Increase your stamina to avoid debilitating MS fatigue
DEAR DOCTOR K: I have multiple sclerosis. For me, the most debilitating symptom is fatigue. What can I do to feel more energized?
DEAR READER: Multiple sclerosis (MS) is an illness that affects the brain and spinal cord. Normally, an insulating cover called myelin surrounds nerve cells and helps transmit nerve signals. MS is an autoimmune disease in which the immune system attacks the brain and spinal cord. This causes the myelin sheath to become inflamed or damaged, which disrupts or slows nerve impulses. The disruption of nerve signals causes a variety of symptoms.
MS can affect a person's vision, ability to move parts of the body, and ability to feel sensations (such as pain and touch). Most people with MS also experience severe fatigue. MS fatigue tends to be more intense and debilitating than what healthy people experience after sustained physical, mental or emotional exertion. It can make it difficult to concentrate and can interfere with daily activities or responsibilities. Fatigue may be a direct effect of MS; it can also be a secondary effect of other symptoms. For instance, people with MS often have bladder problems. This may mean nighttime trips to the bathroom — and that can cause daytime fatigue. The good news is that there are ways to boost your energy levels. Here are some general tips for increasing your stamina:
•EXERCISE. Regular exercise can improve cardiovascular fitness and muscle strength and reduce fatigue in everyone, including people with MS. And most people with MS are not so weakened by the disease that they cannot exercise. Be sure to start slow, and stop if you become tired. A physical therapist can design an exercise program tailored to your fitness level and individual needs.
•STAY COOL. MS fatigue can be worsened by heat. Dress in layers. Drink plenty of fluids to stay hydrated. During warmer months, exercise in the morning or late evening when it's coolest.
•ADDRESS SLEEP PROBLEMS. Treat symptoms, such as urinary problems, that interfere with sleep. Ask your doctor about sleep medications.
• ADJUST YOUR ROUTINES. Plan ahead to bundle errands. Pace yourself and conserve your energy. Talk to your employer about altering your schedule, or working at home some of the time. An occupational therapist can help simplify tasks at work and home that may be draining your energy.
•TRY MINDFULNESS TRAINING. This technique can help you focus in a nonjudgmental way on the present moment.
• MEDICATIONS. Ask your doctor about medications that may help. For example, research has shown that amantadine (Symadine, Symmetrel), a drug used to treat Parkinson's disease, improves fatigue in patients with MS. Several other less-well-studied drugs also may help: methylphenidate, fluoxetine and aspirin.
It is unclear what causes the fatigue in sufferers of multiple sclerosis. In my opinion, it is likely a reflection of the inflammation caused by the immune system in the brain. The chemicals that the immune system uses to orchestrate its attack (called cytokines) cause fatigue. Drugs that neutralize some cytokines now are available, and perhaps they will also help treat the fatigue of MS.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.