Approximately 85% of people with MS are diagnosed with a type of MS called relapsing-remitting MS (RRMS). In this type of MS, people have clearly defined periods when the disease gets worse. These periods are called relapses. Your health care provider may call them "attacks" or "exacerbations."

A relapse is when old symptoms worsen or new ones appear. For a symptom to be called a relapse, it must last for more than 24 hours in the absence of fever and be in some way disabling to you. Relapses may occur at any time, usually without warning, and can be mild or severe. In RRMS, relapses are followed by a long or short period of time when symptoms completely or partially go away. This is called remission.

In RRMS, relapses are followed by periods of remission. Over time disability accumulates.

Secondary-progressive MS

MRI is a safe and painless way for a doctor to see what's going on inside your body.

In MS, an MRI is used to take detailed pictures of the brain and spinal cord. MRI scans show the amount of water in tissues. MS lesions have higher-than-normal water content. MRI uses a very large and very strong magnet to find these lesions. It takes detailed pictures of the central nervous system (CNS). These pictures show the areas of damage.

MRI is an important tool that doctors use to help confirm an MS diagnosis. MRI allows your doctor to see a picture of what's happening to your brain and spinal cord. MRI scans can also help your doctor manage your MS.

The exact correlation between MRI findings and the current or future clinical status of patients, including disability progression, is unknown.

Often, MS can be active in areas that are not causing obvious symptoms. For this reason, your health care provider may want you to have a routine MRI from time to time. He or she will then compare your new MRI scan with your old one. Your doctor can see if you have lasting lesions. And, he or she can see if you have new ones. However, it is important to note that MRI results and a patients' symptoms or disability status may or may not match. Either way, your doctor may want to try a new treatment. Be sure to ask what he or she thinks about your MRI scan results. The more you know about what is happening, the better you can take care of yourself. And the better you can manage your MS.

Types of MRI and How They Work

Fatigue

There are a number of options you can discuss with your health care provider to help reduce fatigue:

• Conserve energy. Rest whenever you can. Rest means doing nothing at all. By resting often you will leave strength for enjoyable activities. Plan and pace your activities. Set priorities. Focus on items that must be done. Learn to let go of any guilt that may be associated with not finishing tasks. And don't be afraid to rely on family and friends for some help.
  
  
• Occupational therapy helps people maintain skills they need for everyday living at home or work. It can help simplify tasks at work and home.
  
  
• Physical therapy helps people improve movement and function. Physical therapy and exercise can teach you energy-saving ways of walking (with or without assistive devices) and performing other daily tasks.
  
  
• Sleep regulation may involve treating other MS symptoms that interfere with sleep (e.g., spasticity, urinary problems) and using sleep medications on a short-term basis.
  
  
• Psychological interventions such as stress management, relaxation training, membership in a support group, or psychotherapy.
  
  
• Medications. Talk to your health care provider about specific treatments that may help relieve fatigue.

Spasticity

Exercise, daily stretching, and changes in activity are all ways to help relieve spasticity. Also, speak with your health care provider to find out if medication is an option for you. There may be treatment options available that can help you deal with spasticity.

Walking Problems

Exercise, physical therapy, walking aids, and, in some cases, a review of your medications can help. Each person's walking issue needs to be examined on an individual basis. Make sure you are carefully evaluated by a trained health care professional.

Bladder/Bowel Problems

One way to treat a bladder problem is to change your fluid intake (e.g., limit fluid intake a few hours before bedtime, cut out caffeine). Also, your health care provider can prescribe medicine. It is important to get examined and treated early, so that you can avoid any complications, like bladder infections.

Your health care provider can help you establish an effective bowel management program. Occasionally, it may be necessary to consult a gastroenterologist. He or she is a health care provider that specializes in treating the stomach and bowel.

Vision Problems

The good news is that these vision problems are usually temporary. Patients generally recover. Steroid treatments may be useful for optic neuritis and nystagmus. Resting the eyes periodically throughout the day and/or wearing an eye patch can be helpful for double vision. Speak with your health care provider if you experience vision problems.

Memory Loss

You may want to be tested if you think you have memory loss. Talk with your health care provider about what you are experiencing and possible treatment options.

One common treatment option is rehabilitation. This means that you use memory exercises to help "retrain your brain."

There are different techniques you can try to help you remember:

• Do things when you think of them because you may forget later.
  
  
• Assign spots for items and always return them to where they belong.
  
  
• Use checklists so you remember what you need to do.
  
  
• Treat yourself to a new gadget, such as an organizer, PDA, or journal, to help you remember.
  
  
• Prioritize; focus on only the most important things of the day.

Sexual Problems

The key to a healthy sex life in any relationship is communication. Talk with your partner, as well as your health care provider. By exploring options and requesting information, you can maintain a satisfying sex life.

A variety of therapies treat sexual dysfunction. Men should speak with their health care providers about oral medications, injectable medications that increase blood flow in the penis, penile suppositories, inflatable devices, and implants.

Women can relieve vaginal dryness by using over-the-counter personal lubricants. Petroleum jelly should not be used because it is not water soluble and may cause infection.

Pain

Fortunately, there are a number of medications that can help. Speak to your health care provider for more information. Non-medication treatments may include exercise, heat, massage, ultrasound, and physical therapy. In addition, biofeedback, meditation, and similar techniques may be of help.

Depression

Depression can be diagnosed only by a health care professional. Therapy or medication may be needed. A health care professional can treat the condition and prevent an even deeper depression that is harder to treat. It may be necessary to try different medications and different doses before an effective medication, or combination of medications, is found. If you suspect you are suffering from depression, please talk with your health care provider. He or she can get you the help you need.

Beating the Heat

During the hot summer months, everyone is looking for ways to stay cool, but staying out of the heat is especially important for people with multiple sclerosis (MS). Many people with MS find their symptoms are aggravated by heat; therefore anyone with MS should take extra precautions to stay cool.

The following tips list easy ways to beat the heat:

• Use your air conditioner. This is one of the easiest ways to stay cool. Even if you don't have air conditioning in your home, go to a mall, a library, or any place that has air conditioning and enjoy theirs!
  
  
• Don't go outside during the hottest times of the day. Instead, get out early in the morning before it has gotten too warm or at night, when things have cooled down. Also, be sure to stay out of the direct sun.
  
  
• Wear cotton clothing. Cotton allows the skin to breathe, which can provide comfort in the hot weather. There are also several products designed to keep your body cool, including cooling vests.

To read more tips about living well with MS, visit www.nationalmssociety.org

Wellness & Nutrition

Good health has a lot to do with what you put on your plate at every meal. Diet is an area where a person with MS can be in control. Studies show that sensible eating habits have a dramatic impact on many aspects of health. For instance, healthy eating can reduce all the risks of heart disease, certain types of cancer, and obesity. But you shouldn't stress yourself out trying regimented eating plans. Learn more.

Wellness & Exercise

We know the benefits of physical exercise: strength, stamina, and weight control. Exercise may also have a protective effect against certain cancers and stroke, and reduces the risk of heart disease and diabetes. Learn more.

Wellness & Complementary and Alternative Therapies

"Complementary therapies" describes those that are used along with conventional medical interventions. Alternative therapies are certain therapies used instead of conventional medicine. Learn more.

Remember, only FDA-approved DMDs have been proven to be effective in the treatment of MS.

Three Keys to Wellness with MS

Nutrition

Practicing healthy nutrition is mostly common sense. The best advice for people with MS continues to be what is recommended for everyone. Most of your food should come from grains, vegetables, fruits, low-fat dairy foods, and legumes such as beans. Smaller amounts of lean meats, fish, and skinless poultry are also beneficial. The US Department of Agriculture's Food Guide Pyramid is a great tool. It can help you decide what and how much food to eat from each food group.

Nutrition labels on packaged foods are also useful. They can help you monitor your intake of fats, proteins, and carbohydrates. It is important to include selections from all of the food groups in your diet. When in doubt, go easy on fat, sugar, and salt.

Food Journal

The journey to healthy nutrition is an easy one. It starts with creating a food journal. Write down your food intake at each meal. At the end of 3 days, compare your meals with the recommendations on the food pyramid. Then make the appropriate changes in your diet. This will help start you on your way to eating healthier.

Water

Water is essential in removing waste products from cells and keeping a normal body temperature. This is especially important in MS because a rise in body temperature may lead to fatigue or an increase in symptoms. Remember to drink at least 8 glasses of water a day. Drink more when in a hot environment or if you are exercising.

Physical Activity & Fitness

The first thing we need to do is change our perception of exercise.

Exercise does not have to be harsh, sweaty workouts. In fact, the less pain the more gain, because you are more likely to stick with activities that feel good. In MS, demanding activity can do more harm than good. Moderate exercise for 20 minutes or so every day can yield the same benefits as infrequent but intense workouts.

Start by talking with your health care provider about the types of exercise most likely to be good for you. What is "good" exercise for one person may not be good for another. Like medication, exercise should be prescribed by a professional who knows how to develop individually designed exercises.

Exercise

Even a little exercise provides benefits. If you find you can't do what you used to do, don't give up. You can always modify or turn to another type of activity. Physical therapists and fitness instructors can provide expert help. With some changes, people with all types of MS can enjoy the benefits of exercise.

Some people prefer exercise that is free from the stress of competing with opponents or keeping up with others. They might choose an activity such as swimming or walking, which doesn't require a team or partner. People who have a competitive streak may find that adaptive sports or group workouts motivate them. Exercising alone at home may not supply the motivation that a class or a group provides but can be an ideal choice for some.

Types of Exercise

• Aerobic exercise: what most people think of as "real" exercise. Bike riding, brisk walking, and running are all examples of aerobic exercise. Aerobic means that the body is taking in enough oxygen to meet its needs.
  
  
• Balance exercises: muscles must use more energy to maintain an upright stance, and anything that increases balance will reduce weakness. Using such tools as an exercise ball can help improve balance.
  
  
• Relaxation exercises: breathing and visualization techniques should be a part of any overall program to help reduce weakness and fatigue.

Start your routine by talking with your health care provider about the types of exercise most likely to be good for you.

Complementary and Alternative Therapies^*1

Complementary and alternative therapies include everything from exercise and diet to food supplements, stress management strategies, and lifestyle changes.

One example of a complementary activity is yoga. Yoga is suitable for all fitness levels. It combines body and mind conditioning. Yoga can build strength and endurance as well as improve breathing and mental attitude. It increases flexibility and strength while helping to eliminate stress. Many people with muscle tightness or decreased range of motion find yoga practice brings noticeable improvement. Because yoga is relaxing and noncompetitive, it is especially recommended for people with MS.

Other examples of complementary therapies include:

• Hypnosis
  
  
• Guided imagery
  
  
• Relaxation techniques
  
  
• Traditional herbal healing*
  
  
• Chinese medicine*
  
  
• Macrobiotics*
  
  
• Naturopathy*

Keep in mind that no complementary or nutritional/dietary therapy has been shown to change the course of MS. Always speak with your health care provider before trying any complementary or alternative therapy.

*There is no drug-to-drug interaction study data on these complementary therapies.

Risks of Alternative Therapy ^*1

Alternative therapies are certain therapies used instead of conventional medicine. Alternative medicine includes everything from drugs and diet to food supplements, mental exercises, and lifestyle changes. Unfortunately, there are no "miracle cures" for MS, no matter how much we'd like to think so.

Most people have little or no idea of the risks they are taking when they use an alternative therapy. They try alternative medicine because they believe that anything sold without a prescription is harmless. But these therapies are not regulated in the United States the same way as prescription medications. So the US Food and Drug Administration (FDA) has not determined whether they are safe or effective, or even accurately labeled. There is little published to prove the claims of these therapies.

If you are interested in trying an alternative therapy, it's best to speak with your health care provider. It's important that he or she know all the therapies you are taking or considering. He or she also can inform you of any possible side effects or drug interactions. If you are thinking about stopping your medicine, call your health care provider's office.

Health & Wellness Resources

The Heuga Center

The Heuga Center^*1 for Multiple Sclerosis believes people should be empowered to lead healthy, productive lives even with an incurable disease like multiple sclerosis. Their innovative and world-renowned programs provide leading-edge education and skills education, skills, and motivation to help people with MS and their families achieve this goal.

The Heuga Center's mission is to lead the way with comprehensive programs that empower people and families living with multiple sclerosis to transform and improve their quality of life. Their health and wellness programs include five-day CAN DO^®, two-day CAN DO 2^® and one-day JUMPSTART^®.

You CAN! ^*1

In collaboration with the NMSS, the Heuga Center has developed the You CAN! page of the NMSS Web site. The site provides information about how to live a full and productive life with MS.

Adventures Within^*1

Outdoor recreational activities for people with MS.

Myelin Repair Foundation^*1

The goal: speeding the time it takes to discover, develop and deliver treatments to MS patients.

CAN DO, CAN DO 2 and JUMPSTART are registered service marks of The Heuga Center.^*1

Taking Control

The key to living with MS is to feel in control of MS. You can do this by keeping track of your symptoms, going to appointments with your health care provider, having regular magnetic resonance imagings (MRIs), and taking any medication your health care provider has prescribed.

Following a well-balanced diet and a properly prescribed exercise program are also good foundations for health. Always talk with your health care provider or MS specialist before starting any symptom management program.

Visit the Listen to Your Body section of this website for a guide on questions to ask yourself about your MS Symptoms.

Staying on Treatment

If your health care provider has prescribed a disease-modifying drug (DMD), it is important to stay on therapy. DMDs are a breakthrough for people with relapsing MS. They slow the course of the disease.

If you are not taking a DMD, talk with your health care provider. He or she is there to help you. It's important that you communicate your needs. Together, you can go over the treatment options and decide whether DMD therapy is right for you.

Managing MS Symptoms

It's very important for you to learn to listen to and take cues from your body. This will help you manage your MS symptoms.

When to Call Someone About Your Symptoms

You should ask your health care provider about when it is important for you to call. Some reasons to call may include:

• If you experience loss of vision or blurry vision
  
  
• If you have an abrupt change in bowel or bladder function
  
  
• If you think you have a urinary tract infection
  
  
• If you have feelings of depression or thoughts of hurting yourself

This is not a complete list. Remember to check with your health care provider about when you should call.

People living with MS should be aware of the types of symptoms that they will experience when managing MS, in order to really confront MS. The most common symptoms of MS are explained in this guide. You should keep track of any symptoms you experience. This may help you prepare for visits with your health care provider and provide you with a greater understanding of the different types of symptoms that you might be experiencing. After all, managing symptoms is one of the keys to managing your MS.

Relapses

Approximately 85% of people with MS are diagnosed with a type of MS called relapsing-remitting MS (RRMS). In this type of MS, people have clearly defined periods when the disease gets worse. These periods are called relapses. Your health care provider may call them "attacks" or "exacerbations." A relapse is a period of more than 24 hours when old symptoms worsen or new ones appear. For a symptom to be called a relapse, it must be in some way disabling.

Relapses may occur at any time, usually without warning, and can be mild or severe. In RRMS, relapses are followed by a long or short period of time when symptoms completely or partially go away. This is called remission.

Sometimes, you may experience a "pseudo-relapse," or false relapse. This usually involves symptoms that last for less than 24 hours and may be triggered by elevations in body temperature, such as a fever or exposure to heat.

Chronic Symptoms

Some symptoms of MS are long-lasting or recurring. These "chronic" symptoms of MS include fatigue, spasticity (muscle stiffness), pain, depression, and cognitive dysfunction. Relapse symptoms that do not fully resolve can also become chronic symptoms.

MS Affects People Differently

MS is different for every person. You may never experience all of these symptoms or you may experience other, unique symptoms that are not included in this guide. Also, keep in mind that not every symptom you experience may be due to MS. Check with your healthcare provider about when it's appropriate to call. It is important that you let your doctor know about any symptoms you are experiencing. That way you can work together to manage your MS, and determine if your current therapy and management of MS is on the right track.

The following is a list of questions to consider. You may want to ask yourself these questions to help you and your healthcare provider understand what you are experiencing.

Things you should note about each of your symptoms:

• When did it start?
  
  
• Is it new? If so, were you feeling ill or did you have a fever when you developed this new symptom?
  
  
• How long have you had the symptom? Has it gotten worse over time or stayed the same?
  
  
• What have you done to manage the symptom? Was it helpful?
  
  
• On a scale of 1 to 5, how bad is it?
  
  
• Does it impact your activities of daily living, such as being able to dress and feed yourself, go to work, take care of your family, and socialize?

When to Call Someone About Your Symptoms

Sometimes a symptom is urgent and you should contact a health care provider right away. Remember to check with your healthcare provider about when you should call. Some reasons to call include:

• You experience a new MS symptom that lasts at least 24 hours that is not related to fever
  
  
• You experience loss of vision or blurry vision
  
  
• You have an abrupt change in bowel or bladder function
  
  
• You think you have a urinary tract infection
  
  
• You have feelings of depression or thoughts of hurting yourself

This is not a complete list. If you are experiencing worsening depression or have thoughts of hurting yourself, contact your healthcare provider immediately.

Fatigue

Fatigue is one of the most common symptoms, occurring in nearly 80% of people with MS. Fatigue can feel like sleepiness or lack of physical or mental energy. It is often described as exhaustion that is not caused by activity and not relieved by rest.

• Are you sleeping well?
  
  
• Are you feeling exhausted, even after you've gotten enough sleep?
  
  
• Does your tiredness/fatigue interfere with your ability to perform or participate in your daily routine?