Everybody’s MS is different, but one thing that an alarming number of us seem to complain about is fatigue. Not just your everyday kind of fatigue, or the exhaustion after a day well and truly seized, but a mind-numbing lassitude and tiredness that can make the smallest task seem out of reach.

It’s also one of the most misunderstood of MS symptoms. After all, everybody knows what it’s like to feel tired, everybody’s been exhausted once in a while, everybody these days knows what it’s like to “power through” some everyday illness like flu or bronchitis without giving in to fatigue or even taking a day off work. And that tends to breed “armchair experts” who think they know everything there is to know about fatigue. But, as I’ve said earlier, MS fatigue isn’t like that. You can’t “power through” it, exhortations of well-meaning family and friends notwithstanding.

Then there’s what a spooky female acquaintance of mine calls “illness poker”. I’m sure you have a friend or relative who, in answer to your “I’m so tired”, says “I’m tired too, and I’ve got a horrible sinus infection”, meaning “I’ll see your fatigue, and raise you a sinus infection”. Somehow in the game of illness poker fatigue is a coin of very low value.

I’ve asked various neurologists and experts on MS for some kind of explanation as to why people with MS feel so tired, and I’ve gotten various shrugs of shoulders with accompanying offhand suggestions. It seems nobody really knows, but here are some ideas:

• 1. Depression: It’s easy to get depressed with MS. Either situational depression or the clinical sort, it all comes with fatigue.
• 2. Neurological energy: people without MS have multiple neural pathways for each signal, say, from brain to big toe, many ways for each signal to get there. People with MS have these pathways compromised by neural damage, which means signals need to be rerouted or repeated, an additional drain on energy leading to fatigue.
• 3. Myelin destruction and repair: The current, dynamic model of MS is that during the so-called inflammatory phase the immune system is constantly tearing down the myelin while the body is working to repair it. It’s only when the damage gets ahead of the repairs that we see lesions on our MRIs. In the meantime, all this low-level demolition and repair takes energy, which means fatigue.
• 4. Spasticity: Spastic muscles mean muscles that never completely relax. This means that the other muscles in our body must constantly fight against them, which means we have a built-in isometric exercise system. With the spastic muscles consuming energy even during sleep and the ones pulling against them consuming energy too, the result is fatigue.
• 5. Lesions: Lesions in the fatigue center of our brains may make us feel tired even when we’re not. Of course, if to our brains it looks like a duck, smells like a duck, and quacks like a duck, then likely it has webbed feet and floats. It’s still fatigue.

So what’s the answer? It may be any number of the above, or none of the above, or all of the above.

I know i feel like crap lately, my brain is not working as before.