, tingling, numbness, fatigue, dizziness, tightness, depression, blurry vision, balance, coordination—the list is endless. These symptoms interfere with everything we think, say or do. They are annoying; they hurt; they are frustrating; and they make us crabby. For persons with MS that do or do not show visible impairment or walking aids, these symptoms are very disabling.

Fatigue is the hallmark symptom of MS. It is a universal complaint by over 90% of MS victims. It doesn’t matter if the case is mild or advanced. It doesn’t matter if one had a good night sleep or if the MS is not currently active. Fatigue is always present with MS, 24/7. Why? Fatigue exists because MS is a disease, a chronic illness that causes other symptoms such is walking problems to intensify. Constant fatigue leads to our moodiness or depression. Often we can combat fatigue by pacing our activities, taking frequent rests, or letting others do things for us. But it doesn’t always work.

MS is an unpredictable neurological disorder. New symptoms can appear and existing symptoms can intensify when we least expect it. We never know how long these disturbances will last, how severe they will become, or if they will go away. A new symptom that doesn’t go away requires an adjustment to accepting it and learning how to live with it.

We live a life of uncertainly.

www.DebbieMS.com

MS: What is Causing What?

The “Chicken or the Egg” dilemma

July 2, 2012

The numbness and tingling is spreading.  The muscles are more spastic, stiffer and tighter.  Legs are weaker; coordination and balance are worse.  Walking endurance is lessoned and the fatigue is escalating.

Figuring out what is going on and what to do about it is frustrating and confusing.  And there’s always the chicken-and-the-egg question of trying to figure out what is causing what.  Is my depression (fatigue, etc.) causing a bad day or flareup, or is the bad day/flareup causing the depression (or fatigue, etc.)???

The MS acts.  But wait–or is it reacting?

It’s very easy to blame what the symptoms are doing and how we are feeling on the MS itself.  However, more often than not, the MS is actually reacting to something else.

So how do you know, and what do you do about it?

MS is highly sensitive to an endless list of things, and existing symptoms intensify due to things like:

• weather changes and types of weather (barometer, heat, humidity, storms)
• sickness (colds, allergies…)
• lack of food, water, rest, sleep…
• medication
• stress (temporary physical/emotional/mental, not chronic)
• monthly menses

For example, a fever can immobilize a person with MS.  When the body is cooled down and the fever is gone, the symptoms will subside.  Spending two hours on the phone trying to resolve an insurance problem can escalate fatigue enormously; taking a nap afterward or venting in some way will ease that stress and help calm down those symptoms.

Or, maybe those intensified symptoms are the result of what I refer to as a ‘pay day’.  For example, if I wake up one day feeling great, I might push myself too hard to do extra things.  Then I ‘pay’ for it the next day and can do only half of my normal daily activities.

In situations like these, the worsening of symptoms can last from several hours, to a full day to perhaps several days depending on what the cause is.  Think carefully about things like this relative to recent or that day’s events:  What happened or didn’t happen?  What changed or didn’t change?

When you figure out what the culprit is, it can then be remedied and the symptoms will calm down.  Things go back to their normal state, whatever ‘normal’ is to you. No residual damage.

So when would the MS itself directly cause intensified symptoms or new symptoms that do NOT go away after a few days?  Now we may be talking about an attack, relapse, or flare-up…i.e. when we come out of remission.  It can just happen on its own, but often will be triggered by any major event, such as:

• falls, accidents, sicknesses, infections
• chronic physical, mental or emotional fatigue/stress
• major life occurrences (death, divorce, new baby, abuse…)

In these situations, or in the case when symptoms don’t calm down after a week, when the cold/infection is over, and rest does improve anything, it’s time to put a call into your neurologist to discuss the situation/ask for some help.  The MS may be relapsing and steroids (like Solu-medrol) may be needed to shorten the duration and severity of the relapse.

Over time, being in-tune with your body will help you figure out if it is the chicken or the egg.

www.DebbieMS.com

MS/Chronic Illness: Rest is Critical

“Recharge those Batteries”

June 24, 2012

This should have been posted last Monday the 18th.  I forgot.  Fatigue will do that to you.  But I will post it anyway, since “later is better than never”………..

I am going to follow my own advice I give to others with MS or chronic illnesses:  Take breaks and rest often to restore mental, emotional and physical stress.

I haven’t been doing that.  I’m exhausted, crabby, in overload and have writer’s block from pushing myself too hard.  With symptoms intensifying, if I don’t slow down I will relapse.

So I am declaring myself on vacation this week and heading for the mountains to camp.  No TV, phone, computer or reading.  Just enjoying nature, sleeping, and visiting other nice campers.

Next week I will be back with another article to post.

www.DebbieMS.com

MS and Heat

“Rising Heat, Rising Problems”

June 11, 2012

Summer is here.  Temperatures are rising, and so are our frustrations since heat causes MS symptoms to go crazy.  Throw in humidity, and the effect become worse.

Strength and endurance is reduced; fatigue is increased.  Numbing and tingling sensations are compounded, knees buckle, hanging onto furniture and walls are necessary as coordination and balance worsen.

Why is that?

Because heat slows down the conduction of nerve impulses in all people, but is particularly troublesome for MSers.  When a person without MS gets out of a hot Jacuzzi or sauna, they move much more slowly.  By comparison, a person with MS might not be able to walk or stand at all.

Heat caused by weather is not the only culprit.  ANY kind of heat has an adverse affect on MS symptoms– fever, room temperature, over-activity, hot flashes, being in the sun too long, etc.

So what can we do?  Speed up the conduction of those nerves by getting and staying cool.

Ice packs are a favorite of mine; I put them behind my neck, my back, or rub them all over me.  I carry them with me in a little six-pack cooler if I’m at an outing on a hot day.  Taking a frozen plastic bottle of water in the car doubles as an ice pack and ice water at the same time.  Air conditioning is a must.  Some people use cooling vests.  Sit in front of a fan.

Cold ice water and showers are very effective in bringing body temperature down rapidly when overheated. One can go from not walking to walking in a matter of minutes.

Want to sit in the sun to get some vitamin D?  Not a problem—just have a spray bottle with ice water in it to mist yourself, stick an ice pack behind your spine, and drink cold beverages.  Make sure you use a sun block to not only protect your skin but to also prevent sunburn;  sunburn will really raise your body temperature until your skin heals.

Another tip:  a common side effect of bladder medications for some people reduces sweating.  So if you are in the sun or someplace with high temperatures, you will overheat faster.

While dealing with heat is troublesome, there is a bit of good news about Heat & MS that should always be remembered:

Although, heat definitely aggravates the nervous system and will cause symptoms to intensify, heat will not cause a flare-up or attack.

Watch my video about Heat & MS for a live explanation and demonstration–
http://bit.ly/KecZ84

www.DebbieMS.com

MS and Walking Problems

“Falling Down”

May 7, 2012

Most people with MS will fall down.  As careful as you try to be, it happens when
you least expect it.

I fell down two weeks ago and I am still recovering.  As I was getting up from my recliner, my knees suddenly buckled and I landed right on my tailbone.  It was probably a good thing that my back hit the end table as I fell.  I think it helped break the fall of dead weight hitting the floor and possibly preventing a broken bone.

Who knows?  I may have a slight fracture because my butt still hurts when I sit, but it is slowly getting better.  I held off from going to the doctor because the thought of X-rays and who knows what else a hospital would do was not something I wanted to deal with.  I didn’t want the added stress of all that added to the stress of the fall, plus all the germs I would be exposed to at the hospital.

I didn’t know if that was a smart decision at the time, but after the fact, in my own mind it was. The truth is, if I had been in severe pain or exceptionally immobile in a new way, I would have gone for a medical evaluation immediately or a day or two later.

There are so many symptoms of MS that make walking precarious, and it is probable that almost all people with MS have at least one of them.  Fatigue.  Dragging feet.  Weakness. Ataxia.  Toe or foot drop.  Poor coordination and balance.  Spasticity.
Vertigo. Medications, lack of sleep, and age also affect walking safely.

We need those handrails on steps.  We love hanging onto those shopping buggies
in stores.  Thank goodness for all those walls and furniture to hold onto.

With my own case of MS, I had walking problems from the onset.  I was very young and the walls and buggies sufficed for a few years.  Then things started getting worse. I bought a collapsible cane and carried it in my briefcase everyday, but never used
it.  Until one day when I was crossing a cobblestone street and I wiped out.

That’s the day I took out the cane—I was thirty-years old and started using it for my poor balance. I was too startled and scared to be embarrassed.  After that day, I never hesitated to use that or any other assistive device.  It didn’t take much to fall down:  a crack in a sidewalk, a toe getting caught in a throw rug, or a shoe heel that was too
high.

I thought of my cane as a pair of glasses that one uses to see better.  So I bought four canes in various colors and styles to match my outfits. Later, the walker-on-wheels with the built-in seat to rest on was a blessing when the weakness and fatigue would cause my legs to crumple after walking a short distance.  The added benefit of the basket to carry my things for me was so convenient.

We MSers need to think about tripping and falling constantly—something “normal” people take for granted.

Falling down is dangerous to us for several reasons.  Obviously, serious injuries can result.  Serious injuries not only impair daily living, they cause enormous stress and often cause a relapse.  Relapses lead to intensifying existing MS and creating new ones from residual damage. Injuries take longer for people with MS to heal because of the autoimmune response of our nervous system.

Steroids (such as Solu-medrol) are frequently prescribed to reduce inflammation and shorten the life of a relapse.  Most people on steroids suffer side effects and over time these cause loss of bone density.

Therefore, the older you are, the more dangerous it is to fall down. Not only are older people prone to fractures because of bone loss from things like menopause and osteoporosis, but those who lived a long life with MS probably used steroids frequently throughout the years to shorten their relapses.  Being fifty-seven years old, I was lucky I didn’t break a bone when I fell.

There is a whole arsenal of tools available to help prevent falling down–physical therapy, walking devices, strengthening/balance exercises, arranging daily habits to enable frequent resting…too many to talk about in this article. I’ve explored and use(d) so many of them and am always looking for new things out there to try.

Where to start?  Go to a physical therapist who has worked with MS patients and talk to other MSers. It is essential to learn how to do and use things correctly.

These things take time, dedication and will power to adjust to lifestyle changes.  They create more interference in our daily life and add more to do and worry about.  But the chance of suffering a serious injury doesn’t fit in with working full-time, being a spouse/parent, running a household or enjoying life either (sigh).

We with MS have to take every precaution we can from falling down.  Our lives (and our butts!) depend on it.

www.DebbieMS.com