2011

Christine

Stefanovic

RN

The Multiple Sclerosis Self

Management Workshop

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The Multiple Sclerosis

Self-Management Workshop

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Write down a positive statement about yourself and what

you would like to learn about managing your MS.

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Notes:

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Introduction to Self-management

Self-management of chronic diseases has been proven to benefit patients,

by providing knowledge and skills needed to maintain and promote

beneficial health behaviors (NIH, 2006).

Medical Management- Administering and taking medications,

adhering to diet, using medical devices appropriately

Role Management-“… maintaining, changing and creating new

meaningful behaviors or life roles” (Lorig et al 2003p.1).

Emotional Management- effectively coping with depression, anger,

fears, frustration and mood swings (Lorig et al. 2003).

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MS SELF-MANAGEMENT

WORKSHOP CONTRACT

To have the best results from this workshop I agree to:

Bring a support person.

Attend all classes.

Arrive on time.

Participate in class activities.

Do the homework assignments to the best of my abilities.

Contract with myself:

_____________________________________.

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COMMUNICATION

1. Before doctor’s appointment write down the topic

to be discussed during your visit.

2. List all areas that you are concerned about.

3. Possible treatments that you would prefer?

Medication, PT, OT…

4. Advocate for yourself or bring someone who will!

4. Before the end of your appointment re-address or

clarify the issues discussed.

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Ways to self-manage medications:

1. Establishing habits-

2. Adjusting routines-

3. Tracking-

4. Simplifying-

5. Valuing medication

6. Collaborating to manage- ask the care provider about side effects,

cost, and benefits before starting a medication to be informed.

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A Few MS Internet Sites

1. http://www.nationalmssociety.org/index.aspx

2. http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html

3. http://www.iomsn.org/slidepresentations.htm

4. http://www.mscare.org/cmsc/index.php

5. http://www4.va.gov/ms/

6. http://nccam.nih.gov/health/whatiscam/overview.htm

7. http://www.msassociation.org

8. http://www.ms-cam.org

9. http://www.brighamandwomens.org/patient/microMS.aspx

10. http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/200

5DGPolicyDocument.pdf

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STRESS-MANAGEMENT

What makes you stressed?

What are some stressors at work?

What are some stressors at home?

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HOME WORK:

KEEP A RECORD OF STRESSORS

Who, what and where?

Record your reactions to stress/ thoughts during stress and after.

What are your responses to stress? (Physical and emotional)

Rate the stressors from mild to severe (1 to 5)

Reflect on which stress management techniques can be effective for

your stressors

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Stress Management Techniques

1. Meditation

2. Relaxation techniques

3. Yoga

4. T’ai chi

5. Aerobic exercise

6. Music

7. Art

8. Visualization

9. Having fun: plan activities to look forward to

10. Communicate with others, esp. to the person causing stress.

11. Reduce unnecessary stressors

12. Provide enough time to complete activities

13. Ask for help

14. Don’t over schedule

15. Stop being a perfectionist

16. Conserve energy- know your limits, avoid doing too much in one day.

17. Get organized- home/work filing system, calendar, or electronic device

(PDA).

18. Avoid saying “I should”, prioritize and do.

19. Respect others coping mechanism. What works for others might not work

for you and vice versa

20. Cognitive Therapy in the treatment of pain and emotions (Thomas et al.,

2006) modifying dysfunctional thinking, behavior, and emotional

responses and breaking the cycle of negative talk

21. (http://healthlibrary.epnet.com/GetContent.aspx?token=0d429707-b7e1-

4147-9947-abca6797a602&chunkiid=101930)

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Notes:

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Keep a record of daily stress.

List the different stressors.

Rate it on a scale of 1 to 5 (mild to severe)

Sun Mon Tues Wed Thurs Fri Sat

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EXERCISE

Exercise is beneficial to people with MS

What types of exercise are participants presently doing?

What are the barriers to exercising for you related to MS?

Problems with exercise for MS, heat intolerance, fatigue, and

physical limitations, could exacerbate muscle spasms (Must

consult a health professional before starting any exercise program).

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The Benefits of Exercise for people with MS

Improve Bowel and bladder function (Harris & Halper,

2008).

Reduce obesity

Increases muscle strength, for better mobility ( walking,

balance)

Can Improve activity for daily living (arm strength)

Can Improve fatigue

Can Improve depression, improves mood (Reitberg et al,

2009)

Can reduce muscle wasting

Can reduce the risk of other illnesses (diabetes, heart

disease...)

Can improve Quality of Life! (Stuifbergen, et al, 2006;

Motl, et al, 2008; Motl et al, 2009; Thomas et al, 2009).

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Notes:

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Quality of Life

Quality of life (QOL) can be defined as wellbeing, and life

satisfaction. It is a multidimensional concept that is

individualized, adaptive and changing throughout one’s life.

The definition of QOL addresses physical, psychological,

spiritual, social connectedness, goals, hopes, and aspirations.

QOL can be both subjective and objective (Plummer &

Molzahn, 2009; Quality of Life Concepts n.d.; Costello, &

Harper, 2004).

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Quality of Life

It is what you want out of life to make it enjoyable

Make a list of your goals for quality of life…

1.

2.

3.

4.

5.

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EXERCISE HOMEWORK

1. Write down an exercise program that you would be interested

in participating in.

2. Select a realistic goal of; time of day, minutes of exercise,

and frequency per week.

3. Share with class. Place in booklet.

4. Put in communication list for healthcare provider.

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Note:

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Diet/ Complimentary and Alternative

Therapies (CAM)

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1. No specific diet has been shown to reduce the progression of MS

(Farinotti et al., 2007).

2. A healthy diet is important to prevent illnesses and other chronic

disease, such as heart disease and diabetes, thus reducing

complications of MS.

3. A balanced diet can reduce obesity that can cause stress on joints and

diminish mobility.

4. A healthy diet prevents weight loss that may lead to skin breakdown,

while promoting health (Halper, 2007).

5. Vitamin D is presently being evaluated as an immune modulator to

prevent MS and treat exacerbations (Correale, Ysrraelit, & Gaita’n,

2009; Soilu-Hänninen, M., Laaksonen, M., Laitinen, I. et al, 2007; ).

6. There is some evidence that a diet low in saturated fats and

supplemented by Omega 3 (from fatty fishes, cod-liver oil, or flaxseed

oil) and Omega 6 (fatty acids from sunflower or safflower seed oil and

possibly evening primrose oil) may have some benefit for people with

MS. (http://www.nationalmssociety.org/living-with-multiple-

sclerosis/healthy-living/nutirtion-and-diet/index.aspx)

7. Good fluid intake, a balanced diet, sufficient physical exercise,

scheduled bowel routine and moderate use of medications (laxatives

and bulking agents) can reduce constipation and fecal incontinence

(Coggrave M,Wiesel P, Norton CC.Management of faecal

incontinence and constipation in adults with central neurological

diseases. Cochrane Database of Systematic Reviews 2006, Issue 2.

Art. No.: CD002115. DOI: 10.1002/14651858.CD002115.pub3.)

8. CAM: Most common- reflexology, massage, yoga, relaxation and

meditation, acupuncture and aromatherapy. Massage therapy,

acupuncture, and other complimentary treatments are considered

useful treatments, but no conclusive studies were found (Rocky

Mountain MS, 2010; National Center for Complementary and

Alternative National Institute of Health, 2007; US Department of

Veterans Affair MS Center for Excellence, n.d.).

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The most important aspect of CAM is

what is safe for you, and does it make

you feel better.

Make a list of CAM therapy that might benefit

you!

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

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DIET/CAM Homework:

Write about a healthy meal you planned and what you can do to

improve your diet, reduce fat, appropriate portion size, increase

fruits and vegetables. Journal about any plans you have started

with an exercise program (join a gym, walk daily, light hand

weights…)

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Managing Fatigue

Definition of Fatigue:

“A subjective lack of physical and/or mental energy that is

perceived by the individual or caregiver to interfere with usual and

desired activities” (Fatigue and multiple sclerosis Evidence based

management strategies of fatigue in multiple sclerosis, 1998).

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What is fatigue to you?

What time of day are you most fatigued?

What activities make you fatigued?

Is it chronic (on-going) or acute (new, just developed)?

Are you sleeping at night?

Communicate fatigue to your doctor.

List ways to improve fatigue:

1.

2.

3.

4.

5.

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Everything you have learned in this workshop can

help you manage fatigue!

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