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Coping with fatigue

Fatigue – that overwhelming sense of being tired that seeps into your mind and body – is one of the most common symptoms of multiple sclerosis (MS). For many it’s a daily event, affecting their work, their relationships with family and friends, and their daily activities. Because it’s so subjective, it’s hard to communicate to the people around you just how devastating it can be. What they see may be interpreted as laziness, or that old sin of sloth – which just adds to the frustration of feeling fatigued.

But MS fatigue isn’t your imagination working overtime while your body works undertime. Nor is it trivial – it’s one of the most common reasons why people with MS have to cut back on working or end their careers entirely.

So what is MS fatigue and how do you cope with it?

MS fatigue has been characterized as an overwhelming sense of being tired (lassitude), muscle fatigue, and mental fatigue. Your stamina may be reduced, your motivation takes a hit, there’s a need to take a nap, and it becomes hard to concentrate. Fatigue is often worse in the afternoons – just when you’re trying to finish off the day’s work, it’s time to pick up the kids, or you were planning for a night out.

MS fatigue differs from normal fatigue in that it usually hits you suddenly, interferes with mental functioning, undermines your ability to keep at a job, interferes with daily tasks, and is made worse by heat and humidity.

In coping with the problem, the first task is to tell the people in your life about MS fatigue and how it may affect you. Your heart and mind may be willing, but your body may stop you from doing all of the things you’d like to do – such as picking up the groceries or driving your son or daughter to soccer practice.

Secondly, don’t work against yourself. Ensure that you’re getting enough sleep, conserve energy where you can, get a moderate amount of exercise, and take rest breaks (or naps) if you need them. Learn to pace yourself. And keep cool – getting overheated will only make things worse.

Try to work smarter, not harder. Plan ahead and try to stay organized. Schedule your more important or demanding tasks for the time of day when you have more energy, such as in the morning. Reorganize your home or workplace to make it more convenient or less tiring. An occupational therapist at your MS clinic or in your community can give you some tips to make your life easier. It’s also important to ask yourself: Does this task really need to be done? Can it be done later?

Try to delegate some of your tasks to the people around you. Don’t be afraid to ask someone – a family member, friend or someone in your community – for some help. Assign a few chores to your spouse or children – they’ll be happy to lend a hand. Local health services, social/community groups or your local church can often provide some assistance. Talk to a social worker at your MS clinic or in your community for a list of local resources. Consider hiring a housecleaning service to do the heavier chores at home. If it needs to be done but you’re not feeling up to the task, try to think of a creative way that will make it easier to do.

Be cautious about the medications you take. Painkillers containing codeine (e.g. 222s, acetaminophen with codeine), antihistamines containing diphenhydramine (e.g. many cold remedies), some epilepsy medications (e.g. Tegretol or carbamazepine), sleeping pills, and some asthma drugs containing fluticasone or terbutaline (e.g. Flonase, Flovent, Bricanyl) can worsen fatigue. Some MS medications, such as interferon-beta drugs (e.g. Avonex, Betaseron, Rebif, Extavia) can also add to the problem, as well as some drugs used for spasticity (e.g. dantrolene, baclofen and tizanidine). If you are taking any of these medications – do not stop taking them. But tell your doctor and pharmacist about these medications and ask them if you can be switched to something that won’t worsen your fatigue.

Thirdly, get a check-up by your family doctor. Various medical conditions can cause or worsen fatigue, such as infections, anemia, thyroid disease, heart disease, lung disease and kidney disease. It’s comforting to know that there isn’t an underlying medical cause for your feeling tired.

And don’t neglect your mental health. Fatigue is a common symptom of clinical depression so your doctor needs to determine if the problem is MS fatigue, or is related to depression. Tell your doctor if you have any symptoms of depression, such as depressed mood, anxiety, guilt, sleep disturbances, recent weight loss or gain, or loss of interest in activities you normally enjoy. If you are feeling depressed – don’t suffer in silence. Depression is a treatable condition and there are many effective medications to help you.

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