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The Riverbend Awareness Project brings you a new conversation each month about important causes and issues in our community. Each episode features a conversation with a professional from our community about significant issues like heart health, Alzheimer’s, literacy, and more. Our goal is to share resources and information that will help you have a better understanding of the particular problems and solutions associated with each topic.
Disclaimer: The views and opinions expressed in this podcast episode are solely those of the individuals participating and do not necessarily reflect the views or opinions of Riverbend Media Group or the Riverbend Awareness Project, its affiliates, or its employees. It is important to note that the discussion presented is for informational purposes only and should not be construed as medical advice. Listeners are encouraged to consult with qualified health care professionals for any medical concerns or decisions. The Riverbend Awareness Project is a product of Riverbend Media Group.
Melissa: Welcome back to the Riverbend Awareness Project.
Emma: Today, doctor Steve Vincent from Eastern Idaho Neurology has come to talk to us about multiple sclerosis.
Dr. Vincent: Hi.
Emma: Thank you so much for coming in.
Dr. Vincent: You're welcome. Thanks for having me.
Melissa: Yeah. We're excited to learn more and hear your experience and knowledge. So how did you become interested in neurology and MS?
Dr. Vincent: Well, I was a computer programmer and started working with neural networks back in the days when computers really didn't have enough power. So I decided to study squishyware, the brain. It's not hardware. It's not firmware. It's kinda squishyware. And, so I went to, I took my pre meds, went to medical school in Chicago, and, and then neurology really was the right next move. I mean, it's...it's like biocomputing.
So I just found it fascinating. And then came here because, interviewed in a lot of places and, you know, Eastern Idaho was... just felt like home.
Emma and Melissa: We're glad you're here. Sorry. Yeah. Sorry.
Emma: We were doing a little bit of research before we asked you to come in, and we read about how MS is an autoimmune disorder, but also affects the brain. Are... is there any other systems that multiple sclerosis affects?
Dr. Vincent: Well, yeah. It's the central nervous system. So that's the brain and the spinal cord. It doesn't affect the peripheral nervous system. That would be like the nerves that are in your arms and legs. You may have an arm or leg symptom, but it's not because those nerves on the outside are affected.
It's just those nerves connect to central nerves and they're the ones that are impacted. So brain and spinal cord is really what it's, affecting.
Melissa: Okay. So it's like the communications between those ones that get affected are then impacted down the line kind of?
Dr. Vincent: If you, if you touch something, there's peripheral nerves that are sensing it And but it has to then relay it to the central nervous system to bring it up to the brain.
Emma: So when I think of immune system, I think of, like, getting sick, you know? So, like, just getting a cold or getting the flu. Is.. does that have anything to do with...is the autoimmune system different than the immune system? Sorry. I'm totally clueless here.
Dr. Vincent: No. So the immune system, you're right. Its, its job is to protect us. But for reasons we don't fully understand, our immune systems make mistakes. Another thing we don't really understand is why women get autoimmune diseases more often than men do.
And the ratio, depending on what study you look at, can be as much as three to one when it comes to multiple sclerosis. And so in MS, your immune system's attacking the central nervous system. If it was attacking your joints, it might be lupus. And if it was your skin, it might be psoriasis. But they're all a similar mechanism and that your immune system is supposed to be protecting us against foreign stuff.
It's supposed to know the difference between that and you.
Melissa: Are there different types of multiple sclerosis?
Dr. Vincent: Yes. There are. So the most common is relapsing remitting.
So what they mean by that is that you get an attack. Your immune system, again, is kind of messed up and attacks you. And, and then you get symptoms after which you improve. Now you don't necessarily improve completely. If you did, then MS would be just annoying.
But unfortunately, you don't really fully improve and you accumulate something, even if it's too subtle for you to notice. And then, and then you get attacked again later. It could be months later. It could be a year later, and that these attacks keep coming. So that's relapsing remitting.
So relapse, you get symptoms, remit, you improve. Then there's a type called primary progressive, which is about twelve percent of of MS patients. They decline and they don't actually ever approve and they improve and they don't really get attacks, so to speak. They just have a slow decline. And that's truly the worst kind and also the hardest for us to treat.
Emma: So with all these different types of MS, what can the progression of MS look like?
Dr. Vincent: Yeah. It's it's so variable. You know, MS might affect someone's vision more and another person, it might be balance or coordination. It can affect cognition, so so thinking and problem solving or word finding, things like that.
And so if you had a dozen MS patients together for the first time talking about their disease, you could almost think it was different diseases. And historically, there was some of that. They weren't sure that they were all... that it was...they thought it might have been more than one disease because people presented so differently.
Melissa: Does that impact diagnosis or getting a diagnosis today for people with MS? Is that diagnosis process difficult? Because there's other things that they have to rule out. What does that process look like?
Dr. Vincent: Well, I think we're much better at it than we used to be. First of all, there was a time, it was before my time, where MRIs didn't exist.
Or when they did, they were harder to access. And, and so they're much easier, now that, you know, MRI is available. Also, the word is out more, and it's part of what we're doing here today because, now that we have so many treatments, it's more important that everyone is aware of it. When there really wasn't any good treatments, then the pressure wasn't on health care providers to sort a disease out because what would you do differently? And once treatments became available, then the pressure was on to, to sort out the diagnosis early and data has shown that the earlier you start treatment, the better you are in the long run.
Emma: How exactly is MS diagnosed?
Dr. Vincent: Well, it starts with a symptom and some of the most common symptoms are vision loss, double vision, numbness, perhaps on one side of your body or the other. It could be face, arm, and leg or just arm and leg. You could be numb in ways that most people, even a lot of, healthcare providers don't understand. Like, it could be numb from the chest down or the waist down.
Or you could have just bladder bowel, bowel control problems. And so when some of those occur, let's say, bladder, a lot of times the patient doesn't know whether this is somehow normal, it's related to having children, is this an age thing? You know, they don't know or they're embarrassed to bring it up. But really, when you've lost vision, if you've had a symptom that sounds like it has something to do with the nervous system and it's continuing for, twenty four hours or longer, somebody should hear about that story and pay attention. Because if you lie funny on your arm overnight, you wake up and over it takes twenty minutes, you get your arm sensation back.
That's not going to be an MS attack. It has to be present typically for twenty four hours or longer. And I've participated in research studies where they required the attack, so to speak, to be forty eight hours. So that would be double vision or droopy face or vision loss in one eye for for twenty four or forty eight hours continuously or longer.
Melissa: You mentioned improved treatments, which is exciting. That's an exciting thing that there's progress in treatment and diagnosis. What are some of the treatment options available for MS?
Dr. Vincent: Well, so the there were no treatments really until 1993. And the first treatment was so hard to get that there was a lottery, system. So you
Melissa: What?!
Dr. Vincent: Your provider could put in a request and then you get on a wait list and then a lottery was was done. And this was in 1993. And so we went from one FDA approved drug in 1993 to now many. And they work in, different ways. And we call it the mechanism of action: how does a drug work. And, but then we can also categorize them based on low, middle, and high efficacy. And even from the beginning of high efficacy drugs like 2004 through 2006, I used them. And there was even some blowback occasionally from people, that I ran into, thinking I was treating maybe overly aggressively. That there was a theory out, you start with the lowest efficacy drug.
And then if you develop disability, then you'd go to a middle efficacy drug. And then if you developed disability, you would go to a high efficacy drug.
Melissa: And sorry. When you developed a disability, does that mean the drug is no longer being effective? Or what does that mean?
Dr. Vincent: It's not achieving our goal
Melissa: Okay.
Dr. Vincent: For sure. But that was wrong way of thinking, really, because you don't wanna wait until someone worsens and then add a drug because you might not get any of that function back again. So really for the last ten years or so, the thought has been to go to high efficacy medications right from the get go and that studies have shown that when you start high efficacy treatment early, that even versus say middle or low efficacy treatment, that even in two years' time, there's a statistically significant difference between the people who went directly to high efficacy drugs, compared to people who were in middle or low efficacy drugs. So again, it's important to make the diagnosis early and then really get on the what turns out to be the newer drugs, higher efficacy drugs.
And, and so that's what's mostly done actually now. Most everyone's kinda caught up to this. And so the higher efficacy drugs tend to be used, right off the bat.
Emma: Another thing we came across in our research was, disease modifying therapies. Is there anything you can tell us about that?
Dr. Vincent: Yes. So that's the drugs we're talking about. So let's say you took a drug that, helped your, you you have a damaged nervous system and you took a drug to kind of goose it up a little bit and make you know, get a little more function out of it, but maybe like a stimulant. You're not fixing a problem. You're just, treating a symptom.
Or if MS caused you to have a tight or spastic arm or leg, you could be on a drug like Baclofen, which would reduce the spasticity, but isn't actually doing anything to prevent or slow the disease. So a disease modifying therapy are drugs like the ones I was alluding to that that really dramatically reduce, for instance, the the chance of new, MS lesions showing up on MRI. I mean, when I mean dramatically, I mean in that some of the lesions are reduced ninety five percent compared not to placebo, but to one of the older drugs that we don't really use much anymore. Head to head, the newer drugs just are, just you know, they outperform the old ones to a level that you can't compare. Ninety five percent reduction in MRI lesions, you know, we're getting to where it's it's kind of a surprise when new MRI lesions pop up.
Melissa: Are there so there's no, like, specific cause for MS. Right? Correct?
Dr. Vincent: Correct.
Melissa: But are there factors that have been identified that could lead to MS?
Dr. Vincent: Yes. There has been. The most important one is probably, related to sex. The, women, tend to get more autoimmune diseases, not just MS, but lupus and Sjogren's and rheumatoid arthritis and Hashimoto's thyroiditis and a lot of other autoimmune diseases. We're not sure why.
There has been theories that that, perhaps women outlive men in part because they have stronger immune systems and that's the good of it. But that, unfortunately, if your immune system is too powerful and makes a mistake, maybe say the word screw up. If it screws up, then unfortunately, you take the brunt of that. So that might be part of, what's going you know, well, we know that to be, a part of what's going on, but we don't know why. As far as, where you live, the further north you live, particularly in the first twenty years or so of your life, the higher your risk.
And we're not sure exactly why. I mean, the problem is we can... there's a book about, biases in good people. So you can be biased and think...and not realize that you're biased. And, so one reason this data could be biased is because historically, people from, Northern European people, they would move to the Northern parts of the US.
And the Southern parts of the US, might attract a different group. And we're talking about whether, you know, eighteen hundreds or nineteen hundreds. So immigration patterns, if it's more common in in Northern Europeans, you know, when you look at data from, say, Olmsted County, Minnesota and that data is really important, MS data. They've been collecting data there for fifty years or more on MS. And the Olmsted County data, it looks like, you know, that, this is mostly a condition that affects, well, it it's from northern areas.
Well, is it because they're northern or is it because they're, you know, a a group of people from, you know, European...
Melissa: Descent.
Dr. Vincent: Descent. And so which one is it? So you could think, you know, boy, it really looks like the problem has to do with where you live.
And maybe it's immigration patterns. So it's hard to know. Another example of these biases is for the longest time, well meaning people have said that, Caucasians got MS more than African Americans did. And we're learning that that's probably not true. Their access to health care was different.
And so we we, you know, that that so that data looks like it was probably biased and that's not the first time. So, so then vitamin d exposure, very important. And it seems that deficiency in, in vitamin d, which further north you live, the less likely you are to get natural vitamin d, which is gonna be, you know, ultimately from the sun. And, so we don't get as much sun and the sun we do get is less direct than say, if you were, you know, in Miami, Florida. Well, and the numbers actually, bear that out.
So the incidence of multiple sclerosis, the closer you are to the Equator is, reduced compared to the risk the further north you are. And so vitamin d, migratory patterns, maybe. And then, the another important one is, Epstein Barr virus, which is the virus that causes mono. And, it looks like that virus may predispose us to getting autoimmune diseases, but particularly MS. And, and so doesn't mean if you had mono that you're gonna get MS.
It just makes the risk a little higher. And so, it it seems like even people who got really bad cases of mono, were are potentially at a little higher risk than say people who got mono and didn't even realize it because it was so mild. And so there's is another factor. Patients frequently worry when they have the diagnosis that their children are going to get it, And the risk is about six percent. And that's much lower than they think because most of us know only what's known as Mendelian genetics.
So, you know, this gene and that gene and half are carriers and you know, and that very that's like a simple example of a single gene.
Melissa: Is that like with the square?
Dr. Vincent: Yes.
Melissa: Is that what you're talking about? Okay. I'm like, have to reach far back in the memory for that.
Dr. Vincent: Yeah. And that comes from-
Melissa: Junior high science class.
Dr. Vincent: Exactly. That's the that's what most of us know. Right? So but it's actually many genes. And in fact, in identical twin studies, if your identical twin gets it, your risk is twenty percent. And so that's because they're they're getting pretty much all of the same genes. And so more more likely than, you know, five genes or 10 genes, it's probably a higher number than that.
And then you get exposed perhaps to Epstein bar virus. Maybe you're deficient in vitamin d, and the combination kind of brings it out.
Emma: That does seem a little tricky to know with so many different factors to really know what the true cause is. But that's cool. There's research going on to try to figure out.
Dr. Vincent: Yeah. For sure.
Emma: What role does physical therapy or lifestyle management play in living with MS?
Dr. Vincent: Lifestyle management, I think one of the best things we can do is, keep our weight down. Something I've not succeeded in, but a lot of people do.
And, it makes it easier for a few reasons. So one is it looks like you're less likely to get MS if your normal weight. Now the difference is so subtle. You you I don't want anyone who's overweight and has the diagnosis of MS to think somehow this is their fault. We're talking about the most tiny increase.
And so keeping your weight down has that advantage. But then once you have MS, if you have a balance problem for MS, then being overweight is gonna make it easier to lose your balance. And and if you were to fall, it makes it less likely that you're gonna hurt yourself. And so, you know, physical therapy for balance and conditioning and such can be pretty helpful. Remember, most people who get caught early do well, so well that, you know, most don't really even need physical therapy.
Melissa: I was thinking about yesterday, we were talking with our...another guest, and she talked about how she talked about exercise was, like, a big thing and then also eating right. So it just seemed like taking care of yourself like you would normally would help too. Is that a lifestyle, like, choice that kind of helps?
Dr. Vincent: Yeah. So there have been books written and people have made money selling books like the MS diet and so forth.
But really, you know, when the books that are reasonable pretty much are saying, you know, eat in moderation. Don't go all caveman and eat nothing but meats and and don't necessarily eat nothing but veggies. I mean, that can be a very healthy lifestyle, but you have to do it right. The average American's just too busy to actually learn the importance of being a good vegetarian. You know, there's some cultures like, in India, they've had so many thousands of years of of vegetarianism that they're good at it.
I mean, it's just like, you know, they don't have to go and look up what's the right bean to get this essential amino acid because that's what mom served and grandma served and grandpa and everybody. And so, but so we kinda do crazy stuff like just get a wild hair and say, that's it. I'm not going to eat x, you know, or I'm gonna eat only meat that I kill or something crazy like that. And and, so most of the most of the data just suggests eating in moderation. And, and I think that's I mean, that's what I tell my patients to do.
Emma: Are there any recent discoveries relating to MS or current research that is being done?
Dr. Vincent: Well, they're always doing research. So as far as questions that my patients are almost always gonna ask, if not on the first visit, in the first couple of visits, is: is there any research going on in remyelinating? So if multiple sclerosis is an autoimmune attack that strips the insulation off your nerves in your central nervous system, Can you put them back? Can you put it back on? So that's remyelination and that research is going on all the time. And it's just not it just hasn't come up with anything solid yet. There there looked to be some close close calls. There was a drug years ago called anti lingo. It looked very encouraging.
It worked on guinea pig and rat spinal cords and things like that. And then it just didn't work on humans, sadly. But they're constantly working on it. So there's multiple steps. You know, when we're born, we're not fully myelinated.
We're barely myelinated. So we're we have nerves, but they're not they don't have the insulation on them. It's part of why, like, babies' eyes don't track very fast. If you put your hand up and they look at it and then you move your hand quickly, they lose it because they don't their nerves don't fire as fast and that's because they don't have the insulation. Well, we then start insulating, you know, in earnest and we're not fully insulated till about 25, which explains why, especially guys, punch walls and do other stupid things because they're not fully insulated and, they finally do.
Well, once that happens, you know, you're you're once you're fully myelinated, you have to tell your brain... there has to be a mechanism to tell your brain to stop myelinating. Because otherwise, you'd you'd grow tumors on those nerves. That'll be... they're called myelin sheath tumors. So you have to say, okay. You're done.
And that's this one of the, steps involved is this lingo molecule. And so they said if this stops it, then if we get an antibody to it, maybe that will start it again. And as I said earlier, it didn't work, but they are really working on it. And, and so we can we can hope.
Melissa: That's fascinating and I didn't know that about that our nerves aren't fully myelinated until a specific age.
So that's so cool that they're thinking, okay. There's gotta be something. It turns it off. There's gotta be something that maybe can turn it back on to fix it.
Dr. Vincent: Yes.
Melissa Are there any misconceptions about MS that you kinda like to clear up that people don't understand fully?
Dr. Vincent: Well, I want people to know it's, not their fault, you know, and it's not because they ate too much of this or not enough of that. You know, there may be little trends. It'd be nice if people would, especially who live in the North, would take a little more vitamin d. But, you know, I think it's important that they know that it's not their fault, that it's not primarily genetic, that if they have it, their children's odds are about six percent.
K. That's typ... I mean, that's overall the typical number that's quoted. And so I'd like them to know that there's a lot of scam artists out there, and a lot of them are in this area and they will say they're doing stem cell. Well, you know, stem cell, the way it is being done and has been shown to to help, still not ready for prime time, still not FDA approved. But in that scenario, what you're talking about is taking your stem cell cells out, you know, typically a bone marrow biopsy from the hip, processing it.
And then they would give you like a chemotherapy to knock out your whole immune system, keep you in a little, you know, a special room to keep all the bacteria and viruses out. And then once that chemo's out of your system, they put your stem cells back and that repopulates your immune system. So it changes your immune system. That's what real stem cell therapy is. This other stuff includes people going, you know, hocus pocus and rubbing on you and doing stuff that we're talking about, people around here doing it who are not doctors, nurse practitioners, PAs, nothing.
They're they're just doing it. And I did have a patient who spent $40,000 on this. Now that patient could have seen me for years and years and years, four times a year, and would not have hit that bill for me. And yet, somebody who's not allowed to do surgery or really draw blood or do anything, unfortunately, suckered them into it. So they need to be really careful.
I like my patients to know, and I'll write it down for them, that there is a website, nih.gov, national institute of health dot Gov. And when they're interested in something, they should search on that. I know there's some, you know, kind of anti government sentiment in America, but I think the NIH does a good job, and I don't have any reason to think they're biased. And you can look up anything there. That's the other thing is that your interest may not be MS.
You you may have a family member that has some some other condition. You want to know a little bit about it. Now it's going to be in medical speak, but that doesn't mean, you know, you can't either figure it out or you copy and paste it into an AI, like chatGPT or Perplexity or something, and say, explain this to the level of a high schooler. And it'll then convert all that into plain English, which is really a nice little thing. It's, you know, AI, I know it's kind of a big big thing and and there's lots of stuff thought about what it could do, good or bad. But in this example, taking complex medical information and just pasting it in and then say, explain this to me, and it does it. It's really quite nice. So it can take medicalese kind of terminology and nih.gov and put it into, layman's terms.
Melissa: Yeah. Learning, learning all you can about it. Definitely.
Dr. Vincent: And by the way, people will apologize and say, 'oh, I'm sorry I looked this up on Google.' That's my job is to, you know, answer their question. I don't care if they got it from Google.
You know, it's like, your job is to worry about you and my job is to worry about you. And so, yeah, I don't care if it-
Emma: You've gotta start somewhere. Right?
Dr. Vincent: Yeah. If you bring something in from Google, you'd you know, don't apologize.
Just bring it in. It's, you know, it's it's worth asking.
Melissa: Use good resources, reliable resources, and ask questions.
Dr. Vincent: Preferably.gov, edu, Org. Maybe a little more than .com.
Melissa: Yeah. For sure.
Emma: What are some of the struggles that people with MS face?
Dr. Vincent: One struggle that I should go get to right away is that if you were to say lose an arm for for whatever reason, people can see it.
And so they, kind of adapt to it and they somehow are a little more understanding if you're having troubles doing something. But when you have MS and maybe nothing is visible, but MS patients get tremendous fatigue. It's it's inherent; if a person isn't undergoing an MS attack at the moment, their biggest complaint is usually fatigue. And it has something to do with immune system, inflammation and activity.
We're not totally, clear as to why, fatigue is such a big thing. But it's it's overwhelming and it's very likely that most of us can't even, well just can't understand what they mean. They're so fatigued. And so when someone's having troubles because they look okay, sometimes they don't get very much support and that might even be from their own family. It's like, 'y'all look fine to me. I can't believe you're just lying around.'
But if you've... the best I can come up with is if you can remember what a fatigue feels like when you have the flu, you feel, oh, you know, quote, "weak as a kitten." You're actually strong. Yeah. If I actually gave you a dynamometer to, like, squeeze and show what your grip strength was, it would still be okay.
So it's not that you're actually weak, but it's an intense feeling of weakness. And like I said, it's unlikely anyone here hasn't experienced that with a flu. And they that's the closest any of my patients have gotten to explaining to someone like me what it feels like to them. So you can't see it and yet they're somewhat incapacitated and they don't get the, the concern as much as someone who has a visible problem. So I don't know if you have if you have any other questions related to that, but that's an important one, I think.
I I do remember that a little bit in the research. It was the what did they call it? The "Well, you look fine..." I can't remember what they called it something. But it was the same sentiment. Like, 'well, you look okay. Like, you look like you're doing great!'
But like you said, the fatigue, balance issues, you don't always see those. Or, like, pain and numbness and tingling sensations. So, yeah, that's definitely gotta be a struggle.
Dr. Vincent: By the way, the balance problem can be interpreted as you're drunk. In fact, there was a this is someone so long ago, none of you know who I am talking about. But there was this, actress, you know, from, like, the fifties or sixties maybe. And her name was Annette Funicello, and she had MS. And, one of the, you know, the tabloid papers was putting out something about how she was drunk.
And so they wanted before they published it, they wanted a comment from her, and she just felt then obliged to tell everyone she had MS. So she didn't want people to know that. But you can you can have MS and stumble or maybe drag a foot a little bit and to someone who doesn't know how to observe a gait, which which I do. So I can tell the difference between, stumbling because I have, you know, a problem with my cerebellum versus, you know, transient stumbling due to being drunk. And, but most people can't.
So they'll project really, you know, concerning and erroneous explanations for why a person's struggling.
Emma: Seems it's better to just be kind because even if their symptoms I mean, obviously, their symptoms probably are way worse than you could ever comprehend. But even if they're not, it's better to just be nice if someone's struggling. So Yeah.
Melissa: How have you seen families and friends support their loved ones with MS? How how is it best to go about doing that, especially with something they can't always see or understand?
Dr. Vincent: Well, first, I would say ask them. Okay? Because, now this seems to be, more of a male reaction to this, which is, suddenly, you know, if it's the patient's a woman and the spouse is a man, then all of a sudden, he's, you know, trying to maybe sell the house and get everything on one level and install a wheelchair ramp. And it's like, you know, the odds of that are incredibly small nowadays.
It's it's like they feel like they wanna do something and they don't know what to do. And so, you know, maybe if they're 25, they would punch a wall, because that's, you know, more of a young man thing. But, but instead, they like start to or they treat them like they're fragile little creatures that, you know, that one little move and they're gonna crack. And they're not. They're just regular people and, you know, generally scared and don't wanna be treated like a, you know, like a delicate flower.
They just wanna be treated normally.
Emma: So that's what not to do. But are there any things that you should do to help support somebody who you know who has MS?
Dr. Vincent: Yeah. But that's the problem is that first answer was "ask them" because because, you know, first of all, they're all different.
And, and, you know, they go through phases, especially now with the medicines are so good. So first phase is scared to death. And what they do is they think about people they know, maybe a neighbor or maybe a relative who had it thirty years ago and did terribly. And, you know, we didn't really have medicines. So, and, and so they're very frightened.
And so just emotional support and, and, you know, you know, if you read on something, maybe they want you to do that. Maybe they don't. I mean, you know this whole story about how men are always trying to fix things and stuff. I mean, maybe the patient wants to do it themselves. Maybe they're glad to accept articles that you found.
You know, maybe the the actual patient's gonna like that and think that's a good thing, but you really have to ask. But remember, most of them are doing fine. You know, if you if you had double vision and that was your first MS attack, you know, with a brief and quick course of steroids, most people, their double vision's gone in three, four weeks. Okay. But then, you know, the expectation without treatment is you're gonna have more attacks.
This is the first maybe of many. And, so that's the person may be absolutely normal, but very, very fearful. So I'm not I'm not sure that it's an easy answer. What what can someone do if you're in that situation? Just be supportive And then find out how they want to be treated.
Maybe they would like a few weeks of being treated like a like, you know, a delicate creature and maybe they just want to go on and pretend like there's nothing wrong. You know, fake it till they feel it kind of thing.
Melissa: You kinda touched on that, the fear and anxiety. Are there other ways that MS can affect someone's mental health?
Dr. Vincent: Well, yeah. So the the the reason you get your MS symptom where you get it is where the lesion happens to be in the brain. And so if the brain if the MS lesion, the inflammation is in the left motor strip on your brain, then you're gonna have something, you know, you know, paralyzed on the right side perhaps. If it's in the brain stem, maybe you get double vision for a little while. Okay. But there are so many structures that aren't visible.
So you don't go weak. You don't go numb. You don't have a change in your voice. So you just might have troubles, thinking as quickly. You may have troubles finding the right, the right, word.
You know, it takes that extra second to get it to get it to come out. And, so, that's the thing. It, affects cognition and balance and it can cause weakness. And anywhere, any part of your central nervous system, if it gets hit, you're going to see a symptom based on that. And there are lesions, like a person who gets their first symptom, we'll scan their brain and see four or five lesions.
And they'll say, 'how did that happen?' and 'how come I didn't notice it?' Because there's parts of your brain that you wouldn't notice. So maybe you would if you're an artist and you wouldn't if you're a neurologist. Maybe you would not notice it if you're an accountant, but you might notice it if I know you're doing research in three-dimensional shapes of proteins, because some parts of your brain, you don't use as much. Now, you can get an attack that I wouldn't if I got it in that location, I wouldn't notice and an architect might, you know, have troubles, you know, imagining her design in three dimensions when she wouldn't have before the attack and not even realize it until she suddenly realizes she's having a trouble.
And she ignores it. Maybe it gets better because a lot of MS attacks do. And then she gets one that makes her numb and that's when the diagnosis gets made. But she was actually having some symptoms before. So cognition, memory. So you're... a big portion of your memory function is in the temporal lobes, you know, left and right. And, you can get lesions there. That doesn't mean you're gonna forget your birthday or or something, but it could be harder, for instance, to learn something new. So maybe you're having trouble in school. You know, you're going back to school at whatever age, and you're having troubles.
And it could be due to something like that. And, and, again, it doesn't garner sympathy because you're not, you know, limping or anything. You're just struggling a bit. And with the diagnosis though, you can then go to the college and say, 'I need tutoring and and, because I have this diagnosis. So I need some help taking my class.' Whether you're taking it in your twenties or fifties.
Emma: Is there anything else that you would like to share about multiple sclerosis?
Dr. Vincent: I think the most important thing is that it's really it's it's so positive compared to the bad old days. You know, you get a lot of people, particularly old people, which I'm part of that group, I guess, now, that that go on about the good old days. Well, I don't know that they were really as good as as most people thought. And this is an example.
So, you know, as I say, they they look at some neighbor who's been in a wheelchair for forty years and think that's what's gonna happen to me. And that is actually low, low probability with modern, medications. And so, yeah. I'd like them to know it's not a death sentence and we've got good medicines and they're not... and they're actually generally quite tolerable too.
There was a time the old medicines, which I don't really use anymore, were shots that you would take daily or three times a week or once a week. I haven't prescribed any of those for years and years and years. So we've got drugs that you take an IV once every six months. And so twice a year, some of these patients will say, 'you know what? The nice thing about it is I don't even have to be reminded every day that I have MS because I'm taking a pill for it. I can practically forget until the infusion center calls you up and says, your infusion is coming up.' And then that's when they kind of are reminded, 'oh, yeah. I have it.' And that's a really good situation. There was a time where patients if I said, I'll see you back in six months, it was not unlikely that they would come back in three months because they had a problem.
Now people will say, 'do I really have to come twice a year?' And that's fantastic. I mean, the answer is yes. I'm I'm suppressing your immune system so it doesn't attack you. And yes, you need to be monitored, but I really think that's such a positive thing for people to now feel so good about it that, they're like, I'm practically bored by this.
Do I really have to come twice a year? For someone with my years of perspective, this is a really, really cool thing. So it's not a death sentence.
Emma: That is really good and really cool that there there is hope and there are treatments. That's awesome.
Melissa: Thank you so much for coming in today. Thank you for sharing your knowledge and your time with us. We definitely learned a lot, and there's a lot to be hopeful about.
Dr. Vincent: There is.
Emma: Please remember to rate, share, and subscribe to the Riverbend Awareness Project.
Melissa: You can find past and future episodes of the Riverbend Awareness Project wherever you get podcasts or on the Riverbend Media Group podcast page.