Chat Transcripts

Good evening, we will begin in just a few minutes.

Good evening, thanks for joining us...we will begin in just a few minutes.

yes, please

Good evening everyone, and welcome to our chat this evening. Our topic this evening is Getting Through the Day: Conserving Energy and Managing Fatigue. We invite you to share the challenges you are coping with as you ask questions of our special guest, Dr. Jennie Lou.

This evening's chat is moderated. To ensure that we do not have duplication, questions you send are reviewed by a moderator, then forwarded to Dr. Lou. For this reason, there may be slight delays between questions. Thank you for your patience!

Hi Dr Lou. Short term memory is bad. Is ther anything I can do for that?

Short term memory deficits is very common in people with MS. While there is no "magical drug" right now to improve the short term memory, there are strategies we can implement to improve our daily life.

Hi...anyone there?

For those who are joining us late, this evening's chat is moderated. There may be slight delays between questions. To view previous questions, click the "View Transcript" button at the top of this window. (It looks like a feather pen in a bottle of ink.)

what are some examples

for examples: make a short to do list, use devices to remind you of things while you are cooking, ask your family members or friends to remind you what you are suppose to do, etc

Hi Dr Lou. I have a very busy life and everyone tells me that my memory lapses are from trying to do too much. I don't think that is true. Are there tests to show what the cause of memory problems is?

Your memory could be affected diversely if you are overwhelmed or stress, that is true for everyone

I seem to run from am to pm and accomplish very little, stay exhausted, and can't figure out how to get off the merry go round and have a realistic schedule. Thank you

I would like to recommend some strategies and you may try the ones that are feasible for you to see if they work

Wow! Everyone brought their questions ready tonight. That's great. While we give Dr. Lou some time to answer, let me remind you to feel free to ask follow up questions, and at the end of this evening's question & answer session, I will give out some links to articles Dr. Lou has written on these subjects that are available here on the MSF website.

#1. Take care of yourself. make compromises. Do the things that are improtant to you and your family and try to eliminate unnecessary or difficult tasks.

#2. Be sensible about how you spedn your tiem and energy. Give yourself permission to rest. Put your feet up when possible and remove the word "SHOULD" from your vacabulary.
Kate: I like that one!

#3. pace your activites and rest before you becom exhausted - very important to do so!

#4 try to break dow a given activity into a series of smaller tasks or, if need be, seek for help from others.

#5 Prioritize, eliminate, consolidate, and streamline actities in all aspects of your life.

#6 use technology such as cordless phones, speakerphones, or wireless intercom to save time and evergy. For example, computers can be used to keeping records, etc

Could you explain how some of the medications for fatigue work, and do you have a preference? I am a stay-at-home mom with a one-year-old and three-year-old so it's difficult to slow down and take breaks during the day.

#7 arrange your office and home for your convenience. Sometiems this means placing furniture in strategic locations to help you wlak from room to rorom or placing a chair halfway down a long hallway so you can stop to rest. Sometimes, it means buying duplicate cleaning supplies for the upstairs rooms and the downstairs rooms.

#8 use adaptive device (such as reachers) to save your energy so you can do more important things.

A reminder for those of you joining us late, feel free to submit your questions. You can view the questions and answers that have already been posted by clicking the "View Transcript" button at the top of this window. (Looks like a feather pen and ink bottle)

These are some general tips for energy conservation, I am sure you can develop more practical strategies as you pay attention to your daily activities. Maybe you can share with others.

Thank you, those are great tips

Dr. Lou - Do you recomend a specific drug for managing fatigue?

Fatigue management requires a multidisciplinary approach.

There are many factors that may contribute to fatigue severity. These include mood, level of physical activity, pain, medicication, and sleep.

I personsally don't have preference for any particular medication. Each one may work differently in different individual. I advocate for a holistic approach in fatigue management which include graded exercise, using or rehabilitative services, behaviroal modification therapy, and medication.

A reminder -- This evening's chat is moderated. To ensure that we do not have duplication, questions you send are reviewed by a moderator, then forwarded to Dr. Lou. For this reason, there may be slight delays between questions. But keep those questions coming!

Thankfully, Dr. Lou is a pretty fast typist! :-)

what about temp?

A unique feature of MS fatigue is that it is markedly affected y temperature. For more than 90% of individual swith MS, heat dramatically worsens their fatigues, whereas cool temperature brigns relief.

Thx Dr Lou. What is graded exercise?

A graded exercise program is designed (usually by your therapist) for you according to your physical status.

For those who are joining us late, we are pleased to be chatting with Dr. Jennie Lou this evening. To view previous questions, click the "View Transcript" button at the top of this window. (It looks like a feather pen in a bottle of ink.)

How big a role does nutrition play in managing fatigue?

proper nutrition helps to maintain health and boost energy in all individuals. There are some recent studies on how on low fat diet can help MS symptoms management

What is the best water temp to shower in? Heat really gets me bad. thx!

I would like to see more studies on how proper nutrition can help with MS people before we officially recommend any specific diet.

sorry, clicked on question

clicked on the wrong question.

I see a few more people have just joined us. Welcome! To view previous questions, click the "View Transcript" button at the top of this window. (It looks like a feather pen in a bottle of ink.) You will notice slight delays between questions, due to the process of moderating the questions.

Can drinking lots of water help with fatigue?

For the question regarding water temp to shower in: I suggest you use the coolest temp you are comfortable with, or gradually lower your water temp during the shower.

how does behavorial modification therapy work?

This one need more time to explain and give examples. I would like to answer this question on the website or MSFocus, is that a good idea?

Yes, that would be very helpful, thank you

I agree. Great idea!

When I am very 'into' an activity, my heart can start pounding. If I don't stop and rest, it just gets worse. Is that ms?

You need get your heart checked out first.

My appetite has been off for some time & I wonder how much of the extraordinatry fatigue I have is directly related to a decreased caloric intake.

Your overall low caloric intake could certainly affect your engery level. However, improper dietary intake due to poor appetite can lead to elegtrolyte imbalance, which will result in severe fatigue. I suggest you seek advice from a nutritionist to guide you through this difficult time so you can have proper nutrition. In the mean time, you may want to talk to your doctor about this problem, he/she may be able to adjust some medications that might be the cause of your poor appetite.

Does coffee and tea help or hurt with fatigue? THx...

In general, coffee and tea help with fatigue management; but each individual's reaction may be very different.

Great questions tonight, everyone! You can keep them coming for about eight - ten more minutes.

It happens when I am excited - like when I play my violin.
Jennie Lou, MD, MSc: Answer: You mean fatigue? Yes, that is common. You hormonal levels change when you are excited.

how can i see the transcript? when I click on the ink bottle nothing happens.

Is anyone else having that problem?

Anne, in any case, when you sign off tonight, it should offer to email you a transcript. If not, you can email me at admin@msfocus.org to receive one.

No, but I do see better when II click on the up arrow on this screen.

for those of us suffering from MS fatigue, should we expect to always deal with it, or as our MS changes, could it go away on it's own, like ON might?

many individuals report that fatigue is an inital manifestiation of their MS, and repapses are oftern associted with increased fatigue. Generally speaking, fatigue is more common in individual whose disease coruse is progressive; however, there is only a weak associatin between fatigue and neurologic impairment as measured by the MRI.

Yes that does work for a viewing everything that was said while you were in the room.

Thank you. I might drop Provigil from my drug list. My PCP thought that might be causing a drop in appetite. But I am taking the Provigil to help with the fatigue!

Besides the factors we discussed tonight, fatigue in MS is exacerbated by a varity of other factors, including poor sleep, pain, psycholigcal stressor, insuffcient exercise, and side effects of medications.

Thnx Dr Lou!

Can my regular doctor do that? What is involved?

yes, go to your family physician first and she/he will know what to do next

Here are the addresses I mentioned to Dr. Lou's articles on our website. Energy Conservation and Work Simplification --

http://www.msfocus.org /publications/
pub_articles_energy.html Cognitive Deficits in MS --

http://www.msfocus.org
/publications/pub_articles_cognitive.html

Well, that ends our Q&A session this evening. I will now open the room for chat among our participants. But first, I'd like to thank you all for joining us, and a special thanks to Dr. Lou for her time and information this evening!

I hope you will all join us for the rest of our webchat series in honor of National MS Education & Awareness Month!

I am extremely greatful that you have chosen to make this career choice. The field of Neuro is like the ocean, and so much is to be learned and experience. I am amire those dedicated young women who rise to the challenge, because this is not mearly a career. It is a life-time of benevolent dedication for the betterment of us all. God Bless! Darlene

Thank you

I had SSEP and EMG and the tech had to elevate the current to 40-60hz in order to get my toe and thumb to hold a pattern. She was concerned about it hurting me. Is 40-60 HZ high? I have been feeling sore burning muscles since and also an area on my spine

it was my pleasure! If you have any unanswered questions, you may send them to me.

Questions to Dr. Lou can be posted on our Ask the Doctor forum. Anyone need instructions to get there?

I think we are having a problem with the open chat feature thise evening. It doesn't seem that we can see each other's messages. I'm going to go ahead and close the room now, and I will work on this technical glitch for next time. Thanks again, everyone for joining us!