Making a List

by Dean Kramer 
December, 2001


Here come the holidays! This can be one of the most stressful times of the year for anyone. We with MS do well to take particular care of our health during the coming weeks. We need to be vigilant in our awareness because, often, a lot is required of us during the holidays. MS is a disease that can leave us with less to give just when more is asked. We try to prioritize, limiting or eliminating tasks and activities we deem unimportant, saving energy for those we really wish or need to be available for. We hope to delegate if possible, allowing friends and family members to help us so that we can be fully present rather than too fatigued to enjoy the festivities.

I watch my old, familiar symptoms wax and wane as I undertake too much and then, realizing, cut back to where I am more comfortable. So, at holiday time, along with my lists of gifts to buy and things to do, I bear in mind a symptom check-list to use as a guide. Although I have a pretty full, low-level compliment of MS symptoms, there are a few that seem to worsen more quickly under stress. In my case they are spasticity in walking, balance, dizziness and numbness in my hands and feet, followed by fatigue.
I notice an increase in spasticity when I'm excited about some approaching event for which I have the primary responsibility such as company coming. I'm usually pretty physically active while getting ready to entertain, cleaning, shopping, and cooking. But I do those activities at other times, too, without a problem. I associate my increased trouble walking with anticipatory pleasure. Often once the event is unfolding I become less spastic. This may happen because with the affair under way I'm no longer worried about whether it will go as planned. I put up with the spasticity while getting ready for a party since I know it will soon diminish in intensity, though I might take a little extra Baclofen if I need to.

Balance problems are most likely to increase when I venture into unfamiliar territory, going out to a concert or restaurant, or visiting in someone's home. Spasticity isn't a problem at those times but I do have trouble keeping my footing. I tend to move more tentatively in unfamiliar space, as does anyone. My feet are generally somewhat numb, my vision compromised by optic neuritis and these factors probably combine with cautious steps to throw my balance off. Once I become used to the terrain my balance improves. Again, I don't worry about the worsening balance difficulties at such times because I know they are not permanent. They are simply a response to situational stress and, though normally I don't need one these days, I almost always take a cane with me into such situations.

The increase in the other symptoms I listed seems to be an after-effect of stress. I am likely to suffer from dizziness as well as decreased sensation in my fingers and feet on the day after the event. In fact, I use those symptoms as a measure of how good a time I've had. The more fun, the more dizziness and numbness the day after. The fatigue doesn't hit me till the day after the day after. If I haven't made it a point to take it easy following a stressful undertaking those symptoms are a definite heads-up. If I continue to ignore them I may end by falling head-down and injuring myself. Experience in the form of a mild concussion after falling last December 26th has taught me to pay attention. I don't have to worry about these symptoms as long as I recognize their message and respond appropriately. I know they will subside within a few days.

I've had MS for 17 years. That's a lot of time to process the comings and goings of symptoms. I've learned which ones are fairly constant, which ones are periodic with no apparent reference to life's vicissitudes, and which ones seem directly related to stress in their intensity. I've learned to distinguish a mild increase in old symptoms from a flare-up, and that from a relapse or attack. I'm not always totally sure and clear about these distinctions. But most of the time I'm certain enough (and can always call the doctor if need be.)

So, check yourself out, if you don't already do so. See how well your body's working and what's "iffy" as the holiday season approaches. Make a list and know what to look for. Decide which of your symptoms are parts of your "early-warning" system and which are the dues you pay for having too much fun. Share your knowledge with family and friends so they can respond caringly when you notice a stress-related symptom increasing. Plan for time out when you need some. Many of us can keep going if we get some solid rest time between activities.

It's true that holidays can be stressful. Most of the references I've come across on the subject talk of depression for the lonely, the strain of dysfunctional family gatherings and onerous obligations. This year may be particularly stressful for those still in shock and grief after 9/11 and for those with family and friends in the military. But stress doesn't attach itself only to unpleasant circumstances. Stress can result from any change in routine— even a darn good one! It's going to be a quietly wonderful holiday season on Cripple Creek. I wish all of you the best for your holidays, too.