The fatigue factor

[Blueeyedreamer]

How do you battle fatigue? I'm in a real funk and can't shake it. Getting thru my work day is a challenge so exercise doesn't feel possible.

[ActiveMSers]

BED, I'd do a search on the forums for "fatigue." This is a common issue and I think you'll find the studies, etc., pretty interesting. Virtually all of us have been in your same type of funk. But to get out of it you'll really need to exercise, even if it seems impossible. Just start super slow. You'll see a difference over time, I'm sure of it. But it will require some rewiring. Good luck!

I also did a blog on the topic, Bending the Spoon Theory:
http://activemsers.blogspot.com/2012...on-theory.html

[AMFADVENTURES]

You might try just a 20 minute walk in the morning before work, a brisk walk if you're able. I haven't suffered from that gawd awful mind crushing fatigue for quite a while now but when I did, the fatigue wasn't as bad in the morning and a walk seemed to help me get through the day more often than not. Sometimes amantadine helped too but in kind of an unpredictable way, for me anyway. Good luck, I can sympathize.

[Blueeyedreamer]

Thanks. It finally lifted and I made all the way thru work, took a nap, then worked out. I was on amantadine a long time ago, but didn't really notice a difference.

Glad it's better now. I've been wanting to go back to kickboxing.

[andreagwolford]

It depends on what possibility is possible for you.

For some people, rest helps relieve fatigue and is an important part
of fatigue management.
Resting can prevent you getting to a point of complete exhaustion
and coming to a sudden halt, half-way through a task. Planned rest
can give you more control over when you choose to be active and
when you take a break.
A few small breaks are best for some people; or you might feel
better after just one longer rest at a particular time. For example:
• try taking a few short rests or ‘power naps’, through the day
• try just one longer rest, at the same time each day
• take a break between coming home from work and getting ready
for an evening out
When you rest, try to make your rest as complete as possible.
Doing smaller jobs around the house, talking to the family or
watching TV might be more relaxing than work or chores, but it is
not really resting. It can be tricky, but the aim should be to switch
off both the mind and the body. You might want to have a short
sleep, meditate or use relaxing music to help clear your mind.
If worries disturb time set aside for rest, try writing down these
concerns and ‘shelving’ them while you are resting. You might
find it easier to tackle them once your energy levels are back up
again. If resting helps you manage your fatigue, it is important that
other people realise how valuable this quiet, undisturbed time is.

Prioritising activities can mean you save energy for the things you really want or need to do. It can help you plan your activities and your time to rest and recuperate.

You might find it useful to make a list of all the activities you do in a typical day or week. Can they be done in a more energy-efficient way, or at different times of the day, to make them easier? Can you get help with any of these tasks?

Whatever your priorities are, try to be realistic about how much you can get done - don't try to take on too much.

You could save energy on a lot of everyday tasks if you have a good, relaxed posture. Keeping a good posture takes practice, but with time it can become easier, as your body re-aligns itself, and it can help you save energy.

A physiotherapist can help you identify any problems you might have with posture and suggest suitable exercises to help.

You could save energy on a lot of everyday tasks if you have a good, relaxed posture. Keeping a good posture takes practice, but with time it can become easier, as your body re-aligns itself, and it can help you save energy.

A physiotherapist can help you identify any problems you might have with posture and suggest suitable exercises to help.

Combining sensible exercise with a balanced diet can help you maintain a healthy weight and get the energy you need. Weight loss and weight gain can both be issues for people with MS and can make coping with fatigue more difficult. A dietitian can work with you to plan a suitable diet to maintain a healthy weight.

What you eat can also make a difference. For example, large, hot meals can make fatigue worse and caffeine or sugary snacks might have an initial 'pick-me-up' effect, but leave you feeling more tired later.

It almost goes against common sense to exert yourself if you experience fatigue, but exercise helps keep your body working at its best and can improve strength and fitness and mood.

It’s possible to do too much exercise, so balance the exercise with rest, and keep cool while you exercise, especially if heat makes your fatigue worse.

You might want to plan your exercise and avoid long sessions to prevent overheating. Some people find water-based exercise helpful for maintaining a steady temperature.

Cooling vests may also help. A physiotherapist can help you devise a suitable exercise programme. Find out more about exercise and physiotherapy in treatments and therapies.

Some people find that drug treatments help them manage their fatigue.

Although there are currently no drugs licensed in the UK specifically for MS fatigue, certain drugs licensed for other conditions are sometimes prescribed:

Amantadine (Symmetrel or Lysovir)

This drug is licensed to treat Parkinson's disease, as well as some viral infections. Unfortunately, research regarding its use in treating fatigue in MS is not conclusive. However, the NICE Guideline for MS states that a small benefit might be gained from taking a dose of 200mg daily. Side effects can include insomnia and vivid dreams.

Modafinil (Provigil)

This drug is used to treat narcolepsy, a sleep disorder which causes people to sleep excessively during the day.

There have been several small studies looking at modafinil to treat fatigue in MS, but they have had conflicting results and have not proved the benefits of taking modafinil.

However, it is sometimes prescribed for people with MS fatigue and some people who take it say it helps. Side effects can include insomnia and headaches.

Prokarin (sometimes spelt Procarin)

Prokarin is a skin patch that contains caffeine and histamine. It is not available on prescription and can be expensive.

Some consider it a complementary or alternative medicine. In one study, people who took it reported less fatigue, but trials of this drug have not proved benefits for treating MS fatigue.

Research into fatigue

There has been some research into the use of drugs for MS fatigue. However, the trials have generally involved only small numbers of people, have lasted only a short time, or have used varying ways to measure fatigue. This makes it difficult to compare the studies and to draw definite conclusions from their results.

The MS Society has recently funded a study looking at using cognitive behaviour therapy (CBT) to improving fatigue management.

Research continues into whether functional electrical stimulation (FES) may reduce fatigue by improving the gait of people with MS and mobility issues.

People might say to you 'If there’s anything you need...' or 'If there's anything I can do...', but it is not always easy to ask for help, even when it is offered.

It can be useful to prepare a list of tasks that you’d like help with.

That way, if someone does offer to help, you can easily tell them how they could help.

At work

At work, you may need to ask your employer to make some changes – perhaps more flexible hours would help, or arranging a parking space closer to the entrance. Find out more about adjustments at work.

Professional support

A social care assessment (community care assessment in Scotland) might identify certain tasks that social services can help with.

Health and social care professionals might be able to help in all kinds of ways. An occupational therapist, for example, might suggest energy–saving gadgets at work or around the home. Or an MS nurse or psychologist might talk with you about cognitive behaviour therapy (CBT) or mindfulness training – approaches which some people find helpful when making changes to habits or routines.

Financial support

It's also worth checking if you are entitled to any benefits like Disability Living Allowance (or, in future Personal Independence Payment).

Self management programmes

In some parts of the country, MS specialists and other health care professionals run fatigue management programmes. They are sometimes done in group settings, sometimes individually, and might involve family members, friends and carers as well.

You may also find it helpful to attend a self-management course. These courses help people living with a long-term health condition maintain their health and improve their quality of life.