The document provides information from a workshop on self-management of multiple sclerosis (MS). It discusses topics like medical management of MS, managing stress, exercise benefits, diet, fatigue management, and complementary and alternative therapies. Homework assignments include keeping a stress journal, creating an exercise plan, and writing about diet improvements.

1. The Multiple Sclerosis Self Management Workshop2011Christine Stefanovic RN<br />The Multiple Sclerosis<br />Self-Management Workshop<br />Write down a positive statement about yourself and what you would like to learn about managing your MS.<br />Notes:<br />Introduction to Self-management<br />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).<br />Medical Management- Administering and taking medications, adhering to diet, using medical devices appropriately

2. 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).<br />MS SELF-MANAGEMENT WORKSHOP CONTRACT<br />To have the best results from this workshop I agree to:<br />Bring a support person.<br />Attend all classes.<br />Arrive on time.<br />Participate in class activities.<br />Do the homework assignments to the best of my abilities.<br />Contract with myself:<br /> _____________________________________. <br />COMMUNICATION<br />Before doctor’s appointment write down the topic to be discussed during your visit.<br />List all areas that you are concerned about.<br />Possible treatments that you would prefer? Medication, PT, OT… <br />4. Advocate for yourself or bring someone who will!<br />Before the end of your appointment re-address or <br />clarify the issues discussed.<br /> <br />Ways to self-manage medications:<br />Establishing habits-<br />Adjusting routines-<br />Tracking-<br />Simplifying-<br />Valuing medication<br />Collaborating to manage- ask the care provider about side effects, cost, and benefits before starting a medication to be informed. <br />A Few MS Internet Sites<br />http://www.nationalmssociety.org/index.aspx

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

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

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

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

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

8. http://www.msassociation.org

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

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

11. http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pdfSTRESS-MANAGEMENT<br />What makes you stressed? <br />What are some stressors at work? <br />What are some stressors at home? <br />HOME WORK: <br />KEEP A RECORD OF STRESSORS<br />Who, what and where?<br />Record your reactions to stress/ thoughts during stress and after.<br />What are your responses to stress? (Physical and emotional)<br />Rate the stressors from mild to severe (1 to 5) <br />Reflect on which stress management techniques can be effective for your stressors<br />Stress Management Techniques<br />Meditation<br />Relaxation techniques<br />Yoga<br />T’ai chi<br />Aerobic exercise<br />Music<br />Art<br />Visualization<br />Having fun: plan activities to look forward to <br />Communicate with others, esp. to the person causing stress.<br />Reduce unnecessary stressors<br />Provide enough time to complete activities<br />Ask for help<br />Don’t over schedule<br />Stop being a perfectionist<br />Conserve energy- know your limits, avoid doing too much in one day.<br />Get organized- home/work filing system, calendar, or electronic device (PDA).<br />Avoid saying “I should”, prioritize and do.<br />Respect others coping mechanism. What works for others might not work for you and vice versa<br />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 <br />(http://healthlibrary.epnet.com/GetContent.aspx?token=0d429707-b7e1-4147-9947-abca6797a602&chunkiid=101930)<br />Notes:<br />Keep a record of daily stress.

12. List the different stressors.

13. Rate it on a scale of 1 to 5 (mild to severe)SunMonTuesWedThursFriSat<br />EXERCISE<br />Exercise is beneficial to people with MS<br />What types of exercise are participants presently doing?<br />What are the barriers to exercising for you related to MS?<br />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).<br />The Benefits of Exercise for people with MS<br />Improve Bowel and bladder function (Harris & Halper, 2008).

14. Reduce obesity

15. Increases muscle strength, for better mobility ( walking, balance)

16. Can Improve activity for daily living (arm strength)

17. Can Improve fatigue

18. Can Improve depression, improves mood (Reitberg et al, 2009)

19. Can reduce muscle wasting

20. Can reduce the risk of other illnesses (diabetes, heart disease...)

21. Can improve Quality of Life! (Stuifbergen, et al, 2006; Motl, et al, 2008; Motl et al, 2009; Thomas et al, 2009).Notes:<br />Quality of Life<br />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).

22. Quality of Life

23. It is what you want out of life to make it enjoyableMake a list of your goals for quality of life…<br />1.<br />2.<br />3.<br />4.<br />5.<br />EXERCISE HOMEWORK<br />Write down an exercise program that you would be interested in participating in.

24. Select a realistic goal of; time of day, minutes of exercise, and frequency per week.

25. Share with class. Place in booklet.

26. Put in communication list for healthcare provider.Note:<br />Diet/ Complimentary and Alternative Therapies (CAM)<br /> <br />No specific diet has been shown to reduce the progression of MS (Farinotti et al., 2007).<br />A healthy diet is important to prevent illnesses and other chronic disease, such as heart disease and diabetes, thus reducing complications of MS. <br />A balanced diet can reduce obesity that can cause stress on joints and diminish mobility. <br />A healthy diet prevents weight loss that may lead to skin breakdown, while promoting health (Halper, 2007). <br />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; ).<br />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)

27. 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.)

28. 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.).