1. Kerry Mutch NMO Advanced Nurse Practitioner Walton Centre Foundation Trust Liverpool

3. You can’t live without it! Reduces Fatigue No calories Stops headaches Reduces urine infections Helps relieve constipation Gives skin a healthy glow Gives energy It’s Free Reduces Fatigue

4.  Affects quality of life and functional ability  Adversely affects ◦ ability to self manage symptoms ◦ ability to cope ◦ mood and self esteem  Can aggravate other TM symptoms Depression Fatigue

5. SleepDietMedicationsMoodStressExerciseDisabilitySymptoms Person with TM Fatigue affects different people in different ways There are many factors that contribute to fatigue

6. ◦ Primary: related to disease process  Probably related to the underlying pathologic alterations in TM such as demyelination, inflammation and axonal injury  The inability of a muscle or group of muscles to sustain the required or expected force ◦ Secondary: associated with disease related factors  Walking difficulties  Sleep disturbance  Pain  Spasms  Bladder symptoms  Breathing difficulties o ‘Normal’ activity related fatigue

7.  Not drinking water  Poor diet – wrong food  Poor Posture seating/bedding  Poor sleep patterns  Temperature heat/cold  Infection/Virus  Emotions mood/stress  Other medical conditions  Anaemia  Doing too much  Excessive exertion  De-conditioning  Taking insufficient breaks  Medications

8. Medications side-effects that can cause fatigue;  Analgesics  Anti spasticity  Anti convulsants  Anti hypertensives  Anti depressants  Anti histamines

9.  Because of my fatigue during the past 4 weeks.... Never Rarely SometimesOftenalways 1.I have been less alert.01234 2. I have had difficulty paying attention for long periods of time. 0 1 2 3 4 3. I have been unable to think clearly. 0 1 2 3 4 4. I have been clumsy and uncoordinated. 0 1 2 3 4 5. I have been forgetful. 0 1 2 3 4 6. I have had to pace myself in my physical activities. 0 1 2 3 4 7. I have been less motivated to do anything that requires physical effort. 0 1 2 3 4 61 people with NMO completed MFIS

10. Physical FatigueTotal Impact of Fatigue Cognitive Fatigue Psycho social Fatigue

11. Ensure the best levels of energy Using Energy Available in Most is availableProductive Way

12.  Planning – Efficient use of energy supplies means more can be achieved.  Prioritising – Better to complete smaller tasks than try everything and complete nothing.  Pacing – more beneficial rather than continuing to point of exhaustion and being forced to rest.  Delegating – Many people feel guilty about asking people to do jobs they previously did. Motto- I Can if I Plan

13.  Increase your fluid intake!!  Make life as easy as possible for yourself  Use labour saving equipment  Do things differently  Organise work area to avoid unnecessary bending, reaching or walking  Activity and exercise benefits  Relaxation, deep breathing, yoga, pilates  Sleep patterns and routine

15. Thank you