Symptom Management

We know that up to 90 percent of all individuals with MS report that they have experienced fatigue, and more than 50 percent admit it is their most disabling symptom. This “invisible symptom” is the most common cause of disability.
 
MS fatigue can be grouped into two categories: primary and secondary fatigue. Primary fatigue (lassitude) is that which is caused by MS itself. Secondary fatigue occurs as a result of a symptom, medication, or other condition. Some of these secondary sources include sleep disturbances, spasticity, medication side effects, deconditioning, obesity, urinary frequency, depression / anxiety, and temperature sensitivity. Oftentimes, these secondary sources of fatigue can compound one another.
 
For instance, fatigue is a symptom of depression which may lead to inactivity, which may increase spasticity, which may lead to difficulty sleeping, which can then increase fatigue. This is called the cycle of symptoms.
 
Breaking the cycle of symptoms may seem overwhelming, but there is help. The first step is to track your daily activity in a log, which will help identify problem areas.
 
Ask yourself these questions:
 
• What does a typical day look like?
• Are there certain days of the week that are more fatiguing than others?
• What are your most energy-consuming activities?
• What time of day does your fatigue set in?
 
Next, further analyze your fatigue.
 
• How do you feel when you are fatigued? Give it a rating from 1-10 in severity.
• What triggers your fatigue?
• What helps to relieve your fatigue?
• Are there other symptoms that occur when you are fatigued?
 
Making Changes
 
Once you have a good understanding of your fatigue, it is time to make some changes. You may need to make changes to yourself, a particular activity, or the environment where the activity takes place.
 
Making changes to yourself is particularly important and begins with basic wellness behaviors. According to a recently published study, 85.5 percent of MS study participants did not meet nutritional standards, and a whopping 90.3 percent were not meeting recommended dietary and physical activity standards.
 
Good wellness behaviors include: light to moderate exercise, a well-balanced diet, good sleep habits, minimal alcohol consumption, and no smoking. If spasticity is an issue, it is important to practice good management techniques including daily stretching. Try to make yourself the healthiest you can be.
 
Changing how things are done can be a challenge, because it often means changing a familiar routine. Begin by choosing what is important to you and prioritize from there. Planning ahead can be very helpful. This may involve thinking through an activity before you begin, or simply making a list of what you want to accomplish and then prioritizing the list based on want is important to you.
 
Next, consider the pace you work. Going too quickly can lead to mistakes and cause anxiety. Going too slow can drag tasks out and drain your energy. It is important to find a moderate pace that works for you. Alternate between easy and difficult tasks to give yourself rest breaks. One of the most energy-saving strategies that you can implement is to sit  while working. Sitting can save you 25 percent more energy than standing. That extra energy can really add up by the end of your day.
 
Finally, think about how to change your environment to maximize your energy. Look at your space. If sitting, make sure your seat is the appropriate height and that it encourages proper posture. Before you start, make sure everything you need is within reach. Because eyes can fatigue as well, make sure the lighting is appropriate. Try to minimize your stress by organizing the space, using calm colors, and minimizing noise. If heat sensitivity is an issue, be diligent about keeping cool. Keep the A/C on, cool your body with an ice-cold drink, wear light clothing, and use cooling products, such as a cooling vest.
 
Although fatigue can be a challenge, there are ways to increase your energy with a little preparedness and ingenuity. If you need help finding the right balance, consider seeing an occupational therapist to set you on the right path to managing your energy.
 
Tips to Improve Your Sleep:
 
• Set and keep a fixed bedtime and wake time
• Keep the temperature cool and comfortable
• Dim lights and decrease noise one hour prior to bedtime
• Follow a bedtime routine to get ready for bed every night
• No TV or electronics once you are in bed
 
Tips to Save Energy in the Kitchen:
 
• Sit while cooking or prepping food
• Prep items in advance (chopping vegetables)
• Use precut items when possible
• Push heavy pots on the counter instead of lifting
• Keep frequently used items within reach
• Use paper plates
• Use a toaster oven or a single-induction burner on the countertop
• Consider online grocery shopping
 
Tips to Save Energy While Cleaning:
 
• Pick one area or item to clean per day
• Use light-weight cleaning tools
• Consider using a robot vacuum
• Sit when you can
• Delegate heavy-duty tasks to others
• Have multiple bins for laundry to eliminate sorting
• Consider getting help for deep cleaning once a month
 
Tips to Save Energy During Daily Activities
 
• Use a seat in the shower
• Sit while dressing and grooming
• Use a raised toilet seat
• Take rest breaks
• Keep it cool (A/C and water temperature)
• Keep items in close proximity