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50shadesofsun

News and Opinions about MS, Health & Disability

Fatigue makes it difficult to push on

I love writing. No surprise there, it has after all been a major part of my life. But, today, it’s not so easy because I have been hit by a bout of fatigue.

Fatigue is just one possible aspect of multiple sclerosis – but there are plenty of other causes too.

And for anyone fortunate enough not to be affected by fatigue, please don’t tell us to get a good night’s sleep. Be assured, that is not enough.

So, what is fatigue?

The medical information website healthline.com says:

Fatigue is a term used to describe an overall feeling of tiredness or lack of energy. It isn’t the same as simply feeling drowsy or sleepy. When you’re fatigued, you have no motivation and no energy. Being sleepy may be a symptom of fatigue, but it’s not the same thing.

Fatigue is a common symptom of many medical conditions, which range in severity from mild to serious. It’s also a natural result of some lifestyle choices, such as lack of exercise or poor diet.

If your fatigue doesn’t resolve with proper rest and nutrition, or you suspect it’s caused by an underlying physical or mental health condition, see your doctor. They can help diagnose the cause of your fatigue and work with you to treat it.

Why do we get fatigue?

Causes of fatigue can be described, in general terms, as your lifestyle, and your physical or mental health.

Healthline lists lifestyle factors as physical exertion, lack of physical activity, lack of sleep, being overweight or obese, periods of emotional stress, boredom, grief, taking certain medications such as antidepressants or sedatives, using alcohol on a regular basis, using street drugs such as cocaine, consuming too much caffeine, and not eating a nutritious diet.

We know that those of us with MS can get fatigue but there are other physical conditions that can also cause it. Healthline says these include, anemia, arthritis, bromyalgia, chronic fatigue syndrome, infections such as cold and flu, Addison’s disease – a disorder that can affect your hormone levels, hypothyroidism or underactive thyroid, sleep disorders such as insomnia, autoimmune disorders including MS, congestive heart failure, cancer, diabetes, kidney disease, liver disease, chronic obstructive pulmonary disease, and emphysema.

As for mental health conditions, fatigue is a symptom of anxiety, depression, and seasonal affective disorder.

In my case, I’ll blame the MS but today the level of fatigue has been made worse by trying to do too much, too quickly.  Right now, I feel totally worn out and am having trouble keeping my eyes open.

Goodnight.

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Affiliate disclaimer: This affiliate disclosure details the affiliate relationships of MS, Health & Disability at 50shadesofsun.com with other companies and products. Read more.

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50shadesofsun.com is the personal website of Ian Franks, a freelance medical writer and editor for various health information sites. He enjoyed a successful career as a journalist, from reporter to editor in the print media. He gained a Journalist of the Year award in his native UK. Ian received a diagnosis of MS in 2002 and now lives in the south of Spain. He uses a wheelchair and advocates on mobility and accessibility issues.

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Note: Health-related information available on 50shadesofsun website is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. I am not a doctor and cannot and do not give you medical advice. You should seek prompt medical care for any specific health issues and consult a doctor before starting a new diet or exercise programme. Any opinions expressed are purely my own unless otherwise stated.

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Handling sleep and rest with MS

Sleep, rest, tiredness, and fatigue. How many times have we heard those talked about in the same breath as multiple sclerosis? So often that they are getting somewhat repetitive and tiring, or should that be tiresome? If I dare say that!

Rest is very important, getting at least eight hours’ sleep at night is just what the doctor orders, a good night’s sleep will help to fend off fatigue. You must have heard all that before. And, before you think I am going to dismiss that, I’m not.

sleepHowever, for me, the idea of going to bed at what most would call a sensible time is out of the question on most nights. I am a night owl, not an early bird. Lisa and I usually go to bed at about 3am. It suits me because unless my body says otherwise, as it does sometimes, this is when it is ready to switch to sleep mode. Going to bed any earlier usually results in a lot of tossing and turning and very little sleep.

Not that turning in so late 1eads to ‘burning the candle at both ends’, because it doesn’t. I tend to wake up about seven hours later and so make my start to the day at about 10.30, now that is a civilized time.

Ten years without going out to work has helped the adoption of such ‘time-shifted’ hours and, now that I am writing for Multiple Sclerosis News Today, it works really well. As the company is based in Texas, when it is 5pm there, my local time is already Midnight.

What’s more, I need to be able to talk to people around the world, so a more flexible timetable is very useful.

Do I get tired earlier than 3am? Yes, naturally, sometimes I do. Then I go to bed earlier. And if a daytime nap is needed, my armchair also happens to be a very comfortable recliner.

Of course, like many people with MS, I am not excused from fatigue. It really can hit hard sometimes, like a train, and has kept me off my feet for much longer than simple tiredness. Actually, one thing that Lisa has just pointed out is that, since moving to the better weather we enjoy in Spain, the dreaded fatigue has only made a very rare appearance. But whether or not that is any way connected to the increase in sunshine and, consequently, vitamin D, I have absolutely no idea.

 

new strap

 

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Danger of ‘silent’ heart attacks is lack of recognition

Ultrasound scan, file picture.

Ultrasound scan, file picture.

There is no doubt that heart disease is a killer. In fact, according to the World Health Organization, it is the biggest killer – and is responsible for nearly half the deaths (48.6%) of all the 10 leading causes.

Some years ago I had a heart attack although there were no obvious signs at the time. It was diagnosed later as a silent attack – the type that people suffer and do not realise they have had.

This week I learned that, as a result of new research, experts now say that 45% of people who have heart attacks suffered the ‘silent’ variety, where patients believe they have strained a muscle or have indigestion. Sometimes these may be associated with unexplained fatigue and discomfort in the jaw, upper back or arms.

Silent heart attacks can cause just as much damage as heart attacks which are instantly recognised. But as silent attacks do not come with the usual symptoms of chest or arm pain, patients do not recognise the danger and tend not to seek treatment which can help prevent another.

The research, published in the American Heart Association journal Circulation, looked at the records of 9,500 middle-aged men and women between 1987 and 2013. Nine years into the study 7.4% of the volunteers had had heart attacks; 317 were silent, while 386 noticed symptoms immediately.

Lead researcher, Dr Elsayed Soliman of the Wake Forest Baptist Medical centre, North Carolina, found the silent attacks are more common in men, but are more dangerous for women who are more likely to die from this type of attack.

Patients who have suffered a silent heart attack should be treated as if they had suffered the usual symptoms, according to Dr Soliman.

As a silent heart attack happens without the usual symptoms, such as chest pain and overwhelming anxiety, shortness of breath may be the only warning sign. But even that is not a great indicator when, like me, you already have multiple sclerosis which includes bouts of fatigue and breathlessness.

However, in 2010 even greater fatigue than usual and more frequent shortness of breath did convince me to see my GP. He diagnosed atrial fibrillation (irregular heartbeat) and referred me to a cardiologist.

There, two ultrasound scans quickly followed. At first, they thought there was a clot in the heart but doubts about that were raised by the second ultrasound – so an MRI was requested. This showed conclusively that the supposed clot was, in fact, a scar from a previous silent heart attack.

The usual ‘go to’ steps for anyone with a heart condition didn’t really apply in my case: having never smoked, being on the heavier side of ‘acceptable’ and cholesterol and blood pressure both testing as normal. Taking more exercise, however, was severely hampered by mobility problems caused by MS.

Today, even though my heart attack was silent and unknown by me, heart-related medications outnumber those taken for anything else.

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MS and fatigue linked with sleep apnea

sleep apnea

At the end of last month, this blog focused on the problem of restless legs syndrome, including the knock-on effects of disturbed sleep and increased fatigue for those living with multiple sclerosis. Of course, sleep problems and fatigue are often parts of life that those of us with MS have to deal with on an ongoing basis

Now a study1 by Pennsylvania State University says that obstructive sleep apnea (OSA) is prevalent in people with MS and goes on to suggest that it may be a contributor to the fatigue that is one of the most common and debilitating symptoms of the disease.

The study found that one-fifth of the MS patients surveyed had OSA and discovered, through screenings, that more than half were at an increased risk of it.

Dr. Tiffany Braley

Dr Tiffany J Braley (pictured, left), assistant professor of Neurology at the University of Michigan Multiple Sclerosis and Sleep Disorders Centers, was the study’s lead author and principal investigator. She said: “OSA may be a highly prevalent and yet under-recognized contributor to fatigue in persons with MS. Our study suggests that clinicians should have a low threshold to evaluate MS patients for underlying sleep disturbances.”

Fatigue is a common symptom of MS and many of us tend to ignore sleep problems. However, we need to get ourselves checked as, if we have OSA, it can often be easily and effectively treated with continuous positive airway pressure (CPAP).

Anyone who has been diagnosed with MS should really consider discussing the possibility of OSA with their doctor. And that includes people who suffer from fatigue but usually don’t snore at night. Why? Well, although snoring is thought to be the most identifying symptom of OSA, experts say that is not always the case.

Dr. Murray Grossan, an ear, nose and throat specialist in Los Angeles, explains: “Patients with MS, as well as those without the disease, may have OSA without snoring. That’s why it’s important to discuss the possibility of having OSA with your doctor whenever you begin experiencing fatigue.”

If a doctor suspects a patient has OSA, he or she may be given the opportunity to take part in a sleep study to monitor breathing, oxygen levels and other functions that help diagnose OSA and check the severity of the disorder.

 

1Sleep apnea may contribute to fatigue in multiple sclerosis: Study

If you need further information about sleep apnea, click this link:  http://doyouhavesleepapnea.com/

 

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Taking the rough with the smooth

In my wheelchair on a better day.

In my wheelchair on a better day.

As everyone affected by multiple sclerosis knows, whether living with it personally or because someone close to you has it, there will be good and bad times. Some may be limited to a day; others can be much longer.

Since forsaking the cloudy skies and rain of Britain for the sunnier and drier climes of the south of Spain, albeit that it is winter here too, I have noticed significant improvements.  I have been enjoying a prolonged good spell with a drastic reduction in both the number of falls and of the amount of time seriously affected by fatigue.

Two days ago, however, it was the start of a bad time. It started with, of all things, a stomach ache but that in no way warned me of what was to come.

After watching me fall asleep in my armchair in the middle of the afternoon and then seeing me fall on the way to the bathroom, my wife Lisa decided it was time for me to go to bed and there were no protests from me. The pain was still there and fatigue had set in. And I don’t mean tiredness; fatigue is so much more than being tired.

I did try and get up later but only as far as my electric wheelchair and, even then, I soon returned to bed.

Yesterday morning, I awoke to discover my stomach ache had gone but, instead, it felt as though there was a tight band around my body – widely known as the ‘MS hug’. I spent awhile on my computer until, trying to get around indoors led to two more falls, resulting in Lisa insisting that I return to bed. Once there, I was soon oblivious to the world.

Today, Thursday, I have only got out of bed to visit the bathroom which, so far, I have managed without falling. My legs seem to be becoming mine again. I am sitting up in bed while writing this. I think that the worst of the fatigue is behind me.

Maybe, just maybe, I’ll try and get out of bed again this afternoon. If I can make it from bed to armchair – on my feet without falling, that would be a major improvement. Not much to ask, is it? Just ask the uninvited guest in my life; ask my ‘friend’, multiple sclerosis.

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MS: Symptoms vary and can be hidden from view

ms means_edited ms montage

Recently, I have been asked to explain what MS is – but that is really impossible apart from saying it is a neurological illness. I could talk about loss of parts of the myelin sheath but there are others far better qualified to do that. Let me be clear, I only know about MS because I have it; I live with it every day.

Multiple Sclerosis can be a cruel illness. It affects different people in different ways, no two people have exactly the same symptoms and just because you may know someone with MS, please don´t think you can know how another person is affected.

First of all, there are different types of MS – Relapsing Remitting, Primary Progressive and Secondary Progressive – then there are the many and varied parts of the body that can be affected and also the severity of the symptoms that someone with MS can experience.

ms strongAt the most serious end of the scale, I have met people who need carers to lift them in and out of bed and to take care of their personal needs and others who show no outward physical sign of the illness. They are the ones for whom MS is described as an invisible illness. They might, however, be affected by fatigue, incontinence or other symptoms that can be hidden for the most part.

There are also people with MS who experience cognitive problems and may need help both understanding and communicating.

I consider myself very fortunate indeed. Ok, so not very fortunate to have MS at all but very lucky to only be affected in relatively small ways. My two biggest problems are that I cannot walk more than 10-15 yards without needing to rest or sit down, nor can I stand for more than two minutes or so before sitting on the nearest available step, ledge or whatever. Wheelchairs are used when the need to walk or stand would be beyond my capabilities.

MS generally affects my left side, particularly my left leg, so that I can now only drive an automatic car as my left foot cannot operate a clutch pedal, and my left arm cannot be raised very high at all.

My brain, speech, hearing and sight seem, thankfully, to be unaffected and this blog helps keep me alert and mentally active. Yes, I sometimes can get fatigued if I overdo things – and by that I don’t mean tired but really fatigued – but I am so lucky to not be in constant pain like so many others are.

Yes, I can fall over easily; yes, it frustrates me; yes, I can get annoyed and event upset BUT I can also see the funny side. I often joke about the floor and I being good friends, I can see the funny side and cannot get up until I stop laughing.

ms not aloneIt’s good to laugh and to smile, it is good to be happy whatever life brings and that really is what is behind my positive outlook. There are all sorts of things I have done in my life that I can never do again but at least I have done them and don’t regret not having done so. Now, I look at what I can do and live my life to the full – or the fullest I can.

The past is for remembering the good times while forgetting the bad; the present is for doing what can be done; and the future is for anticipation and expectation, not for regret.

Is there anything else that I need? Yes, and I have it – the love and care of the one and only love of my life, my darling sweetheart, my beloved wife, Lisa.

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