Symptom Characteristics And Management
Coming to Terms with the Symptoms
A lot of people feel uncomfortable talking to their doctors or specialists about something as personal as many of these symptoms are. That's only natural. But if that feeling of embarrassment or humiliation becomes so strong that it stands in the way of someone getting help, then it becomes a problem.
No one likes to admit to something that feels embarrassing. Remember that these health care professionals who specialize in treating particular symptoms have spent years studying the causes, effects and treatments. They have helped hundreds of people come to terms with these symptoms, and worked as their partners to help find treatment programs that worked. And it all started by someone walking in their door, and admitting they needed help. That first step feels like a giant leap, but like the saying goes, you can't move forward when you're standing still.
Bladder Dysfunction
Of course with all that said, the first symptom is probably one of the most uncomfortable for people to discuss: bladder and bowel dysfunction. (Nothing like jumping right into things.)
While these may be some of the least favorite symptoms to talk about, the good news is that they can generally be successfully treated.
Bowel and bladder problems tend to become more frequently seen as the disease progresses. Common bladder problems associated with MS include increases in frequency of elimination, urgency and a hesitancy to begin once the need is realized. Incontinence affects many people in Canada and is also thought to affect up to 80% of people with MS.
Through different medications and lifestyle modifications, the goal of urologists and related specialists is to create a treatment program that helps people go about their daily activities more confidently and comfortably with less anxiety. Dietary changes may include drinking less caffeine, alcohol, artificial sweeteners or citrus juices, all of which may increase frequency.
Today there are a number of medical devices available to help people who are dealing with these symptoms. There are also dozens of medications, hormones and herbal remedies being used to treat MS.
Because there are so many different treatment options, it is important to be as open and honest with the physician or specialist as possible, so that he or she can customize a treatment program specific to an individual's own personal needs.
Depression
It is natural, especially for people who have just been diagnosed, to go through stages of denial and grieving before acknowledging and finally accepting the disease. If it sounds familiar, that's because this is similar to the grieving process people go through when they lose a loved one. For some people, their initial reaction to the diagnosis seems so monumental, the parallels are all too real.
When people finally do acknowledge the disease and begin to take action against it, lots of times these feelings begin to fade once they start to see treatments beginning to work. In fact, many people are surprised when people with MS say that the disease awakened them to the important things in life. For them, they recognize how much they have learned about themselves and their world by confronting this disease and learning how to live a fulfilling life in spite of it. Their mantra is "MS is what I have, it's not who I am."
Some people, unfortunately, have a hard time ever seeing themselves in that place. People suffering through this depression brought on by MS may suffer from a loss of sleep, eating disorders, withdrawing from family and friends, feelings of low self-esteem and fears of feeling rejected.
Sometimes depression is not so much a symptom of MS as it is a side effect of certain treatments. In fact, the beta-interferon medications (Avonex®, Betaseron®, Rebif®) contain warnings regarding depression in their labeling. If you are diagnosed with depression, it’s prudent to advise both your family doctor and your MS clinic doctor that you are taking a beta-interferon.
The good news is that depression is a symptom with a number of successful treatment options. There are literally dozens of prescription medications and herbal supplements on the market today, but remember that these should be added only with a doctor's approval.
Individual and group counseling are also effective ways to help people come to terms with the disease, and remove any feelings of blame or low self-worth that are standing in the way of seeking treatment. This is a hard step for some people. But even the most hardened skeptics can benefit by first admitting that this is a bigger problem than they can deal with on their own, and that seeking advice from a person skilled in human behavior and thinking can mark an important turning point toward happiness.
Fatigue
The majority of patients with multiple sclerosis experience fatigue, making it one of the most frequently reported symptoms across the board in MS. Family and friends or coworkers who have never felt the difference between feeling tired or run down and actually feeling fatigued have a hard time comprehending that this symptom can sometimes be more disabling than the disease itself. Fatigue is sometimes described as a feeling similar to the exhaustion felt with flu-like illnesses. Fatigue and flu-like symptoms may be compounded by certain medications, such as interferon therapy, which have been shown to produce flu-like symptoms that include fatigue, fever and chills.
Fatigue can also be made worse from stress, a lack of sleep or exercise and especially by hot temperatures. In fact, many people with MS quickly learn how much heat they can take, and have learned to extend their time outside by drinking lots of fluids and taking advantage of new cooling devices or wearing light-weight clothes.
Medications that stimulate the central nervous system and those used to treat behavioral disorders may be used in conjunction with other non-medical forms of treatment, particularly exercise. Certain antidepressants may also be an effective form of therapy.
More than anything, fatigue may be most effectively controlled by knowing your body and responding to its needs. It's not uncommon to hear people who have experienced fatigue talk about the idea of conserving energy. Since fatigue can be worse in the later part of the day, many people have learned to cope by taking it easy during the day, so that they feel like their energy will last longer during the evening.
Sexual Issues
Sexual issues are highly common for both men and women living with MS. Still, this is usually the last thing people want to open up about to a health care professional. This can turn into an awkward issue for both parties. In recent years, an increased emphasis has been placed on helping health care professionals learn how to talk to their patients about this common yet delicate issue.
As more treatments became available to help enhance sexual interest, performance and satisfaction, more people are beginning to recognize that they were not alone in dealing with this issue, and realizing there is help. Some people also find it easier to talk to nurses about this subject, especially since a lot of people see nurses as having more time to talk to patients and listen to their concerns.
Whether it's a doctor, nurse, or especially with a partner, communication is key. But more importantly, so is a positive self image. That means doing something too many people don't let themselves do: feel good about who they are and how they look. That's easier said than done. But working toward it is the first step toward being at peace with ourselves and our bodies.
Spasticity
Muscles are put into motion by nervous impulses sent from the brain. These impulses act as messengers to the body. Once a signal has been received, a series of movements is carried out by one muscle flexing and another relaxing. When there is a problem with a nervous impulse as a result of demyelination caused by MS, both muscles may flex or relax at the same time, creating a pulling sensation or muscle stiffness known as spasticity. Because trying to get around when muscles are stiff takes a fair amount of energy, this can be an exhausting symptom.
Spasticity is often treated by physiotherapy and stretching exercises or practices. Physiotherapists and wellness instructors can help design a program that can be used either at home, in a group class or sometimes may require a PT's supervision in a rehabilitation center.
There are also antispasticity drugs that may be added to a treatment program under a doctor's supervision. In patients with severe spasticity, however, antispastic drugs are typically not effective in pill form and require more specialized care and methods of administration to be successful.
Vertigo, Imbalance, Incoordination
Everyone remembers what it was like to spin around in circles so fast when we were kids that we finally got dizzy and fell down. Usually this meant laughing, catching our breath, and wiping off the grass clippings before jumping up to do it all over again. Those days were a lot of fun - when we were four. When that same feeling hits someone as a symptom of multiple sclerosis, there's no fun and games about it. This spinning sensation is called vertigo.
Balance and coordination are common problems for persons living with MS. Most limb problems, specifically the legs, are a result of lack of coordination, called ataxia. Because of myelin damage, nerve signals from thecerebellum are interrupted, causing coordination problems. In extreme cases, individuals have great difficulty walking. This is known as gait ataxia.
With many people, these problems correspond directly with flare-ups. With others, it's an ongoing challenge that increases slowly over the course of the disease.
In MS, vertigo is thought to be the result of brainstem functions that control coordination between the eyes and ears, the centers of our sense of balance. Sometimes the sensation is so intense, it can be physically nauseating.
Doctors may prescribe antihistamines to help bring mild vertigo under control. Many of these medications are available over the counter. Other medications that actually help suppress the functions of the inner ear may be prescribed in more severe cases.
Vision
Although almost anyone can experience problems with their vision, it's especially common in people with MS.
Inflammation of the optic nerve, called optic neuritis, causes blurred vision, which can last from a few minutes to several hours. Most young people who develop optic neuritis are later diagnosed with MS.
The ability to distinguish color is diminished more so in people living with MS because of demyelination in the optic nerve. Even small amounts of demyelination can block the signal to the brain that identifies color.
Speech
Although not everyone experiences the same symptoms, speech problems are fairly common with MS.
Coordination of the tongue, lips and vocal cord can become difficult, along with a change in rhythm, or cadence. This is called dysarthria. When it becomes severe, speech is exaggerated, and spontaneity becomes a problem.
The part of the brain responsible for speech coordination is the cerebellum. Unfortunately, for people living with MS, the cerebellum is one of the areas more likely to be affected by demyelination. Speech therapy can sometimes help individuals to learn techniques to improve certain speech patterns.
Pain
Although pain is common in many diseases, it's more common in MS than once thought. Localized pain occurs in many people. Facial pain can be especially uncomfortable. Everyday tasks such as brushing the teeth, shaving, or even eating can become almost unbearable.
The other part of the body affected by localized pain is the eyes. Usually, this happens in people who have been diagnosed with optic neuritis. A thorough examination needs to be done to eliminate other possible problems such as glaucoma.
Whether pain is acute, chronic, or localized, you should always seek the advice of a healthcare professional. Treatments can be prescribed to help.
Weakness
Another symptom common among people living with MS is weakness. Anyone, no matter what shape they're in can develop weakness. Muscle weakness isn't because there is anything wrong with the muscle itself, rather the result of demyelination.
Because of demyelination, the signal responsible for muscle coordination is interrupted, affecting the ability of muscles to contract and relax. Without coordination and exercise, muscle bulk is lost. This is called disuse atrophy. With some people, weakness is experienced constantly, others only during an exacerbation, or flare-up.
Although weakness can occur in any part of the body, it's most common in the legs. In many cases, leg weakness makes walking very difficult, sometimes to the point of dragging a foot. When this happens, an ankle brace or cane may be useful. Exercise may also be helpful, but you should always seek professional advice on the type of exercise program or physical therapy that's best for your personal needs.