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 6423 msfocusmagazine.org This kind of intense fatigue can often make us think we are having a relapse. That is not always the case. I personally have found that I am often dehydrated or over- heated when this happens, and rehydrating, especially with very cold beverages (with chopped ice, or in a slushy consistency) is often immediately helpful. Likewise, if it has an overheating component, I will put on a cooling vest or collar and that can minimize the intensity of both the fatigue and mental fogginess, and it will allow me to continue what I am doing. What I have found to be helpful to combat fatigue: • Cueyoursignificantotherorafamilymember to intervene if they see you slipping into this intense fatigue. Remember that mental fog often accompanies fatigue and we may not recognize it in the moment. Another person’s observations can cue us to cool off, take a drink, or stop a task that is not essential. • Try rest, cooling, and hydration to manage fatigue. If that doesn’t help, ask your neurologist if there is a medication that would be effective in fighting your fatigue. • Remember, some symptom-management drugs can contribute to fatigue and mental fog, such as medications for spasticity, nerve pain, and bladder control. Current medicines to manage fatigue have the potential to mess with our sleep patterns which may lead you to ask your doctor for something to helpyou sleep. Beverycautious of falling into a vicious cycle of medications designed to keepyou awake and alert during the day and sleep at night. • When I was working full time, I took medication for fatigue only on days when a heavy load was scheduled at work. I did not take it on days when I was in the office or meetings most of the day. Also, I did not take it on my days off, as you can build up a tolerance to many of these medications, and overtime, theycan become less effective. • If you frequently have trouble making it through work, it may be time to disclose that you have MS and might need some energy conservation measures as accommodations. For me, some of those accommodations were grouping my patient load in a more densely populated area. This cut my driving time between patients, and my driving mileage went from 90 miles a day down to 10. It also meant working more in the office with A/C than in homes with none. • Posture is important! I honestly feel better when I force myself to sit upright. I breathe better and feel more alert. • Exercising, even when I am fatigued, is therapeutic. Getting the body moving and the mind active can greatly reduce the effect of fatigue for me. MSFocus:TheMultipleSclerosisFoundation helped me to turn my life around and take control of my MS with the MS Focus Cruise for a Cause®. The high quality of education there was eye-opening for me, and it empowered me to learn as much as I could about how to manage MS. That first cruise got me energized to give back. I found the Multiple Sclerosis Certified Nurse program and became one of these nurses in 2003. My world has expanded, health has improved, and life has greater meaning as this journey continues. I’m happyto share myexperiences, from both sides now, and hope these tips will be useful for you in managing your MS fatigue.