Metamorphosis: Coping With Change

Posted on August 22, 2016 by MSAA

By Meagan Freeman

All things are temporary, including darkness.

Butterflies are a wonderful example of this. Look at these incredibly beautiful creatures, fluttering and dancing on flowers like living magical fairies from some other world.

These are some of the most graceful, elegant creatures on Earth, but they did not start out this way, did they? These creatures began as rather ugly caterpillars and worms. They become beautiful after a long period of change.

This period of change is spent alone, in darkness, with no input from the outside world. They depend on no one during this time, only themselves. This metamorphosis, or period of transformation, is one of the most miraculous biological phenomena on our planet.

These creatures completely transform every aspect of their lives, and they do it alone. Lessons of our own can be learned just by observing these creatures. Our period of darkness and transformation begins with our diagnosis of MS. Most of us experience a long period of darkness and crisis from that moment on, lasting for months, or even years. Beginning at the moment of diagnosis, we must completely change our self image. This is a difficult process, and no one can really help us through it. We must resolve this new identity within our own minds, and it takes time.

I often refer to my own years following diagnosis as my “metamorphosis.” I changed entirely, and I am not the same person I was before August 24, 2009. Change is difficult, painful, and uncomfortable. Change is awkward, frightening, and exhausting. But, change is an essential part of life. All is temporary, every single thing in this world. This helps me get through the tough times, because I am reminded that the darkness will not last forever. All is temporary.

The transition from “healthy” to “MS patient” is not immediate, and we should allow ourselves time to adjust to this new identity. After all, we spent decades of our lives as healthy people before we obtained this new label. How can we adjust to this overnight? The diagnosis of MS is made on one specific day, and it is shocking.

After time, I learned to accept this diagnosis, though it still makes me angry, frustrated, and sad at times. The first year after diagnosis was the most difficult, when the mind struggles to accept. Slowly, though…I began to realize that this was reality. This was part of me, whether I liked it or not. What else was there to do other than accept it? I learned to predict my symptoms more efficiently, to understand which symptoms were familiar and which were new.

We each spend a period of time transitioning, accepting, and changing after diagnosis. The most important thing to realize is that it takes time. The way you feel after initial diagnosis: The shock, the anger, the fear…won’t last forever. Your life will go on, and it may even be wonderful. MS does not mean that life is over, rather it means that life has changed. Change is never easy, but it can often lead to great things. Try not to fear the metamorphosis, because you never know how beautiful your life might end up being in the end….

*Meagan Freeman was diagnosed with RRMS in 2009, at the age of 34, in the midst of her graduate education. She is a Family Nurse Practitioner in Northern California, and is raising her 6 children (ranging from 6–17 years of age) with her husband, Wayne. She has been involved in healthcare since the age of 19, working as an Emergency Medical Technician, an Emergency Room RN, and now a Nurse Practitioner. Writing has always been her passion, and she is now able to spend more time blogging and raising MS awareness. She guest blogs for Race to Erase MS, Modern Day MS, and now MSAA. Please visit her at: http://www.motherhoodandmultiplesclerosis.com.

Maintaining a Social Life Despite MS

Posted on June 10, 2016 by MSAA

By Meagan Freeman

Sometimes, I avoid social contact because I fear that I might need a helping hand from my friends due to my MS issues, whether that might be a simple door being held open, or help with bags. This need for assistance keeps me from interacting at times, and I realize that I may not be alone in my feelings. This fear of dependence might keep us from enjoying our friends and family, and this is not something we should ever allow. I detest feeling dependent on others, especially my close friends and family. In fact, one of the first thoughts I had after my MS diagnosis was: “I refuse to be someone’s burden!”

There are little things that happen each day, my inability to open a jar, my inability to drive at night, my fatigue in the afternoons. Then, there are larger issues such as my ability to earn a living the way I used to, the missed children’s football and soccer games due to heat and flares, and the emotional impact this is having on my husband and children. How do you cope with this loss of independence? It is almost inevitable that this diagnosis goes hand in hand with increased dependence on others.

The MS patients I have met in the last few years are just like me. Have you noticed that? Most of us are very strong, stubborn, independent individuals who feel just as I do. I find myself feeling guilty every time I have to ask for help. Apparently, this is my life lesson, my challenge, my big obstacle to overcome.

As I examine my motivations and feelings more closely, I realize that a lot of these feelings are purely my ego. I gain self-esteem from being independent, and I always have. I have had a constant little voice in my mind throughout my life asking “would I be okay if I lost everyone I know?” My answer was always a resounding: YES! However, now I realize that this was not a healthy mindset. Now, I have much to lose.

In the past, I mistakenly saw my lack of dependence as strength. I thought that because I had nothing to lose, I was untouchable emotionally. No one could ever hurt me if I did not care that much. I needed nothing from anyone, and I liked it that way. Boy, was I wrong.

We need to feel supported by others. It is a basic human need.

The question then, is: How do we do this? How do we accept our small (or large) losses of independence? My answer is that our loss may actually be our gain.

When we ask for help we:

1. Show that we are trusting of another human being.
2. Show that we are in need at the moment, but not forever.
3. Develop a bond with another human being.
4. Form the foundation of a long, connected relationship.
5. Create an opportunity to help someone else in the near future.

How great would that feel? To know without a doubt that your friend/spouse/caregiver/family member will always be there for you, no matter what? This is what I gain when when I lose. I may need a hand opening my next jar, but I have a lifelong bond with my spouse that is strengthened each time I need a hand.

Do not mistake needing help for weakness, or independence for strength. Strength comes from building a strong relationship with those closest to you. This is where our true strength lies. Socializing is an important part of our lives, and MS should never stand in the way of enjoying activities with those we love.

Coping With the Diagnosis of Multiple Sclerosis

Posted on May 16, 2016 by MSAA

By Meagan Freeman

Hypervigilance: “Abnormally increased responsiveness to stimuli, and scanning of the environment for threats.” (The Free Dictionary, 2014.)

The longer I live with the diagnosis of MS, the more convinced I become that the most difficult and life-altering consequence of this disease is my constant awareness of its existence. I have relapsing-remitting MS, and the very essence of my disease involves periods of relapse, with severe symptoms that affect my entire world, followed inexplicably by periods of near remission.

This is something we slowly learn to live with, this uncertainty, but it never becomes normal. It is almost like being robbed of our innocence, our ability to feel at ease is taken forever. Even in periods of relative remission, we are followed by a dark cloud of uncertainty.

This state of alertness is designed to protect us from threats and danger, and it serves a much-needed purpose in those situations. When we are in an acutely dangerous environment, we must have the ability to respond. Our heart rates increase, our respiratory rate increases, our blood pressure rises, and our pupils dilate to allow us to respond to the impending destructive force headed our way.

What happens when we are in this state of alertness and vigilance for an extended period of time? In the case of multiple sclerosis, we are in this state for the rest of our lives.. Never again (without an absolute cure) will we feel utterly at ease.

Extended periods of hypervigilance will eventually lead to secondary problems. The main issues become anxiety, insomnia, fatigue, and social withdrawal/seclusion. Many MS patients begin to withdraw from normal social circles, becoming so overly-focused on the disease in exchange for formally enjoyable activities. This experience can be even more devastating than the physical symptoms.

In my own life, I found that I would wake up in that early morning haze, just barely conscious from my sleep, feeling peaceful from my last dream, and immediately upon opening my eyes it was as if a voice would scream into my ear: “YOU HAVE MS!!!!!”

I would feel my heart start to race, I would sit upright, and the crushing blow of diagnosis would sink in yet again. This experience repeated itself daily for the first couple of years post diagnosis. It was very hard for me to communicate this experience to anyone I knew. I had no close friends with MS, and I did not believe my family would understand.

Soon, I became obsessed with scanning my sensory experiences, looking for a new symptom. Each day, there was something new. A new buzzing sensation, a new numb area, a new area of skin that felt “sunburned” and painful, and several times, new onset of blurry and dim vision. I have lost much of my vision in the last 5 years. I went from having 20/20 vision 5 years ago, to 200/100 today due to repeated bouts with optic neuritis.

When we live with daily fear of new deficits, we change. That feeling of “what new symptom will I wake up with tomorrow?” How do you live your life? How do you plan your work? Your children’s activities? Your driving? Many of us like to carry on like brave soldiers, but in the end it is sometimes better to plan for the worst and be happy if it isn’t that bad after all.

Here is the good news: You can learn to manage this issue. If you find yourself staying home rather than enjoying your normal activities, losing sleep worrying about MS, feeling tremendous anxiety, or any other life-altering symptom, get help. Sometimes it is as simple as finding the right support group. Sometimes, individual or group counseling is helpful. The point is, don’t just suffer alone needlessly. And most importantly: Don’t feel like you are “crazy.” You aren’t!

Sometimes, I just want to hear reality, don’t you? I want to hear that I am not insane, that this experience is real, and that others are going through similar experiences. Connecting through mutual struggle is something I find incredibly necessary in the case of any chronic condition, especially MS. I am hopeful that my sharing of my own experience will help someone out there having a particularly difficult day. Reach out, because you are most definitely not alone in your experience.

Mothering Through MS

Posted on May 6, 2016 by MSAA

By: Meagan Freeman

How will my children remember me?

Isn’t that a question every parent asks? We want to set the best example for our kids, leaving a legacy behind when we are gone. Often, this is one of the main reasons people choose to become parents in the first place. One of the first fears in the minds of parents who are diagnosed with MS is: “How will this disease affect my ability to parent?” Followed soon by, “Will my young children remember me when I was healthy?” MS often strikes in the prime of adulthood, when most people are finally successful in a career, finally married, or starting new families. This is the cruelest aspect of this illness, the theft of young optimism. We want our children to recall these years of health, vitality, energy and strength. We want them to remember vacations, playing ball, swimming, and dancing with us. We want them to remember us as young, beautiful adults who never failed them; however, illness interferes with that image, and creates an image of inability and dependence.

Mothers with MS face an incredible challenge, coping with an incurable illness while tending to the needs of little ones, putting the needs of others before their own. In my own family, I witnessed the strength and perseverance of two mothers, facing incredible odds, refusing to give up no matter how difficult life got. MS was no match for these incredible women I am referring to, my grandmother Bette, and her daughter Susan, who happens to be my own mother. My grandmother was diagnosed with MS in the 1950s, and she had 7 children at the time. As a child of 5 or 6, I have vivid memories of visiting the home of my grandparents. We spent many holidays there, the home where my mother and her 6 siblings grew up. My grandfather Stan was the breadwinner, and my grandmother Bette struggled while trying to raise her children. She had been diagnosed with multiple sclerosis in the 1950s, when there were no treatments available. She was basically told to “get in bed and stay there.” Faith, love, and hope were the keys to their success, and my grandparents were a living example of heroism and true love despite devastating life circumstances.

When I feel weak, I think of them. When I feel overwhelmed with my lot in life, I think of them. When I want to give up, cursing the universe for the bad hand I was dealt, I think of them. When I question whether truly unconditional love exists, all I need to do is recall this life story and look at their pictures. Despite MS, my grandmother dedicated her life to her children, instilling love and values that remain to this day. You see, what matters at the end is our life story, our legacy; the story that will be told to future generations. Each of us is slowly writing a story that will be told someday, and it is incredibly important that we write one that we will feel proud of.

My mother was the oldest child in her family. Due to her mother’s progressive MS, at age 12, she took over a majority of the household chores and duties, becoming a surrogate mother for the 6 younger siblings in the home. My mother needed to grow up quickly, and assume the role of a parent at a very young age. At the time, there was simply no choice. Rather than playing, my mom would cook, clean, and help younger children bathe. She sacrificed her own needs for those of her family, and she never failed in her duty. The defining characteristic of a mother is the resolve to care for her children and protect them from harm, no matter what. My mother continued to care for others when I was born, and she was the most wonderful mother anyone could have asked for; I truly don’t know how I got so lucky! She provided me with a beautiful childhood, and gave me all any child could ever need, always putting my needs before her own.

My mother set a wonderful example for me, and I try to carry that on each day. I struggle with MS daily, but despite those struggles, I can still enjoy my children. I see their innocence, their desire to see the world as a beautiful place. My goal is to continue to allow them to see things as awe-inspiring, breathtaking and amazing for as many years as possible. I try to share openly and honestly with them, letting them see certain aspects of my disease, but shielding them from others. I am fortunate to have witnessed two incredible examples of motherhood in my own family, and I think of these incredible women every day. Each mother with MS is going above and beyond, coping with physical challenges while sacrificing daily for her children. Thank you to every one of the MS moms in the world; each of you is a true hero. Thank you, Grandma Bette, and I love you, Mom! Happy Mother’s Day to all…..

Relapses: Not Always Easy to Define or Diagnose

Posted on March 25, 2016 by MSAA

With a majority of MS patients diagnosed with relapsing-remitting MS, the idea of defining and recognizing the signs of relapse becomes very important. This topic can cause both MS patients and neurologists to debate the issue, and some of the lines can be blurry, to say the least. The official definition of a relapse is as follows:

“During a relapse, inflammation is occurring along the nerves and the myelin, causing patients to have a temporary worsening or recurrence of existing symptoms and/or the appearance of new symptoms. This can range from a few days in duration to a few months, followed by a complete or partial recovery (remission). Acute physical symptoms and neurological signs must be present for at least 24 to 48 hours, without any signs of infection or fever, before the treating physician may consider this type of flare-up to be a true relapse.” (MSAA, 2016.)

The new physical signs and symptoms must be separated from a previous relapse by at least one month. As you can see, this definition leaves a great deal of room for interpretation, and every neurologist responds to relapses in very different ways.

Some neurologists treat each relapse with steroids, and do not perform MRIs each time. Steroids are anti-inflammatory medications, almost like “Mega Ibuprofen.” Steroids are very effective at calming the inflammation that causes MS symptoms, but they come with a load of side effects that always need to be considered and weighed. Treatment can be done with IV steroids (Solu-Medrol,) or with oral steroids such as Prednisone. Other neurologists insist on performing MRIs before ordering steroids. Some neurologists prefer to save steroids for only the most severe relapses such as weakness and vision loss, and do not use them for sensory symptoms such as numbness and tingling. It is very much a matter of opinion, and there truly is no “right or wrong” answer in this area.

My own neurologist does not perform MRIs for my relapses, because he does not believe that there is a clinical correlation between the MRI and clinical symptoms. A clean MRI does not necessarily indicate that we are not experiencing relapse, and vice versa. It is also possible that we may be experiencing a pseudoexacerbation. Pseudoexacerbations are temporary increases in symptoms caused by external factors such as heat, which go away after a short period of cooling off. These can also be the result of infections and fever.

I have had RRMS for almost 7 years, and in that time I have experienced very active disease. On a daily basis, I experience new and varying symptoms, ranging from buzzing/tingling/numbness, to burning/pain/spasm, to weakness/vision loss/bladder issues/cognitive issues. These symptoms come and go very unpredictably, and it is truly maddening. The one thing I have learned is that I can’t allow myself to panic if I experience something new, because most often these symptoms with leave as quickly as they appear, within a few hours. However, if they do persist beyond 24-48 hours, make sure you contact your neurologist and get advice, because if there is something you can do, you should! I am always grateful to get my neurologist’s advice in these situations, because it can be very difficult to assess our own symptoms in an unbiased way. Don’t ever hesitate to ask for advice in this area, because it can be very confusing for even the most experienced MS patient!

You and Your Neurologist: One of the Most Important Relationships

Posted on February 17, 2016 by MSAA

By: Meagan Freeman

Finding an excellent Neurologist is one of the first things we need to do after diagnosis with MS. It can be very difficult to choose a random name from a list of covered providers from our insurance companies, and without a solid recommendation from someone we know, we often need to take a “test drive.” Patients and providers are much like any relationship we have in life: Some personalities are a perfect blend, and others will never work together. It is incredibly important to seek out a provider who is not only medically competent, but also a good fit for your personality.

I find that some providers are cold and distant, only seeing patients as a disease process. What about the mind? We are so much more than a body. Providers should always see the patient as a mind-body unit, addressing the full scope of chronic illness. Psychological and emotional symptoms are common, and no one should leave an appointment feeling dismissed.

I am a family nurse practitioner, and we are trained from day one to see the humanistic side of medicine, to view the patient as a whole being, rather than the sum of the parts. The body cannot be healed without addressing the spiritual, emotional aspects of the human being. After being diagnosed with MS, I appreciated this manner of teaching more than ever before.

There is an intricate, indivisible connection between the body and the mind, and treating only one while ignoring the other will never prove effective. There is, what we call in medicine, an “emotional overlay,” to almost every physical issue. Whether this means that the condition is purely psychological, or whether the mind is reacting to a physical issue (anxiety, panic attacks, depression,) the mind must always be taken into consideration when treating every patient.

Our society is very quick to assume that modern medicine has all the answers, a secret book of treatments, available only to those who have attended medical school. This magic book contains all of the recipes for treating illness, and is kept hidden, under lock and key. The providers of the world are assumed to have the ability to fix anything, treat anything, and if they do not offer a fix, they are assumed to be withholding treatment intentionally.

I can tell you, this is not the case. One of the most shocking things I learned while transitioning from a registered nurse to a nurse practitioner was the absolute limitation in options we have as providers. We only have a few things to offer, a few laboratory tests, an x-ray or two, a few medications that may or may not be effective. Most medications also go along with an enormous list of potential side effects that have to be taken into consideration. Many prescription medications are not necessary, and can lead to a variety of new problems. The risk versus the benefit of any treatment needs to be considered. Treating physical illness is not only a science, but also an art; and sometimes, providers simply run out of ideas. Every possible treatment option has been exhausted, and there is simply nothing further to offer. I find that patients are shocked when this is the answer. “What do you mean, there is nothing left to do?” Sometimes, the answer is just that, and we are left trying to cope with our “new normal,” whether it is pain, numbness, weakness, or any other symptom.

When you visit your provider, keep in mind that they may not have an answer for every question you have. Your provider is doing their best, I am sure; but the answer “I do not know,” is an acceptable one sometimes. I always trust providers who admit that they do not have an answer, because this is honesty. If your provider says, “Well, if you really want to take something you can try this…” this is code for- “you really do not need this.” Sometimes, in medicine, less is best. The minimalist approach to treatment is wise, and so many patients have been “overtreated” in recent years. Too many medications, wasteful, unnecessary diagnostic testing, and the resulting side effects and anxiety are major issues in medicine currently. Patients and providers need to take a moment and ask themselves, “Is this really a necessary test or treatment?”

Trust your body to be able to handle most minor issues. Your body is an intricate, well-constructed, dynamic machine that is much wiser than we are as health providers. Now and then, the body might need an extra hand at combating an infection, but not always. Listen to your body! Prevention is the key! Get your immunizations, get some exercise, eat healthy foods, and obviously avoid smoking and alcohol. MS aside, we all need the same basic advice on remaining healthy and living the best life possible.

Questions to Ask Your Provider at Appointments:

1. Do you feel that my disease is well controlled with my current medication?
2. If not, are there other medications available that you would recommend?
3. Do you recommend any other treatments for my current symptoms (alternative or traditional?)
4. How often do you recommend appointments and MRI?
5. Is there any new research that has become available since my last appointment?

Try to develop a relationship with your provider, and if you feel dismissed or ignored, it may be time to consider a change. Like any relationship in life, some people just don’t “click.” But in this case, your health is at stake; so don’t be afraid to find the right fit for you.

The Art of Reflection

Posted on January 8, 2016 by MSAA

By: Meagan Freeman

The start of a new year brings with it the opportunity for each of us to do an internal review, analyzing the things we experienced during the past 12 months. With an illness like MS, we are constantly challenged to evaluate our treatment choices and lifestyle decisions, and this time of year is a wonderful time to do some reflection. How did we feel during the past year? How many relapses occurred? How are we feeling now compared to the previous year? Are there things we would like to change, or are we content with our current state of health?

Life with MS brings constant, daily “fluctuations,” with some symptoms appearing and quickly disappearing, and others seeming to accumulate and resolve very slowly or not at all. I find that looking back over an entire year, comparing full years rather than days, is more helpful in determining whether my treatments are successful. It is important to keep an optimistic attitude despite our condition, and try to see the coming year as a time of opportunity and renewal.

I always like to spend time around January 1st reflecting on the past year; doing a sort of “life review,” and analyzing the success, failures, and learning opportunities. I am always amazed at how many things have changed during the year, and it takes the perspective of time to realize that. Sometimes, we feel that everything is “stuck,” standing still, and no progress is being made. However, if we simply turn back and look at how far we have come, we can see that everything changes.

Often, I hear other MS patients asking why a cure hasn’t been found yet, why it seems that no progress has been made. I would argue, quite the contrary. From a historical perspective, we can see incredible progress. We have come such a long way in our fight against this disease, even though we haven’t quite reached the end of the battle. We have 13 disease modifying drugs in 2016, and in 1992 there were none. Isn’t that a striking statistic? In just over 30 years, MS has gone from being untreatable, to having 13 possible treatment options. Much progress has been made, and we need to try to keep our collective eyes on the finish line, toward the inevitable day that will bring an ultimate cure for this disease. There is much to be hopeful for, and much to be grateful about. Never lose hope, and stay strong knowing that you are never alone. Happy New Year to all!

Unwanted Advice During the Holidays: How to Cope?

Posted on November 18, 2015 by MSAA

By: Meagan Freeman

During the holidays, we may find ourselves in the idyllic, peaceful scenes depicted in a Norman Rockwell painting. Surrounded by loving family and friends, sipping hot beverages and laughing by a crackling fire. Along with those scenes, we often partake in traditional meals, full of wonderful foods and desserts. The downside of this beautiful family tradition might be the hazards of incredibly high calorie, high fat, high sodium foods that may take a toll on those with multiple sclerosis.

For the past 6 months, I have made tremendous changes in my own diet. I have made fruits and vegetables the focus of my diet, along with low fat, low sodium options. I have worked very hard on maintaining this way of eating, and in general, have been supported by my family and friends in this process. In a few short months, I saw dramatic reductions in my blood pressure (I have hypertension in addition to MS,) and I have also seen large reductions in my cholesterol. In combination with my medication, I have reduced the severity of my MS symptoms through this lifestyle.

Why do the Holidays seem to completely derail healthy lifestyle choices? I have already begun to hear comments from family, such as: Why don’t you just take a break from the diet? Why don’t you skip a few days? What is the big deal? Why are you being so extreme? It is amazing how quickly “tradition” becomes the priority at holiday meals, rather than health. I am a believer in the concept that healthy meals can also be incredibly tasty.

In addition to these dietary comments, we may also find ourselves being showered with the ever-present “helpful advice” from family members about how to best manage our MS. “Have you tried———?” I happen to be a licensed family nurse practitioner, and even with my medical background, I have family and friends who ask me this very question constantly. They send me articles about new research, suggest different alternative and traditional therapies, and question my treatment decisions with regularity. Sometimes I feel a twinge of anger, and I have to hold back an emotional response. Instead, I find the response, “Thank you for letting me know about that, I will look into it,” to be the best.

Sticking to our choices while being gracious recipients of unwanted advice can be especially trying during the holidays. The most important thing to keep in mind is that we are loved and surrounded by people who only want the best for us. This is important to remember when you find yourself at the Thanksgiving dinner table receiving your 50th comment about the food (or lack of) on your plate!

Happy Holidays!

Wellness: The Importance of the Mind

Posted on October 30, 2015 by MSAA

By: Meagan Freeman

When I was diagnosed with MS in 2009, I never would have imagined that my greatest challenge would be overcoming my own demotivation and fatigue. My struggle over the past six years has involved many physical challenges, but I have found that my mind can truly pose the greatest threat to my own wellness.

I have never been diagnosed with depression, but I do cope with extreme fatigue, and the symptoms can be very similar. It is often confusing for patients to determine whether they suffer from a psychological, MS related depression, or rather the well-known phenomenon of MS fatigue, known as lassitude.

I have made many lifestyle changes since my diagnosis, including adopting a plant-based diet rich in fruits and vegetables, exercising regularly, and challenging my cognitive skills with writing and academics. According to my most recent blood pressure readings (I also have hypertension,) and my cholesterol panel, I am incredibly healthy from a cardiovascular standpoint. However, the one issue that remains my greatest obstacle is fatigue. As I sit on the couch, my life often swirls around me at the speed of light.

I sit, and my family moves around the house, carrying on with a normal day. Children play, my husband bustles around cleaning, picking up toys. Friends come and go, family members chatter on the phone. Children are getting ready for school, a trip to the park, or horseback riding lessons. All the while, I sit.

It is a feeling like no other, this inability to get up and take part in my life. This experience of being an observer, rather than an active participant. My mind wants desperately to get up, to join in and be there instead of here. My mind urges me, “Get up! You can do it! Let’s go! Don’t miss out!” But my body doesn’t listen. My life feels like a movie at certain moments. It is as if I am sitting in a theater seat, watching images on a screen. The only difference is, the scenes passing by in front of me are my life. Laughing, running, spinning, jumping children fly past me, friends call, invitations are declined. And my internal voices do battle. The mind vs. the body: The epic saga continues.

How do we cope with MS fatigue? Are there any good answers? Often, we ask ourselves whether we are just being lazy, or could we be clinically depressed? The answer is typically, neither! 80% of MS patients suffer from fatigue, and it isn’t your average, everyday exhaustion. It is specific to MS, and incredibly debilitating.

What can we do to manage this fatigue? First and foremost, see your provider. Make sure you aren’t missing a treatable reason for your fatigue, such as a thyroid disorder, sleep apnea, or anemia. Once those causes are ruled out, our options (as always) are quite limited. Physical therapy might be helpful. Sleep regulation is incredibly important, and should be addressed first. Stress reduction and relaxation techniques may be helpful. Avoiding extreme heat is a must, as heat may dramatically worsen fatigue. In addition, several medications are approved for fatigue management with MS.

Most importantly, make sure you are taking care of yourself in all the classic ways. Adequate hydration, nutrition, and rest are essential parts of your daily routine as an MS patient. Avoiding excessive caffeine and alcohol, avoiding smoking, and getting as much activity as possible are all effective ways to manage MS fatigue. Though it may seem counter-intuitive, getting some degree of physical activity can actually increase your energy, even if it is the last thing on Earth you feel like doing. Getting up and off that couch and taking in some sunlight can elevate your mood.

Consider inviting friends to visit you at your home, if you don’t have the strength to go visit them. Being completely honest is essential. Let your friends and family know the degree of your struggle with fatigue, and give them the opportunity to understand. It is important not to isolate and withdraw from friends and family due to fatigue. We often jump to the conclusion that “no one gets it. No one will ever understand.” Maybe they will if you give them a chance. Educating our family and friends about our illness is our responsibility, as patients. We should offer as much advice and information as possible to those in our circle. They will likely be happy to help if they can!

My own fatigue continues to be an ongoing battle, but with my Neurologist’s help, I am learning to manage my symptoms more effectively. I believe the most important thing to remember is that we are not alone. Many of our symptoms are entirely treatable, but we can never hope to see improvement until we reach out and ask for help.

Medical Necessity: Advocating For Needed Treatments

Posted on August 10, 2015 by MSAA

By: Meagan Freeman

As a Nurse Practitioner, I became extremely familiar with dealing with the often-frustrating denials by insurance companies, particularly when it comes to prescription drugs. After all, I am the one who holds the professional medical degree, and I am the one who should be determining what treatments my patients required, not an insurance adjuster.

The problem is, insurance companies often have a policy of “automatic denial” for expensive prescription drugs. This policy means that no matter what the circumstance might be, they will always issue a denial when an expensive medication is ordered. This policy may be a deterrent for new providers and patients, and may lead to an unnecessary change in treatment, opting for a less expensive drug that is less effective.

When dealing with insurance companies, my experience has led me to realize that it is incredibly important for providers to immediately argue the case, rather than to simply accept this automatic denial of needed treatment. I often find that a simple phone call to the insurer, with my insistence that the treatment was a medical necessity, and that no other alternative would be acceptable, is all that is needed for an eventual approval. These automatic denials are in place in order to save unnecessary expenses for insurers, whose main focus is always the bottom line. These are not medical professionals on the other end of the phone, and their opinion is not more important than your treating provider’s.

With the new affordable care act, all insurers are required to offer at least one covered medication in each disease category, and cannot deny patients needed medical treatments. Thankfully, no patient can be denied for coverage any longer due to a pre-existing condition such as MS. Our illness is one of the most expensive diseases to treat, with drug prices often exceeding $50,000 per year. This means that we need to become very skilled at advocating for ourselves as patients. If you are told that a necessary treatment was denied by your insurer, let your provider know that you would like them to make a call and argue the medical necessity of the treatment. A simple phone call is often enough to sway the initial opinion, and this simple step is well worth the time if it leads to coverage for a needed multiple sclerosis treatment. If your provider will not take the time to appeal a denial, you may need to consider finding a new provider. Your provider should always be your advocate, no matter what the circumstance may be.

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