Overall wellness is important for everyone - with or without a condition such as multiple sclerosis (MS). For individuals who are diagnosed with MS, taking care of your body and mind is vital to feeling and performing at your very best.
MSAA offers a wealth of information on topics that can contribute to your overall wellness. From strategies to help you physically - such as exercise, physical therapy, and cooling technology - to strategies to help you mentally and emotionally - such as information and support to help cope with stress, anxiety, or depression.
MSAA provides this information in many forms, including: printed and online publications that may be ordered or downloaded (to view or print); online articles (to view or print); MSi educational videos and recorded webinars that may be accessed directly from our website and viewed on your computer; and MSAA educational events held in cities across the country, featuring top experts in the field of MS care.
In the sections to follow, written materials and online videos are highlighted according to each wellness topic. With all of the articles, excerpts are used to give a brief introduction to what is included in the article. Please select "Read more..." that follows each excerpt listing to view the full article.
Many of our writings have come from years of work with experts in different areas of MS care and treatment. A portion of these publications, articles, and videos were originally published or filmed three or more years ago. We refer to these as "evergreen," since the information is still current and continues to be of great value through the years. Please note that a small amount of information may have become outdated, particularly certain contact information that may have changed since the article was published - however the main messages and vast majority of information remains current today.
MSAA also has a toll-free Helpline at (800) 532-7667, for individuals who wish to speak one-on-one with a trained consultant, who can provide support and direct callers to additional resources. Questions may also be emailed to MSquestions@mymsaa.org. MSAA provides many of its resources through MSAA's My MS Resource Locator program - an MS-specific, online database offering targeted information and unique support services, including detailed guides. For individuals seeking additional reading materials, please visit MSAA's free Lending Library for a listing of all MSAA library books, along with instruction on how you may request to have books mailed to your home, and returned to MSAA, at no charge to you. Additionally, MSAA offers a Networking program, where individuals with MS and their care partners may find peer support and online friendships by corresponding through email.
Please note that as with all of MSAA's information:
MSAA strives to provide useful, up-to-date information on matters of concern to MS patients and their families. This material is intended for general informational purposes only, and it does not constitute medical advice. You should not use the information presented as a means of diagnosis or for determining treatment. For diagnosis and treatment options, you are urged to consult your physician.
Good News about Pregnancy and Raising Children
Not long ago, many physicians discouraged women with MS from becoming parents. Cheryl Faber, MD, a St. Louis, Missouri-based neurologist who treats women with MS, explains, "Physicians feared that MS would flare up following pregnancy, preventing women from parenting. They also thought that progressive disability would cause difficulty in raising a family. Doctors thought avoiding pregnancy would be an answer.
"We now have better treatment options for women with MS. Newly diagnosed patients using appropriate treatments can often go on to live a full life without disability, if their disease course isn't very aggressive. With the improved outcomes that we now have for MS, most patients can live decades without incurring a lot of disability. Most people find that giving up parenthood isn't a tradeoff, since women with MS can raise children."
Easterling explains that MS does not impair fertility or lead to miscarriage. "Pregnancy has a positive effect on MS. It's a natural immunosuppressant. Higher levels of natural corticosteroids and estrogen are present during pregnancy, so relapses decrease by about 70 percent during the second and third trimesters. "
Improved Quality of Life
MSAA's Chief Medical Officer Jack Burks, MD, explains that MS can create enormous challenges for women. MS is typically diagnosed in the "prime" of life, when young people are preparing for their futures in terms of education, career, and family. This can be a very emotional time for a woman, and so much depends on her physical and mental health, as well as social and professional activities.
"The number-one advancement to help women with MS has been the development of disease-modifying therapies within the past 15 years," states Dr. Burks. "These medications are improving quality of life tremendously, and the future looks brighter than ever before for individuals with MS. More people are now able to continue working while raising families, and this just was not possible for many individuals 15 years ago, when these long-term treatments were not yet available."
General Healthcare for Women with MS
As with all women, those with MS need to maintain their health. Women can take an active part in this by keeping up with routine blood tests for blood sugar, thyroid, and cholesterol, as well as screenings for high blood pressure.
While these tests and exams are just as significant for men, some tests and exams are specific to women. [This article lists such tests as: breast exams, pap smear, HPV vaccine, bone-density scan, and mammogram.]
Other topics in this article include:
Medical issues for women with MS (including FDA pregnancy ratings for MS drugs) [please note that this article was published in 2008, so it does not include the specific ratings for the two newer, FDA-approved oral drugs.]
Physical Issues for Men with MS, Separating MS from Non-MS Symptoms
Stephen Z. of Norfolk, Massachusetts has MS and knows the value of good healthcare. He receives regular checkups to maintain his health, while seeing a neurologist every six months and scheduling MRIs as necessary. He also sees a primary care physician and various specialists for overall good health.
Stephen explains, "With any chronic disease, you tend to forget about other medical conditions. Overlooking symptoms is easy because you think they are part of the MS, even if they are not. These can be difficult to separate. Doctors do this as well as patients. It becomes more difficult to get other medical professionals to pay as much attention to you because you have a chronic disease.
Diet, Exercise, and Physical Therapy for Men with MS
Stephen has learned what most men his age have come to know - that it's easy to gain weight when you hit 60, but not so easy to take it off. "I've never been very good at diets, but eating right has become more critical now. I can't exercise much, so getting the weight off is more difficult. I've spent some time looking for programs with exercises that I can do."
Nurse Practitioner June Halper, MSN, APN-C, FAAN is the executive director of the Consortium of Multiple Sclerosis Centers and the International Organization of Multiple Sclerosis Nurses in Hackensack, New Jersey. She emphasizes that certain men are more likely to develop a larger abdomen due to family traits, so these individuals in particular need to be more vigilant about preventing weight gain.
Emotional Issues for Men with MS, Depression, Identity, and Adjustment
Some men find that adjusting to life under altered circumstances to be overwhelming, especially when a man's disability is severe enough to change his lifestyle. David Rintell, Ed.D., is a psychologist at Partners MS Center, Brigham and Women's and Massachusetts General Hospital and clinical instructor of psychiatry, Harvard Medical School. Rintell notes that this difficulty with adjustment can cause problems. "Men are brought up to be protectors, doers, wage earners, and people who maintain control of their situations. This is how male identity is formed, and it makes MS difficult, because MS may interfere with one's ability to earn money and protect his family."
Written by Susan Wells Courtney, Richard Blanck, MD, and Jack Burks, MD
(An MSAA "evergreen" article published in 2008)
A Doctor's Style
Every doctor has a certain style, philosophy, and way of communicating with his or her patients. Finding the right doctor-patient match is not always easy, but when successful, patients and doctors may enjoy a long-term relationship with open communication and mutual understanding.
Dr. Richard Blanck is a neurologist who specializes in MS, and has been seeing patients for more than 30 years. One of Dr. Blanck 's most urgent objectives has been to spread the word about the importance of doctor-patient communication. By openly speaking with a patient - and perhaps more importantly, listening closely to what the patient has to say - a solid rapport will likely develop. This helps to bring about a correct diagnosis more quickly, as well as encourage better treatment adherence and compliance.
The Initial Interview
The initial interview is vitally important, not only to work toward an accurate diagnosis, but also to lay the foundation for a positive rapport and ongoing treatment plan. According to Dr. Blanck, a good rapport begins with a heartfelt greeting. Making eye contact, shaking hands, smiling, and leaning in to show a sincere interest, all work toward making a patient feel welcome, relaxed, and comfortable. One of the first goals is to reduce anxiety, which a new patient often experiences.
Delivering the Diagnosis of MS
Delivering a diagnosis of MS is a very sensitive issue. Dr. Blanck is passionate about the importance of delivering a diagnosis in the best manner possible. He believes that the messages should be clear and precise, using understandable terms. The physician should also show compassion and convey hope for the future.
Other topics in this article include:
Successful Doctor-Patient Communication
Preparing for Doctor Appointments
Physician Models of Care for Patients and their Families
Written by Susan Wells Courtney
Contributions by Jayne Ness, MD, PhD; Daniel Kantor, MD; Maria Milazzo, MS, CPNP
(An MSAA "evergreen" article published in 2007)
Diagnosis and Research
Multiple sclerosis (MS) has long been identified as a neurological disorder affecting young adults. For many years, when young children or teens would show signs of MS, their family doctor or neurologist would explain that children "don't get MS." They were thought to be too young, and were assumed to have another condition that mimics MS.
Even in recent years, with the knowledge that children could develop MS, this was never an easy diagnosis to make. Many doctors continued to steer away from a diagnosis that would be difficult to confirm, was a chronic and potentially disabling condition, and until the 1990s, had no effective treatments.
Jayne Ness, MD, PhD, is the director of the Center for Pediatric-Onset Demyelinating Disease at the Children 's Hospital of Alabama University in Birmingham. Dr. Ness explains, "Ten to twenty years ago, there was reluctance amongst neurologists to diagnose children with MS and 'label' them with a life-long disease without a treatment. However, MS in childhood and adolescence is now being diagnosed more frequently, due in part to an increased awareness that children can get MS and there are available disease-modifying therapies. Thanks to advanced neuroimaging techniques and the publication of diagnostic criteria, the diagnosis of MS in childhood has become more straightforward, but extra caution is still needed when diagnosing pediatric MS, particularly in young children."
The Impact of MS on Children and Teens
The psychosocial effects of MS can impact many aspects of a young person's life. School, family, friends, activities, and quality of life can all be greatly affected. Healthcare professionals, parents, and teachers (among other educational specialists) can all play a role in helping a child and family adjust to the symptoms and implications of a chronic illness.
When children or teens have MS, they typically feel different and socially isolated, as though they don't "fit in." Unlike some other, better known disorders (such as asthma or juvenile diabetes), not many children are diagnosed with MS. Parents and children feel alone without others to identify with and provide support. Given that pediatric MS is a relatively rare condition, family members may feel frustrated over a lack of information available and a lack of understanding from others who are not familiar with MS.
[As with all of the excerpts, additional information from this section may be found by going to the full article.]
MS Camp and Shining Stars
Ms. Milazzo is thrilled with the success of her center's summer camp. "I feel so lucky to be at a center where we've developed a camp for kids with MS.
"Each session goes for four-to-five days, and during that time, the kids stay in the retreat center. This is like a college dorm with a dining room...more of a 'luxury camp,' since we're not in tents. The kids do a lot outside - sailing, kayaking, high ropes course, going to the beach (many are from areas that do not have a beach), and many other fun things. They learn to work together as a team, building a connection, being together, doing very physical types of activities. We also do activities involving music, movement, and performing arts therapy."
Ms. Milazzo continues, "Our kids are amazing. One of the camp kids had two full scholarships offered for soccer. She does a lot of public speaking, serving as a mentor to many.
"Another girl in Boston is working to raise awareness at the high schools. In Pennsylvania, one of the children wrote a book for kids with MS, talking about symptoms and how friends can help. "Every one of these kids is special. They are all really nice, and all really driven. They are 'A' students, athletic, healthy, well-rounded, doing great, and motivated."
Aquatic therapy, a sub-specialty in the fields of physical or occupational therapy that is done in a swimming pool, can benefit people with MS by improving flexibility and motion, allowing muscles to relax, and reducing pain. Aquatic exercise - exercises done in a pool - can also help achieve these same results. Knowledge of swimming is not required for either aquatic therapy or aquatic exercise.
Donna Adler, an Arizona-based aqua specialist and continuing-education provider for both the AEA and the ATRI, states that aqua exercise "is on the bridge between fitness and therapy." She works with many people with MS who have spasticity [tightness] and pain.
Water therapy and water exercise also have psychological benefits. Sprehe says, "It improves the quality of life for people with MS. Moving better, getting out of the house, socializing at the pool, having fun, and relating to other individuals with MS are all important aspects." Adler adds, "It's something different from going to doctors' offices. It gets people with MS out of the depressive cycle. Socializing is one of the most important attributes of aqua exercise, even if a person can't do every step."
The importance of filling your life with the activities and people you value
Written by Samantha Artherholt, PhD and Aimee Verrall, MPH
(An MSAA article published in 2012)
Although remaining active may be more difficult when experiencing symptoms, increasing one's physical activity has the potential for significant health benefits among individuals with MS. Currently, no clear recommendations are available on the amount of physical activity that is appropriate for people with MS. Guidelines for adults without a chronic condition are 150 minutes of moderate-intensity aerobic activity (such as walking) per week, plus muscle-strengthening activities at least twice per week. The best advice is to talk to your doctor or physical therapist about the amount and type of regular physical activity that is right for you.
You may find many benefits to remaining physically active, both for your body and for your mind. Studies of individuals with MS indicate that exercise results in improved strength, reduced pain, less stress, improved mood, and greater endurance. Regular exercise can also help prevent other diseases that can impact your life and your health. We know that exercise provides many benefits to your heart and vascular system. It can increase the efficiency of the heart, and decrease the risk of heart disease. Regular physical activity can lower blood pressure and decrease harmful (LDL) cholesterol, while increasing good (HDL) cholesterol. Exercise can also help regulate blood sugar levels and prevent diabetes. In addition, physical activity can help to maintain muscle strength, maintain bone density and reduce the risk of fracture, and regulate breathing.
Research has identified many good reasons to care about social support, but one of the most important might be the direct impact that social support can have on your health. Several theories have been developed to explain how social support contributes to health in general. One theory is that when you meet the basic human needs for companionship, intimacy, a sense of belonging, and reassurance of one's worth as a person, supportive relationships may enhance wellbeing and health, even if the person is dealing with a lot of stress. Sometimes this is referred to as "buffering," which uses the theory that the more social support we have around us, the more we're able to deal with stressful situations or events in our life (such as the diagnosis or management of a long-term illness). Social support may be particularly important for people living with a chronic condition like MS.
MS can also be stressful for spouses or partners. Significant others of individuals with MS often describe relationship changes that go hand-in-hand with an MS diagnosis. Some significant others (or care partners) report feeling helpless and wishing they could do more, but are often not sure what they can do. Some significant others may be very good at one type of social support, such as instrumental support (tangible aid and services that directly assist a person in need), but aren't sure how to provide a deeper emotional support. Couples counseling may be an option during this time to ensure your relationship stays strong, that communication stays open, and to give both people the best tools to support one another. Support groups for spouses and care partners of people living with MS are also available and some may find these to be very helpful.
Written by Susan Wells Courtney
Contributions by Brian Hutchinson, MS, PT and Valerie W. Gibson, PT
(An MSAA "evergreen" article published in 2006)
Weakness may result from one or more of a number of factors. When weakness is caused directly by MS, it is caused by damage to the nerves and an interruption in the flow of nerve impulses, going from the brain or spinal cord to the affected extremity. Additionally, weakness may result from other impairments of MS, such as fatigue, spasticity, or balance problems. "Disuse" can cause weakness as well, and this is when the symptoms of MS reduce one's level of activity and movement of an extremity.
Some people with MS will attempt to overcome a weakness problem by trying to aggressively strengthen muscles on their own through exercise and lifting weights. Unfortunately, this may further fatigue the muscles. On the other hand, lack of exercise can cause a muscle to become weaker from disuse. Although this sounds like a no-win situation, a physical therapist can design a program aimed at keeping the affected muscles healthy while avoiding further weakness.
According to Physical Therapist Brian Hutchinson, MS, PT, "Different types of exercise therapies may be used to help strengthen muscles. These include weights, elastic tubing, gravity, and manual resistance through skilled intervention by a physical or occupational therapist. In this latter type of therapy, the therapist provides controlled resistance against the limb being strengthened, while the patient pushes against the therapist.
"When treating MS through exercise, the key is 'quality of movement,' versus 'quantity.' In other words, how you do the movement is far more important than how many times you do the movement. Individuals with MS need a thorough assessment with a physical or occupational therapist to prescribe the appropriate exercises for strengthening as well as overall conditioning."
Instruction on how to properly perform the exercises is vital. When exercises are prescribed by an experienced therapist, he or she will include: type of exercise, how long to exercise, how often to exercise, and to what degree of intensity. All of these factors promote safety and success.
Written by Susan Wells Courtney & Linda A. Lucuski, MPT
(An MSAA "evergreen" article published in 2004)
The Role of Rehabilitation
Rehabilitation can be of significant benefit to an individual who is experiencing a change in his or her physical abilities. Most people are familiar with the importance of rehabilitation following surgery, injury, or stroke. More recently, the medical community has come to recognize the enormous value of ongoing rehabilitation for people with chronic illness, particularly MS, whose variety of changing symptoms can affect virtually all areas of movement and function.
Rehabilitation addresses many of the issues and challenges experienced by individuals with MS. Some of the specific symptoms that may be helped include spasticity, weakness, and resultant movement problems; balance, dizziness, and coordination difficulties; as well as changes in speech, swallowing, cognition, and vision. Treating these specific symptoms, however, is only the beginning. Limitations in movement and other abilities affect many other aspects of everyday life, and the different types of therapy offered through rehabilitation work to regain, or find ways to compensate for, lost function. Safety precautions and the prevention of pressure sores are also vital issues that are promoted through rehabilitation.
MS symptoms impact how someone is able to function at work and at home. They affect one's ability to drive or participate in outside activities. They also play a big role in one's self image and how an individual interacts with others. As a result, social, psychological, and emotional changes coincide with the onset of physical symptoms.
The unique and wonderful concept behind rehabilitation is that it incorporates an individual's entire situation, taking into account how physical changes may impact one's activities, emotions, and well-being. With rehabilitation, a team of specialists work together to address all aspects of an individual's disability. Their overall goal is to improve a person's quality of life, while helping preserve one's independence and safety.
I wanted my family to eat more healthfully when my son was born, but I had no idea where to start. It began one day at a friend's house. She offered me some sugar-free, caffeine-free soda. "If there's no sugar or caffeine in it, what is in it?" I asked. Puzzled, she said that she had no idea. The next morning, I opened my cabinet to prepare breakfast and saw an assortment of cereals. I wondered whether eating cereal was a good way to start my day. Looking at lists full of ingredients that I couldn't decipher didn't help matters.
I wasn't alone in my confusion. People know it's better to eat broccoli than a candy bar, but what about all those gray areas in between the two? It's even more complicated when a person has MS. Which foods are best to eat for optimal health?
Editor's note: Readers are strongly advised to consult their physician before making any changes to their diet. A doctor can also help determine the exact types of foods and number of daily calories that are specifically appropriate for an individual.
What to Eat
According to Nancy Davis, a noted spokesperson on multiple sclerosis and the author of Lean on Me, a diet low in saturated fats and high in fiber is the foundation for a healthy eating plan. A good way to follow this plan is to eat fiber-packed fruit and vegetables. Fresh and frozen are best, but sodium-free canned vegetables and sugar-free canned fruit are also good. If canned produce without sodium and sugar isn't available, rinsing canned produce in water is helpful. Whole fruit contains more fiber, less sugar, and fewer calories than fruit juice, so whole fruit is the better option.
Gillian Goodfriend is a registered dietician at the University of Illinois at Chicago (UIC)'s Department of Disability and Human Development. To begin a healthy diet, Goodfriend advises adding one or two more servings per day of fruit and vegetables. "Slowly work your way up to five to six servings each day. A large banana is two servings. Two cups of salad is two servings. Big Red Delicious apples count as two servings. Reaching your goal is more achievable when you think of it that way."
I lost count of how many nutrition shakes I drank as a teen in an attempt to gain weight. If I didn't consume 3,000 calories a day, I'd shrink to 97 pounds - too low for my 5'4" frame. My father kept feeding me steak and potatoes, saying it would "fill me out." Yet, no matter what I ate or drank, I couldn't get past 105 pounds. As an adult, I stayed the same weight, wearing a size-5 wedding gown and size-5 maternity clothes.
After becoming disabled at age 35, I couldn't stand up long enough to prepare healthy meals, so I began relying on convenience foods. My activity level dropped, as I could barely move some days. Adding symptom-relieving medications to that mix was a prescription for weight gain. Lots of it. Within four years, the size-5 girl became the size-3X woman.
"This scenario is common for people with disabilities, including MS," notes Gillian Goodfriend, a registered dietician at the University of Illinois at Chicago (UIC)'s Department of Disability and Human Development. "People choose fattening convenience foods because of difficulty standing, lack of energy, and sometimes stress and depression brought on by MS. Inactivity, reduced activity, and certain medications also put weight on."
Individuals with MS can take steps to prevent weight gain or reduce weight. Goodfriend emphasizes the importance of eating three meals each day. "People shouldn't deprive themselves by skipping meals. Skipping breakfast causes people to eat too much at lunch, because they are starving. Their metabolism also slows down from not eating. "
In her book, Apples and Pears: The Body Shape Solution for Weight Loss and Wellness, Marie Savard, MD, points to studies showing that people who eat breakfast are half as likely to be obese as people who don't eat breakfast. So, what's good to eat for breakfast? Goodfriend says the healthiest, most satisfying breakfast is one that combines protein and whole grains or fruits. "Protein helps keep people more satisfied and less hungry. Whole grains and fruit provide filling fiber."
(An MSAA article published in 2010)
Lara Krawchuk, MSW, LCSW, MPH, a clinical social worker in West Chester, Pennsylvania, says it's common for people in our culture to make grieving individuals feel uncomfortable. "Disability is an ambiguous loss, which makes it trickier. The losses aren't always obvious. If someone is still working, still has a family, or is still alive, people tell them to be grateful for what they have instead of supporting them. People try to force a happy face on them when they aren't ready for it, because ours is a very grief-phobic culture. Nobody can tell someone how to grieve or how long to grieve."
Krawchuk, a professor at the University of Pennsylvania who teaches clinical social work practice and a class on loss through the life cycle, has worked with many MS patients. She says that when MS patients lose the ability to physically function as they used to, others frequently fail to acknowledge that loss. "Grief is often under-recognized, unrecognized, or devalued. If nobody calls your loss a loss, you don't call it a loss. You don't have words for your grief and you don't have a way to make sense of what all of these losses mean to you."
Understanding and Treating Depression in Multiple Sclerosis
Written by Allison Shadday, LCSW
Foreword by Dr. Jack Burks, MSAA Chief Medical Officer
(An MSAA "evergreen" booklet published in 2007)
Depression is a common symptom of MS, and sadly, is often overlooked. This booklet from MSAA will help you to understand depression and learn useful tips for overcoming this difficult symptom.
Three experts in the fields of counseling, medicine, and therapy provide supportive information on the topic of changes within a relationship
(An MSAA "evergreen" article published in 2004)
Part I: Introduction
(Information for this portion of the article has been provided [in 2004] by Lara R. Krawchuk, MSW, LSW, MPH, director of clinical services of the Conill Institute for Chronic Illness.)
Intimacy may be defined as anything that makes one feel close to another, particularly in a personal and private way. Achieving intimacy can be difficult for many people, not just in a physical sense, but in a mental and emotional one as well.
When a chronic illness such as MS is involved, new challenges may arise, including physical limitations, changing emotions, and new roles that each partner may need to fulfill. While these issues can make intimacy more complicated, taking a pro-active approach can bring physical, mental, and emotional closeness into a relationship.
Part II: Looking at Intimacy from a Medical Perspective
(Information for this portion of the article has been provided [in 2004] by Alicia M. Conill, MD, medical director and CEO of the Conill Institute.)
Many doctors might agree that the most important sexual organ is the brain. With respect to intimacy and MS or any chronic illness, a major barrier may be a poor self image and lowered self esteem. Sometimes people with an illness may not be feeling well, or may feel unattractive, leading them to believe that no one would be interested in them romantically. This sets up an unhealthy environment for exploring personal relationships.
Everyone needs to feel and cultivate an attitude that he or she is worthwhile. To improve self image, an individual must first acknowledge that a problem exists and that he or she has a poor self image. Once the problem is recognized, talking with someone (a friend, relative, care partner, health professional, or others in a support group) can be helpful. If uncomfortable speaking with a partner about intimacy, confiding with a close friend or relative can often serve as a good practice run before broaching the subject with a lover.
[This portion of the article discusses specific symptoms of MS that may interfere with intimacy and provides strategies on how to overcome them.]
Part III: Regaining Intimacy
(Information for this portion of the article has been provided [in 2004] by Sabitha Pillai-Friedman, PhD, LSW, a relationship and sex therapist at the Institute for Sex Therapy, Council for Relationships in Philadelphia)
Intimacy problems for individuals with MS are two fold. First, the affects of nerve damage may compromise the messages sent from the brain to the sexual organs. Second, MS symptoms such as fatigue, spasticity, pain, and sleeplessness can play an important role with intimacy. Some of these symptoms are invisible, so partners may have trouble empathizing with someone who looks fine, and may feel rejected when their partner does not respond positively.
Couples may need to reorient themselves to a different kind of intimacy, broadening their definition of what intimacy can be for them. Intimacy is not limited to the physical act of intercourse, and when redefining intimacy, couples should stress the importance and pleasure of touching and feeling. Couples need to explore other ways of being sensual, which includes cuddling and holding one another.
The inspiring stories [in this article] have all been written by individuals whose lives are affected by MS. Each person talks about his or her unique situation and offers a special perspective on life with this challenging disorder. Many are devoted to their family, friends, and faith. Many have found a positive side to being diagnosed with MS, having discovered that wonderful silver lining hidden within their new situations.
Some stories talk about diet, exercise, and medications. As always, readers are cautioned not to make any changes to their routine or lifestyle (including diet, exercise, and medications) without consulting their physician. Even though we have everyone's permission to print his or her story, please note that with the exception of the opening story (written by a volunteer writer for MSAA), only first names have been used to protect each person's privacy. Stock photos have been used throughout and are not intended to resemble any specific person, place, or thing.
Please enjoy these stories of inspiration sent in by readers of The Motivator!
[Please note: Before making any changes to your diet or routine, always consult your physician.]
Fourteen Easy Ways to Improve Your Life
Change can be overwhelming, especially when viewed in terms of life-long restrictions. Instead of just depriving yourself of the things you enjoy, add to your happiness by following these suggestions [explanations of each listing are included in the full article]:
Learn to laugh.
Get what's troubling you off your chest.
Dig around in the dirt [through gardening].
Make exercise a regular part of your day.
Write down your feelings.
Keep your relationships happy.
Practice balance in everyday life.
Don't forget to pray.
Boost your brain power.
Allow yourself to feel.
Learn something new.
Take time to relish the simple things.
Call a faraway friend.
[Other topics in this article include: "Give Yourself a Financial Makeover" and "How to Train Yourself to Be Happy"]
Written by Susan Wells Courtney
Reviewed and Contributions by Miriam Franco, MSW, PsyD
(An MSAA "evergreen" article published in 2008)
An Introduction to Guided Imagery and Its Potential Benefits for Individuals with MS
We often hear about the mind-body connection in regard to our health and wellbeing. Many Western-trained physicians and researchers are discovering that the mind appears to have a powerful influence over one 's physical and emotional health, a concept long held by those who practice Eastern Medicine. In recent years, a technique known as guided imagery has been gaining much recognition by individuals, families, care partners, and health professionals. This is an exciting area of complementary and alternative medicine, offering benefits to almost anyone who practices this therapeutic exercise.
Dr. Miriam Franco is an experienced psychologist and social worker who is also certified to practice Integrative Guided Imagery. According to Dr. Franco, "Guided imagery may be described as specific mind-body techniques that first teach people to become deeply relaxed, and then to use sensory images to focus attention on positive and intuitive images. These images are from their own experience or their imagination, and are healing as well as helpful. In so doing, processes change in their body. By relaxing the body first, this promotes mental relaxation and allows worrisome thoughts to become less prominent.
"With practice, guided imagery can produce radical shifts in attitude, coping, and problem solving...which, in turn, can increase positive coping skills. Unlike some forms of meditation or hypnosis, guided imagery does not involve focusing your mind on a single word or image. Instead, guided imagery takes you on a journey through your own sensory experience in a relaxed state. It is based on the assumption that the mind can influence certain functions of the body."
My introduction to yoga came at age 14 when a pen pal sent me the book, Be Young with Yoga, by Richard L. Hittleman. For twenty-one years, I practiced the Hatha yoga poses shown in the book every day. After becoming disabled, I began doing the poses in bed, as the floor was no longer accessible to me. With each exacerbation of my disability and the resultant weight gain, I did less yoga, so I became less flexible and eventually stopped exercising altogether.
The book, Yoga and Multiple Sclerosis: A Journey to Health and Healing (Demos Medical Publishing, 2007) by Loren M. Fishman, MD and Eric L. Small, couldn't have come across my desk at a better time. After a 126-pound weight loss, I had gingerly resumed exercising, but no longer had my book of yoga postures. I leafed through the pages of Fishman and Small's book, eager to attempt some basic poses.
People with MS - whether they show no outward signs of illness or whether they use a wheelchair - need physical exercise. Yoga is especially beneficial, as it releases muscular tension, improves flexibility and circulation, helps with balance and fatigue, and boosts mental alertness. It reduces the effect of sensory changes by increasing functional abilities to a higher level.
Yoga is a gentle form of exercise, and the authors point out that yoga always gives more energy than it takes, making it ideal for those whose energy is limited from MS. Since yoga involves sustained muscle stretches, it helps with the spasticity that sometimes accompanies MS by promoting muscle relaxation. Holding these postures requires isometric effort that increases strength. Because yoga encourages muscle groups to work together, it helps with impaired coordination and balance.
Some Physicians Combine Conventional Treatment Therapies with Complementary and Alternative Medicine to Provide Optimal Care
West Meets East...
A Western-Trained Doctor Evaluates and Integrates Eastern Therapies and Other Forms of Complementary and Alternative Medicine into MS Treatment Plans Written by Susan Wells Courtney
(An MSAA "evergreen" article published in 2007)
Dr. Allen C. Bowling is medical director at the Rocky Mountain Multiple Sclerosis Center in Englewood, Colorado, where he focuses on the use of CAM therapies and the treatment of multiple sclerosis (MS). As a student, Dr. Bowling was intrigued by medicine and science. His interest led him to earn an MD in medicine and a PhD in pharmacology from the Yale University School of Medicine. He went on to attend the University of California in San Francisco where he completed his training in neurology, and this was followed by his fellowship training at Massachusetts General Hospital and Harvard Medical School.
Seeing a possible connection, Dr. Bowling conducted research in the areas of diet, antioxidants, and neurologic disease. He has spent several years researching complementary and alternative medicine (CAM) therapies and how they may affect MS. He explains, "A good deal of gray area exists with the CAM therapies, however, some might be helpful, especially in treating neurologic conditions."
Dr. Bowling continues, "The evidence supporting CAM therapies in the treatment of MS is limited. My driving force has been to get good information out to the patients, so they may make wise decisions when considering their treatment options. I am not trying to promote anything; I have no agenda beyond looking at the therapies available in order to provide a good and fair assessment."
Given his extensive experience in the area of neurology and CAM therapies, Dr. Bowling speaks regularly and has given numerous educational programs on the topic to patients as well as medical professionals. He observes, "The patients want to know which CAM therapies are helpful, while the doctors want to know which CAM therapies are harmful."
Dr. Bowling finds this dichotomy to be interesting, as it illustrates the two viewpoints that exist with these therapies. On the one hand, some CAM therapies show potential for treating individuals with MS, but on the other hand, these therapies are often lacking strong clinical evidence to support their effectiveness and safety. Clinical evidence refers to rigorous blinded studies conducted with people affected by the condition for which the therapy is being tested. Many times the evidence for CAM therapies is largely anecdotal (based on someone's personal experience), which is the most controversial as well as the least reliable type of evidence.
East Meets West...
An Eastern-Trained Doctor Integrates Western Medicine with the Practice of Eastern Therapies in Treating MS
Jingduan Yang, MD
Dr. Jingduan Yang is the medical director at the Tao Institute of Mind & Body Medicine in Mt. Laurel, New Jersey. He is also a physician at the Jefferson-Myrna Brind Center of Integrative Medicine, which is a division of the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. Before completing a psychiatry residency at Thomas Jefferson University, Dr. Yang was a neurologist at the Fourth Military Medical University in China. He was also a research fellow in clinical psychopharmacology at Oxford University in England.
Dr. Yang specializes in neurology, integrative psychiatry, and Classic Chinese Medicine. In addition to writing numerous peer-reviewed articles on the topic of integrative medicine, he has been a speaker at many national and international conferences as well as academic meetings. At his practices in Pennsylvania and New Jersey, Dr. Yang integrates Chinese herbal medicine, acupuncture, neuro-emotional techniques, and psychotherapy in the care of his patients, while supporting their use of disease-modifying and symptom-management medications.
When asked about his motivation to become a physician, Dr. Yang responds, "I was born to a family that has a tradition of practicing Classic Chinese Medicine for generations. As a child, I observed my father treating patients with neurological conditions and mental illness using acupuncture and herbal medicine. In medical school, I was fascinated by the complexity of the mind, brain, and body interactions and interconnections. These were well emphasized and described in the Classic Chinese medical textbooks. I have found that my training in neurology, psychiatry, and Classic Chinese Medicine have served my patients very well for their conditions, which almost always require integrative approaches to address health and wellbeing in body, mind, and spirit."
Find therapeutic benefits, enjoyment, and even profit through writing!
Written by Maryann B. Hunsberger
(An MSAA article published in 2012)
For people with physical disabilities, including MS, it's tough to deal with such potential issues as losing mobility and skills, possibly giving up a career, and perhaps even losing friends or romantic partners. Sometimes, people with MS find it tough to talk about the way their symptoms affect their lives. A journal can be the sanctuary that people with MS need - no matter what a person admits to his or her journal, the journal won't respond with pat answers or be judgmental. Journaling often helps people to clarify their jumbled thoughts, and in the process, allows them to understand their feelings. Often, writing about one's feelings can be enough to make one realize that everything isn't as bleak as it seems.
If you want to take your writing a step further to earn some income, send your published articles and letters to community newspapers, local magazines, and nearby businesses with a resume and a cover letter offering your writing services for a fee. Nearby businesses might use your talents to write content on their website. Local magazines could possibly use an article about any number of things - such as couponing, car repair, or the best fishing spots in your county. Community newspapers, for example, might want you to write a column on parenting with a disability. Another option is to purchase a copy of Writer's Market to find publications that might publish your work.
Last but not least, for individuals who are truly inspired, options such as writing and publishing a how-to book, a memoir, a fictional novel, or even a screenplay, are all within the realm of possibilities! Of course, this requires a tremendous amount of work and dedication, but the end product can be greatly rewarding. For anyone without formal training, instructional books and computer software are available to assist you through the process. These may be found by going to your favorite book retailer or online bookstore. Adult-school classes at your local high school or community college are sometimes offered as well. A recent addition to MSAA's Lending Library is the book, Writing Books for Fun, Fame & Fortune, which may help you to get started.
[Throughout the year, individuals, families, and friends celebrate many events...] These might include bridal showers and weddings, birthday and anniversary parties, holidays, and any special occasion throughout the year.
With such events comes the need for gift giving, which isn't so easy when counting pennies. A great solution is to create your own decorative packaging and gifts. This doesn't just save money, but also provides a fun activity for families and friends to do together. Husbands and wives, parents and children, or just a few good friends, can get together, socialize, and create a personalized work of art.
[This article goes on to give instructions on how to hand-make your own gift packaging and gift tags, bookmarks, greeting cards, scrapbooks, and more.]
Besides creating a lovely gift, making crafts with a group of friends helps people to develop friendships with a purpose. Kathy Zackowski, PhD, OTR, Assistant Professor at the Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute and Johns Hopkins School of Medicine, spoke with The Motivator about this. Zackowski, an occupational therapist (OT) who works solely with people who have MS, says making crafts gives people something in common to share. "This is more binding than casual friendships because you work toward the same goal. People can do this with many mediums, such as sewing, exercise, a book club or other activities. The social interaction is so important. Much evidence says this can help with healing in different ways."
I live in Madison, Wisconsin, which is often referred to as one of the best places in the country to live, find a job, or raise a family. I know it's true because I've lived here for 40 years. I also know that it is easy for me to become a "homebody" and miss a lot of what my hometown has to offer, especially since I have been living with MS for many years. Sometimes it's just easier to stay home where I can control my surroundings. I have all my creature comforts, things are where I need them, and generally, there are no surprises. And, during this tough economy, I have another excuse for staying home - saving money.
But who wants to stay in the house all summer, or for that matter, any time? When the weather does permit, I really do try and get out, at least for an hour or two. It's good for my mental health and it's especially fun to take advantage of the free and inexpensive activities that surround Madison and the small towns close by. Your community probably offers the same type of activities - concerts in the park, county fairs, farm tours, school and community recreational programs, fishing for people with special needs, water-skiing shows, free boat rides, semi-professional ballgames, and more.
Family history is one of the fastest growing hobbies in the United States. More and more people have discovered the fun of tracing their ancestors. With the advent of the internet, it has become easier than ever before.
Genealogy is a versatile hobby. One's family history may be recorded with a simple pen and paper, or it can involve expensive computer equipment. People with MS are discovering that genealogy is fun and flexible enough to allow for when they are having both good and bad days.
I got started doing family history research back when I was in college. I had been reading my great grandmother's obituary in a faded scrapbook. It said that she was survived by a brother and a sister. I realized that I had information on three of her brothers, but I had no record of a sister. Suddenly, I had to find that missing sister. I had found my great grandmother and her brothers in the 1860 census in a small town in Ohio. No sister was mentioned. I got the roll of microfilm for the same town in the 1870 census. At that time there was no index, so I started with the first family recorded by the census taker. After reviewing records of dozens and dozens of families, I finally found the right people. The ink had faded, but I could make out a six-year-old sister named Cora. Later I found a family photograph of a large lady in a big hat, labeled "Aunt Cora." Finding Cora hooked me on genealogy.
Since my diagnosis with MS, I realized that genealogy was perfect for me. On days when I felt good, I could search the web, write letters, or visit a Family History Center. On days when fatigue took over, these people - now deceased - could wait until my energy returned.
Doing family history research is like a detective looking for a missing person. Working from known information and making educated guesses has led me to public records that have helped fill in the gaps in my pedigree.
People just getting started should begin with some blank forms. Pedigree charts show one person's direct ancestors. Family group sheets record all the children in each family. There are several places on the internet where blank forms can be downloaded. One place is at Ancestry.com: www.ancestry.com/charts/ancchart.aspx.
Many people choose to work for reasons greater than money alone. The interaction with others, the feeling of completing a well-done task, and the human need to feel valued in society, all make a paycheck so worthwhile. But when an illness strikes, individuals cannot always perform their jobs in the same way as they did in the past. Individuals with MS may find that symptoms such as increased fatigue, limited mobility, and visual changes may impact their ability to work. While the symptoms of MS can often be managed, job accommodations may be necessary to continue to work productively.
Some people with MS remain in their jobs with little or no modifications to their present working situation, while others may decide to leave their current position to be retrained to do something else. Fortunately, government funding is available for individuals with disabilities to receive the help they need to enter, re-enter, or remain in the workforce. This assistance enables men and women with MS to find the right occupation, work environment, work schedule, and game plan for their unique circumstances.
Once diagnosed with MS, some individuals may go through the process of rethinking their life, but finding the necessary help to achieve new goals can be difficult. These individuals may take comfort in knowing that a good deal of assistance is available to help with determining the best employment path to take. Several sources have been listed in this article for anyone interested in more information.
You love your job. In addition to much needed income, it gives you a sense of pride and accomplishment, perhaps even a level of status in the community. Our work is an integral part of who we are.
In our culture, we are defined by what we do. If you don't believe that, just think, when you meet people for the first time, what's the first question they ask? Isn't it, "So tell me, what do you do?" When what we do is so much a part of who we are, how do we know when it is time to give up that part of us, and when we do, how do we deal with the psychological, emotional, and social toll surrounding such a major life change?
With a chronic illness like MS, the time may come when the effort it takes to continue working becomes so draining that your health and family life begin to suffer. At first, you may cope by giving up time with friends, and recreational activities are put aside so you can rest up to continue working. At the job, you take short cuts, cut back on extra duties, and find creative ways to have others do the things that are hard for you. But no matter how hard you try, you may not be able to keep up the pace, and you have to face the fact that something has to give. When the symptoms of MS affect your ability to continue working, this may trigger feelings of anger, frustration, and perhaps even embarrassment.
Should you need to leave your job because of the symptoms of MS, I hope that my experience can help to bridge the gap between how things were and how things are now. I also hope that my experience may inspire you to find a new sense of purpose and accomplishment in your life.
Written by Susan Wells Courtney, under the direction of Thomas D. Foy, Jr.
(An MSAA "evergreen" article published in 2006)
Attaining financial security is a goal that everyone shares. This goal is particularly important for families whose financial obligations include caring for one or more members who are unable to work, and who may be sick or disabled. Having adequate funds available, as well as money held in a Trust with very specific instructions, are just two of several strategies that can help to ensure financial protection and security for your family in the years ahead.
Achieving such a goal, however, requires important decisions, sound investments, and informed planning for the future. Insurance, investments, Trusts, and Wills have become far more complicated than just a generation ago, when our parents were planning for their own futures.
Legal battles and the resultant changes in government laws over the years have led to the need for specific wording in all financial and health-related documents. New laws have added many restrictions. Without such important documents in place, you and your family may not necessarily have the opportunity to decide how one will be cared for, how the money will be distributed, and who will represent a family member if he or she cannot make decisions on his or her own.
According to Thomas D. Foy, Jr. of Foy Financial Services, specific language within a document is crucial for how things will be handled when the time comes to put these plans into action. While [some experts hold] the opinion that most legal documents may be completed using standard forms without a lawyer, Mr. Foy strongly defends the need for a lawyer when creating documents such as Wills and Trusts. He also encourages seeking professional help when purchasing insurance and making investment decisions, all of which can have an enormous impact on a family's financial future and healthcare choices.
Many people at one time or another enter into a care-partner relationship with a loved one. Whether caring for a parent, spouse, child, or friend, a care partner may be responsible for another's physical, emotional, and spiritual well-being.
This article is a reference that may be used if someone is caring for a loved one with MS, but also for anyone, including an individual with MS, who is or will be caring for an ill or aging parent, other family member, or friend. Knowing the many responsibilities and dynamics involved can help someone to plan ahead and be prepared for common issues that may arise.
Receiving care at one's own home rather than residing at an assistive-care or nursing facility is becoming increasingly more common. For the person receiving care, the environment is comfortable, familiar, and promotes a feeling of security. Family and friends are often nearby. For the care partner, having the opportunity to provide assistance to a loved one at home can be a very rewarding experience. When both individuals are informed about care partnering, and are devoted to one another, the relationship may grow closer.
Compared to a sudden injury or acute illness, multiple sclerosis is unique in that it often enters the household gradually. For the majority of individuals with MS, family and friends have had several years to become familiar with the disease and its symptoms. This allows time for everyone to slowly accept the changes MS brings and make whatever modifications are necessary to the home and schedule as the needs arise.
A few years after I was diagnosed with multiple sclerosis (MS), my husband, Dave, and I went back to his childhood home for his 20th high school reunion. The room was packed, the music was deafening, the air was warm, and I was expending great amounts of energy trying to communicate with those around me. I could feel myself wilting by the moment. Not wanting to interfere with my husband's ability to reconnect with his high school pals, I casually wandered off to a table away from the "maddening crowd," where I sat drinking glass after glass of water.
Then I needed to use the facilities. My legs felt like they weighed 1,000 pounds each as I walked to the ladies room - my energy draining out of me like a balloon with a slow leak. Maybe, if I sat in the air-conditioned car for a bit, my strength would return. I asked the wife of one of Dave's friends to join me.
The air outside was like a furnace blast; the heat index was more than 100. Walking through the unpaved parking lot, on heels that were too high given my instability and weakness, was very stressful. I would have fallen three times if my friend hadn't been there to catch me.
That was my first experience with what heat can do to a person with MS. Thankfully, I recovered within a few days, and over the more than 20 years that have followed, I have never experienced as severe of a reaction to the heat. I believe that's because I took the issue of getting overheated, and how it can affect MS, very seriously. Perhaps some of the things I have learned to help me keep my cool will help you too.
Understanding the Effects of Heat
You may not be aware that the heat is affecting you. Here are some signs to watch for:
Overall muscle weakness
Significant loss of energy
Nausea and/or lack of appetite
Thought processing becomes impaired; you feel as though you can't think or find the right words; you may even have trouble remembering how to do things
Signs of dehydration include dry, sticky, or cotton mouth; low or no urine output, or concentrated urine appears dark yellow; not producing tears; or feeling lethargic
Many individuals with MS experience trouble sleeping, which often leads to fatigue, a common and disabling symptom of MS. MS patients are not alone in having trouble sleeping. A 2005 survey of the general population found that 75 percent of adults had at least one sleep problem during the preceding year. With busy lifestyles and access to media 24-hours a day, Americans average less than seven hours of sleep per night - and some people get by with six or less hours a night. Research shows that at least seven-and-a-half or eight hours are needed each night for proper repair and restoration of the body and mind.
The benefits of a good night's sleep include increased alertness, a quicker reaction time, and better performance with tasks at work and at home. One's memory, concentration, and creativity are also improved. When well-rested, people are more motivated to get things done and they are more efficient at what they do. In general, a good night's sleep helps someone to feel good throughout the day, and ultimately, sleep may improve one's overall health.
To encourage a good sleep regimen, experts recommend practicing a healthy lifestyle, which includes daily exercise, a healthy diet, limiting one's alcohol and caffeine intake, and not smoking. Staying on a good sleep and waking schedule is important, as is preparing for sleep. For the latter, time should be allowed to finish household chores or take care of any loose ends before going to bed. Writing down any concerns is a good way to put them aside until the next morning. And taking time to unwind and relax - by drinking herbal tea, taking a warm bath (if not heat sensitive), or reading a book, can assist with falling asleep more naturally. Some individuals may find relaxation techniques, such as guided imagery, meditation, or biofeedback, to be of great help.
Written by Shelley Peterman Schwartz
Edited and portions written by Susan Wells Courtney
(An MSAA "evergreen" article published in 2006)
My Own Story: The Last Time I Drove a Car
September of 1985 was the last time I drove a car. I vividly remember following my husband Dave to the Chevy dealership to have some work done on our Impala. He drove "my car," the Ford Pinto with a stick shift that required more strength and energy to drive than the automatic.
For months leading up to that day and the days following, I was severely depressed about losing my ability to drive and the independence that driving represented. Our children were ages 11 and nine; I was 39 and knew that I would never drive again.
Today, 21 years after that emotionally painful day, I can look back without the pain and sadness. I understand why I began grieving the loss long before I gave up driving, and why I found excuses not to drive. It took months and months to come to terms with how my MS was affecting all aspects of my life, and as my MS worsened, I began to feel unsafe behind the wheel. That day in September, I knew it was time to hang up my keys.
I can honestly report that my life did not end when I gave up driving; it just changed. As time went on, I found ways to manage. Perhaps some of the lessons I've learned will help you to drive longer and with greater safety than I was able to - given the technology and adaptive devices that are available today.
Are You Able to Drive Safely?
This is a scary question, but one you MUST answer honestly. Do symptoms such as fatigue, tremors in your legs, hand strength or coordination, vision problems, or cognitive function affect your driving? Talk openly and honestly with your family and/or your doctor. You don't want to put yourself, your family members, or anyone else at risk because your skills, thought processes, or reaction times are not up to par.
For me, leg tremors, strength to turn the key in the ignition, and fatigue were the symptoms that got my attention. As much as I wanted to continue driving, I was terrified of being involved in an accident because I might hurt someone else, and I certainly didn't want the adverse effects an accident might have on my MS.
In an effort to hold onto our freedom to come and go as we please, we may initially be in denial about our driving abilities, ignoring the signs that may tell us it is time to restrict or even give up our driving privileges. For instance, many individuals with MS have visual problems, which might limit their side (or peripheral) views, while others may experience blind spots. Maybe signs and traffic signals have become difficult to distinguish, and judging distances and the rate of speed that other drivers are going has become challenging.
Other MS symptoms may include weakness, reduced coordination, and slower reaction time. Being able to quickly move your foot between the gas and brake peddles at appropriate times, as well as precise steering and signaling, are crucial when driving. Following signs and the rules of the road, making snap decisions while speeding along the roadway, interacting with other drivers, and knowing where to turn and when to stop can all be affected by reduced cognitive functioning.
If you or someone you are close to has MS and can see that the symptoms are interfering with the ability to drive safely, then you must view the situation objectively. Identify exactly what symptoms are having an effect on driving and investigate to see if any solutions are available. The first place to look would be with your medical professional, to see if any symptom-management strategies or medications may be of help.
[This article gives descriptions of assistive devices that help individuals to get in and out of a car, to make driving easier, and other useful information to assist people with MS to drive - or ride - safely.]
I've always taken pride in the way I look. Perhaps it is because my mother and my grandmother did too. There was even a family joke that no matter what ailments my grandmother had in her final years, whether hospitalized or sick in bed, she always put on lipstick, earrings, and a pretty bed jacket.
Dressing Tips to Make Life Easier
Assess your morning rituals. Is it easier to get dressed before or after you take your medication, shower, or eat breakfast? Everyone is different, so experiment with the order of your morning routine to find what works best for you. For me, I always drink a glass of juice before my husband helps me out of bed. This gives me the little energy boost I need to get dressed.
Make sure your home thermostat is set to a comfortable temperature when you get out of bed. Avoid getting overheated from a house that feels too warm, or becoming stiff and clumsy from a house that feels too cool.
Each night, select and gather all of your clothing items for the next day. This will not only save time and energy in the morning, but if you need assistance with buttons or zippers, you may be able to enlist the aid of a family member before he or she leaves the house.