Tips to Manage MS Fatigue

 Read the tips on:

https://www.webmd.com/multiple-sclerosis/ss/slideshow-tips-to-manage-ms-fatigue?ecd=wnl_mls_072823&ctr=wnl-mls-072823_lead_title&mb=q80%2F%40kIeuyYKtyaYzOxdbc6RVoMqf%400VkpmvpK5yEEQ%3D

MS and Breathing Problems

 

When you’re living with multiple sclerosis (MS), there’s a chance you might have trouble breathing. It’s not as common as other MS symptoms, like numbness, tingling, blurry vision, and trouble walking. But it can still happen.

If you start to have trouble breathing, your doctor and other specialists have lots of ways to help. Once they find out the exact cause of your breathing problem, they can recommend treatments that allow you to breathe better and improve your quality of life.

MS can impact the muscles that affect your breathing. So breathing problems with MS usually happen when those muscles lose strength and endurance. There can be other causes, though, and some of them need treatment right away.

If you suddenly have trouble getting air, or if you’re having problems breathing right now, call your doctor or 911 immediately.

What Are Some Symptoms of MS Breathing Problems?

You may have shortness of breath or feel like you can’t take a deep breath.

You might have trouble talking, too. Breathing problems can make it harder and more tiring for you to hold a conversation or speak loudly enough for others to hear you.

Other possible clues of breathing problems with MS are:

• Sleep apnea
• Coughing or hiccupping a lot
• Sighing

What Can Cause Breathing Problems With MS?

The most common cause is weakness in muscles of the chest and belly that help you breathe.

Muscle weakness is common with MS. It can happen in any part of your body, including the muscles involved in breathing. It can also start early in the course of MS and gradually get worse over time.

If the muscles involved in breathing become weak, you’ll need to work harder to breathe in and out. And the more effort it takes, the more it could tire you out, especially if you already have MS fatigue (a symptom that may affect up to 80% of people with multiple sclerosis).

Other things can cause MS-related breathing problems, too. Certain prescription drugs that some people take to ease their symptoms -- like tranquilizers, muscle relaxants, or opioid painkillers -- can cause you to breathe slower and less effectively. Your doctor may want to watch you closely if you’ve had trouble breathing or swallowing and you take any of these meds.

Another cause of MS-related breathing problems is a dangerous condition called aspiration pneumonia. It can happen if you’re not able to clear things like mucus from your nose and throat, or if you accidentally inhale food, liquids, or other particles into your lungs.

A common multiple sclerosis symptom known as the MS hug (which feels like a tight band is wrapped around your torso) can also bring on breathing trouble by causing pain and tightness in your chest.

One much less-common cause of trouble breathing is a problem with the autonomic nervous system. That’s the part of your nervous system that automatically controls things like your breathing and heartbeat. MS doesn’t usually affect your autonomic nervous system.

What Treatments Can Help Breathing Problems?

Talk to your doctor right away. They may send you to a specialist who’s trained to treat breathing problems. Depending on your needs, your treatment plan, and the exact cause of your breathing troubles, your doctors might prescribe a breathing aid like:

• A nebulizer: A small machine that turns liquid medicine into a mist, which you inhale deep into your lungs through a mouthpiece or mask
• An inhaler: A handheld device that lets you breathe medication into your lungs in the form of a mist or spray
• CPAP: A machine that treats sleep apnea by helping you breathe through a mask or nosepiece while you sleep

Build up your breath. Ask your doctor to refer you to a respiratory therapist. They’re a certified medical professional who can come up with a plan to help your lungs work better.

Your plan may include breathing exercises that strengthen the muscles involved in breathing. Along with helping you breathe better, some of these techniques may lower your stress, too. A few examples are:

• Square breathing: Inhale for 2 counts through your nose. Hold it for 2 counts. Then exhale through your mouth for 2 counts. Do it a few times to relax and lower your heart rate.
• 4-7-8: Breathe in through your nose for 4 counts. Hold it for 7 counts. Then slowly breathe out for 8 counts. Closing your eyes while you do this may help you relax.
• Inhale-release, exhale-engage: Place your hands on your stomach. Inhale into your belly and feel it expand. As you exhale, tighten your stomach and engage your abs.

Treat any swallowing issues. If your breathing problems come from trouble swallowing, ask your doctor to refer you to a speech-language pathologist. This communication expert can also help you if your breathing issues affect your ability to talk.

A speech-language pathologist can teach your exercises and do other forms of therapy that help you swallow or speak more easily, which may improve your breathing. They might also recommend changes in your diet, as well as changes in your posture, to help you swallow better while you eat. If you’ve had aspiration pneumonia, they may suggest you use an assistive device called a feeding tube to lower your chances of getting that condition again.

Quit smoking. If you light up, ask your doctor to help you quit. Smoking makes you more likely to get breathing problems -- and it can cause your MS to get worse more quickly. Kicking the habit is one of the best things you can do for your overall health.

On MS from a Mayo Clinic Physician

 

I'm Dr. Oliver Tobin, a neurologist specializing in multiple sclerosis at Mayo Clinic. In this video, we'll be covering the basics of multiple sclerosis. What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers about your own health or that of someone you love, we're here to provide you with the best information available. Multiple sclerosis is a disorder in which the body's immune system attacks the protective covering of the nerve cells in the brain, optic nerve and spinal cord, called the myelin sheath. And this sheath is often compared to the insulation on an electrical wire. When that covering is damaged, it exposes the actual nerve fiber, which can slow or block the signals being transmitted within it. The nerve fibers themselves might also be damaged. The body can repair damage to the myelin sheath, but it's not perfect. The resulting damage leaves lesions or scars, and this is where the name comes from: multiple sclerosis, multiple scars. Now everyone loses brain cells and spinal cord cells as they get older. But if part of the brain or spinal cord has been damaged by MS, the nerve cells in that area will die off faster than the areas around it that are normal. This happens very slowly, usually over decades and typically shows up as gradual walking difficulty happening over several years. When you read about multiple sclerosis, you may hear about different types -- the most frequent being relapsing-remitting multiple sclerosis. And this is characterized by attacks, or relapses.

We don't know what causes MS, but there are certain factors that may increase the risk or trigger its onset. So while MS can occur at any age, it mostly makes its first appearance in people between the ages of 20 and 40. Low levels of vitamin D and low exposure to sunlight, which enables our body to make vitamin D, are associated with an increased risk of developing MS. As people who have MS who have low vitamin D tend to have more severe disease. So people who are overweight are more likely to develop MS and people who have MS and are overweight tend to have more severe disease and a faster onset of progression. People who have MS and who smoke tend to have more relapses, worse progressive disease, and worse cognitive symptoms. Women are up to three times as likely as men to have relapsing-remitting MS. The risk for MS in the general population is about 0.5%. If a parent or sibling has MS, your risk is about twice that or about 1%. Certain infections are also important. A variety of viruses have been linked to MS, including Epstein-Barr virus, which causes mono. Northern and southern latitudes have a higher prevalence, including Canada, the northern US, New Zealand, southeastern Australia, and Europe. White people, especially of northern European descent, are at the highest risk. People of Asian, African, and Native American ancestry have the lowest risk. A slightly increased risk is seen if a patient already has autoimmune thyroid disease, pernicious anemia, psoriasis, type 1 diabetes, or inflammatory bowel disease.

Symptoms of a relapse usually come on over 24 to 48 hours, last for a few days to a few weeks and then improve in the region of 80 to a 100 percent. Those symptoms include loss of vision in an eye, loss of power in an arm or leg or a rising sense of numbness in the legs. Other common symptoms associated with MS include spasms, fatigue, depression, incontinence issues, sexual dysfunction, and walking difficulties.

There's currently no single test to make a diagnosis of MS. However, there are four key features which help to secure the diagnosis. Firstly, are there typical symptoms of multiple sclerosis? Again, those are loss of vision in an eye, loss of power in an arm or leg, or sensory disturbance in an arm or leg lasting for more than 24 hours. Secondly, do you have any physical examination findings consistent with MS? Next, is the MRI of your brain or spine consistent with MS? Now here it's important to note that 95 percent of people over the age of 40 have an abnormal brain MRI, just the same as many of us have wrinkles on our skin. Lastly, are the results of the spinal fluid analysis consistent with MS? Your doctor may recommend blood tests to check for other diseases that share the same symptoms. They may also recommend an OCT test or optical coherence tomography. This is a short scan of the thickness of the layers at the back of your eye.

So the best thing to do when living with MS is to find a trusted interdisciplinary medical team that can help you monitor and manage your health. Having a multidisciplinary team is essential for addressing the individual symptoms that you're experiencing. If you have an MS attack or relapse, your doctor may prescribe you corticosteroids to reduce or improve your symptoms. And if your attack symptoms do not respond to steroids, another option is plasmapheresis or plasma exchange, which is a treatment similar to dialysis. About 50 percent of people who do not respond to steroids have a significant improvement with a short course of plasma exchange. There are over 20 medications currently approved for prevention of MS attacks and prevention of new MRI lesions.

As learning to function with MS can be challenging, there are medical experts ready to work with you to help you manage it, so you can still live a full life. Consulting with a physiatrist, physical or occupational therapist can help you deal with physical difficulties. Physical activity is strongly recommended for all people with MS. Mental health is also an important consideration. So keeping up personal connections with friends and family and trying to stay involved with your hobbies is important. But also be kind to yourself and realistic about what you're up for. This can change from day to day, so it's okay to give yourself permission if something seems like too much or if you need to cancel plans. You may also find support groups helpful to connect with people who understand what you are going through and discuss your feelings and concerns with a doctor or a counselor. Meanwhile, scientists are hard at work, expanding our understanding of this disease and developing new treatments and medications which are ever more effective. If you want to learn more, watch more of our videos or visit mayoclinic.org. We wish you well.

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).

In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerve fibers.

Signs and symptoms of MS vary widely between patients and depend on the location and severity of nerve fiber damage in the central nevous system. Some people with severe MS may lose the ability to walk independently or ambulate at all. Other individuals may experience long periods of remission without any new symptoms depending on the type of MS they have.

There's no cure for multiple sclerosis. However, there are treatments to help speed the recovery from attacks, modify the course of the disease and manage symptoms.

Symptoms

Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers.

Common symptoms include:

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time
• Tingling
• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
• Lack of coordination
• Unsteady gait or inability to walk
• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Blurry vision
• Vertigo
• Problems with sexual, bowel and bladder function
• Fatigue
• Slurred speech
• Cognitive problems
• Mood disturbances

When to see a doctor

See a doctor if you experience any of the above symptoms for unknown reasons.

Disease course

Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.

Small increases in body temperature can temporarily worsen signs and symptoms of MS. These aren't considered true disease relapses but pseudorelapses.

At least 20% to 40% of those with relapsing-remitting MS can eventually develop a steady progression of symptoms, with or without periods of remission, within 10 to 20 years from disease onset. This is known as secondary-progressive MS.

The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS.

Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses, known as primary-progressive MS.

More Information

• Multiple sclerosis care at Mayo Clinic
• Multiple sclerosis: Can it cause seizures?

Multiple Sclerosis (MS) Tremors

 

What Is a Tremor?

A tremor is when a body part moves or shakes and you can’t control it. Many people with multiple sclerosis (MS) have some form of tremor they can’t control, in different parts of their bodies, like their head, arms, or legs.

What Are the Types of Tremors?

• Intention tremor. There’s no shaking when you’re at rest. It starts when you try to reach or grasp something or move your hand or foot to a precise spot. This is the most common form of MS tremor, and it usually causes the most problems in day-to-day life.
• Postural tremors. You shake when you sit or stand, but not when you lie down.
• Resting tremor. You move more when you’re sitting still and less when you move. This is more common with Parkinson’s disease than MS.
• Nystagmus. This type causes jumpy eye movements.

Why Does MS Cause Tremors?

This disease damages the protective sheath (myelin) that covers the nerves in your brain and spinal cord. Tremors result from damage to a part of your brain called the cerebellum. It controls your balance and coordination and smooths out the actions that you make when you move your limbs and eyes or speak.

Medicines That Treat MS Tremors

These problems are one of the hardest MS symptoms to treat. There aren’t any drugs made just to treat MS tremors. Your doctors may prescribe drugs for another condition that could help, like:

• Acetazolamide (Diamox), which treats a type of glaucoma and altitude sickness
• Buspirone (Buspar) and clonazepam (Klonopin), which are anti-anxiety drugs
• Hydroxyzine (Atarax, Vistaril), an antihistamine
• Isoniazid (INH), a drug for tuberculosis
• Primidone (Mysoline), a seizure medicine
• Propranolol (Inderal), which treats heart problems, high blood pressure, and migraines

 Nonmedicinal Tremor Treatments

• Braces: These can hold your joint still and stop extra movement. A brace on your ankle or foot can make it easier to walk. They can help control your arm, hand, or neck, too.
• Deep brain stimulation: This experimental approach is mostly used for people who have tremors from Parkinson’s disease. A doctor implants electrodes into your brain. Wires connect them to a gadget in your chest. You use it to send your brain signals that stop the tremors.
• Medical cannabis: There’s little evidence that cannabis can help with tremors, but study results are mixed and usually only include small numbers of people.
• Physical therapy: It can show you exercises that increase your range of motion, improve your posture and balance, and make your body more stable
• Speech therapy: If you have tremors in your lips, tongue, or jaw, a health professional can work with you to slow your speech, make it clearer, and control the volume.
• Occupational therapist: This person will set you up with special tools called adaptive or assistive devices. They can help you grab things from up high or off the floor, pull up a zipper, or hold a fork more easily.
• Weights: Adding extra weight to a body part can help keep it still. You can also add weights to commonly used items like forks, pencils, pens, eating utensils, canes, and walkers.

Tremors and Depression

Tremors can be tough to handle in social situations. You may feel like you want to be alone, but that can make you feel lonely and depressed. A psychologist or counselor can help you find ways to feel more comfortable in public and keep the tremors from changing how you live your life.