Thomas P. Leist, MD, PhD, Professor of Neurology, Director Comprehensive MS Center, Thomas Jefferson University, continues the discussion about fatigue among patients with multiple sclerosis (MS).
This is part two of a two-part interview. Click here to watch part one.
That’s something that probably an MS patient can ultimately better describe or even so, it is something that is difficult to experience as an individual that doesn’t have MS. Normally, is when we are fatigued, rest or stepping back from an activity and then getting kind of a power nap or a 15 minutes away from the task or having a good night’s rest. The next day, we are rejuvenated and go about our life unencumbered from the prior events that made us fatigued or the prior activities have made us fatigued.
In multiple sclerosis, patients wake up with this wall of fatigue, or may wake up with this wall of fatigues that never lift. Even restful sleep doesn’t lift it. It’s this extreme lassitude. In a certain way, perhaps the closest individuals without MS experience about the fatigue that MS patients describe is when they experienced the bad flu or something like this, the tiredness that is present at that point in time when you’re just feeling exhausted and even just going to the kitchen and get a cup of water or having to go to the bathroom essentially needs your total convincing of your body to do these actions. So I think it’s this extreme lassitude. It’s the fact that it cannot be pushed aside. And it’s the fact that it doesn’t ameliorate itself just with the rest or for example, sleep.
Obviously, if fatigue is present in the morning already or arises during the work day in the afternoon, this can affect job performance. So fatigue can have a significant impact on somebody’s capacity to do things. Also, if somebody has to plan the regular activities of life around the fatigue, there is not much left at the end of the day to do all the things that will be more leisure activity. Also think about it, if a person is fatigued or has significant fatigue, just the idea of going and hanging out with family, going and enjoying an afternoon on a walk or so would be something that they will try not do or would only be there for a period of time. So, fatigue certainly stunts social involvement of patient that experiences it because every activity becomes more planned and many activities are being avoided.
It also has an effect on the work. Yes, some of us have a lot of capacity to plan our workday. Many of us have to do the work as it is presented. And there is a constant stream of activities during the period of time, so there is no place to hide. And if obviously a person tires out or has more difficulty in the afternoon to concentrate because of fatigue, this ultimately impacts their job performance. And with that has a direct impact on whether they are in for a promotion or whether they are in for retention during difficult times. So it has a direct social and economic impact on the individual.
And then obviously, when one is fatigued and with the change in body image of MS and fatigue, this can often also lead to, or is associated with depression, low self-esteem. And you get the idea that obviously, if you have low self-esteem, you may be less likely to interact with others. You may be socially isolating yourself. If you’re socially isolating yourself both at work and in the private life, there are other secondary consequences that all of us can think that arises out of such. The core of this is the fatigue experience of the individual.