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Women and Wellness: Achieving Wellness while Living with MS
National Education Session
May 28, 2011
I’l start with a written question. Can you give us examples of strategies for coping with changes? That’s quite a question. I think we’re getting off to a good start.
Z. Vourantoni: That’s a very broad question. Changes, of course. Could you repeat the exact
Can you give us examples of strategies for coping with changes?
Z. Vourantoni: Well, the first strategy—and I think we both talked a lot about it—is to realize that
change is necessary. We have to be creative, look at what is not working and then check out solutions that would work.
J. Vigneault: I think we also have to figure out what changes have been imposed on us, then what
we want to do to change voluntarily, because that will change the strategies. I’l try to put it more clearly.
Multiple sclerosis is unpredictable. It happens to us, we don’t choose it. We have no choice but to deal with it. So we need to use strategies that suit the choices that have to be made.
If I decide – I’m not sick now, but I decide that I want to eat an apple every morning. Well, that is something I want to do. I don’t have to do it. So it will be easier to adopt strategies. I think that to implement strategies, you need to see your target objective, and then decide what to do to achieve that objective. Should I go to the store every morning to buy myself an apple? No. Maybe I’l buy seven so that I can shop just once a week. This is a silly example, but you have to list everything you need to do to achieve the target objective.
For example, one change: stop exercising. Now, what do I do? First, I’l go to see the doctor. Second. But you need to write things down, you have to see them. You have to prepare them. I really think that you have to map out actions that relate to the objective you want to achieve.
To be a leader in finding a cure for multiple sclerosis and enabling people affected by MS to enhance their quality of life.
Founding member of the Multiple Sclerosis Society International Foundation
I don’t know if that’s a good answer. But it’s what I do when I want to achieve something. I think the same can apply to sex as wel . She said, ―I have my armchair, my lubricant and my vibrator.‖. Wel , I have mapped out strategies that wil achieve my objective, which is to improve sexuality, or to be more comfortable, or whatever.
In other words, you really have to determine what very specific action is required to achieve your objective.
Perfect. Thank you. A question for Zoé and maybe for Josée too: is there a Viagra-type drug for women? If so, what is the drug’s name?
Z. Vourantoni: Not really. This is important: some people think that Viagra is for libido. There are a lot
or rumours about a pill that enhances sex drive, but so far there is nothing available on the market. Some women still try taking Viagra or Cialis. I see there are also some men in the room so I’l say a word to them: the biggest difference between Cialis and Viagra is that Viagra remains in the system for only about one hour while Cialis remains in the system for 36 hours. That doesn’t mean he’l have a 36-hour erection, only that the drug is there to have an effect. So if there are men who have difficulty, I would advise you to ask your doctor for Cialis instead of Viagra. Why? Because it relieves the pressure of: ―Okay, I’ve taken my pil . Ask for the restaurant bil right away because we have to leave now.‖ Okay? It gives you more time.
Some women with multiple sclerosis have tried taking Viagra, Cialis, Levitra, whatever, to cause clitoral engorgement and increase sensitivity. However, study results are rather disappointing. You can always ask your doctor for a prescription, try it to see if it works for you, explore the possibility. If it works, so much the better. Just don’t expect a miracle solution. But try it, you never know.
Thank you. How long after a meal should you wait before exercising?
J. Vigneault: I would say that would depend on how slowly the person digests. Not two hours. It
would also depend on whether or not it was a big meal. I don’t think exercising within 30 minutes of eating is a good idea. But someone with slower digestion could still be digesting after an hour and still feel full.
Personally, I think it’s important to eat small meals often during the day for better digestion. I might eat a bit but at least an hour before the meal. Sometimes just a handful of peanuts, or if my supper wil be at 6 and I want to exercise before supper, I’l eat a bit to boost my energy before going to the gym, especially if I ate at noon then didn’t have time to eat again. But I won’t eat steak and potatoes and vegetables. Sometimes I’l just snack on fruit or something that’s easy to digest quickly and wil give me energy before I exercise. But maybe one hour is okay. Our parents told us ―don’t go swimming, you just ate‖. There is a good reason for that.
But depending on how fast you digest or assimilate food, an hour or an hour and a half might be fine too.
Thank you. Are there any questions from the audience? We’l continue with the written questions then. How can you tell when a professional is competent to coach you in a physical activity program? Physiotherapist, kinesiologist, etc.
J. Vigneault: I think that some fitness centres—I won’t name them—focus on cardio. But the
universities have good programs. Also, talk to the person because I know that the
Society works with people who have certain qualifications for conducting physical activity programs that are adapted for multiple sclerosis. They have training to understand the symptoms and progression of the disease and whatever can cause difficulties. Partners have been chosen in some cities. I’m not from Montreal, but I know that in my area there are partners connected with the Society. I also think that when you discuss what you need with the person, you will feel whether they understand. Some people have university training in physical education and they are well prepared with regard to energy, symptoms, etc. Talk to them about what you need. Also, it might help to go to high-performance fitness centres.
Some physiotherapists, yes; sometimes occupational therapists can provide technical aids to help you do exercises. There aren’t very many physiatrists. But I think people who specialize in physical education are well-qualified to meet your needs.
Perfect. To complete what Josée said, I have here a question from someone who is asking if there are groups of people with MS on the South Shore and if there are activity programs in an adapted pool, again on the South Shore. For specific questions like that about services available in Montreal, I recommend that you contact either the Montreal office or the Montérégie office because specialized services do exist.
Thank you. Any questions from the audience? No? What dose of vitamin D do you recommend?
J. Vigneault: Actual y, I’m not the one who recommends it. But generally they say 1,000 units per
day. We sometimes prescribe 10,000 units once a week. People who have osteoporosis know that. Their doctors prescribe that. Of course, a balanced diet will give you some. But you’d have to drink a lot of milk to get that daily dose of vitamin D.
It depends on age too, because it’s different for children. There are some good articles that talk about dosage. But we recommend 1,000 to 2,000 units per day or 10,000 once a week so you don’t have to take a pil every day.
I have two questions on menopause. Can premenopause or menopause increase MS symptoms? And there is someone here—it isn’t real y a question—who talks about multiple-sclerosis related fatigue that increased with menopause. She also mentions sleepless nights. Do you have anything to say about that? Can menopause or premenopause increase MS symptoms?
Z. Vourantoni: I can’t say if menopause aggravates symptoms, but there are symptoms that may be
similar, like fatigue or vaginal dryness. So for women in perimenopause or menopause who come to see me, sometimes it is difficult to determine exactly what is causing the problem. Hormonal changes can have an impact on sex drive. I don’t want to say that aggravates it, but when both happen at the same time, there are so many similar symptoms that sometimes they can be felt more intensely.
And, Nadine, the other question about menopause?
It’s not exactly a question. The person talks about fatigue with multiple sclerosis. She says fatigue with multiple sclerosis and menopause-related changes that increase energy, for example, sleepless nights and sleep.
Z. Vourantoni: Yes. Well, sleep disruption in menopause is far more often hot flashes, hormonal
changes, that can disturb the circadian rhythm and hence the sleep cycle. So it isn’t
necessarily related to MS. And as Josée said earlier in her presentation, not everything is related to MS. Women who are going through menopause see lots of changes in their sexuality. For changes in their sleep cycle, it’s just that both are occurring at the same time and sometimes symptoms are similar and it is hard to distinguish between them.
J. Vigneault: What I could add to that is that menopause is a time of hormonal upheaval and we
know very well that in MS, disturbed hormone levels will cause symptoms to vary during the month, or during pregnancy. As for hot flashes, we talk about heat intolerance, but when we are hot, whether it is caused by an infection or being in a sauna or it’s just hot outside, it slows nerve impulses. And menopause-related hot flashes can accentuate some symptoms such as fatigue, leg motricity, spasticity, etc.
So yes, menopause can have an indirect influence on some multiple sclerosis symptoms.
Then there are also things that can be measured for menopause. The doctor can do blood tests to see what your hormone levels are, check your body chemistry. Discuss this with your doctor to know what your situation is: premenopause, menopause or something else. Also try to track where you are in your menstrual periods and how that affects your multiple sclerosis. Is it before – some people, before or during menstruation, can track fluctuations themselves. I’m coming back to my diaries here, but I like people who keep diaries. It sometimes really helps us to see what is happening during the month because we can get an overall picture but, today I had hot flashes and at the same time I slept badly, and so on. There may also be other factors in play.
So write about typical days and provide details about how you feel, and take that to the health professional: it will be easier to help you if we know what changes occur during the month. It’s like diaries for migraines. ―I have a headache.‖ ―How often in a month?‖ But they don’t know. Is it related to alcohol? Is it related to the drugs I take? Side effects?
When you keep a diary of the medication that you take, your feelings, fatigue, insomnia, it really helps the professional guide you and determine what causes may be related to what symptoms in your situation.
Perfect. One last question: should we really talk about sex with our boyfriends? Is it normal not to talk about it?
Z. Vourantoni: Once again, I detest the word ―normal‖. It would be normal not to talk about it simply
because the percentage of the population who doesn’t talk about it is truly enormous but that doesn’t mean that since much of the population doesn’t talk about it that’s the way it should be. I strongly encourage people to start a dialogue to achieve the best possible quality. Better communication about what makes me feel good, what doesn’t work. But there is also a way of going about it, for instance it can be embarrassing to say, ―I attended a lecture today. There was a sexologist. I realized that we don’t talk about our sexuality.‖ But yes, (inaudible) definitely the more communication there is, the easier things will be and I would say that it would be normal not to talk about it because many people don’t. Is that what I recommend? No, not at all.
That ends our Education Session. I would again like to thank the sponsor, Pfizer, the volunteers and the staff members who made this event possible. Thank you, also, for your participation. And thank you, I think our two speakers deserve our applause.
[Applause] End of recording
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