MS, Cognition and Yoga: What I Learned

(Cue the Voice-over Guy) “Previously on Clear Reflection Yoga”:

Now, back to the current/recent flare-up.  As I mentioned two posts ago, it took a couple of weeks after the leg weakness set in to realize I was experiencing cognitive impairment (CI).  My first reaction was, “Oh, so that’s why writing my blog was so difficult.”  My second was to laugh at the universe’s sense of humor in taking me from researching yoga and MS-related cognition issues to experimenting with them.  In all honesty, I don’t know if my reaction would have been the same if I’d still been in fund development or any other field that required the cognitive functions that were on the fritz.  Since I can’t step into an alternate plane of existence (if I could I’d chose the one with cures to MS and fibromyalgia), I’ll share what I learned.

My experience mirrored the findings of the little research I found on yoga and MS-related cognitive impairment.  Yoga isn’t going to make CI symptoms go away.  It’s not going to make the exacerbation heal more quickly.  But it definitely makes the whole thing easier to deal with.

influence 1The first thing I noticed was when I found myself having difficulty, I automatically went into Yoga Breathing. I teach that one of yoga’s goals is to learn to pause and respond from a place of thoughtfulness, rather than following a knee-jerk reaction.  To help with anxiety and panic attacks, or the general need for calm, I teach Dirga Pranayama (3-Part Yoga Breath), encouraging students to practice when they are feeling calm so it “kicks in” when they aren’t.  Pausing to breathe gave my brain a chance to try to process.  When the processing didn’t happen, pausing to breathe gave me a chance to try another tactic.

For example, when the clerk asked, “Paper or plastic?”, what I wanted to say was, “Wet stuff (meaning lettuce and spinach) in plastic.  The rest in paper.”  But, when after a beat or two I could tell that wasn’t going to happen, I switched gears to “whatever is easiest for you.” During my previous experiences with CI, not being able to answer the question the way I wanted would have started a spiral of frustration that, in all likelihood, would have included tears.  But this time, the simple act of pausing and breathing kept me from feeling overwhelmed and frustrated.

And when there didn’t seem to be another tactic that worked, breathing allowed me to find a place of acceptance, in that moment, rather than pushing/forcing.  Because the only thing pushing or forcing would do is ramp up feelings of frustration.

influence 2A couple of days after I realized I was having CI problems I went back to writing my post.  I changed the title to “Now – what was I going to say?” and changed my approach from analysis of the research and their applications, to a story about what was happening with my own cognition. In doing so, most of my writing difficulties vanished. This was true even though I included some of the same research information.  I decided to try using storytelling as a way to communicate whenever possible.  I think this noticing of “what was working,” was a direct result of practicing mindfulness and present-moment awareness.  These practices teach us to look at the whole of our experience, not just the part that is squeaking the loudest.  If I had keep my focus only on what was wrong, I would have missed out on something that turned out to be very helpful.

Staying in the present moment is helpful for everyone.  But, I think it’s particularly helpful in the case of MS, or any other illness that takes a relapsing-remitting form.  Exacerbations of any type can be upsetting, if not down right scary.  It is so easy to slip into worrying about the future or ruminating on the past. I love the following quote by davidj, in “Freedom Resides in the Present,” Deepak Chopra Newsletter, July 2012.

“The past is the known and offers no opportunity for choice and possibility. And the future exists only in the imagination. Freedom lies in the present moment, the only place where we can choose from an infinite range of possibilities.”

It is so true.  Focusing on what I used to be able to do is depressing and a waste of energy.  Trying to imagine the future is impossible.  Every person’s path with MS is different.  The possibility lies in now, this moment.

influence 3This leads me to the concept of “impermanence,” which is really a whole post in and of itself.  What I’ll say here, is that remembering the cognitive impairment wasn’t going to last forever was very helpful.  Since being diagnosed with MS, I’ve become a big fan of neuroplasticity.  In its simplest definition, neuroplasticity refers to the brain’s ability to change and regrow connections between neurons.  This concept is tied to developing new habits and to learning.  It’s also the reason those of us with relasping-remitting MS often recover abilities after an exacerbation.  In many cases the brain grows a new neural pathway around the spot of the plaque.  I know this is a very simplistic explanation, but its in the name of trying to keep a long post from getting longer.

To reduce frustration, I shared what was going on this those in my life.  Letting people know I might not be able to answer a question quickly, reduced the pressure to do so.  Less pressure = less frustration.  And everyone’s reaction to my situation was great.  No pity, just understanding and patience when needed.

While yoga did not improve the CI problems, I believe two acupuncture treatments I received during this time did.  I get acupuncture from a neurologist a couple of times a month to help with fibromyalgia pain, spasticity and fatigue.  It’s a nice complement to my yoga practice. The doctor is very much a Renaissance Man in his blending of Eastern and Western medicine, as well as traditional with “alternative.”  I’ve had no trouble accepting the results of needles in my belly to help with fatigue or in the webbing between my thumb and index finger as one of the “main gates” to help with something else.  But the fact that a needle in the area of the crown of my head actually improved my thinking is something COMPLETELY DIFFERENT.  That seems very “woo-woo” for lack of a better term.  If I sit down and look at the various meridians used in acupuncture it might feel more concrete. Or maybe it won’t.  And to be honest, right now I don’t know that I care.  I’m okay with “woo-woo” since two treatments, two weeks apart definitely made a difference.  So, if you are dealing with MS-related cognitive impairment,you might want to check out acupuncture.

momentumThe newest edition of Momentum (National MS Society magazine) arrived in the mail last week.  One article noted on the cover deals with cognition impairment.  They don’t mention yoga, mindfulness or acupuncture as coping tools.  But, its still a good read.

Be good to yourself.

Namaste,
Deb

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My Personal History with MS and Cognition

In my last post I shared my discovery that the current MS exacerbation was effecting not only my legs, but also some of my cognition functions.  In it I promised to use the opportunity to explore/do field research on how yoga might help with the cognition aspect. I kept that promise and I will share what I learned.  But, I think telling a bit about my previous encounters with MS-related cognition issues can provide important perspective. To keep this post from becoming even longer , I’m making this Part 1 of a 2-parter.

I was diagnosed with MS in January 2005 and that June began to have trouble with many of my executive functions (planning, problem-solving, switching tasks, verbal reasoning, working memory, etc..).  I was working in fund development, an area I’d been in for 10 years. The work was highly dependent on executive functioning skills and required the ability to juggle several projects at once. One day I found myself having trouble reconnecting with my train of thought when switching between projects.  Another day I’d read guidelines and information material from a potential funding source and discover I couldn’t translate what “We” did into language that matched what “They” were interested in.  I also began to struggle with pulling information I knew from my brain to my lips.  Then there was the day I sat down at my desk and had no idea where to start.  I was so frustrated.  Many of my drives home were made in tears.

No one had told me MS could affect my ability to think.  Back then, cognition problems weren’t on most lists of potential MS-symptoms.  I thought I was losing my mind.  I have always been labeled as “smart.”  In school I ran with the “smart kids” and always gravitated towards people with a quick wit.  Multi-tasking was second nature and the field of fund development had fit me like a glove.  Now, my gloves had holes and I had no idea why.

I developed coping skills that, for the most part, kept my struggles hidden at work.  (In writing this I’ve realized that these coping skills also kept my neurologist from seeing how bad the problems were.) I confided in the receptionist and my assistant, and will be forever grateful for their help during the summer of 2005.  Still, staying on top of things required an extraordinary amount of mental and physical energy.  I had struggled with fatigue from the start and these added challenges drained me.

When I spoke to my step-mom about what was going on, she told me that my uncle (who’d had MS and passed the year before I was diagnosed) experienced cognitive difficulties.  It was something my parents had chosen not to tell me because (1) they didn’t want to scare me, and (2) they hadn’t been sure it was MS-related.  Afterall, he lived most of his life during a time when it was thought MS couldn’t effect cognition. A viewpoint that had only begun to be called into serious question a few years before my diagnosis.  It wasn’t until reading Facing the Cognitive Challenges of Multiple Sclerosis by Jeffrey Gingold in mid 2006 that I even came across another whose experiences mirrored some of mine.

The cognitive problems began to subside by the end of summer. But other non-health circumstances arose and I resigned in October.  I tried doing some consulting work in early 2006, but cognitive problems resurfaced that spring. That’s when I put my fund development career on the shelf.

Of all the MS-related symptoms I’ve experienced, none has messed with my sense of self and identity like the cognition problems did.  During those times I didn’t feel smart.  The wit wasn’t there — well, not at the speed I was used to.  I’d been a talker, a communicator.  I’d always said that I’d rather ask someone for a $1,000 donation than plan a special event. During these “phases” my ability to get my point across was compromised. Conversations with me became a guessing game for my husband as I substituted “thingy,thing-a-ma-bob, whatcha-ma-call-it” and other expressions for words I couldn’t find in my mental dictionary.

If I wasn’t the Smart Girl, the Witty Girl….  If I couldn’t drive the freeway or read a map due to spatial relationship problems….. couldn’t read a book without constantly re-reading passages to remember what was going on…. couldn’t make quick decisions, even on something as simple as “paper or plastic”…… wasn’t able to convince people and institutions to invest in the work my organization was doing… then WHO WAS I????

I didn’t rediscover yoga until January 2006. My understanding of it as more than “just stretching” was still in the future when the cognition problems resurfaced that spring. It hadn’t yet become a sustaining practice in my life.  I hadn’t yet learned I was more than what I did to earn a living; more than my hobbies and interests; more than my brain and sarcastic wit.

The “About” section alludes to the fact that I grew up in an abusive situation. I won’t elaborate here except to say that growing up with an abusive parent, especially when there is significant mental and emotional abuse,does a number on your sense of self-worth and self-esteem.  I saw a therapist earlier in the decade and thought I had worked through all that.  But, this identity crisis brought the old wounds and doubts to the surface.

Though it didn’t seem so at the time, this was a good thing.  I went back into therapy with a different counselor — one who understood both the dynamics of abuse and the challenges of living with a chronic illness.  The question of “Who am I?” required me to look at the stories I’d been told — stories I’d believed about not being lovable and “less than.” It was during this time that my yoga practice shifted from stretching to something much more; something healing.  And because of this shift and my practice for the last seven years, I was better prepared when cognitive problems arose this past July.

Until next time (when I really will share what I learned this time around)…..

Namaste,
Deb