SMART Start to 2018: Goal Setting for your Wellness

January 9, 2018Presented by:

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Stephanie Buxhoeveden, MSCN, MSN, FNP-BC

MS Nurse Practitioner

Fredericksburg, VA

Peggy Crawford, PhD

Psychologist

Maine

Physical Therapist

Omaha, NE

Mandy Rohrig, PT, DPT

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

Polling Question

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

Setting SMART Goals

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

Polling Question

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

http://www.medbroadcast.com/channel/back-health/back-care/workstation-ergonomics

Incorporating Physical Activity is often a Choice…..

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

Polling Question

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

Polling Question

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

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Mandy Rohrig, PT, DPT

Stephanie Buxhoeveden,

MSCN, MSN, FNP-BC

Can Do MS Resources

Find these resources at www.MSCanDo.org.

National MS Society Resources

nationalMSsociety.org

Intimacy & MS

February 13, 2018Presented by:

Thant is correct. 5:30pm ET.Thant is correct. 5:30pm ET.

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