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Symptom Management 101

By Cherie Binns
neonbrand-1-aA2Fadydc-unsplash.jpgMultiple sclerosis presents a wide array of symptoms for us to deal with over time. For some of us these are pretty much the same set throughout the course of the disease and for others more are added over time. Infection and overheating can cause many of those symptoms which are well managed to worsen. I want to offer tips on how to best manage some of the more common symptoms.

Fatigue is probably the most commonly reported symptom by people with MS. MS fatigue is characterized by an almost incapacitating sense of “I can’t move,” or “I just can’t do this right now.” Tiredness or sleepiness is also common in people with MS because of poor sleep (up to the bathroom, spasticity issues, pain), medication side effects and deconditioning of our muscles due to inactivity. MS fatigue or lassitude has an intensity to it that other forms of fatigue do not have.
  • Manage tiredness and sleepiness by practicing good sleep hygiene. The bed is only used for sleep or intimate activities and not for TV, reading, etc. Dark, cool room and comfortable bedding are essential to a good night’s sleep.
  • Avoid, whenever possible, getting hooked in a cycle of medications to wake you up and get you through the day and then other meds to calm you and get you to sleep at night. Ultimately this worsens fatigue.
  • Move regularly and deliberately. More energy has to be expended to do even simple things if our muscles are flaccid and out of shape. Research has now begun to show us that persons who move regularly and exercise regularly have less severe fatigue than those who do not.

Spasticity sometimes takes time to recognize as it may manifest as hip or back pain and the individual is not aware that the tightness of muscles pulling on joint connections are causing discomfort. If you are in more pain during the night or first thing in the morning, you may want to ask your doctor if you have spasticity. The “MS Hug” is a form of spasticity.
  • Stretching exercises (usually given by a physical therapist) can often relieve spasticity without adding medications to the mix.
  • Use of a cane or walker can improve the symptoms of spasticity in many individuals and make walking safer as well.
  • A regular exercise program (at least 20-30 minutes of exercise four or more times a week) has been shown in a number of studies to reduce the severity of spasticity in those affected by it.
  • Ask about a Baclofen pump if medications and exercise do not give the needed relief.

Cognitive or mood changes are reported by about 60 percent of people with MS at some point in time. These may be triggered by stress, infection or illness or could be directly related to lesion location in the brain.
  • Learning and practicing mindfulness techniques, yoga, full body breathing can all help reduce anxiety, help to improve mental focus and instill a sense of wellbeing.
  • Speaking with a counselor, attending support groups, doing online or paper games that exercise your brain are helpful to both improve mood and speed of mental processing.
  • In some cases, medication might be needed for a time to manage mood changes but this is rarely a “for the rest of your life” treatment.

Mobility or dexterity problems are more visible than some of the symptoms listed earlier and generally are addressed more quickly by the healthcare team because they can “see” that there is a problem and do not necessarily have to rely on your account of how they are affecting your quality of life.
  • Exercise is a key to comfort and safety in persons with mobility issues even if they are confined to a wheel chair. Working with a physical or occupational therapist to tailor a program to your particular needs is essential to allow you the greatest possible freedom and comfort.
  • Difficulty with hand function that affects writing, typing, selfcare all need professional help to manage effectively.

Bowel, bladder and sexual problems are often not shared with your doctor because of embarrassment. Many people who have spinal cord lesions suffer symptoms in this group. Hydration and high fiber diets are essential to good bladder and bowel control and there are numerous tailored treatment plans for sexual issues. MS Focus has several resources for this.
  • Drink a full glass of water at a time if you have urinary issues. This glass of water will almost always have the individual in the bathroom within 20 to 30 minutes while sipping throughout the day allows for greater threats to leakage.
  • Foods high in fiber content are a must for those with bowel issues. It is recommended that we get two to three fruit servings and at least five vegetable servings daily.
  • Bulking products such as fiber substitutes can be helpful as well as products that pull water from the body into the bowel to promote emptying.

Lifestyle changes that Help Reduce Symptom severity can give the individual better control over their quality of life.
  • Stop Smoking. Family members cannot smoke around the people with MS.
  • Eliminate or significantly reduce sugars in your diet as sugar worsens inflammation which in turn magnifies symptoms.
  • Get at least 7-8 hours of sleep a night and work with someone to help you achieve this if needed.
  • Exercise regularly. Restoring tone to muscles that have lost it reduces fatigue, spasticity and pain and has been shown to improve mood.
  • Selfcare such as meditation, spiritual activities, social activity have all been shown to reduce a sense of isolation and loneliness and improve mood.