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Monday, April 1, 2019

Understanding and Managing MS Fatigue

MS Fatigue

Featuring Benjamin Segal, MD, and Aliza Ben-Zacharia, MD, discussing fatigue in MS.


Fatigue is one of the most common symptoms of MS, occurring in about 80 percent of people. It can significantly interfere with a person's ability to function at home and work, and is one of the primary causes of early departure from the workforce. Fatigue may be the most prominent symptom in a person who otherwise has minimal activity limitations.
The cause of MS fatigue is currently unknown. Ongoing studies seek an objective test that can be used as a marker for fatigue, and for precise ways to measure it. Some people with MS say that family members, friends, co-workers or employers sometimes misinterpret their fatigue and think they are depressed or just not trying hard enough.

Fatigue & lassitude

People with MS can experience fatigue that is unrelated to having MS. Other medical conditions and vitamin deficiencies, for example, can cause fatigue. It is important to ensure that your fatigue is a result of your MS and not something else that has a different treatment.

Several different kinds of fatigue occur in people with MS. For example, people who have bladder dysfunction (producing night-time awakenings) or nocturnal muscle spasms, may be sleep deprived and experience fatigue as a result. People who are depressed may also have fatigue. Anyone who needs to expend considerable effort just to accomplish daily tasks (e.g., dressing, brushing teeth, bathing, preparing meals) may also experience additional fatigue as a result.

In addition to these sources of fatigue, there is another kind of fatigue — referred to as lassitude — that is unique to people with MS. Lassitude or "MS fatigue" is different from other types of fatigue in that it:
  • Generally occurs on a daily basis
  • May occur early in the morning, even after a restful night’s sleep
  • Tends to worsen as the day progresses
  • Tends to be aggravated by heat and humidity
  • Comes on easily and suddenly
  • Is generally more severe than normal fatigue
  • Is more likely to interfere with daily responsibilities
MS-related fatigue does not appear to be directly correlated with either depression or the degree of physical impairment.

Managing fatigue

Fatigue can also be caused by treatable medical, side effects of medications or from inactivity. Persons with MS should consult their healthcare provider if fatigue becomes a problem. Early identification of the cause of fatigue can lead to an effective treatment plan. Your healthcare provider can complete a comprehensive evaluation to identify the factors contributing to your fatigue and work with you to develop a treatment plan specific to your needs. Some strategies to manage fatigue include:
  • Occupational therapy to simplify tasks at work and home and conserve energy use.
  • Physical therapy to learn energy-saving ways of walking (with or without assistive devices) and performing other daily tasks.
  • Physical therapy to develop a regular exercise program to prevent deconditioning.
  • Sleep regulation, which might involve treating other MS symptoms that interfere with sleep (e.g., spasticity, urinary problems).
  • Psychological interventions, such as stress management, relaxation training, membership in a support group, or psychotherapy.
  • Heat management strategies to avoid overheating and to cool down.
  • Medications can be used although none are currently approved by the U.S Food and Drug Administration (FDA) specifically for the treatment of MS-related fatigue. Clinical trials of these medications have shown mixed results but they are commonly used off-label for fatigue from MS.


Article Provided by:  #MSViewsandNews

MS and Bladder Problems

“I gotta go…but not now.” A Discussion of MS and Bladder Problems

By Ted Brown, MD

EvergreenHealth MS Center

The bladder is a vital part of our normal anatomy. The kidneys remove waste products from your blood and expel them in your urine. The normal range for an adult urinary output is between 1/2L to 2L per day given a normal fluid intake of about 2 liters per day (1/2 a gallon). The normal bladder capacity is ¼ to ½ liter (1-2 cups), so unless deprived of fluids, a person needs to empty the bladder several times per day. 
There is a lot of neurological input into the process of storing urine in the bladder, signaling the brain of need to empty and then coordinating contraction of the bladder muscle with relaxation of the bladder outlet to achieve complete and timely emptying. The complex process of urination is prone to fail when there is damage to the brain and spinal cord in multiple sclerosis (MS). 

Just how common is it? 

Bladder problems are present from disease onset in 35% of people with MS and over 80% will eventually have some urination dysfunction. Urinary problems have a major psychological impact, and are among the most socially disabling manifestations of MS. Types of bladder dysfunction include problems of storage, problems of emptying, and a combination of both. Storage problems are the most common, typically caused by an “overactive bladder,” where the bladder begins to contract prematurely with a small volume of urine. Symptoms of an overactive bladder are urgency (feeling pressure or need to empty soon/hard to hold on to it), frequency (urinating more often than normal (>7x/day), including during the middle of the night), and having incontinence (bladder accidents).  Problems of emptying (urinary retention) in MS are usually caused by inadequate signals to make the bladder outlet relax and let the urine flow. With combined dysfunction, there is simultaneous bladder overactivity and trapping of urine at the outlet. The symptoms of combined dysfunction are urgency, hesitancy, frequency and incontinence.  As if these symptoms are not enough, bladder dysfunction may lead to skin care problems, bladder infection, bladder stones and damage to the ureters and kidneys. 

So, what can be done about it? 



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Article Provided by:  #MSViewsandNews

Managing Changes in Bowel, Bladder and Sexuality - Sensitive Issues in Multiple Sclerosis

MS Workshop: Sensitive Issues in Multiple Sclerosis

Managing Changes in Bowel, Bladder and Sexuality

People living with multiple sclerosis can often experience hidden and sensitive symptoms, such as changes in bowel, bladder and sexual function. These symptoms can be difficult to discuss, challenging to manage, and can impact intimate relationships.
There are things you can do to effectively manage these symptoms and minimize the impact on your life. Our experts panel of experts present how you can proactively manage these symptoms and effectively communicate about them with partners and others close to you.
Videos from this workshop are available on the EvergreenHealth YouTube channel.
Part 1 - Overview of MS, Symptoms Related to MS 
Virginia Simnad, MD, neurologist at the EvergreenHealth Multiple Sclerosis Center
Part 2 - When MS Hits You Below the Belt: Bowel, Bladder and Sexual Function
Lora Plaskon, MD, urogynecologist at EvergreenHealth Urology & Urogynecology Care
Part 3 - A Practical Approach to Pelvic Health
Amy Ross Gordon, MPT, pelvic floor physical therapist at EvergreenHealth Rehabilitation Services
Part 4 - Sexuality & Intimacy
Kristy Brewer Sherman, PhD, clinical psychologist EvergreenHealth Neuropsychological Services


Article Provided by:  #MSViewsandNews

MS Workshop: Fall Prevention -- #EvergreenHealthMS

Each year, millions of adults ages 65 and older fall. People with disabilities are also at high risk. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are preventable!
Videos of the workshop are available below or on the EvergreenHealth YouTube channel.
Part 1 - How to Prevent Falls
Melissa Gilbert, DPT, NCS, physical therapist at EvergreenHealth Rehabilitation Services
Part 2 - All About Balance
Alicia Nowak, DPT, NCS, physical therapist at EvergreenHealth Rehabilitation Services
Part 3 - Occupational Therapy and Fall Prevention
Susan Watters, OTR/L, occupational therapist at EvergreenHealth Rehabilitation Services

Information source Link - at #EvergreenHealth 

Article Provided by:  #MSViewsandNews

Resilience: The Key to Living Well with MS - Video Workshops from #EvergreenHealth

Resilience: The Key to Living Well with MS

Multiple sclerosis creates challenges and uncertainty for those who live with it. One of the cornerstones to maintaining happiness and life satisfaction while living with MS is resilience.
Resilience involves dealing with challenges, making adjustments and bouncing back so you can continue to find satisfaction in life. It's what enables us to thrive in the face of adversity.
People may be naturally more or less resilient, but the good news is that resilience is a skill that we can all develop and improve. 
Videos of the workshop are available below or on the #EvergreenHealth YouTube channel.

Part 1 - Introduction
Virginia Simnad, MD, MSc, Medical Director of Neurology at EvergreenHealth
Part 2 - Brain Function and Coping with Chronic Disease
Brad Tyson, PsyD, Clinical Neuropsychologist at EvergreenHealth Neurology Care
Part 3 - Strategies and Behaviors to Handle Stress
Kristy Brewer Sherman, PhD, Rehabilitation Psychologist at EvergreenHealth Neurology Care
Part 4 - How My Husband and I have Adapted to MS: Sharing Our Coping StrategiesHolly Slay Ferraro, PhD, Associate Professor, Seattle University Albers School of Business & Economics; family member of a love one living with MS


Article Provided by:  #MSViewsandNews