Category: Health

By Laura Wells, as told to Rachel Reiff Ellis

When I was diagnosed with MS at 39, I would say my focus on my health was sporadic. I had young kids at the time, and my diet and exercise habits were all over the place. Before kids, I’d jog a few times a week, or get on the treadmill or bike. I’d also work in some weight training. But after the kids came along, I no longer did much regular physical activity. I was focused more on my kids’ schedules and needs than my own.

Once the kids were older, I began to have more time and attention for healthy eating, but my worsening MS symptoms were a real barrier to moving my body the way I once could. Because of my fatigue and balance issues, I could no longer jog or even go for long walks. So I started trying to figure out what I could do for myself. I decided to turn to yoga — something I used to do years ago.

I started by going to classes twice a week, but even that got hard for me, because keeping myself steady is so challenging. I was constantly worried that I might fall over and embarrass myself trying to do a Standing Warrior pose. And then I discovered one-on-one sessions. My instructor was so good about modifying any pose I needed help with. She’d show me how to use a wall or chair for support. These changes in my yoga practice meant I could do a little bit of exercise daily, which has turned out to be an important key to my well-being. 

When I challenge my body to do small spurts of intentional movement every day, it keeps me stronger both mentally and physically. It’s very easy to go down the rabbit hole thinking about all the things you can’t do when you have MS. So if I can do even just 15 to 20 minutes of yoga a day, it can go a long way.

I’m also fortunate that I live in an area with access to a physical therapist who specializes in MS. She’s been amazing at showing me exercises that can strengthen the weak parts of my legs and help me work on my stability.

When it comes to healthy eating habits, my philosophy has always been everything in moderation. I know a lot of people who have tried special diets, but I just try to fill my plate with a lot of fruits and vegetables and whole grains, and eat fewer packaged and processed foods. My downfall is my sweet tooth, which I’ve always had. And sugar causes inflammation, which can ramp up MS symptoms. But being aware of how foods make me feel helps a lot. I know that I feel better when I eat a salad for lunch instead of something carb-filled. So I try not to overdo it in any unhealthy category.

It’s funny, because while MS has worsened my physical balance, it’s forced me to find balance in my day-to-day life. I’ve always been someone who feels guilty if I’m not doing or helping, or being productive. But it’s become clear that it’s not only OK to relax, it’s necessary. Fatigue is one of the main symptoms of MS, and being more mindful of my activity levels is one of the ways I keep my stress low and help manage that symptom.

It’s no longer an option for me to stay up too late at night or pack my schedule so full that I don’t have downtime. If I don’t take time to sit still and read or listen to music, go for a relaxing stroll, or take a nap, I won’t be able to function. My brain will simply hit a wall. I call it “pea soup brain.” Now, I’m really good about going to bed at the same time every night, and taking a nap every single day. Not a long nap — just enough so my body can finish the rest of the day strong. I’ve learned that you have to take care of yourself before you can take care of anyone else.

I’ve also found that it’s important to celebrate small successes. The more I can embrace who I am and what I’m able to achieve, the better my mental outlook. If I’m able to do one more set of leg-strengthening exercises today than I was yesterday, that’s cause for celebration. It may not look like much to anybody else. But to me, it’s an accomplishment.

When it comes to your multiple sclerosis (MS), you want to do what’s best for your body. But you wonder about alcohol. Is it OK to enjoy a drink from time to time? Or is alcohol completely off the table? The answer is a little more complicated than a simple yes or no.

Don’t Overdo It

“For most people with MS, the answer is to use alcohol in moderation,” says Jennifer Graves, MD, PhD, associate professor of neurosciences and director of the Neuroimmunology Research Program at the University of California, San Diego.

According to the U.S. Dietary Guidelines for Americans, that means no more than one drink a day if you’re a woman or two if you’re a man.

“Regularly having several drinks could worsen neurological damage and function for patients living with MS, but a glass of wine or single beer at dinner is unlikely to cause significant issues,” says Graves.

Alcohol is neither all good nor all bad. For example, the antioxidants and flavonoids in red wine may actually lower your risk of heart disease, which is a concern when you have MS. But this isn’t a reason to start drinking if you don’t already. These compounds are in other food and drink, says Graves.

And in case you’re wondering if past alcohol use may have caused your MS, set your worries aside.

“Based on data available, that’s unlikely,” says Graves.

Alcohol’s Effect on MS Symptoms

If you do decide to enjoy an occasional glass of wine or beer, know that it could ramp up certain symptoms of MS. Even one drink can make issues like unsteadiness worse.

“If you have a lot of trouble with balance, thinking, or memory symptoms from MS, it may be better to avoid alcohol altogether,” says Graves.

Alcohol can also lead to sleep problems and worsen bladder symptoms. You also raise your risk of other conditions when you drink alcohol, especially if you drink too much. Your chances of certain cancers, high cholesterol, and stroke go up. Some of these conditions can make your MS worse overall, says Graves, so doing what you can to keep them from happening is important.

Several medications used to treat MS symptoms like pain, headache, insomnia, and depression don’t mix well with alcohol. “Combining these medications with drinks could lead to excessive sedation and health risks,” says Graves.

Be sure to ask your doctor how your specific treatments might act with alcohol so you know what to look for.

Short and Sweet

Remember that everyone with MS is different. Have an honest conversation with your doctor about your habits so you can make smart decisions for yourself.

It’s likely fine for you to celebrate with a glass of bubbly, add a nice red to your meal, or enjoy a beer while you watch the game. Just know your limits and try your best to stay within them.

If you have multiple sclerosis (MS), you may look completely fine to your loved ones and colleagues.

Meanwhile, your vision may be so blurry you can’t see your computer screen clearly. Or you have trouble socializing because the entire right side of your body is numb or tingling.

“Just imagine how distracting something like that is,” says Sharon Stoll, DO, a neurologist with Yale Medicine who specializes in MS.

It’s easy to see how these changes can affect your mental health. But MS can affect your mood for a mix of reasons, including changes spurred by the disease process.

Mental health issues are treatable no matter what’s causing them. You may need medication or talk therapy. Work with your doctor to find what’s best for you.

Can MS Cause Depression?

Up to 50% of people with MS may get major depressive disorder at some point. That makes your odds of depression about three times higher than the general public.

For a long time, doctors thought depression was a common response to the stress of life with MS. But there’s growing evidence that the disease changes the brain and immune system in a way that affects how you feel and act.

“With more research, more understanding, and more treatment, we’ve realized it really is part of the disease itself,” Stoll says. “It’s more than just a reactive depression.”

Michelle Heil, 40, found out she had relapsing-remitting MS in her late 30s. She’s finishing up a 2-year treatment on a drug that targets certain white blood cells. These white blood cells play an important role in MS. So far, the lesions are limited to her brain.

Heil, who was diagnosed with bipolar disorder 20 years ago, says she’s noticed and uptick in depressive symptoms lately, such as:

• Lack of motivation and energy
• Little interest in leaving the house
• Difficulty paying attention to more than one thing
• Sleep problems
• Feeling down or irritable

Along with her neurologist, Heil sees a psychiatrist and a therapist. She urges others to do the same but understands focusing on your well-being takes work.

“You don’t have a lot of energy to give when you have MS, so you put that energy toward getting through the day,” she says. “Mental health gets pushed back to the wayside.”

Unmanaged depression can make it harder to start or stick with your MS treatment. It also raises your odds of other health issues, such as:

• Inflammation and immune system problems
• Blood vessel diseases
• Heart disease
• Suicidal thoughts
• Death for any reason

Tell your doctor if you have symptoms of depression. Get medical help right away if you think you might hurt yourself.

Can MS Cause Anxiety?

Stoll compares life with MS to the stress of living through the COVID-19 pandemic: It’s unpredictable.

“That big unknown, that is something that MS patients live with on a daily basis,” Stoll says. “And part of treating the disease — and the anxiety and depression — is kind of coaching (people with MS) through this world of uncertainty.”

For example, Stoll says, lesions on your spinal cord can make it seem like your skin isn’t really there. That can trigger feelings of anxiety. “Imagine standing in a group and talking at a cocktail party and you’re holding onto your stomach to make sure your insides aren’t falling out.”

Heil started to have really bad anxiety “all of a sudden” a few years before her diagnosis. Her symptoms got so bad that she had to take medical leave from her job. She thought it was stress. But she wonders if it might’ve been something else: the MS hug.

“It’s like you’re being put in a giant tight bear hug, and you can’t catch your breath. It felt like I was having a panic attack,” Heil says. “But more than likely, I was having a flare-up and that’s how it was presenting.”

Like with depression, Stoll says anxiety may be partly caused by the “reworking and rewiring of your brain” that can happen with MS. But it could also stem from life events. Your doctor can help you figure out the difference and find a treatment to help manage what worries you most.

Can MS Trigger Other Emotional Changes?

Some people with MS also have adjustment disorder — when you have a really hard time adapting to stressful changes in your life. And you’re about twice as likely to get diagnosed with bipolar disorder as the general population.

You or your family may notice that you get moody or angry really fast. That might happen because of changes in your brain, stress, or mood issues like depression.

Heil says she has a hard time controlling her emotional reactions. “When I get upset about something, I get so upset that I basically can’t talk or function,” she says. “It’s like my brain short-circuits and I just start crying. I have an incredibly short temper.”

Less commonly, MS brain lesions can cause pseudobulbar affect (PBA). “It’s inappropriate emotions,” Stoll says. “Somebody is crying for no reason, then minutes or an hour later they’re laughing and they’re ecstatic for no reason or with minimal stimuli.”

PBA can seem like depression, mood swings, or bipolar disorder. But it tends to come on more suddenly than a mood disorder. Some people compare their outbursts to a seizure. Talk therapy isn’t likely to help, but there are medications for PBA.

Where Can I Get Help for Depression and Anxiety?

You can start with your regular doctor. They can look for any other medications or health problems that might be causing your symptoms. But your neurologist will be able to give you better MS-related care.

Ask your doctor to refer you to a rehabilitation psychologist who treats people who have MS.

A therapist can help you accept your diagnosis and find ways to manage problems head on. A method called cognitive behavioral therapy (CBT) may help ease pain, fatigue, anxiety, and depression.

Stoll regularly refers people with MS to counseling. Antidepressants can also be a big help. And there are some depression medications that can also treat nerve pain, headaches, or sleep problems.

“As an MS specialist, I like medicines that are two for one.”

To Heil, mental health treatment is just as crucial as her yearly brain scans and MS medication. But she says  her wellness is still a work in progress.

“Nobody gives you a handbook on how to do this stuff, like a top 10 list of things that are guaranteed to make things easier if you have MS.”  

Vincent Macaluso, MD, found out he had multiple sclerosis (MS) when he was in medical school. Today, he treats people who have MS at his clinic in New Hyde Park, NY.

He understands that MS can change the way you think, feel, and act better than most people. He also knows firsthand how hard it can be to explain this to others.

Symptoms like memory problems and depression happen because MS affects the way your brain works. Although these problems can have a huge impact on your life, other people may not always know you have them. Macaluso says it’s common for people with MS to look fine on the outside but not feel fine on the inside.

It can go the other way, too. Tim Vartanian, MD, director of the Judith Jaffe Multiple Sclerosis Center in New York, says family members or co-workers may notice the changes first.

Either way, it’s important to let those closest to you know what’s going on now and what could happen down the road. This helps them better understand any changes they see. They can also offer help when and if you need it.

Cognitive Problems

At some point, more than half the people with MS will have cognitive problems. (Some people with MS call it “cog fog.”) Vartanian says the most common symptoms are:

• Slowed thinking
• Fuzzy memory
• Trouble with executive function — your ability to plan and do things

And sometimes you just might not feel as sharp as you used to.

People with MS can have some or all of these things. But for most, memory problems top the list. Vartanian says MS can affect recent memories or those in the distant past.

For many, though, day-to-day symptoms are often mild. But even minor lapses can be a challenge. (Memory problems are one of the main reasons people with MS stop working.)

To explain how this feels, try putting it in terms others can relate to. You could say, “Remember how upset you were when you couldn’t find your car keys yesterday? As my MS goes on, that could happen to me more often.” 

People with MS should work with a doctor called a neuropsychologist who can suggest ways to sharpen the mind. This includes both mental and physical exercises. Things that can affect how well your brain works, like “depression, anxiety, and stress, all need to be addressed head-on,” Vartanian says.

Let your loved ones know things that can help you manage the memory problems that come with MS.

Keep it cool. Damaged nerves don’t work well in the heat. That’s why many (but not all) people with MS think and learn better when it’s cool. To improve focus, spend time with your friends in a cool, quiet place without distractions. (Step away from Netflix!) Let them know that’s the goal in case you forget now and then.

Make to-do lists. Many people with MS say they lose track of bits of paper. Instead, you may use a small recorder you can hang around your neck or the voice recorder on your phone. And let your friends know you’re doing it so they can help.

Set a routine. Put your car keys, phone, and glasses in the same place so you always know where they are. Let your loved ones know where that place is, so if they spot them someplace else, they can put them back.

Sound the alarm. Use bells and whistles on your phone or computer to remind you to do things. Loved ones can set the same alarms so they can remind you in case you forget what the alarm is for.

Put it on repeat. When someone tells you something, repeat it to them. That way, it’s more likely to stick in your mind — and theirs.

Depression

Depression is one of the most common MS symptoms. It can be hard to discuss. Some people see it as a sign of weakness. Others feel embarrassed or ashamed. And when you’re depressed, it’s normal to want to withdraw from others.

But it’s important to share how you’re feeling with people close to you. Explain that depression is a natural part of the process of MS and it needs treatment, just like any other symptom. It isn’t something you can snap out of. And despite their best efforts, your friends and family probably won’t be able to cheer you up.

Jessica Thomas is a social worker in Greensboro, NC. She has MS, as do many of the people she sees. She says that while a counselor can help manage the emotions of living with MS, people who are depressed may need medication, too. She also notes that people need an MS-free zone — “a part of life or a passion that MS may not interfere with.”

Exercise is a crucial piece, too. It’s important for your overall health and well-being. It also helps almost every aspect of MS and may work better for depression than antidepressant medicine. So you can tell a friend that a workout partner can really help you stay on track.

Also tell those closest to you that these things can help keep depression away:

• Healthy ways to manage stress
• A more plant-based diet
• Plenty of rest
• Help finishing your to-do list when you need it

For years, George Kramb, who’s 29 and lives in San Diego, CA, thought he had a severe case of dry skin.

“I had dry skin basically my whole life. It was always flaky, irritated, and even got to the point of cracking,” he says. Sometimes, in the winter, his fingers were so cracked and dry that he couldn’t open his hands.

Kramb tried over-the-counter ointments like Aquaphor, Cetaphil, and Gold Bond. “I used practically every single lotion and ointment that CVS sells, and nothing worked. It would offer temporary relief but didn’t address the underlying problem,” he says.

What Kramb didn’t know was that he didn’t just have dry skin. He had atopic dermatitis. “It wasn’t until I was a teenager and saw a dermatologist that I got a proper diagnosis,” he says.

What Is Atopic Dermatitis?

Atopic dermatitis (AD) is a skin condition where itchy rashes come and go. It’s usually associated with some type of allergy.

“Unlike dry skin, AD is a chronic inflammatory disease,” says Annabelle Garcia, MD, a board-certified dermatologist and owner of Sonterra Dermatology in San Antonio, TX. “Symptoms often appear as a rash on your skin. In its moderate-to-severe form, AD can cause constant itching, which can lead to cracking and bleeding of the skin.”

Common AD skin symptoms include:

• Dry, discolored skin
• Itching
• Painful or sore skin
• Rashes that may ooze fluid or bleed from scratching
• Sleep problems from itching
• Thick, hardened skin from scratching

Experts don’t know exactly what causes AD, but it may be related to your genes and environment. If you or your family members have asthma or allergies, you’re more likely to get AD.

“Atopic dermatitis typically begins in childhood but can appear at any age,” Garcia says. For some people, it tapers off when they get older. Others have it their whole life. AD may get better at times and then flare up at other times.

How Is AD Different From Dry Skin?

AD is more than dry skin. “While both dry skin and AD can make your skin flaky, AD can also include red or dark rashes and persistent itch that can lead to oozing and bleeding skin lesions,” Garcia says.

If you have AD, you may have an itch-scratch cycle. Your rash is itchy, so you rub or scratch your skin. That causes more irritation and itching, so the cycle of itching and scratching keeps going.

With AD, a chronic condition drives your symptoms, Garcia says.

Getting the Right Diagnosis

Atopic dermatitis can be difficult to diagnose, Garcia says. Your rash may look like psoriasis or poison ivy. If you have dark skin, it may be less noticeable, and it may take longer to get the right diagnosis.

If you have an itchy rash, see your doctor. “It’s important to know if you’re living with AD so you can take the necessary steps to control your skin health and find a proper treatment,” Garcia says. Topical creams may help with dry skin symptoms, but you might need a stronger treatment to target the cause.

Kramb had a feeling his dry skin could be AD because some flare-ups were severe. “My theory was confirmed when I met with the dermatologist, they prescribed my first steroid ointment, and it did wonders,” he says.

Treating AD

Finding a treatment that works for you is a process. If one doesn’t work, your doctor may recommend another.

It took Kramb a while to find the right mix. He tried a range of over-the-counter and prescription treatments, but they didn’t help. Later, he found that steroid ointments and creams work best.

Kramb says learning that his dry skin was atopic dermatitis inspired him to help others. He created PatientPartner, which helps people who have similar health conditions connect so they can learn from each other.

“A lot of people are nervous and scared to share their health conditions with others,” Kramb says. “I wanted to create a safe place for them to share with one another so they can learn and build a community.”

Oct. 17, 2022 – Does Instagram make new moms feel inadequate? Yes, suggests a new study that warns images of new mothers on social media may drive body dissatisfaction and feelings of not being good enough. 

Lead researcher Megan Gow, PhD, a National Health and Medical Research Council early career fellow at the University of Sydney Children’s Hospital Westmead Clinical School, says she wanted to find out if Instagram images reflected the actual population of postpartum women. 

“We were concerned images would be idealized, placing postpartum women, who are already a vulnerable group, at increased risk,” she says.  

The findings, published recently in the journal Healthcare, suggest social media may not be the right platform to target health messages to new moms. 

A Vulnerable Time

The months after an infant’s birth are a vulnerable time for new moms. Women contend with huge hormone shifts, sleep deprivation, and a major life change — all while caring for a new child.

A 2021 Nestle study found 32% of parents feel isolated, while a 2017 online poll in the United Kingdom found 54% of new moms felt “friendless.” And according to the American Psychological Association, up to 1 in 7 new mothers will face postpartum depression, while 9% will have posttraumatic stress disorder, according to Postpartum Support International. 

The pandemic may have worsened the isolation new mothers feel. A May 2022 study in the Journal of Psychiatric Research found U.S. rates of postpartum depression rose in the first year of the COVID-19 pandemic.

While new motherhood was stressful enough in the analog age, women today must contend with social media, which increases feelings of isolation. A June 2021 study published in Frontiers in Psychology said social media users between the ages of 26 and 35 reported higher rates of loneliness. That’s in line with Gow’s study, which noted 39% of Instagram’s monthly active users are women between the ages of 18 and 44. And nearly two-thirds of them – 63% — log onto the platform daily.

 “The postpartum phase can feel very isolated, and being vocal about the postpartum shifts that all mothers go through helps set expectations and normalize the experience for those of us who are postpartum,” says Catie de Montille, 36, a mother of two in Washington, DC. 

Instagram Sets the Wrong Expectations

Instagram sets unreasonable expectations for new mothers, Gow and her colleagues found in their study. 

She and her fellow researchers analyzed 600 posts that used #postpartumbody, a hashtag that had been posted on Instagram more than 2 million times by October 2022. Other hashtags like #mombod and #postbabybody have been used 1.9 million and 320,000 times, respectively.

Of the 600 posts, 409 (68%) focused on a woman as the central image. The researchers analyzed those 409 posts to find out if they reflected women’s post-childbirth reality.

They found that more than 9 in 10 posts (91%) showed women who appeared to have low body fat (37%) or average body fat (54%). Only 9% showed women who seemed to be overweight. And the researchers also found just 5% of images showed features commonly associated with a postpartum body, like stretch marks or scars from cesarean sections. 

Women need to be aware that “what is posted on Instagram may not be realistic and is not representative of the vast majority of women in the postpartum period” Gow says. 

The images also did not portray women as physically strong.

Gow’s team examined 250 images for signs of muscularity. More than half, 52%, showed few or no defined muscles. That finding came even though more than half of the original 409 images showed women in fitness attire (40%), underwear (8%), or a bathing suit (5%).

According to Emily Fortney, PsyD, a licensed clinical psychologist in Sacramento, CA, the study shows that health care workers must work harder to set expectations for new moms. 

“This is a deeper issue of how women are overall portrayed in the media and the pressure we face to return to some unrealistic size,” she says. “We need to be encouraging women to not focus on photos, but to focus on the postpartum experience in an all-encompassing way that includes both physical and mental health.”

Childbirth as an Illness to Overcome? 

While retail brands from Nike to Versace have begun to show a wider range of female shapes in advertisements and on the runway, postpartum women seem to be left out of this movement. Gow and her fellow researchers referred to a 2012 study that examined images in popular Australian magazines and concluded these photos likened the pregnant body to an illness from which women needed to recover. 

The images posted on Instagram indicate that belief is still pervasive. The images of postpartum women in fitness clothes suggest “that women want to be seen to be exercising as a means of breaking the ‘hold’ that pregnancy had on them or ‘repairing’ their postpartum body,” Gow and her fellow researchers say. 

New Orleans resident Sydney Neal, 32, a mother of two who gave birth to her youngest child in November 2021, said social media helped shape her view of what “recovery” would be like.

While Neal said some celebrities like Chrissy Teigen, a mother of two, have “kept it very real” on Instagram, she also “saw a lot of women on social media drop [their weight] quickly and post as if they were back to normal much faster than 6 months.”

Body-Positive Tools for New Moms 

Gow is continuing to study this topic. Her team is currently doing a study that will ask women about social media use, how they feel about their bodies, and how their beliefs change after viewing images tagged with #postpartumbody. (Women with children under the age of 2 can access the survey here.) 

Because of the unrealistic images, Gow and her team said Instagram may not be a good tool for sharing health information with new moms.

But there are other options. 

The Washington, DC-based de Montille, whose children were born in 2020 and 2022, used apps like Back to You and Expectful, and she follows Karrie Locher, a postpartum and neonatal nurse and certified lactation counselor, on Instagram. She said these tools focus on the mind/body connection, which “is better than focusing on the size of your jeans.” 

Women also should be able to turn to trusted health care professionals.

“Providers can start speaking about the romanticization of pregnancy and motherhood starting in prenatal care, and they can start speaking more about social media use and the pros and cons of use specifically in the perinatal period,” says Fortney. “This opens the door to a discussion on a wide range of issues that can actually help assess, prevent, and treat perinatal mood and anxiety disorders.”

Neal, the mother of two in New Orleans, said she wished her doctor had talked to her more about what to expect after giving birth. 

“I don’t really know how to crack the body image nut, but I think starting in a medical setting might be helpful,” she says.