At this time, I would like to welcome everyone to the Exercise for Everybody conference call. All lines have been placed on mute to prevent any background noise. After the speakers’ remarks, there will be a question and answer session. If you have a question at that time, please press star followed by the number 1 on your telephone keypad. And if you’d like to withdraw your question, simply press the pound key.

Thank you.

I will now turn the call over to Ms. Christine Ratliff, the editor of MS Focus, the national magazine of the MS Foundation.

You may begin.

Christine Ratliff: Thank you, (Matthew). Good evening, everyone. Thank you for joining us.

As you know, the Multiple Sclerosis Foundation has designated the month of March as National MS Education & Awareness Month. And this is the last of our MS Education & Awareness Month teleconference series.

I’ll be your host for this evening’s program, Exercise for Everybody with Jeff Segal.

At the age of 25, Jeffrey Segal was diagnosed with MS. Within two years, he was spending the better part of his days in a wheelchair due to balance difficulties, partial paralysis, visual impairment, chronic fatigue, and a host of other symptoms common to those with MS.

Determined to fight back, Jeff launched his own wellness and rehabilitation program. Today, Jeff is in top physical condition and has reclaimed his life through exercise, nutrition and other wellness strategies.

He is a certified strength and conditioning specialist. He’s certified in fitness instruction, fitness testing, nutritional education and weight management, and functional training.

Jeff, welcome to the conference call.

Jeff Segal: Hello. Thanks for having me here today. And I hope everyone who’s listening can get something to take home with them, or if they are home, something that they can do about changing their life with exercise, because that’s what’s worked for me.

And just to fill you in, I was in pretty rough shape for some time and I took it into my own hands. And I had this as a background, my educational background in exercise, so I took it step further and kind of dedicated all of my energy towards that.

(And I) still use other modalities, but MS is where my heart’s at because it’s helped me, and like you’ll find out in the minutes to come, how exercise has helped me and how it can help you as well.

Christine Ratliff: Okay.

Jeff, well, let’s see, (Matthew), can you just repeat one more time the instructions for anyone that has a question?

Operator: Sure.

If you have a question, please press star followed by the number 1 on your telephone keypad; again, star then the number 1 for all questions or comments.

Christine Ratliff: Thank you. And we’ll take questions throughout the call.

Okay, Jeff, how can a person with a chronic, often debilitating illness like MS exercise? And with the fatigue associated with MS, why would they want to?

Jeff Segal: Well, there’s a bunch of reasons. But the best thing I can tell you is why wouldn’t you want to? If fatigue is something that’s going to be a problem in your life – it’s been a problem in my life – really the only way to fight fatigue other than medicating yourself is to fight it and to gain stamina doing different things.

And there’s a bunch of ways that you can learn to get around the fatigue. And one of the ways that I would have you do that is ask yourself a bunch of questions.

Could there be something emotional going in your life that’s making you more fatigued than you should be? Did you get enough sleep? Were you tired when you woke up? Could you be depressed? Could fatigue be a side effect of one of the medications you’re taking?

There are so many different things that can be a part of fatigue, such as you may be anemic or you may have a problem with your thyroid.

And after you’ve taken all of those out of the equation, you’re left with MS. And with MS, yeah, it is a very tough thing to get through a day sometimes when you’re tired. But the more you exercise, the more energy you should have. That’s the way the body works. It’s a progressive way of doing things.

So when I started exercising, it did it in the morning for a couple hours. And for the first couple weeks, it wasn’t the easiest way to go. But after a while, the more I exercised, the more energy I had as the day went on. And at the end of the day when I was kind of dragging, now I don’t feel that way anymore.

So basically the more you exercise, the more strength, and the more endurance gained, the less possible disability. And the less disability, the better we feel about everything that’s going on.

Christine Ratliff: Can you start –we mentioned in the beginning that you were actually a wheelchair user.

Jeff Segal: Right.

Christine Ratliff: And that’s before I met you. When I met you, you were doing very well when you walked into the Foundation for the first time.

How did you get from the wheelchair to the exercise?

Jeff Segal: Well, it was kind of a funny way. Every morning I’d wake up and get out of my bed and expect to be able to stand up perfectly fine and I’d fall into my closet. And eventually I put some comforters in the closet. And I learned to walk I think the same way I learned to walk at – when I was a little – when I was a baby. I learned to crawl.

I’d get up out of bed, fall over and I’d crawl a little bit. And once I was able to stand up, that was a big step for me. I mean, no pun intended. It was a big thing for me. And then once I made that step, I didn’t want to stop.

So eventually I made myself, you know, I did a little bit at a time and a little bit at a time. And after doing such little things at a time, it became a big thing. And I was walking and the next thing you knew, I was running and getting back to my old self.

In fact, today I could say I’m in better shape than I probably have ever been in my whole life. And that goes back to playing football (and) all different levels and basketball and, you know, having all kind of great awards from all that stuff.

But there’s – there hasn’t been anything more rewarding in my life, besides my daughter, than being able to get up and walk around and do those kinds of things when I haven’t been able to in the past.

Christine Ratliff: Right, right.

Now there are obviously people with MS that aren’t going to be able to get up and run and do those things. Is exercise still useful for them? And is it still going to help their fatigue and their symptoms?

Jeff Segal: It should. The reason I say it should is because everybody’s different that has MS. There are no two cases that are alike. But if you were to come to me and I was counseling you on exercise, there’s only two reasons that I would say are okay for not exercising, one being that your doctor told you that you should not exercise because, you know, there’s going to be some adverse effects of it and it’s not – it’s going to be dangerous if you do it.

And the other reason is that you don’t know how. And I love hearing that because if you don’t know how to exercise and you’re not exercising, you might be doing a little better for yourself than if you tried to do something a little bit too hard.

So there’s, you know, there’s something for everybody to do. No matter how disabled or abled you are, you can still do something. If you can use only one of your arms, you can use that one arm to move the other arm. And if you have to have somebody else move that arm for you, that is still exercise. That’s a range-of-motion exercise.

So there’s really – unless you just don’t want to do it and feel it’s not for you, there’s really not much reason for you not to because just the emotional effects alone are overwhelming.

Christine Ratliff: But talk a little bit about the benefits that you’ve seen. I know you work with – you train people with MS, don’t you?

Jeff Segal: Yes. I train a lot of people with MS. And I’ve trained people with all kinds of MS. And I’ve had great success with them. Really the best part about it is seeing them smile when they do something that they think they can’t.

And I’ve had people that really didn’t think they can get out of a chair. And my business is not to correct your problems. It’s to make you do what you can do better, but just to take baby steps in standing up.

I had a person that lost about 45 or 50 pounds with MS that could not stand up out of a chair. And by the time four months had gone by of training her, she was holding an eight pound medicine ball and she stood up 25 times in a minute.

So that’s someone who, you know, the…

Christine Ratliff: Wow.

Jeff Segal: …benefits of exercise, she needed that. And if she hadn’t done that, she would probably still be unable to get out of a chair.

Now for other people, I’ve had people that couldn’t lift their legs up while they were sitting in a chair. And so I’d work on them doing that and have them, you know, show them this might be a little bit easier to do it this way. And once we find a way to do it, we just work on doing it better.

And it – but that doesn’t matter. If it’s them doing it themselves or them lifting their leg up or me stretching them and them telling me what’s the best feeling for them. But at – when it’s all said and done, I’ve never had a client with MS that’s been upset with the results.

Christine Ratliff: Right, right.

Jeff Segal: And I think the emotional part is, you know, half of it because besides maybe feeling a little better from some of your symptoms, if you go – if you’re in a prolonged exercise program, after a while, besides feeling good, you’re going to look at yourself and you’re going to see a different person. And that’s when it all comes together.

Christine Ratliff: Right.

I have a very good friend with MS who is pretty much paralyzed from the chest down. She has a pretty severe form of MS. And she actually took up yoga – of course, seated yoga. And it just made her feel so much better.

And, you know, she’s not very, you know, she’s pretty mobility-impaired. And she had such incredible benefits from doing yoga, just the breathing and the relaxation and the meditation, and like you said, stretching what you can stretch and the range of motion and those kinds of things. So I understand what you’re saying.

Jeff Segal: Yeah, the range of motion is so important because it – you know, the less you do, the less you can do. And the less you move, the less you can move, even if it’s someone else moving you. And your body acts just like your mind would.

So all of that put together comes out saying the less you want to do, too. And when you’re not doing it and your body’s not doing it, your body’s not going to want to do it. And then that’s when you get frozen joints and those kinds of things. And that becomes a co-morbidity of MS.

And unfortunately because the disability status of so many people, they don’t choose to exercise and they start coming down with other problems, such as cardiovascular disease, diabetes, osteoporosis. And that’s – if you can prevent those things, you’re ahead of the game already, even in the general population.

Christine Ratliff: Right, right.

Let me just ask you one question and then we’ll open up the phone lines and see if we have some questions for you, okay?

Jeff Segal: Yeah, sure.

Christine Ratliff: Now I know that all of the benefits of exercise for MS have not been proven, clinically proven yet.

Jeff Segal: Correct.

Christine Ratliff: In your experience, what – you know, you know the array of MS symptoms.

Jeff Segal: (Mm-hm).

Christine Ratliff: What symptoms have you seen improvement for through an exercise program?

Jeff Segal: Well, one is strength gains are basically parallel to the general population. And there’s studies that show it, that isometric contraction, that means holding something without movement, and like if were you to push against a – in a doorway as hard as you can, it’s pretty similar to the general population when you’re gaining strength, how much you can do for that one push.

Christine Ratliff: Okay.

Jeff Segal: So there are a lot of things.

Can you address the question again (unintelligible).

Christine Ratliff: Sure.

Think of all of the MS symptoms – pain, spasticity, numbness…

Jeff Segal: Right.

Christine Ratliff: …bowel and bladder, all of those issues – which symptoms have you seen can improve with an exercise program?

Jeff Segal: Okay,

The strength, like I was saying, strength is the number one thing. Self-esteem is up there with it. And along with the self-esteem I think comes some of the fatigue.

Christine Ratliff: (Uh-huh).

Jeff Segal: The fatigue is – definitely as a direct correlation with the exercising.

Christine Ratliff: Okay.

Jeff Segal: But with your self-esteem getting better and your emotional status at a better level, there is less depression. There are fewer things that can cause you to be fatigued.

And a lot of the time, it might not be the MS. I know MS does cause fatigue, but you have to train and train and train and that’s how it comes back. And those are the things – those are the main things.

You know, there are – there is an endurance factor. You do gain more endurance from exercise. And any time you have any kind of progressive exercise program, it is progressive.

You know, you start here and you end up and you go to here and you go to there and eventually you get to this great spot. And – but you have to remember that everybody’s different and everyone progresses at a different rate.

Christine Ratliff: Right.

And just one more question – does this mean that fitness and exercise, is this the only way that you manage your symptoms?

Jeff Segal: No.

I found a medicine that works for me. And everybody’s got a medicine that works for them and I use one of the ABCRs. And once I got on it, I realized (about) six months after taking it that it was the one for me.

And it didn’t cause any extra or additional fatigue. And in addition to the exercise, that’s helped me. I got back on my feet about the same time that I think that medicine worked. But I think that everybody that’s out there should listen to their doctors, but don’t make – don’t let their doctors be the only one making their choice.

You have just as much a decision as the doctor does. It’s your body that you’re putting the medicine into. And if you feel it works, great. And if you feel it doesn’t work, tell your doctor.

Christine Ratliff: (Right).

Jeff Segal: That’s the way I’ve lived with MS and it has worked for me.

Christine Ratliff: And do you take anything for your fatigue at this point?

Jeff Segal: Yes, I do. I’ve taken a few different things. I’ve taken Provigil for it. I took – and I’ve taken Amantadine. Unfortunately Provigil’s not covered for me right now. Amantadine didn’t work. And I take Adderall and I’m getting off of that currently. So…

Christine Ratliff: Okay.

Jeff Segal: But I do have the fatigue problems. And in order to work and be a sole provider of my family, I have to take that stuff with the MS. And I’m slowly weaning myself off of any kind of a – I cut off of caffeine completely and everything else. I’m pretty much on my MS medication and my fatigue medication and that’s the only thing I’m taking right now besides a multivitamin.

Christine Ratliff: Well, it’s nice to know you’re human, Jeff.

Jeff Segal: Yes, I kind of feel (unintelligible).

Christine Ratliff: (Matthew), do we have any questions from callers at this point?

Operator: We sure do. Our first caller is (Pat Childs) with – from Tucson, Arizona.

Christine Ratliff: (Okay).

(Pat Childs): Yes, I’d like to know how (lung) involvement, if you have spinal cord MS as I do on the cervical or the neck area, what exercises should be avoided or not engaged in for fear of quote breaking my neck as one doctor specified it?

Can you delineate between the spinal cord MS and general MS…

Jeff Segal: Yeah.

(Pat Childs): …in your experiences?

Jeff Segal: I can. You know, like I was saying before, everyone’s so different and every spinal cord instance is completely different than another one.

(Pat Childs): (Mm-hm).

Jeff Segal: Some have similar characteristics. But if you have the symptom of when – do you ever have a problem putting your head towards your chest, your chin to your chest? (Unintelligible)…

(Pat Childs): Yes. It’s C2 through 3, so it’s my lungs are also involved.

Jeff Segal: (Unintelligible).

(Pat Childs): And when I do exercise, it directly affects my speech and lung power.

Jeff Segal: Well, the problem that happens when your head goes down, that’s L’hermittes is what it’s called. And what you want to do is stay away from getting in any kind of position that causes it.

And so I know that’s kind of a cop-out answer. But you really have to know what’s causing any problems that you’re having, whether it be a movement, a motion, and stay away from those.

And I – and I’ve dealt with some people who’ve had the cervical lesions where if they just (tilt their head)…

(Pat Childs): Did you do exercises with the legs rather than the upper extremities?

Jeff Segal: You can do both. You really have to find out from your doctor where the worst problems are occurring and find out what you can’t do.

But whatever you can do is what you got to work with. So the legs, yeah, if you’re having problems with your legs from those lesions and it’s affected by the way you’re positioning yourself, you got to change the way you position yourself.

It’s almost like a game of finding out what the perfectly fit puzzle piece is. And sometimes it takes a little bit of time. Sometimes it’s like (oh), that was an easy thing to do.

But it’s a good thing to work with a physical therapist as well because if you have those lesions and physical therapist knows about it, they are going to make the notes of what you can and can’t do and give you a prescription to go home with, or you should ask them for that.

(Pat Childs): Okay.

Jeff Segal: Are you get – do you get those problems? Is that…

(Pat Childs): I’ve had it for about 30 years. And I just was wondering where the physical therapist comes in. I have a wonderful one, but I wanted other people to know that if they do have spinal cord involvement, don’t go out and do a somersault or whatever or you may literally break your neck.

Jeff Segal: (Unintelligible) keep that neck neutral.

(Pat Childs): Check with your doctor first. But I appreciate your sharing.

Jeff Segal: Yeah, of course.

It’s so important to keep that neck neutral because you don’t want to get the shooting pains anywhere because especially if you’re using free weights, which you shouldn’t be using if you have the problems with your spinal cord.

(Pat Childs): (Mm-hm).

Jeff Segal: You should be using a fixed machine. That way it prevents injury.

But once you turn your head the wrong way, you have the chance of dropping a piece of equipment or have problems grasping. And, you know, if it goes into your chest, into your lungs, it – you don’t want to get involved in all that.

So basically you want to keep the weight light and increase the amount of reps that you’re going to do pain free.

(Pat Childs): Okay, thank you.

Jeff Segal: You’re welcome.

Christine Ratliff: Thanks for the call.

Operator: Our next caller is (Vanna Welty) from York, Pennsylvania.

(Vanna Welty): Yes sir, my question was if you have spinal cord injuries again with the lesions in the spine and you develop a lot of tingling and numbness with exercise, which almost makes you to the point that you can’t really keep exercising because your legs are so numb and tingly that it’s creeping up higher and higher, is there any solution for that?

Jeff Segal: Yes.

I’m happy that you asked that question because what you’re going through is – it’s…

Christine Ratliff: I’m sorry, Jeff, could you just speak a little bit louder?

Jeff Segal: Sure.

Christine Ratliff: Thank you.

Jeff Segal: That better?

Christine Ratliff: Yes.

Jeff Segal: Okay.

I’m happy you asked that question because that’s a common problem just from the body’s core temperature going up. The core temperature…

(Vanna Welty): Okay.

Jeff Segal: …can bring in some problems that you’ve had in the past with exacerbations or where you have lesions such as the tingling.

(Vanna Welty): (Mm-hm).

Jeff Segal: And the more your core temperature stays high and the more these things happen, the worse that pain’s going to get and it’s going to push you away from exercise.

So the best thing to do is find out your limits. And that’s the best way to find your limits out is let your body talk to you.

With me, I have through my experiences, my vision gets a little bit blurry. And that’s the first symptom that comes. The next thing that comes is the side of my face starts to tingle.

Once that side of the face starts to tingle, I’m either cooling myself down or I’m completely cutting back on the amount of weights I do. I think I’ve conditioned myself well enough to get past all that, so I don’t have that happen to me anymore.

But for someone like yourself anyone else out there, you got to know your body and you really have to listen to it. And once…

(Vanna Welty): So at that point, the best thing is just to stop and rest and then wait maybe like hours later or whatever and then exercise again?

Jeff Segal: Yeah.

Well, it depends on the person. I’ve had people that it comes from the heat. And what I do with them is I’ll wrap a towel around their neck that’s been in the freezer…

(Vanna Welty): Okay.

Jeff Segal: …and a little bit dampened. And sometimes just that can produce the sensation that your body needs. And that can slow it down.

But to answer the real question, short (burts) of – short bursts of exercise and spurts of exercise is what you need to do if you can’t carry on long amounts.

(Vanna Welty): Okay.

Jeff Segal: The duration, (it’s important to) add up 30 minutes a day. But if you can only do it for five or ten minutes at a time, you wait that amount of time to where you’re feeling better or well enough to do it again and it all adds up to that 30 minutes.

(Vanna Welty): Okay, that’s good advice.

The other thing – how does someone like with this condition ever get their cardiovascular rate up?

Jeff Segal: That’s a tough one.

What I like to do is some circuits, so where you’re doing some resistance training…

(Vanna Welty): Okay.

Jeff Segal: …and then following the resistance training, you do a short bursts of, you know, short spans of walking or doing something aerobically. And then from there, you go back to the resistance.

So basically…

(Vanna Welty): Okay.

Jeff Segal: …(you’re doing) an interval training, if you can do it.

(Vanna Welty): Okay.

Because, I mean, I really have a problem ever getting a very good cardiovascular workout because I’m fatigued and tingling before I can get the heart rate up.

Jeff Segal: Right.

Well, that’s – (see, that’s) when you have to go – unfortunately with MS, the heart rate does not dictate how much you can do (at your) rate of perceived exertion.

(Vanna Welty): Okay.

Jeff Segal: (But you) can increase your CO2 max, which is (what your) – the way your body functions, your oxygen consumption, by just doing more than what you’re doing right now.

(Vanna Welty): Okay.

Jeff Segal: (Unintelligible).

(Vanna Welty): Okay.

Well, thank you very much. I appreciate that.

Jeff Segal: You’re welcome.

Christine Ratliff: Thank you.

(Vanna Welty): (Mm-hm).

Christine Ratliff: Jeff?

Jeff Segal: Yes.

Christine Ratliff: Could someone wear a cooling vest or a cooling collar or something while they were exercising?

Jeff Segal: Yes. I strongly think that people should really find something that works for them if (they’re have) heat intolerance. There str all kinds of cooling vests. The Foundation had some available.

Christine Ratliff: Yeah, we actually are in the middle of our cooling program.

Jeff Segal: Are you? That’s great that there’s – to me, if you can find something that’s going to make you feel cooler than you are and you have heat problems, you got to it. If you don’t do it, you’re doing an injustice for yourself.

Christine Ratliff: Okay.

And I just wanted to stress also that Jeff said this, but you definitely should talk to your doctor and, you know, visit a physical therapist and get an assessment because with MS, it is so important that you know the source of the symptoms.

Jeff Segal: And let me add something to the whole exercise thing. Since everyone’s listening and you want to exercise and some of you might be doubting it, this is a scenario that I (tell) – that I ask people when I’m giving lectures, whether they have MS or not.

And MS is a great group to tell this to because you don’t know when you’re going to get sick. And I’ll ask the whole group of – you know, if I’m talking to 1000 people, if everyone in this room knew that in three months from today, you were going to get into a car accident, however, you’re going to make it out okay.

You’re going to have all kinds of bumps and bruises, but if you exercise between now and then and get yourself in tip-top shape, you’re going to recover that much faster – how many people in the room would not exercise? And there’s not too many people that are going to raise their hand.

Well, with MS, we don’t know when our exacerbations are going to come. And the stronger that you go – that you are going into it, the strong you’ll be coming out.

I mean, it – sometimes you do lose some functions that you had going in, but you still maintain that strength. And the body has a evening out effect. If you can only work one side of your body, the other side, it has a crossover effect where it does gain strength.

So there are good things out there with exercise.

Christine Ratliff: Okay, do we have another question, (Matthew)?

Operator: Yes, we do. It’s from (Wanda Hooley) from Queens, New York…

(Wanda), your line is open.

(Wanda Hooley): Hello?

Jeff Segal: (Wanda).

Christine Ratliff: Hi (Wanda).

(Wanda Hooley): Hi. Hi.

I wanted to ask if there was one particular exercise that a person could do? And if it bothered them too bad, is it best that they stop doing it?

Jeff Segal: Well, exercise is supposed to – there are lots of different parts of exercise that can hurt. But you’ve got to have – you have to understand that when your muscles are working and they’re getting fatigued, that’s the good kind of pain with exercise.

(Wanda Hooley): Because I’m in an aquatics class.

Jeff Segal: Okay.

And if it’s not a fatigue – if it’s not a muscular fatigue problem, because muscular fatigue is painful. It burns. But…

(Wanda Hooley): (Oh).

Jeff Segal: …that’s what you’re looking for. (That’s) what the outcome’s supposed to be like.

If something is bothering you or hurting you, you’ve got to talk to your doctor because it might not be from the MS.

(Wanda Hooley): (Uh-huh).

Jeff Segal: Or it might be some kind of orthopedic problem you have. There are so many different things that have to be addressed when you’re getting into a program. It should be a comfortable time for you. You shouldn’t have discomfort.

(Wanda Hooley): Good.

Because when I’m getting out of the water…

Jeff Segal: (Uh-huh).

(Wanda Hooley): …I feel that I have someone else on my back…

Jeff Segal: That’s normal. That’s okay.

(Wanda Hooley): …when I’m (pulling) out the water.

Jeff Segal: That’s a combination of fatigue. That’s a combination of being used to the water and having, you know, 90%…

(Wanda Hooley): (Yeah).

Jeff Segal: …of your weight gone.

(Wanda Hooley): Yeah.

Jeff Segal: And then getting back into the real world, you know?

(Wanda Hooley): (Oh), okay. All right.

Jeff Segal: But it’s a good thing. It’s good. If it’s to the point where you can’t walk out and you…

(Wanda Hooley): (Uh-huh).

Jeff Segal: …normally can…

(Wanda Hooley): (Mm-hm).

Jeff Segal: …you’re probably going a little bit too hard.

(Wanda Hooley): (Oh), okay.

Jeff Segal: All right.

Christine Ratliff: Keep it up, (Wanda). Thanks for the call.

Operator: Our next caller is (Howard Goldberg) from Clearwater, Florida.

(Howard Goldberg): Hello.

Jeff Segal: Hello (Howard).

(Howard Goldberg): I’ve got a question for you.

I’ve got primary progressive. And I’ve progressed to the point where I stopped exercising about a year ago because with all the tingling in my hand and stiffness, I felt it was too much of a danger. I was doing pull-ups and pushups and I felt it would be a danger to myself to try and use the pull-up bar because I couldn’t grip it. I would fear I would fall off it.

And being as that I have no balance, right now just trying to stand up and transferring to another chair or to my wheelchair is a problem. And pretty much I’m on the couch. I can’t do anything but.

But what I noticed, that when I go to bend my legs, I have major stiffness in my knees and I feel a slight burning sensation for about a second or two.

Jeff Segal: (Right).

(Howard Goldberg): Is it too late at this point…

Jeff Segal: Never.

(Howard Goldberg): …to try physical therapy? Or what kind of physical therapy would be advantageous to me? Because if – when I do try and stand up, it is just so difficult to even try and move my legs or to even take one step.

Jeff Segal: Well, that’s – it sounds like you’re having severe agonist/antagonist spasticity, which means that whatever would make your knee flex is fighting the muscles that would make your knee extend.

(Howard Goldberg): Right.

Jeff Segal: And that’s common in MS. I can’t tell you by talking to you and I’m not a doctor, so I can’t – I’m not – I’m a ‘suspect-ician.’ I’m not a diagnostician.

But it’s never too late to start an exercise program. And if pull-ups are something that you can’t do right now, don’t worry about them. Just don’t do them.

Do what you can do. And if you can move in any way, get that movement going. Get the range of motion going. Get on your feet. Get on your hands. Do whatever it takes. If you can move one side of your body, move the other side of your body with it, like I was saying before.

Now you should join a gym. That’s an important thing because– gyms have fixed pieces of equipment. And they’re not dangerous and you don’t have to worry about dropping weights.

Or if you were to use a trainer that was, you know, educated and knowledgeable about MS, they would be able to use their own body weight or their own resistance to help you.

So, you know, like you would do an arm-wrestling move, it – you can do the same thing by doing pulls, pushes, anything like that. Or strapping – if you strap something to your arm and strap yourself to a bar, you can do it that way.

If balance is an issue, I always stay away from free weights though. Balance – in free weights, balance is (unintelligible)…

(Howard Goldberg): Well, let me ask you, would aquatic therapy be better to start out with?

Jeff Segal: Definitely. Definitely. Because if you’re having problems moving around with your weight and the gravity outside of the water, the water’s only going to assist you.

(Howard Goldberg): Because at this point, I have no strength whatsoever. And I used to do 1000 pushups a day.

Jeff Segal: Right.

Well, you know, you got to work with what you got today. And that’s – that was one of the big problems I had, was, you know, I used to squat 500 pounds and I never even want to put 500 pounds on a rack anymore now, because A, it’s not a functional thing for me because there’s no reason for it anymore.

That’s where functional exercises come into play. Every exercise has some sort of function. And you have to find the function for whatever you’re doing. And if it’s just to get stronger, it’s functional for strength. And if it’s to be able to do something better, it’s functional for your daily modalities.

(Howard Goldberg): You said you deal with spasticity, correct?

Jeff Segal: Spasticity can be helped with exercise. It’s been proven in many cases to be helped with exercise. But there’s some times where it can’t be. And sometimes medical (pharmaceutical intervention)…

(Howard Goldberg): Let me ask you this real quick.

When my symptoms were first starting, I noticed that I was getting double vision that would come and go.

Jeff Segal: (Mm-hm).

(Howard Goldberg): And when I would get that double vision when I was walking, my legs became very spastic. They would just go whatever way they wanted to. I would have to stop and wait for the double vision to clear up and then I could walk fine.

Jeff Segal: Yes.

(Howard Goldberg): Now when I get the double vision, it doesn’t get to that point, but it still comes and goes for about ten seconds.

Jeff Segal: I can give you a reason, but it’s understandable why that would happen. I can’t say this is the definite reason.

But your body works with proprioception. I don’t know if you know what proprioception is, but…

(Howard Goldberg): No.

Jeff Segal: …it’s basically you see something, you move, each joint has receptors, and it’s just your way of getting from like your thoughts to your foot and all of the movements in between. I mean, it’s the way your body communicates.

So without seeing and without using your vision, you’re going to be off balance, any time. If you don’t have MS and you stand up and you put your feet together and you close your eyes, you’re going to be a little bit wobbly.

So if you do have MS and you’re having problems with your vision, yeah, other problems can occur and you can lose balance and you can have all kinds of other issues.

But that’s something to talk to the doctor about and see if it is – I think it’s the seventh nerve that causes that in your face that causes your eyes to not match up pretty much.

(Howard Goldberg): Lesion on the brain stem doesn’t cause that?

Jeff Segal: Yeah, it does. That’s one of the things that does cause it – brain stem and pons, in that area.

(Howard Goldberg): Okay.

Jeff Segal: But that’s more of the diagnostic part of it and…

(Howard Goldberg): Right.

Jeff Segal: …I’m – want to get – stay more about the exercise part.

(Howard Goldberg): All right. Thank you. I appreciate it.

Jeff Segal: (Oh), you’re very welcome.

Christine Ratliff: Take care. Good luck.

I just want to interject for a moment here and let all of you know that Jeff has a website and an email address. His web site is balancedpersonaltraining.com. And his email address is jeff – J-E-F-F at balancedpersonaltraining.com.

And if for some reason you didn’t get that, you can always email me at chris – C-H-R-I-S – at msfocus.O-R-G.

And also we are in the middle of our (cooling) grant program, so if any of you want cooling items, you can call us at 888-MSFOCUS and just ask for a cooling application. And you fill it out and send it back and hopefully we’ll have a cooling item for you this year.

Okay, (Matthew), do we have another question on the line?

Operator: We sure do. Our next question is from (Irene Hume) from Mount Sinai, New York.

Christine Ratliff: Hi (Irene).

Jeff Segal: Hello (Irene).

(Irene Hume): Yes, hi. How are you?

Jeff Segal: All right. How’re you doing?

(Irene Hume): I’m okay.

I have – also have primary progressive MS. And I do walk with my walker occasionally, you know, just to get some exercise. And I have a stationery bike with the motor on it that I use 20 minutes a day.

But my biggest concern is from (sitting up there), I notice my body’s getting really out of shape. And I was wondering if you could recommend some kind of seated exercises that you could do like for your stomach area and, you know, your legs and that kind of thing?

Jeff Segal: Yeah.

I’ll give you – first, how mobile are you? Can you move around with the walker?

(Irene Hume): I do, but it’s like a big job now.

Jeff Segal: It’s a big job.

(Irene Hume): Yeah.

Jeff Segal: Well, what you can do is you can just try to do a little bit more each time. And if it doesn’t work, wherever you stay at is okay. But if you’re seated, there’s exercise that you can do while you’re in the chair that’s going to work your core.

Just leaning forward and leaning backwards is going to get your stomach muscles to fire and your lower back muscles to fire. And that can be an exercise in itself, just a slight lean to the front and slight lean to the back, left…

(Irene Hume): (Oh) really?

Jeff Segal: Yeah.

(Irene Hume): Do you have to (move) any certain way?

Jeff Segal: No, you can do it – that’s just balance. Imagine you’re sitting on your butt in a chair. And if you were – if someone were to walk by you and just kind of bump into your shoulder, you’d go and fall over to the left. But if you’re strong enough, you’re going to stay upright.

(Irene Hume): (Oh) okay.

Jeff Segal: Well, those are the muscles that you want to work. That’s functional. That’s how functional comes into play.

If you lean over to the left a little bit and then rebound and come back, lean back, go forward, as long as it’s pain free, you’re strengthening your core and that’ll prevent things like that, like falling over.

And that does transfer to when you stand up. If you have a strong core, it may help you, you know, your posture or just taking that extra step that you wouldn’t have taken in the past.

(Irene Hume): Okay. I have one other quick question.

You mentioned before something about isometric exercises. How does that work?

Jeff Segal: Well, I didn’t – I wasn’t talking about the actual isometric exercises. But isometric exercises are just squeezing a handball and holding that squeeze.

(Irene Hume): Yes.

Jeff Segal: That’s isometric. And you can strengthen for that one range of motion that you’re in.

The problems with isometric is it’s going to get you strong just at that point, just at that range of motion. So if you’re doing like a – if you can do a pushup standing up against a wall…

(Irene Hume): I can do that. I can do six of them.

Jeff Segal: Yeah. So you push off the wall. Now isometric would be just to go halfway down and hold it there. (But)…

(Irene Hume): (Oh), I see what you mean.

Jeff Segal: Yeah.

But my reference was in measuring strength, they measure isometric contractions to see how hard you can squeeze or how hard you can push (in one) motion. And…

(Irene Hume): (Oh), I see. Okay.

Jeff Segal: ..and when they – yeah, when they did that, that’s to measure overall strength. And that was compared to the general population.

(Irene Hume): Okay, great. So the sitting with the moving back and forth and up and down is the best thing for you – your core.

Jeff Segal: That’s good, as well as you can do marches with your feet, lifting your legs until they tire out. And they’ll tire out from nerve conduction failure sometimes…

(Irene Hume): (Mm-hm).

Jeff Segal: …prior to…

(Irene Hume): (Okay).

Jeff Segal: …your muscles…

(Irene Hume): That’s great.

Jeff Segal: …getting tired.

(Irene Hume): Thank you very much.

Jeff Segal: (But keep) active. Whatever you do, just stay active and don’t overdo it.

(Irene Hume): Okay. Thank you very much.

Jeff Segal: You’re welcome.

(Irene Hume): Bye-bye now.

Christine Ratliff: Bye.

Jeff?

Jeff Segal: Yes.

Christine Ratliff: Can you just touch briefly, because I know people want to call in with their questions – remember that article that you wrote on the – for the Internet newsletter about how people can incorporate a little bit of exercise into their day?

Because you talk about, you know, maybe training for an hour or two. And I know there’s people that are saying forget it. There’s no way. I last for five minutes.

Can you hit on a few points that – a few ways that people can, you know, increase their endurance and get some of the benefits that seem attainable to them?

Jeff Segal: Yes. That’s not a problem.

Well, there are a lot of little things that you can do. And hopefully everyone understands that a lot of little things equal a big thing.

And the little things that you do during the day – if you can walk and you can park your car, park it a little but further every time, if you’re able to. As long as it’s not a problem, as long as it’s not going to make things more difficult, one spot further isn’t going to hurt you. And if it does, don’t do it.

The best thing about parking a little bit further is there are trees to park under. And you know how bad the heat is. If you can get to park underneath a tree and you get out of wherever you are shopping or doing whatever it is and you’re in a cool car rather than a hot car, your body’s going to function that much better with MS and you’re going to get that much more exercise.

And you don’t want to be one of those people driving around the parking lot looking for the first spot and, you know, and be able to do something a little bit more.

The other things are, you know, if you have some groceries and you come home, whether you’re in a chair or not, don’t take them all up in one trip. Take them in two, three trips, because that’s more movement that you’re going to get. And that’s the same thing that goes for when you’re going to the mall or you’re going anywhere. You want to do a little bit more each time.

And if you can’t, you can’t. You remember, we’re only working with the things that we can do. The things that we can’t do are things we can’t do and we don’t want to sit and worry about them. I mean, we can remember them, but, you know, that’s why it’s all about, you know, that disability is out of my mind. It’s the ability that we’re working with.

Christine Ratliff: Okay.

Like something as simple as folding the laundry?

Jeff Segal: Yes. Anything, household chores, is exercise. Gardening – exercise; folding laundry, putting the laundry away, taking dishes out of the dishwasher, in and out of the washing machine – anything, anything around the house that you can do, do it. And if you can do it more and better and work harder at it, it’s going to be that much more effective.

If you can stand up out of a chair, the best exercise for you to do with MS is standing up out of a chair. If you’re in a chair and you can move your arms and you can reach for things, the best exercises that you can do is to reach for things.

You know, have a little bit of resistance against it. And that way you’ll be able to do it better. And when it becomes something that you have to do that’s not an exercise, you’ll see that it works out better that way. You’ll be better at it.

Christine Ratliff: Okay.

And I just also want to mention that most of you are familiar with our MSF lending library where we send out books, videos and DVDs that you can borrow at no cost and we pay the postage.

We have a really nice selection of yoga, tai chi, seated yoga, different DVDs and videos that you can borrow. So you if you’re interested in that, do call us. And the number again is 888-MSFOCUS. That’s 888-673-6287.

We’ve gotten a really good response on several of them. And some of them even have participants with MS, which is kind of neat to work out with them.

(Matthew), do we have another question?

Jeff Segal: (Chris, I – let) me add one thing please.

Christine Ratliff: Sure.

Jeff Segal: If any of you are working with a personal trainer or have – or intend to in the future, I have no problem with you giving your personal trainer my contact information and I can go over the guidelines of exercise. I do that for lots of other professionals in my field around the country.

And it’d be very helpful for you and for the trainer because I think the more people out there that know about MS and know how to train people with MS, the better it’s going to be for us.

Christine Ratliff: Good point.

Operator: Our next caller (Christina Foster) from Geneva, Illinois.

(Christina Foster): Yes, hello. Thank you very much. I’m writing down all of these little notes.

One thing I note, when I first started exercising, I tended to overdo and I would get dizzy and as you explained with the double vision and everything and I’m like whoa. And when you said (unintelligible), is that my body telling me you’re doing to much?

Jeff Segal: Yeah.

(Christina Foster): (Unintelligible) a little bit (unintelligible).

Jeff Segal: You’re overdoing it. You can’t jump into something too quick because there are lots of negative effects of exercise that you can get. And that’s the last thing you want. Exercise is supposed to be enjoyable. It’s supposed to be fun. And it’s not supposed to be associated with a lot of discomfort.

So if you didn’t have MS and you jumped into an exercise program, you’d probably be (going) through the same thing that you’re going through right now.

So you start out slow. And if it’s – are you talking about cardiovascular exercise? Or are you talking resistance? Is it one or the other?

(Christina Foster): Well, what I was doing (was) walking with barbells and everything. It was like trying to do it all at one time. I was like wait a minute, I’m trying to do everything here. And that was a mistake.

Jeff Segal: Well, if you’re by yourself and you don’t have a professional that you’re working with, the best advice I can give you is don’t go into an exercise about with it being unplanned.

(Christina Foster): Okay.

Jeff Segal: You should sit down and think about it before you do it and say hey, no one’s going to be giving me instruction. What’s enough for me? What’s too much for me. And if it – if you are – you know, if you’re an overachiever like the rest of us, you’re probably…

(Christina Foster): (Yeah).

Jeff Segal: …going to try a little bit more than you should. So…

(Christina Foster): (Yes).

Jeff Segal: …(just) keep that in mind. And when you feel the first symptom or the first discomfort, that’s your body saying, you know, hey, slow down, give me a break. And do it, because if not, it’s not going to – you’re not going to have a good outcome.

(Christina Foster): Yeah.

The problem is that dancing is my background, so it’s hard to say whoa, wait a minute, you can’t do all that anymore, so it’s…

Jeff Segal: Yeah, well, you can do it. You just have to start – do you have progressive or do you have relapsing/remitting?

(Christina Foster): I have secondary progressive.

Jeff Segal: Secondary progressive.

(Christina Foster): (Yes), (Mm-hm).

Jeff Segal: So, you know, it’s basically you’ve probably had MS for some time if you have secondary progressive now.

(Christina Foster): Yes. Yes. I was diagnosed back in 1977.

Jeff Segal: Yeah, okay.

So you know yourself with the MS better than probably any doctor you’ll ever come into contact with.

(Christina Foster): Right, right.

Jeff Segal: And that’s just because you know yourself. And remember, it doesn’t all have to be done at once. And if – (and) dancing was your background, it doesn’t…

(Christina Foster): (Yes).

Jeff Segal: …mean you can’t – you have to stop dancing. It just means that you might want to slow it down and, you know, take your time with it. And you might enjoy it a little better that way.

(Christina Foster): Yeah, I think you’re right.

Jeff Segal: Because, you know, exercise is supposed to be enjoyable. I’ll keep telling you that and some people will never believe me until they have an enjoyable bout with it. But exercise is enjoyable and the benefits of it are very enjoyable.

(Christina Foster): Thank you very much.

Jeff Segal: You’re welcome…

Operator: Our next caller is (Florence Rainey) from Laurel, Maryland.

Jeff Segal: Hello (Florence).

(Florence Rainey): Hi.

Christine Ratliff: Hi there. How are you?

(Florence Rainey): (Oh), we’re fine. We’re sitting here just listening.

My question is what is his diet? Is he eating something that we should know about when we’re – when you’re on MS? And what does his diet consist of?

Jeff Segal: Okay, I can tell you about my diet. I can’t give you more than just general information about diet due to the laws in Florida.

However, I can tell you my diet is basically I eat very well. I eat a very big breakfast. I probably have close to 1000 calories first thing in the morning.

And as my day goes, I decrease what I eat. That’s just the way I lost my weight. I don’t know if Chris told you, but I lost 80 pounds after being diagnosed with MS and I lost it the right way. And that was one of the ways I did it.

While doing so, I was eating the healthiest of foods. And, of course, I think it had something to do with my MS being the way it is. Most people know how to eat healthy, but they don’t. And that’s the problem.

And one of the biggest and most important things about eating healthy is the amount of foods that you eat. So if you have a big plate of food and it’s all healthy foods, if you can eat half of it and get by with it, you’re okay, you know? You don’t need to eat that second half because you don’t want to have those extra pounds.

But the food pyramid is the best thing to go by. If you look – have you ever read the food pyramid or looked at it?

(Florence Rainey): (Oh) yes, (thank you).

Jeff Segal: Stick with that. Stick with the whole grains Stick with, you know, you don’t have to worry about protein that much because we get a lot of protein in everything we eat. And a portion of protein is basically the size of your fist, if it’s a piece of meat. Vegetables and fruits are very important.

They’re – basically one of the big problems people have in dealing with MS is constipation and one of the big problems we have in the United States is not enough people eat fruits and vegetables. Only 3% I think of the population eats the proper five-and-five.

So, you know, eat the right foods. If you think you’re eating something wrong, you’re eating something wrong and go by that. And if you have any more questions, get a dietitian and have them talk to you.

But there is not a secret diet out there that’s like the MS diet that’s going to cure MS. If you’re a healthy person, you eat healthy, you’re going to be healthy. That’s the best way to look at it.

And MS isn’t the only thing that you have to worry about out there. Everyone that has MS has the same chances of having everything else. So if you eat healthy while you have MS, the rest of the things may not become a problem.

(Florence Rainey): Okay.

How long did it take you to just stop taking any of the medications? And are you on any medications now?

Jeff Segal: Yes.

Currently I take – I do take Copaxone. And I used to take an interferon prior to that. And the Copaxone’s been doing well for me. I’ve been on it since 2000. I don’t plan on going off it because it’s done me justice.

The energy medicines that I was on, I’ve tried a few. I’ve tried a little bit of this and a little bit of that, like I said, the Amantadine and the Provigil. And I’d rather go back to the Provigil than the amphetamine that I’m on right now, which is the Adderall. But it’s a matter of the prices of them and what insurance covers what.

So I’m trying to get myself back off of everything and just eating healthy and taking my shot. And that’s pretty much it.

(Florence Rainey): Okay, thank you.

Christine Ratliff: (Unintelligible). Thank you so much for calling.

Jeff, how important is drinking water?

Jeff Segal: It’s just as important as breathing. Drinking water is so important. And if you have a problem with, you know, your bladder or if you have an overactive bladder, you still need to drink.

And one of the big issues that people will stop drinking liquids because they don’t want to have a problem or anything. One thing that can help – and I’ve talked to some clients about this, (that it’s) your choice to do – if you’re exercising, sometimes a sports drink is better because it doesn’t release into your bladder as fast as water does, such as Gatorade or Powerade or that kind of thing. It’s something you’d want to ask your doctor, too, if it’s okay. I’ve never heard someone say it isn’t.

But Gatorade and those kinds of drinks, they work in a unique way. They’re flavored so that you want to drink them. And if you’re tired and dehydrated and you drink them and they taste sweet, that means you need them. And if they have a salty – kind of a salty taste to them, that means that you really don’t need them. And that’s like the secret behind Gatorade.

Christine Ratliff: Really?

Jeff Segal: Yeah.

Christine Ratliff: I didn’t know that.

Jeff Segal: (Yep). So they help promote your craving for liquids.

Christine Ratliff: Wow.

And I also want to mention here because of that last question, we also have a booklet called, “Nutrition and MS,” which you can get by emailing or calling us. And I gave you the number already. I’ll give it again at the end.

This booklet has the very latest on research of the dietary supplements and the dietary guidelines that are believed to be beneficial for MS. And it’s a very good booklet. I hope you’ll call and request it. It’s got a lot of great information in it.

(Matthew), do we have another question?

Operator: We sure do. It’s from (Denise Hodges) from Bossier, Louisiana.

(Denise Hodges): Hi.

Christine Ratliff: Hi (Denise).

(Denise Hodges): Hi.

You know, I swim a couple days a week. Been doing it for four years now. And I was paralyzed with transfer (unintelligible) in ’89 and diagnosed with MS in 2002. And I find that even though I’m paralyzed, I can swim real well, dive under.

But I’m – kind of reached my point, my peak. I wanted to know if it’s more important to swim longer or swim more often? I prefer swim longer.

Jeff Segal: It depends how your body feels when you’re done. (That’s the whole)…

Christine Ratliff: Speak up a little louder, Jeff.

Jeff Segal: That’s the debate with all exercise, is the intensity versus the duration. You’re saying that you don’t know if you want to go harder for a shorter amount of time or lighter – or a little bit less for a longer amount of time.

And it’s basically what you can put up with. If you can deal with doing it more often for a longer amount of time, then that – the length should increase with the intensity.

Does that make sense?

(Denise Hodges): Yeah.

So if I can swim four or five hours at a time a couple days a week…

Jeff Segal: Then you’re ready for the Olympics.

(Denise Hodges): And being paralyzed, I’m real proud of that, you know.

Jeff Segal: Yeah, you should be.

(Denise Hodges): But now what I’ve done is started swimming under the water. It’s four feet deep, so my resistance built up and built my lung capacity. So I think I’ve accomplished a lot.

But then people say well, why don’t you go three days or four days and I feel like I’m getting it done in two.

Jeff Segal: You – it’s not going to – it doesn’t work that way. The more often you do it, the better it is.

(Denise Hodges): Is that right?

Jeff Segal: Yeah.

You can’t substitute the days because cardiovascular conditioning starts to decrease with two to three days off. So you always want to keep – if you can do it, do it.

You know, if it’s something that’s giving you trouble, back off a little bit and don’t do it as often. But, you know, if you’re talking about the hours you’re talking about doing it…

(Denise Hodges): (Uh-huh).

Jeff Segal: …you might be over-training anyways.

(Denise Hodges): Okay.

Well, there’s other people in the pool that walk, so some is just swimming with them, but some is swimming harder.

But is there other – like the isometric, are there other exercises I can do in the pool besides swim?

Jeff Segal: (Oh) yeah.

(Denise Hodges): Unable to use my legs, remember.

Jeff Segal: Okay.

And you can’t use them in the pool even. You have to swim when you’re using your arms to swim?

(Denise Hodges): Right, yeah, because I’m a T12 paraplegic.

Jeff Segal: Right.

So if you’re – at T12, you’ve got your – you’ve mobility in your arms and you can do pushups in the pool. You can do pushups against the side. You can do pulls. You can do stretching with your lower body even, just by using your weight.

There’s – there – the – with – underneath the water, there’s so many different things that you can do. You can get pool weights. You ever seen the floats? You probably have used those.

(Denise Hodges): Right, right, yeah.

Jeff Segal: (Unintelligible) use those. Anything that you can do that’s going to be pain free and through your normal range of motion is going to help you.

(Denise Hodges): So go ahead and try and go three days instead of the two days and (you’re)…

Jeff Segal: I would try that. And if you think you’re doing it a little bit too hard, just back off a little bit. You know, you’re – if you’re into the hours like you said, you’re doing all right.

The amount of days, three days should be what you’re shooting for because for muscular endurance, three times a week is what’s supposed to be prescribed for MS. Cardiovascular is also at three times a week. And resistance training is three times a week and range of motion is five-to-seven times a week.

But all of those don’t – they overlap. And…

(Denise Hodges): Right.

Jeff Segal: …a lot of them overlap. And the point of it all is three days is what the prescription is supposed to be. So…

(Denise Hodges): I see.

But you also have to add in the transferring the dressing, that type of stuff. I count it (as exercise).

Jeff Segal: That’s exercise.

(Denise Hodges): Yeah, that’s right.

Jeff Segal: That is exercise.

(Denise Hodges): You’re telling me, yeah.

Jeff Segal: Anytime you’re doing something that takes a little more energy to do than your normal – what you’re normally used to, that’s exercise. And you’re getting cardiovascular benefits from it and you’re getting resistance and muscular benefits from it.

(Denise Hodges): Okay.

Jeff Segal: So you’re doing pretty well. You’re a role model for the people out there. And that’s the best thing about it, is when you know that you have some sort of a problem or a disability and you’re working hard and the next person isn’t, they’re going to think twice about it the next time and chances are we’re going to have a healthier country.

(Denise Hodges): Well, that’s right.

Because they do. People can’t tell I’m paralyzed when they see me swim while they – you know, so it is kind of a – it’s everybody’s inspiration to each other in the pool, you know?

Jeff Segal: Yeah. (Yeah, that’s great).

(Denise Hodges): And the pool kind of makes everybody even.

Jeff Segal: (Yep). It’s uplifting for anyone to see someone do something that they’re surprised to see them do. You know, it’s – it helps. And that was one of the things that I – that helps me train people is I show people where I was and I tell them where I was and I tell them hey, I understand that it’s difficult and some days are going to be harder than others and some days aren’t, but, you know, it’s about getting by those days and the outcome is going to be good and that you just got to live optimistically.

(Denise Hodges): Do you know how many calories you would burn in a hour, average swimming (an hour)?

Jeff Segal: It’s – there’s so many calculations for it. It would depend on how hard you were going, how – what, how hard you were going with your upper body and your lower body versus your weight versus – there’s so many components to the equation that I can’t give you just a…

(Denise Hodges): Yeah.

Jeff Segal: …about this type of answer.

(Denise Hodges): (Yeah).

Christine Ratliff: What about if she were to email you? What – might you be able to figure it out with some more details?

Jeff Segal: Yeah, I might be able to figure it out. I’ll look into it, for sure.

(Denise Hodges): Thank you.

Jeff Segal: You’re welcome.

Christine Ratliff: And I’ll repeat his email address again for everyone. That was a great call.

Jeff Segal: Yeah, very good.

Christine Ratliff: Jeff’s email address is jeff – J-E-F-F – at balanced – that’s B-A-L-A-N-C-E-D – personaltraining.com.

Okay, I had a question for you, Jeff, but it seems to have slipped my mind. So let’s ask the – for the next question.

Operator: Okay, our next question is from (Teresa Washington) from Coatesville, Pennsylvania.

Jeff Segal: Hello (Teresa).

(Teresa Washington): Yes, I’m (Teresa).

I was diagnosed in 1997. And ever since then, I’ve been losing weight for the whole ten years. And I mention it to my doctors and they seem to just tell me (oh), that’s the MS. But I don’t know of anyone who lost weight. People tell me that they gain weight since they was diagnosed.

Jeff Segal: (It – like) I was saying before, there’s no two identical cases of MS. But it’s very important to look at everything around you.

What I do…

(Teresa Washington): I have a good appetite, you know. Yeah, my appetite, there’s nothing wrong with it at all.

Jeff Segal: So you’re – you think that you just – (are you) having problems swallowing food or are you having…

(Teresa Washington): I have no problems swallowing food or any…

Jeff Segal: And you’re – are you eating as much as you were before?

(Teresa Washington): Well, sometimes yes. But some days I don’t eat three meals, but I eat a big breakfast. I mean, a really big breakfast every day. And dinner, I eat pretty much. For lunch, I don’t really get a chance (unintelligible) when I’m kind of busy doing things and I miss my lunch, but I do eat fruit. But I don’t eat a lot of, you know, lunch every day.

Jeff Segal: Well, it’s important to eat a lot throughout the day.

(Teresa Washington): (Uh-huh).

Jeff Segal: And we’re – I’m kind of – this is kind of a backwards answer to what you were saying because the more often you eat, the higher your metabolism is.

(Teresa Washington): Yeah.

Jeff Segal: The higher your metabolism is, the lower your – the easier it is to lose weight. And you’re not eating very often, but you’re losing weight. So that only says one thing – you’re not eating enough food.

(Teresa Washington): Okay, okay. And when I get up in the morning, when I stand, after I finish my exercises in the bed, I’ll stand. My – back of my knees are like someone’s swinging on them, like pulling down, and also my ankles.

Jeff Segal: That’s a – that’s probably motor fatigue, and – or it could be spasticity as well.

(Teresa Washington): Yeah, I have a lot of that…

Jeff Segal: Yeah.

(Teresa Washington): …you know, when I’m sleeping. I have a problem sleeping.

Jeff Segal: Talk with your doctor on that.

But the eating part, here’s a solution that might work for you. Emotions play a major part in how you eat and how much you eat. So if you can ever – and I always tell my clients that are – because most of my clients, they have an issue with their body image.

They want to either gain weight, get stronger, get bigger, get smaller, get thinner. And that’s a problem for this country because everybody wants to look like the last person they saw on television.

So what I’ll tell them to do, and you, is write down everything you eat, okay?

(Teresa Washington): Yeah.

Jeff Segal: (And) what time you eat it. Do it for four days – what time you eat it, how’d you feel when you at it…

(Teresa Washington): Okay.

Jeff Segal: …how much did you eat. And then if you go back after those four days and you look back at it, you might be able to figure out, you know, hey, this is a problem that I’m having with, you know, I’m upset, I’m not eating or, you know, when I’m happier, I’m eating a little bit more, or I’m too busy and I’m just not getting enough time to eat.

But eating is like breathing and like drinking water and all of that. It’s something you have to do. And, you know, in the aging process, you’re supposed to lose weight as you go, but it’s not supposed to be a drastic thing.

(Teresa Washington): Yeah.

But I – my regular weight, I lost that. You know, I wasn’t a big person. But I lost a number of pounds – it was too much – after I was diagnosed. Before that, I was not losing weight.

Jeff Segal: Yeah.

(Teresa Washington): And when I was diagnosed, I started losing weight from then years.

Jeff Segal: Yeah, will you – if you try what I said, it might help.

(Teresa Washington): Okay.

Jeff Segal: But I think, you know, basically the body works this way – the amount of calories that you bring in versus the amount of calories you burn during the day, and that goes into your metabolic rate.

(Teresa Washington): (Oh), okay.

Jeff Segal: And if you’re eating more than you’re burning, you’re gaining weight. And if you’re eating less than you’re burning, you’re losing weight, unless you have a thyroid problem or a metabolic disease.

(Teresa Washington): Okay.

Jeff Segal: That’s just the way it goes.

(Teresa Washington): All right, thank you.

Jeff Segal: You’re very welcome…

Christine Ratliff: (Matthew), do we have time for one more questions?

Operator: Sure. Our next caller will be (Priscilla Brown) from Brooklyn, New York.

(Priscilla Brown): Yes, good evening.

The question that I wanted to ask about, first of all, I’ve had MS actually the fourth of next month will officially be 19 years diagnosed, but I’ve been suffering for like 21 years.

And like in ’94, I had a big exacerbation that put my in the hospital and I went into a coma and everything. I – basically (I’ve brought) the majority of my strength back, but my biggest problem is like my legs and my feet. And I have drop foot.

And I wanted to know if you would be able to answer this question – now with drop feet, I wanted to know if you exercise your feet, is there a chance that your foot could be corrected? Because I’ve heard that drop foot can be corrected.

Jeff Segal: I’ve seen and heard of cases of drop foot being corrected. And I’ve seen and heard of cases of it being done by doing – by exercise and other things. But the main thing is your body has to heal. And your drop foot’s not being caused by your leg. It’s being caused by your brain for, you know, for the most part.

So, you know, you can try to train your muscles independently. What I tell everybody is, you know, if we’re optimistic, we’re here for a reason, we’re hoping there’s going to be a cure, we’re hoping something is going to turn, maybe remyelination, something might happen.

So what you need to try to do is move that foot as much as you possibly can. Work the muscles. Even if it’s strong enough to carry your body weight and get that foot up, get them moving. Get – don’t let your joints lock because if per some chance we do come up with something, which I think we will at some point, you’ll have the mobility to do stuff with it.

And don’t give up. Keep trying to do those little things with your foot. Because remember, sometimes little things add up to bigger things. And if you’re telling your foot to do something and it’s not doing it, then, you know, that’s a problem.

And, you know, you got to (work) your away around it, not (toe to say) through it. You know, if you try to work through it, you might not – you might be overshooting your expectations.

(Priscilla Brown): Well, what kind of exercise do you think I can do with my feet? Because like I said, my – like after – it’s been like 12, 13 years or so since I had this big exacerbation. And my upper extremities are excellent because when I had this exacerbation and at first I lost all the feeling in my body. But when the feeling came back, it came back strange.

You know, some people say well, this side is my weaker side or, you know, either left or right. And with me, the strength came back in my right leg and in my left arm. But my right arm and hand, I (forced) back because I’m right handed.

But my problem is like my left leg, both of my feet are drop foot. But it’s like my left leg and foot is the worst.

Jeff Segal: Have – do you have access to a pool?

(Priscilla Brown): No.

Jeff Segal: Try – when it gets warmer of if you get access, try doing stuff in the pool, because there’s a lot of things that people can do in – under water that they can’t do on the land.

And there’s a little exercise that you can do for your foot. Can you move your feet? Or is it you’re just not able to plant or flex or push down with the front of your foot?

(Priscilla Brown): Well, I do have some movement in my feet.

Jeff Segal: (Movement)…

(Priscilla Brown): Yeah, I have more in my right than I do the left.

Jeff Segal: Do whatever you can with either of them. The body has a crossover effect so that if you do strengthen one arm, your other arm does get some strength, just because your body’s trying to be even, even though – the body acts unilaterally. But, you know, when you’re getting some benefits from different things, it does – you’ll get them bilaterally.

So you can still, you know, whatever you can do, do it. That’s the point. Do what you can. If your right leg is working better than your left leg, work your right leg a little better than your left leg. Let your left leg try to catch up.

But don’t not do anything because you’re having problems, you know. Don’t give up. There’s always a reason to keep going. And you never know what’s in, you know, what’s to come in the future and there’s all kinds of great advances.

And, you know, there’s no limit to what you can’t do. You know, you have to just find out what your levels are, where you need to be.

(Priscilla Brown): But let me just ask you this last question.

And my problem also is weight, because also I left out one important thing. Because of that exacerbation, it also left me with a tracheostomy.

Jeff Segal: Okay.

(Priscilla Brown): So I don’t know. I even do – because I do exercise in, you know, from my bed, I can still like have the bed basically down and I can come up and I’m able touch my toes and come back and things like that.

But do you have any exercises you can really recommend for me, you know, to strengthen myself? But I also need to lose weight.

Jeff Segal: Well, losing weight would mean longer duration of exercise.

This is what – this is a big problem, is the diet. People who I train, I tell them what, I think there’s 168 hours in a week. And if I train them three times a week that’s 165 hours they have on their own to do whatever they want, eat whatever they want and act however they want to act.

And I try to tell them during that time that I’m not with you, you’ve got to stay on top of what, you know, what you need to do. And if diet is an issue for you, you should not be eating more than what your body is exerting.

So I don’t know if that’s answering the question. If you’re overweight, you need to cut your weight down. It’s just – it’s a – it’s like a mathematical equation. Eat, but don’t eat too much.

And if you can exercise, exercise a little bit more. There’s – you know, it’s a formula, what goes in versus what comes out. And if you can – if you’re not able to output, then the input has to slow down a little bit.

Christine Ratliff: Okay, I’m afraid we’re just about out of time here. Thank you so much for calling in. We appreciate your questions.

Again, if you want to talk to Jeff more, he is incredibly dedicated to helping other people with MS. So do visit his web site or email him.

And if you did not get his information, you can email me or call the MS Foundation at 1-888-673-6287. And I will make sure that you get in touch with Jeff or that I get your questions to him.

And I want to thank - thank you, Jeff, so much. You’ve been really…

Jeff Segal: (Oh), you’re very welcome. I hope someone – I hope everyone’s leaving with something new that they learned.

Christine Ratliff: I think everyone definitely is. And for me, it was that little Gatorade thing. I didn’t know about that.

So you’ve been great. And I hope you encouraged everyone to focus on what they can do. And again, thank you all very much for calling.

And I’d also like to extend a thank you to Berlex for the educational grant for National MS Education & Awareness Month.

So goodnight everyone. Take care.

Operator: This concludes today’s teleconference. We thank you for your participation. You may now disconnect.

END

1-888-673-6287 * Multiple Sclerosis Foundation * www.msfocus.org

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