Spring is in full bloom and summer is beckoning. It’s a lovely and uplifting time of year, but for people with multiple sclerosis, summer’s heat and humidity can cause symptoms to become more extreme. These temporary flare-ups are called pseudo-exacerbations and they pack a powerful punch.

They are common enough that before the introduction of MRI and other modern testing, the “hot bath test” was sometimes used to diagnose MS. Doctors would observe people who were immersed in hot water and watch for neurological impairment that improved after cooling.

Unlike true exacerbations, pseudo-exacerbations do not involve neurological damage, although symptoms can be quite severe. Pseudo-exacerbations can be caused by any number of stressors such as urinary tract infection, fatigue, flu, or elevated body temperature.

Exposure to heat can quickly lead to trouble. Raised body temperature makes it difficult for already damaged nerve fibers to transmit electrical impulses, resulting in an exaggeration of existing symptoms which may include weakness, fatigue, dizziness, decreased cognitive function, numbness, and blurred vision.

As one who experienced this early on in my life with MS, I can say without hesitation that I do not ever want to experience it again. A little extra vacation sun in a climate much hotter than I was used to knocked the wind out of my sails in a major way, rendering me almost completely unable to move until I cooled down. Unable to drag myself back to the hotel room, it took an hour in the shade and several tall glasses of ice water to get me back on track, and another several hours to fully recover.

Temporary though it is, it is a frightening ordeal, and quite debilitating. I’ve given up on hot tubs and hot baths forever, I’ve sworn off mid-day sun, and I am cognizant of the pitfalls of traveling to warmer climates.

Spring is a good time of year to review the phenomenon of heat-related pseudo-exacerbations and what to do about them. If you have MS, you don’t necessarily have to avoid summer fun. There are several things you can do to help avoid pseudo-exacerbations caused by heat:

• avoid hot tubs, saunas, hot baths, and showers
• choose shade over direct sunlight
• enjoy an occasional cool dip in the pool
• some sunlight is good for you, but try stay out of the sun during the hottest part of the day, from 11:00 am – 3:00 pm
• wear lightweight breathable clothing made from natural, breathable fabrics like cotton
• wear a hat with a brim
• drink plenty of cool, refreshing water

If you begin to feel the warning signs of overheating, such as lightheadedness, dizziness, weakness, and extreme fatigue:

• find some shade, or try to get indoors to a room with air conditioning or fans
• drink something cool
• take a cool shower or bath
• use a spray mist bottle
• rest!

Overheating is enough of a problem for people with MS that there are products like the cooling vest that are made specifically to help. For more information about these products, how they work, and how to get them, check out these cooling programs.

• Multiple Sclerosis Association of America Cooling Equipment Distribution
• Multiple Sclerosis Cooling Foundation
• Multiple Sclerosis Foundation Cooling Program
• National Multiple Sclerosis Society Cooling Product Information and Assistance

Writer Ann Pietrangelo embraces the concept of personal responsibility for health and wellness. As a person living with multiple sclerosis, she combines a healthy lifestyle and education with modern medicine, and seeks to provide information and support to others. She is a regular contributor to Care2 Causes. Follow on Twitter @AnnPietrangelo

Sometimes it’s the little things that make a big difference in quality of life and maintaining independence.

If you have relapsing/remitting multiple sclerosis, as I do, it’s easy to overlook simple things that can make life easier when in relapse. Since my own diagnosis in 2004, I have come to appreciate some simple household helpers that assist me in managing daily life with MS.

1. Tall Stool for Kitchen Work: An inexpensive solution to a big problem. If standing at the kitchen counter for any length of time is a problem, a tall stool is just the right height for kitchen duty. Get in the habit of gathering together everything you’ll need in one spot rather than making multiple trips around the kitchen. Grab the stool, have a seat and enjoy your kitchen again. Make sure the stool has firm support and no arms so you can easily maneuver. You don’t need to buy anything fancy or go to a specialty store — any tall stool will do.

2. Mobility Aids: An adjustable folding cane can be tucked away in a large purse, suitcase, or car, out of sight and out of mind until you need it. There is even a cane that folds out into a stool! They are available in lots of styles and colors, too. If you need them, lightweight, folding wheelchairs and walkers are excellent devices for people who only need them occasionally.

3. Shower Chair: If you have difficulty with balance and strength, the shower can be a little intimidating, but a small, sturdy shower chair can give you back your confidence, and can be easily moved aside when not needed. Grab bars can also boost safety. While you are thinking about the bathroom, you may want to consider investing in a blow dryer stand to relieve your uncooperative arms.

4. Handicapped Parking Placard: People with multiple sclerosis often appear healthy and strong even though they have difficulty walking for any length of time. Problems with fatigue, stamina, balance, and coordination can interfere with daily activities. If you have difficulty walking or standing for more than a few minutes, you might want to consider applying for a placard. The ability to park close to a place of business or shopping center could make all the difference in the world when it comes to maintaining a sense of independence. The information you need, along with the application, are available online from the Department of Motor Vehicles in your state.

5. Sensible Shoes: Sensible shoes don’t have to be ugly shoes. High heels and pointed toes aren’t very sexy if you teeter around on the brink of disaster all day. Opt for shoes with a low heel and sturdy construction. Shoes that have no support at the heel and do not stay put when you walk can cause trips and falls. Even flip flops can cause trouble if you have difficulty walking. For hanging around the house, lightweight slippers with flexible soles that move with your foot are comfortable and safe.

6. Cooling Products: Heat and humidity makes it even more difficult for already damaged nerve fibers to transmit electrical impulses, resulting in an exaggeration of MS symptoms (pseudo-exacerbation), which may include fatigue, dizziness, and extreme weakness. A simple rotating fan can make a big difference. Information on Cooling Programs: Multiple Sclerosis Foundation: Cooling Program, Multiple Sclerosis Association of America: Cooling Equipment Distribution Program, National Multiple Sclerosis Society: Cooling Product Information and Assistance.

7. Visual Aids: Most drug stores and department stores have magnifying reader glasses at various strengths. Magnifying screens, good lighting, and a host of options for your computer help people with visual disturbances.

8. Handy Helpers Around the House: Devices to help you reach reach things in high places, gripping tools for opening jars, and even pens made for people who have trouble with their grip make little chores easy again.

9. Yoga/Wii: Yoga is often recommended for people with MS and there are programs designed specifically with MS in mind, including exercises that can be done from a wheelchair. Wii is more than just a game and Wii Fit includes some yoga positions and a series of exercises to improve your balance and coordination. With no need to leave home, you can progress at your own pace.

10. Stress Reducers: Your spirit needs some TLC, too. Try using candles and essential oils with calming scents like lavender and sandlewood as you go about your household chores. Water fountains bring the soothing sounds of a stream or brook inside your home. Meditation and deep breathing exercises can rejuvenate in just minutes a day. Don’t neglect the mind/body connection.

Writer Ann Pietrangelo embraces the concept of personal responsibility for health and wellness. As a person living with multiple sclerosis, she combines a healthy lifestyle and education with modern medicine, and seeks to provide information and support to others. She is a regular contributor to Care2.com’s Reform Health Policy blog in Causes. Follow on Twitter @AnnPietrangelo.

Silencing a Voice That Says You’re a Fraud

By Melinda Beck

A physician starts playing a harsh mental tape in her head every time a new patient calls: What if I make the wrong diagnosis? I’m a terrible doctor. How did I get into medical school?

An executive loses his job and despite 25 productive years, he tells himself: I’m a loser. I can’t provide for my family, and I’ll never be able to again.

An eminent scholar is offered a top post in the Obama administration and his first reaction is: They must have made a mistake.

If these real-life examples sound familiar, you may have a caustic commentary running in your head, too. Psychologists say many of their patients are plagued by a harsh Inner Critic — including some extremely successful people who think it’s the secret to their success.

An Inner Critic can indeed roust you out of bed in the morning, get you on the treadmill (literally and figuratively) and spur you to finish that book or symphony or invention.

But the desire to achieve can get hijacked by harsh judgment and unrelenting fear. “There’s a healthy version and an unhealthy version,” says Daniel F. Seidman, a clinical psychologist at Columbia University Medical Center in New York. In some cases, he says, “people may achieve a lot, but they are totally miserable about it.”

Unrelenting self-criticism often goes hand in hand with depression and anxiety, and it may even predict depression. In a study of 107 patients in the latest issue of Comprehensive Psychiatry, David M. Dunkley at Jewish General Hospital in Montreal and colleagues found that those who were most self-critical were the most likely to be depressed and have difficulties in relationships four years later, even if they weren’t depressed to begin with.

Self-criticism is also a factor in eating disorders, self-mutilation and body dysmorphic disorder — that is, preoccupation with one’s perceived physical flaws. “We have expanded what we expect of material success and physical appearance so that it’s completely unrealistic,” says Robert L. Leahy, a psychiatrist and director of the American Institute for Cognitive Therapy in New York.

Many people’s Inner Critic makes an appearance early in life and is such a constant companion that it’s part of their personality. Psychologists say that children, particularly those with a genetic predisposition to depression, may internalize and exaggerate the expectations of parents or peers or society. One theory is that self-criticism is anger turned inward, when sufferers are filled with hostility but too afraid and insecure to let it out. Other theories hold that people who scold themselves are acting out guilt or shame or subconsciously shielding themselves against criticism from others: You can’t tell me anything I don’t already tell myself, in even harsher terms.

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Commentary by Betsy McCaughey

Ruin Your Health With the Obama Stimulus Plan

Feb. 9 (Bloomberg) — Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

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