The Brain, The Brain… The Center of The Chain

I think it’s over here… or upstairs… or in the trunk… wait, did I donate that??

Lapses in memory or just general forgetfulness can happen to anyone and doesn’t have to be directly related to any one issue or associated with any diagnosis in particular. In the world of MS though, Cognition Issues, or what is sometimes referred to as Cog Fog can be a significant concern. Cognition and overall Brain Health is a complicated beast especially within the MS community. Here are some general info and tips about helping to improve cognition and overall brain function and how to build in a defense against the Cog Fog.

The Brain, The Brain…. The Center of the Chain (yes, that’s a Babysitters Club reference)

  • While many factors may impact Cognition some big ones to keep in mind are Nutrition, Sleep and Stress
  • Nurtirion
    • A healthy diet (while there is not an MS specific diet, read balanced diet here) can help support brain function and health. Giving the body important nutrients it needs to use in cell building and repair
    • Vitamin E, Omega-3 Fatty Acids and other anti-inflammatory foods have been found to impact brain function in a positive aspect
  • Sleep
    • Sleep can be hard to come by but getting proper rest may trigger your glymphatic system which essentially helps flush your central nervous system (in part your brain) of buildup and toxins
    • Sleep allows your body to heal and repair cells that can help you get a fresh start on the next day
  • Stress
    • Stress is a big one as it can trigger an increase in the activity of your sympathetic nervous system and cause inflammation which can lead to issues associated with not only your cognitive system but also your immune system
    • Decreasing stress levels (easier said than done I know) can aid your body in being in a good spot defensively for illness as well as loss of attention and focus

Now none of that may be new news to you, but it’s good to be reminded that Nutrition, Sleep and Stress all play a part in our overall health and especially as it relates to brain health. So, what can you do to combat or alleviate some of the problems brought on by Cog Fog. We’ve heard some great tips from clients that they use and wanted to share

  • Notes, notes and more notes: when you think of or hear important information write it down on a post-it and put them up in a spot in your home that you pass by very often such as a hallway, bathroom or near the front door
  • Calendars are your friend: A large wall calendar can be purchased or if you want to be creative, drawn/painted/sketched onto a wall and similar to the notes put appointments, important dates and other information into it so you have it on hand
  • You are getting very sleepy: There are a lot of theories on how much sleep you should get, generally speaking we hear that 8 hours is optimal. But in addition to this try working on a sleep cycle. Sleep cycles last approximately 90 mins and there are 5 stages that you go thru during that time. It takes on average someone 15 mins to fall asleep. So try and schedule your sleep to include not only the 90mins in each cycle but also the 15mins at the start (its an average, I know it may not work for everyone in exactly that amount of time) and set alarms to wake up at what would be the end of a sleep cycle. You’ll definitely feel the difference
  • Meal planning: Seems like the whole world is on a meal plan or diet kick these days. But meal planning can be helpful when you are not only trying to have healthy meals but also when you are attempting to be intentional about implementing things like Vitamin E and Omega 3 fatty acids. Mark out a plan for your weekly meals (yes you can deviate to occasionally allow for that cheeseburger or pizza) and be intentional about incorporating healthy aspects into your diet

There are lots of other great tips to include, these are just some that we wanted to share and hope are helpful to you. Definitely share with us some of your tips and takes on helping with Brain Health. We’d love to hear them!

To continue the conversation about MS relapses during MS Awareness Month, MSAA will be hosting a live Ask Me Anything” event with Rohit Bakshi, MD, today, March 19, 2018 from 6:00 – 7:00 pm Eastern on MSAA’s Facebook page. And throughout the week, MSAA will be hosting free in-person events across the country.  Find an education event near you by visiting our Calendar of Events page.


Relapse Management Ask Me Anything – A Recap

On Monday night, MSAA held its first Ask Me Anything session of MS Awareness Month 2018!  Focusing on the topic of Relapse Management, MS Expert Annette Okai, MD spent one hour answering more than 25 questions from our My MSAA Community members.

Some of the most popular questions from the AMA with Dr. Okai include:

  • “How do you differentiate relapse from progression or what I call symptoms creep?”
  • “Is there a disadvantage to waiting out the symptoms, and not initiating steroids?”
  • “How long does a relapse typically last?”

Find Dr. Okai’s answers to these questions and many more on the community at:


Relapse Management

By Stacie Prada

Managing MS relapses can mean different things to different people, and success varies immensely depending on how long you’ve had multiple sclerosis, the symptoms you experience, your level of physical ability, your disease course, and your expectations. When I think of managing relapses, I think of treating, avoiding and learning from them in order to slow disease progression and reduce the justifiable fear that comes each time one occurs.

  • We can treat relapses to try to shorten the duration.
  • We can try to avoid relapses with lifestyle and medication. This is an idealistic goal and may be possible, but it places a lot of blame or praise on the person with MS. It’s a pass-fail test that doesn’t necessarily correlate with how well a person manages their health.
  • We can learn from relapses each time we have one to better understand how our body works.
  • We can work to manage the fear that comes with relapses and disease progression. This part holds a lot of mystery and is sometimes the most difficult part.

When I was first diagnosed, I had no idea at any given moment if I was having a relapse or not. My scans made it clear I’d likely had MS for over a decade before diagnosis, and I’d had no idea I even had a health issue.  My symptoms were just my life, and I had no comparison.  It was scary and felt unpredictable.  I didn’t know if there was anything I could to do reduce them, if I was doing things that made it worse, or if at any moment I was in the midst of a relapse.

Managing relapses at that time meant figuring out when I was having one and trying to stop it once it started.  It took learning about MS symptoms and paying attention to how I felt.  I compared how I felt to my MRI scans and neurologist’s assessment in order to know whether or not I was having an MS exacerbation.  Steroid treatment was done to try to stop relapses. Because my biggest symptom was fatigue and I had no way to objectively measure it, I lived in a fairly constant state of fear and self-doubt.  What got me through was a belief that I would get through this phase and learn what I needed to know to live with MS. I didn’t know how, but I trusted it would happen eventually.

At six years past diagnosis, I experienced an MS milestone. I achieved a point of confidence where I felt like I could finally tell if I was having an exacerbation or not.  I knew how terrible I felt when I was having a relapse, and I knew how well I could feel when I wasn’t.  I’d learned my body enough to know which symptoms were normal for me.  I could distinguish between when the intensity and duration was likely due to existing damage from previous relapses and when it was likely new active MS activity.

I attribute this MS milestone to constant monitoring and self-assessment.  After a relapse, I would consider what helped and what was hard about it.   I’d speculate on what would have made it easier and how I can prepare for the next relapse. I’d think about how it felt, and I’d try to match up that feeling to my test results.  When I felt poorly but wasn’t having a relapse, I’d use that information to learn what is normal for me.  Knowing that helped me increase confidence and lessen my fears.

There’s so much to learn about MS, relapses and how your unique body behaves that has no prepared reference manual or shortcut around education and effort.  It’s a moving target since our bodies are aging and old damage can cause new symptoms. There is no one proven or best way to manage health to avoid relapses.  Monitoring your health, learning all you can, and trying things to see what works helps build self-confidence.  Understanding how MS affects a body in general and yours specifically helps reduce the fear of the unknown. Reducing fear can make every aspect of living with MS more bearable.

People with MS do not have complete control over whether or not they have a relapse.  If someday there is a determined cause, cure and 100% effective management regimen, then that might be possible.  Until then, the only ways I think relapses can be managed are to tackle them when they happen, to reflect on them after they happen to try to find any patterns or contributors that you might be able to control, incorporate what helps, avoid what doesn’t, and to try to make the fear manageable when they do happen.

*Stacie Prada was diagnosed with RRMS in 2008 at the age of 38.  Her blog, “Keep Doing What You’re Doing” is a compilation of inspiration, exploration, and practical tips for living with Multiple Sclerosis while living a full, productive, and healthy life with a positive perspective. It includes musings on things that help her adapt, cope and rejoice in this adventure on earth. Please visit her at 


The Confusing World of MS Relapses

MS relapses continue to be one of the most notorious conundrums within the MS space and community today, which is one reason why the MSAA has made MS Relapse Management one of the MS Awareness Month activities this March. Many individuals living with MS question their symptoms and if they relate to relapses or not on a daily basis, no matter how long they’ve been diagnosed, because this issue remains a head-scratcher to those affected. This occurs because MS relapses can be difficult to diagnose, they’re unique to each person (like many other factors with MS), and they can sometimes be pseudoexacerbations and different from a “true” relapse. Several issues can influence whether or not a true relapse is occurring, these include other illnesses or infection, heat, stress, fever, and exercise. So how do you determine what is a relapse vs. a pseudoexacerbation vs. something else? This is a question that concerns many from day to day.

For a relapse to be considered there has to be certain signs and evidence pointing to it without other factors involved like those mentioned above. Symptoms may present as a worsening or recurrence of existing symptoms and/or new symptoms and need to be present for at least 24-48 hours. This is hard for individuals to distinguish sometimes, especially if it’s a symptom they’ve had before but maybe not recently, if they’re not sure that it’s an actual symptom issue, or if it’s a symptom related to MS at all. Another question that comes up often is how long do relapse symptoms last? The length of time can vary from days to months, again making it hard to know the exact ins and outs of relapses and all they entail. These are the type of great, valid questions to ask the doctor when and if the opportunity presents itself because it’s something many face and are unsure about.

Talking to others living with MS can also help to validate some of these questions and concerns too, to gain feedback and perspective from those dealing with the same types of issues. My MSAA Community, MSAA’s online peer support forum where those affected by MS connect with their peers, is one platform that can be used for this outreach. Additional information about MS relapse management can also be found through the MSAA’s online MS Relapse Resource Center and MS Relapse Toolkit publication.

To continue the conversation about MS relapses during MS Awareness Month, MSAA will be hosting a live Ask Me Anything” event with Annette Okai, MD, today, March 12, 2018 from 6:00 – 7:00 pm Eastern on My MSAA Community. And on Tuesday, March 13, 2018 from 8:00 – 9:00 pm Eastern the MSAA will be hosting a free Live Webinar “Helpful Tools for MS Relapse Management”  featuring Elizabeth Crabtree-Hartman, MD. Be sure to join in!



MS Awareness

By Lauren Kovacs

Guess what? Awareness goes both ways.

Yet another thing that MS folks deal with is awareness. You have to be aware of your own limits and make others aware, too. Who doesn’t want people to see MS? Sadly, awareness has to be spoon fed to others. Little bits. The taste is bitter so, go slow.

If you overdo the information, glazed eyeballs are the result. Some choking may also happen. Strained MS information spit back at us is the last thing we need. Like feeding a baby strained peas, take it slow. Be patient. Little bites.

I see MS awareness as conjoined twins when it comes to others. I give others the scientific/medical side and I always couple it with a simple explanation. MS is not easy for anyone to understand. Analogies help when explaining a symptom to others.

Yes, there are times I lied and said it was from my college cheerleading days. I tell them it was a neck injury from falling off a pyramid. What? I was, in fact, a college cheerleader and I did fall off a pyramid. Not a total lie. Plus it is way more glamorous and interesting. The people I have told this to were usually repairmen that I will never see again.

Lying is wrong, I know. Everyone likes a bit of drama though. I now say it is MS and let them digest it and ask questions, if they want. Boring. Most people need time to digest MS information. Awareness is part of that digestion. Frustration at others not grasping or understanding it is the greased pig of MS.

Heat and fatigue plague most of us. I never keep that to myself. This is when you get to play detective too. If you think the person can take a bigger bite, share. If not, back off a bit. You have to kind of see what the person can handle.

Know your own limits too. We are all super heroes, but even super heroes have limits. The Flash can only run so fast, for example. Super heroes know their limits and have enough humility to know when to stop.

It has gotten easier, as my MS shows now. People know I can’t regulate my temperature.  The ice wraps and frozen drinks give it away. Maybe me looking like a wet dishrag was a clue. I make the drowned rat style look good.

Explaining neurological fatigue is not easy. We don’t really have chronic fatigue, but it is chronic. It never goes away and sleep doesn’t mean energy, ever. It helps that my sons and husband see when I begin to wilt. Around others I say it politely and do what I got to do. I exit the stage and if people boo and hiss, I let them. Take care of YOU. Self-awareness is important too.

Awareness is tough, but be aware that you are the one dealing with MS on a personal level. Fatigue and heat ruin YOUR fun. We are the ones who deal with what happens when we get too tired and/or hot.

Years ago, I once got too hot and lost vision in both eyes for about 30 minutes. My life stopped. Fear tore me apart. No one else knew and life didn’t stop for them. It was a very long 30 minutes for me.

We have roadblocks and we have to find a way around them. Even if people had known, would it have made my eyesight come back faster?  If I had avoided getting hot, my sight would have been fine. Learn to be on top of your own awareness.  Awareness goes both ways.


Finding a Support Network

A support network is somewhere that you can share feelings or vent frustrations – a place to be able to check in and touch base with others or make connections. Ultimately, it’s a system that is there for you without judgment or expectation that you can depend on. That’s what members have found on our platform, My MSAA Community. This online forum not only offers a safe place to ask questions and find information, it has also become a reliable “check-in” community for those involved.

Updates are often sent to one another, as members check in with the community to let everyone know about their medical appointments to get feedback and encouraging words.

“I know it can be overwhelming with all the different tests and doctors. Try to relax (I know, easier said than done). Good luck.”
– Community Member

Countless moments of kindness and empathy can often be found on the community, especially as members face some challenging issues such as depression. Community members often find themselves showered with support. Members also reach out to each other to ask how things are, to send well wishes when needed, and to offer encouragement to those having a difficult time. One member of the community shares, “just letting you know all our thoughts are with you today – keep smiling” to another member having an MRI done that day. In addition, the community’s Birthday Ambassador keeps track of birthdays and sends special messages on celebrating the occasion.

If you haven’t done so already, take some time to check out My MSAA Community and find a new support network today.


About MS – Newest MSAA Publication

MSAA is pleased to announce its latest booklet, About MS. In this second edition, MSAA provides a comprehensive introduction to the development and treatment of MS, along with a great deal of useful information that touches on many aspects of the disease.

The second edition of About MS includes:

  • An overview of the history, development, types, and potential causes of MS
  • Information on who gets MS, how MS is diagnosed, and how disease activity is evaluated
  • Descriptions for treatments for both relapses and long-term disease activity
  • And more!

Read an excerpt from About MS here:

Initially, most people with MS experience symptom flare-ups, which are also known as relapses, exacerbations, or attacks. When someone experiences a relapse, he or she may be having new symptoms or an increase in existing symptoms. These usually persist for a short period of time (from a few days to a few months) and afterward may remain symptom-free for periods of months or years. This type of MS is referred to as relapsing-remitting MS (RRMS). Approximately 80 to 85 percent of people with MS are initially diagnosed with this form of the disease.

Over time, RRMS may advance to secondary-progressive MS (SPMS). This form of MS does not have the dramatic variations in symptoms that RRMS does, but rather has a slow, steady progression – with or without relapses. If relapses do occur, they usually do not fully remit. Without treatment, approximately half of individuals with RRMS convert to SPMS within 10 years. However, with the introduction of long-term disease-modifying therapies (DMTs), fewer individuals advance to this latter form of the disease.

Individuals who are not initially diagnosed with RRMS may be experiencing a more steady progression of the disease from the onset. Approximately 10 percent of the MS population is diagnosed with primary-progressive MS (PPMS), where individuals experience a steady worsening of symptoms from the start, and do not have periodic relapses and remissions.

Continue reading this booklet at to learn more about multiple sclerosis history, diagnosis, treatments, and resources.


March 2018 Artist of the Month: Celebrating the Work of Artists Affected by Multiple Sclerosis

All-New Artists for MSAA’s 2018-2017 Art Showcase!

As a part of MS Awareness Month, MSAA is very proud to present our 2018-2019 Art Showcase, celebrating the work of artists affected by MS.

We have received many wonderful submissions from across the country and are delighted to share their work and their stories with you.

To view all of the new submissions, please visit our online galleries:

MSAA Ability Art Showcase 2018
MSAA Four Seasons Art Showcase 2018
Throughout the year, we will highlight one artist during each month by sharing their artwork and their story as a part of our Artist of the Month series.

MSAA’s March Artist of the Month

Paula Breiner - Love Me, Don't Break Me
Love Me, Don’t Break Me
Paula Breiner – Tamaqua, PA
About the Artist:
“I am an MS Warrior. I make the most of each day. I enjoy yoga and meditation.I live day to day with this disease and pray for a cure. I do a paint/craft day each month with the gang in our support group. It has given me such happiness at seeing all the wonderful finished projects and see the smiles, laughter, and the awesome mental therapy that we all supply each other with. My support group has become my second family and we are so much stronger as a group. We live, one day at a time.”
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