smart start to 2018: goal setting for your wellness
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SMART Start to 2018: Goal Setting for your Wellness
January 9, 2018Presented by:
Thant is correct. 5:30pm ET.Thant is correct. 5:30pm ET.
Wellness
Work & Home
Emotional Wellbeing
Spirituality
Cognitive Well-Being
Diet, Exercise &
Healthy Behaviors
Relationships
New Year…..New Goals
http://northshorefamilyservices.com/5-smart-goals-every-child-should-aim-to-accomplish-in-the-new-year/
Your Team
Person
with MS
&
Support
Partner
http://www.ajmc.com/journals/supplement/2013/ace014_nov13_ms-ce/ace014_nov13_ms-ce_ross
Carl30y/o, single, attorney, MS diagnosed 3 years ago
• Symptoms include numbness, tingling, and weakness
in his legs
• Preoccupied with his MS, didn’t renew gym
membership, and rarely spends time with friends
• Anxious about his future and less confident in general
• Can’t shut his mind off at night
• Untreated Vit D deficiency
Sleep• People with MS are more likely to have sleep
disorders such as sleep apnea and RLS
• Impaired sleep can be a result of medications, MS symptoms, and/or mood disorders
• Talk to your healthcare provider if you have trouble falling asleep, staying asleep, or don’t feel well rested during the day
• There are several management techniques to help you get better sleep including cognitive behavioral therapy, adjusting medication regimens, improving symptoms, over-the-counter treatments, and other medication
Diet, Exercise &
Healthy Behaviors
Sleep Hygiene• Maintain a regular time for going to bed and
getting up in the morning
• Keep your bedroom cool, dark and quiet
• Reserve your bedroom for sleep and intimacy
• Make your ‘To Do’ list before bed
• Avoid exercise, caffeine, smoking, and alcohol before bed
• If you cannot fall asleep within 30 minutes or wake and cannot return to sleep, GET OUT OF BED and do something else
Diet, Exercise &
Healthy Behaviors
Vitamin D• We know there is a relationship between vitamin D levels,
MS development, and disease progression
• We typically get vitamin D via sunlight and our diets, but we may need additional supplements
• Your vitamin D level can be checked with a simple blood test
• Normal is 30-100 ng/mL
• Your MS provider will help identify your personal goal, and give you recommendations for supplement dosage
• Foods high in vitamin D include oily fish, egg yolks, dairy products/juice/cereals that are fortified with vitamin D
Diet, Exercise &
Healthy Behaviors
Wellness Priorities - PT
• Exercise vs. physical activity vs. rehabilitation
• Fatigue management at work• Tired from work; no energy for
exercise
• Potential impact of exercise and physical activity on sleep
Diet, Exercise &
Healthy Behaviors
Work & Home
Wellness Strategies - PT
• Exercise• PT evaluation – consultation
relationship• Identify strengths/areas of improvement
• Initiate exercise program
• Aerobic, strength training, balance, and flexibility
• Workstation assessment
• Strategic standing for physical activity
• Potential emotional effect of exercise
Diet, Exercise &
Healthy Behaviors
Work & Home
Emotional
Wellbeing
Sitting Disease
• “Sitting Disease”increases risk for:• Cancers
• Cardiovascular disease
• Type 2 Diabetes
• Obesity
• Low back and neck pain
• Shortened life span
• Standing may help:• Reduce risk for
cardiovascular disease,
obesity, cancers, and Type
2 Diabetes
• Bone health
• Muscle tone
• Posture
• Mental alertness; fatigue
reduction
• Burns more calories
**Exercising the recommended 150 minutes of
moderate exercise/week does not compensate
for inactivity the remainder of the day!
Ideas of How to Incorporate Physical Activity
• Sneak movement into your day…..• Park the car further away to walk
• Stand during commercials on TV
• Standing desks
• Dance in the car at a stoplight
• Movement alarms
• Wheelchair user ideas
• Isometrics; weightshifting; standing frames; move arms/trunk
**Strategize with health care team to help
find the appropriate amount of movement
without causing unnecessary fatigue!
Diet, Exercise &
Healthy Behaviors
Work & Home
Emotional Wellbeing
• Mood issues are very common in MS
• Moods can be related to MS itself, medications, and changes in life circumstances
• People who are depressed/anxious/moody may:
• Have more difficulty coping with stress
• Engage in unhealthy behaviors
• Have difficulty taking care of themselves and others
• Lose time from work
• Be more difficult to get along with
• Notice changes in their sleep patterns
• Not function as well cognitively
Emotional Wellbeing
The Reality in MS…
• Depression is under-diagnosed; some symptoms overlap with symptoms of MS
• Depression is under-treated; people may not report and healthcare professionals may not ask
• Depression can make other symptoms worse (cognition, pain, fatigue)
• Depression can be life-threatening
• Regardless of cause, depression responds well to treatment
• Psychotherapy + antidepressant medication is the treatment of choice
Emotional Wellbeing
MS Can Challenge Resilience and Spirituality
• Resilience• Ability to bounce back from adversity• Includes persistence, flexibility,
resourcefulness
• Spirituality• Being concerned with human spirit, values,
meanings, and balance• Supports personal development
• Shared goals of adaptive coping and living with purpose in the face of challenges
Emotional Wellbeing
Spirituality
SMART Goals for Carl
• I will call my MS provider this week to discuss my mood and ask for referral to mental health provider
• I will make ask my neurologist to check my vitamin D level at my appointment next week.
• I will contact a physical therapist to gather information on an appropriate exercise program in 1 week.
John52y/o, car salesman whose wife has secondary progressive MS with increasing disability
• 2 adult children live out of town
• John’s health problems include poorly controlled blood pressure and diabetes
• Both are smoking more than usual
• Ran out of prescribed medications more than once and cancelled his last medical follow-up
• Stopped bowling with friends
• Feels stressed out, frustrated, and guilty much of the time
Wellness Priorities - PT
• Diabetes and blood pressure reduction management
• Aerobic Exercise Guidelines for People with Type 2 Diabetes
• 150 moderate intensity exercise/week
• 3-7 days with no more than 2 consecutive days without exercise
• Precautions
• Physical activity and decreasing sedentary behavior
• Back strengthening exercises
Diet, Exercise &
Healthy Behaviors
Work & Home
Wellness Strategies - PT• Physical Therapy for the support
partner!• Evaluation/assessment of physical
abilities• Core Strength/endurance
• Aerobic Exercise
• Exercise in safe environment
• Proper lifting and transfer techniques
https://drjeffreytucker.com/Fitness/DailyExercises/healthy
back.asphttp://www.movewellfit.com/2015/09/07/bridge
-exercise-three-benefits/#.WjckdrpFzIU
Diet, Exercise &
Healthy Behaviors
Work & Home
Body Mechanics with Lifting
https://www.fairview.org/patient-education/88898
http://www.elderstore.com/images/produ
cts/Kinsman/KE80311GaitBeltMED.jpg
https://www.healthykin.com//p-188-wooden-sliding-transfer-
board.aspx?gclid=CLzrl7Og8NMCFZu3wAodzdYGaQ
http://www.spinalcordesse
ntials.ca/handouts/floor-to-
chair-transfer/
Caring for Support Partners• Support Partners need to be at their best in
order to help their loved ones
• Support Partners have higher rates of chronic illnesses than the general population
• Your overall health deserves to be a priority!
Relationships
Diet, Exercise &
Healthy Behaviors
Emotional Wellbeing
Primary Care
• Routine primary care is an essential part of our health
• Vaccinations, physicals, gynecological/prostate exams,
• Age-appropriate screening tests
• The goal of routine primary care is prevent and/or effectively manage chronic illnesses like heart disease and diabetes
• Acute and chronic illnesses can negatively impact MS, so primary care should be a priority for both John and his wife
Diet, Exercise &
Healthy Behaviors
Smoking
• Abstaining from tobacco use should be a household priority
• For the person living with MS exposure to smoke (first or second hand) can:
• Increase the risk of disease progression and disability
• Increase the risk for developing antibodies against DMTs including Interferons and Tysabri
• The good news: quitting can reverse these risks, so come up with a plan!
Diet, Exercise &
Healthy Behaviors
Recognizing and Managing Stress
• What are your stressors?
• How is stress affecting you physically, mentally, emotionally, and
behaviorally?
• Focus your efforts on the stressors you can change and occur more
frequently
• Seek out information and resources; generate multiple options and
possible solutions
• Utilize your support system
• Make a healthy lifestyle a priority
• Allocate time for relaxation—downtime alone and with others, practice
specific skills such as deep breathing
Emotional Wellbeing
Effective Communication• Making it a priority!!!!
• Accurate and shared information—using a common language
• Using both active listening and speaking skills
• Paying attention to tone and body language
• Eye contact, asking questions & summarizing
• Checking out assumptions vs mind reading
• Respecting differences in coping and communication styles
Relationships
Emotional Wellbeing
SMART Goals for John
• I will use a gait belt and good body mechanics, per the guidance of a physical therapist, during all bathroom transfers in 2 weeks.
• I will schedule a “communications” date with my wife on my next day off
• I will cut back my smoking by 4 cigarettes a day by February 1st
Valerie45y/o, married with 2 teenage children, MS diagnosed 11 years ago
• Left teaching last year due to increased fatigue, feeling less sharp mentally, and several falls
• Trying to establish routines and organization but without much success
• Spends much of her time napping
• Both she and her husband feel overwhelmed, ineffective, resentful, and lonely
Cognitive Health and MS
• Cognitive changes are very common
• Multiple cognitive functions can be affected (memory, speed of information processing, attention & concentration, verbal fluency, visuospatial abilities, problem-solving)
• Cognitive changes and fatigue are most common reasons for leaving workforce
• Many factors including mood and sleep can contribute to and be affected by these changes
Cognitive Well-Being
Pursuing Cognitive Wellness
• Cognitive evaluation/screening with neuropsychologist, occupational therapist, language-speech pathologist
• Disease-modifying treatments
• Regular use of compensatory strategies
• Notebooks, lists, organizers
• Time and energy management
• Consistency and routines
Cognitive Well-Being
Fatigue Management • Is her fatigue caused by her MS, or something else?
• There are a lot of strategies to combat fatigue. Your neurology team may:
• Adjust medications that can cause fatigue
• Assess your sleep quality
• Come up with a diet and exercise plan
• Rule out other health problems
• Discuss medications that can help
• Naps do not replace a good night’s sleep, but a brief 20-30 minute nap can improve alertness
• Longer naps can make you feel more groggy
• Do not take naps too close to bedtime
Diet, Exercise &
Healthy Behaviors
Diet• Obesity can worsen MS, and decrease overall quality
of life
• No one specific “MS” diet has been identified, but research
is being done.
• Some people see symptom improvement with special diets
(such as gluten free, Paleolithic, Swank, or Whals diets)
• In general: follow a heart-healthy diet to optimize overall
health• Limit sodium, sugar, and processed foods
• Increase fruit and vegetable intake
• Choose lean proteins
(chicken, turkey, fish, beans, soy)
• Choose healthy fats
(nuts, seeds, vegetable oils, oily fish)
• Consume plenty of fiber
• Hydrate well
Diet, Exercise &
Healthy Behaviors
Wellness Priorities - PT
• Physical Therapy - Fall risk reduction• How balance works (next slide)
• Assistive devices
• Impact of falls or risk of falls on family• Fear; hesitancy; isolation; others?
• May contribute to cycle of inactivity
• Fatigue management• Primary fatigue versus secondary fatigue
• Exercise program for abilities
Diet, Exercise &
Healthy Behaviors
Relationships
• Sensory and motor contributions to balance
• Dual cognitive and/or motor task influence
• Interventions and strategies are highly individualized!
Wellness Strategies - PT• Physical Therapy
• Balance exercises
• Highly individualized; PT to help prioritize safe, effective and appropriate exercise options
• Environmental Modifications
• Consider surfaces, lighting, positioning objects to improve convenience
• Assistive devices
• Fatigue Management – OT• 4Ps – Planning, Pacing, Prioritizing, Positioning
• Alternative exercise options• Telehealth group exercise
• Group exercise class
Diet, Exercise &
Healthy Behaviors
Relationships
SMART Goals for Valerie
• Tomorrow morning I will write down 2 or 3 routines that have been effective in the past
• I will contact my MS provider by Friday about specific cognitive concerns and possible assessment
• I will prepare dinner at home 5 days this week instead of eating out.
• I will use a walker for all mobility in the home after 4 PM, when my fatigue intensifies, to minimize my risk for falls, 1 week.
Wellness
Work & Home
Emotional Wellbeing
Spirituality
Cognitive Well-Being
Diet, Exercise &
Health Behaviors
Relationships
Questions/Comments
Peggy Crawford, PhD
If you are enjoying tonight’s presentation, please consider donating to our
programs:
Text to donate: 970-626-6232
https://www.mscando.org/get-involved
Mandy Rohrig, PT, DPT
Stephanie Buxhoeveden,
MSCN, MSN, FNP-BC
Intimacy & MS
February 13, 2018Presented by:
Thant is correct. 5:30pm ET.Thant is correct. 5:30pm ET.