Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 6422 msfocusmagazine.org Symptom Management Both Sides Now: A Nurse’s Guide To Managing Fatigue as an MS Patient By Cherie C. Binns, RN, BS, MSCN “Something’s lost, but something’s gained in living every day.”–Joni Mitchell, 1967, “Both Sides Now” I have multiple sclerosis and I am a MS- certified nurse. This puts me in a unique position to be able to share my experiences from both sides of an MS diagnosis. In fact, it was my diagnosis that led me to make the decision to use my nurse training to help others with MS. Acouple ofyears afterI received mynursing degree, I was working in an inner city clinic in Houston. I worked 60 hours a week, often with no air conditioning. I was also a musician on theworship team of ourchurch, so manyhours were taken up with rehearsal and leading worship. Out of nowhere, I had a major health event that left me essentially bedridden for about three months. Looking back, I now believe it was the first manifestation of my MS. I recovered, more or less completely, from that incident. But during the next 19 years, I had similar unexplained episodes: left eye pain and dimmed vision; falls and balance problems; incredible fatigue; heat sensitivity and more. My symptoms would last forweeks or even months at a time. Finally, in 1994, I sought help from my ophthalmologist. It looked like I had optic neuritis, so he sent me totheBrighamandWomen'sHospitalinBoston, where I was finally diagnosed with MS. My diagnosis came just months after the first disease-modifying therapy became available. Because it appeared that I had been living with MS for nearly two decades and was still walking unaided, it was assumed that I had a more benign form of the condition and did not need a DMT. I have since learned that was not the case and disease-modifying therapy is a must! Fatigue was the main symptom that dogged me for the next few years, but no available medications seemed to alleviate it much. In fact, the medications interfered with my sleep, which only added to the fatigue. We all know what it is like to take on an intense project around the house and be so exhausted that you fall into bed and sleep soundly. MS fatigue is nothing like that! It can hit suddenly and is more intense than any- thing I have ever experienced as a result of hard work or long hours. Worst of all, it is often not relieved by resting. I tell my husband that the “starch has gone out of my spine” when it becomes hard to hold myself upright. Or I will say the fatigue is “knuckle dragging” – so intense it is hard to stay standing or even move. MS fatigue, especially when piled atop normal fatigue, can be extremely disabling. For me, intense fatigue often comes with mental fogginess and difficulty finding words. My balance becomes shaky, and my vision is no longer crisp or bright. The bladder doesn’t empty as easily or fully as it normally does. I often wake during the night with hip pain telling me that spasticity is once again a problem.