Fatigue in Transverse Myelitis

Kerry MutchNMO Advanced Nurse Practitioner

Walton Centre Foundation TrustLiverpool

Fatigue after Lunch

Benefits of Drinking Water• You can’t live without it!• Reduces Fatigue• No calories• Stops headaches• Reduces urine infections• Helps relieve

constipation• Gives skin a healthy

glow• Gives energy• It’s Free

• Reduces Fatigue

Affects quality of life and functional ability Adversely affects

◦ ability to self manage symptoms◦ ability to cope ◦ mood and self esteem

Can aggravate other TM symptoms

Depression Fatigue

Impact of Fatigue

Sleep

Diet

Medications

Mood

Stress

Exercise

Disability

Symptoms

Fatigue in NMO

Person with TM

Fatigue affects different people in different waysThere are many factors that contribute to fatigue

◦ Primary: related to disease process Probably related to the underlying pathologic alterations in TM such

as demyelination, inflammation and axonal injury The inability of a muscle or group of muscles to sustain the required

or expected force

◦ Secondary: associated with disease related factors Walking difficulties Sleep disturbance Pain Spasms Bladder symptoms Breathing difficulties

o ‘Normal’ activity related fatigue

Fatigue Types in TM

Trigger Factors of Fatigue Not drinking water Poor diet – wrong food Poor Posture

seating/bedding Poor sleep patterns Temperature heat/cold Infection/Virus Emotions mood/stress

Other medical conditions Anaemia Doing too much Excessive exertion De-conditioning Taking insufficient breaks Medications

Medications side-effects that can cause fatigue; Analgesics Anti spasticity Anti convulsants Anti hypertensives Anti depressants Anti histamines

Medications and Fatigue

Because of my fatigue during the past 4 weeks....

Modified Fatigue Impact Scale

Never Rarely Sometimes Often always

1. I have been less alert. 0 1 2 3 4

 2.

 I have had difficulty paying attention for long periods of time.

    

0

    

1

    

2

    

3

    

4

 3.

 I have been unable to think clearly.

   

0

   

1

   

2

   

3

   

4

 4.

 I have been clumsy and uncoordinated.

   

0

   

1

   

2

   

3

   

4

 5.

 I have been forgetful.

 0

 1

 2

 3

 4

 6.

 I have had to pace myself in my physical activities.

   

0

   

1

   

2

   

3

   

4

 7.

 I have been less motivatedto do anything that requires physical effort.

    

0

    

1

    

2

    

3

    

4

61 people with NMO completed MFIS

Never/rarely Sometimes Often Almost alwaysPhysical fatigue 0-36

0

2

4

6

8

10

12

14

16

18

20Pts

Never/Rarely

Sometimes Often Almost always

Cognitive fatigue 0-40

0

5

10

15

20

25

30

Pts

Never/Rarely Sometimes Often Almost always

Psychosocial fatigue 0-8

0

2

4

6

8

10

12

14

16

18

Pts

Physical Fatigue

Never/Rarely

Sometimes Often Almost always

Total fatigue 0-84

0

5

10

15

20

25Pt Nos

Total Impact of Fatigue

Cognitive Fatigue Psycho social Fatigue

Priciples of Managing Fatigue

Ensure the best levels of energy Using Energy Available in Most

is available Productive Way

Planning – Efficient use of energy supplies means more can be achieved.

Prioritising – Better to complete smaller tasks than try everything and complete nothing.

Pacing – more beneficial rather than continuing to point of exhaustion and being forced to rest.

Delegating – Many people feel guilty about asking people to do jobs they previously did.

Using Energy in Most Effective Way

Motto- I Can if I Plan

Increase your fluid intake!! Make life as easy as possible for yourself Use labour saving equipment Do things differently Organise work area to avoid unnecessary

bending, reaching or walking Activity and exercise benefits Relaxation, deep breathing, yoga, pilates Sleep patterns and routine

Energy Effectiveness Strategies

For the Lion To Wake up Drink More Water

Thank you