Ask the Doc: Q & A with Edward Kasarskis, MD, PhD

Edward Kasarskis, MD, PhD is Director of the University of Kentucky ALS Multidisciplinary Clinic at Cardinal Hill Rehabilitation Hospital in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY. 

Dr. Kasarskis

Q:  What should people with ALS know about fatigue? I seem to get much more tired lately.

Dr. Kasarskis:  The term “fatigue” is broadly used to cover a wide range of situations, but for many people it means you just don’t have the energy level you once had. For some, it’s very specific: they realize they get especially tired walking into the grocery store, taking a shower or getting dressed in the morning.

Fatigue is a common concern among people with ALS. When muscles are working less efficiently and effectively, it can take additional energy to accomplish physical tasks of all kinds. You may be sleeping less efficiently, especially if you have muscle spasms or other issues during the night. If your breathing is somewhat compromised at night, that, too, can leave you feeling tired. Sometimes people with ALS find they are stressed and depressed, and those issues can also contribute to a sense of fatigue.

There are some things you can do to minimize the fatigue. First, pace yourself. Give yourself the extra time you need to accomplish things than you did before you developed ALS. Try not to get frustrated by the extra time it takes; keep reminding yourself that it is natural and expected.

Schedule a nap or two during the day to allow yourself to catch up and relax. You’re not being lazy; you’re re-charging your batteries. The relaxation will also help relieve stress and tension.

Consider using assistive devices to make things easier and help you exert less effort to complete a task. You may benefit by using a walker, a wrist brace, or other tools designed to help you save energy for the activities you most want to do. Sometimes it’s hard to make the decision to use an assistive device. You may feel you’re “giving in” to the disease or taking a step in the wrong direction, as some people say. But saving more energy and reducing fatigue will ultimately make life a lot easier for you.

And be sure to talk with your physician, and physical therapist, respiratory therapist and occupational therapist, if possible. Try to put into your own words what you see as causing your fatigue and describe what tasks are most exhausting. Don’t minimize your smaller problems, the little things that frustrate you or make life more difficult. Tell your doctor; he or she can then help find practical ways to manage those issues.

Each issue we feature a leading neurologist specializing in ALS responding to a question. If you would like to submit questions for a future Q & A, please send your questions to Amber Walters. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally.