February 2, 2025 • 27 mins
02/02/25
The Healthy Matters Podcast
S04_E08 - The MS Journey: From Symptoms to Solutions
Did you know that 1,000,000 people in the U.S. alone are living with Multiple Sclerosis? We've all likely heard of MS before, and many of us may even know someone with the condition, but there are always a lot of questions when it comes to these types of diseases. Like, what's actually happening in the body? What are typical symptoms? And what help is there available to those living with it?
Thankfully, we've got experts on hand to guide us through the basics. On Episode 8, we'll be joined by Dr. Ali AlMoamen (MB, BCh, BAO), a board-certified neurologist at Hennepin Healthcare and a specialist in autoimmune conditions like MS. He's helped many patients and their loved ones navigate this perplexing, and oftentimes scary condition, and has assisted them on their way to continuing to live a fulfilling life. On this show, we'll take a look at the root causes of the condition, the challenges in diagnosing it, the current and forthcoming treatment options, and how we all can help anyone living with MS. Please join us.
Additional resources and information can be found on the National MS Society website.
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Den .
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilden , your host of
the Healthy Matters podcast andwelcome to the show. Today we
are gonna talk about multiplesclerosis. It's an illness that
many of you maybe have heardof, maybe you even know
somebody or have a loved onewho is living with ms. But do
you really know what it istoday? I invited a colleague of
mine at Hennepin Healthcare indowntown Minneapolis, Dr. Ali
(00:41):
Alman. He is a neurologist anda physician who treats and
diagnoses multiple sclerosis.
Ali, welcome to the show. Thank
Speaker 3 (00:49):
You so much. It's
Speaker 2 (00:49):
Great to have you here. I want to , if you could
just start right out for us,what is multiple sclerosis?
Speaker 3 (00:55):
So multiple sclerosis is a immune-mediated
inflammatory disease of thecentral nervous system. When
you say immune-mediatedinflammatory, it means like the
body is attacking itself andaffects part of the central
nervous system called the whitematter predominantly. So what
is the white matter of thebrain? So the brain is divided
(01:15):
into gray matter and whitematter. The gray matter has
these cells that are remaincalled neurons and then they
have these cables or a axons,they're covered by something
called myelin . So, which islike the kind of like the
outside covering of cables. Andby attacking the , the lin can
cause like differentmanifestations and different
(01:37):
symptoms. So it can affect yourbrain, your spinal cord and the
covering around part of youreyes called the optic nerve.
Speaker 2 (01:45):
So the myelin this, I like that description. It's
like the covering of a cable.
Speaker 3 (01:49):
That's what it is.
Let's ,
Speaker 2 (01:51):
I really like that.
Yeah . Um , and that's thewhite matter. And apparently
it's quite important for yourbody's neurologic function,
right? What , uh, what , what ,what exactly does this
covering, this myelin do?
Speaker 3 (02:02):
So basically the way your brain communicates and
your nervous systemcommunicates, it sends signals
through these cables. And ifthese cables are damaged, the
signals are not sent properlyand can lead to problems and
dysfunction because of that.
Speaker 2 (02:16):
Okay. So that's the basic thing is that your body's
attacking the white matter ofyour central nervous system.
The covering on the cables, themyelin, I really do like that
. Uh uh um, so do weknow what causes it?
Speaker 3 (02:28):
We are not a hundred percent sure exactly what
causes it. There is differenttheories on what's causing it.
One of the theories is it'ssomething called a common virus
in the population that affectslike 80 90% of people call
Epstein bar virus,
Speaker 2 (02:43):
Epstein Bar ,
Speaker 3 (02:44):
It's a common virus that's
Speaker 2 (02:46):
Everywhere. Epstein bar virus is everywhere.
Speaker 3 (02:48):
Yeah, exactly. So like 18 90% of people have it.
Uh, but in some people it's farto be involved in triggering
this immune attack. So therewas a study done at the VA and
they noticed that pretty mucheveryone who had MS had Epstein
bar and the people who weren'tinitially diagnosed with
Epstein bar and developed MSended up having Epstein Bar .
(03:09):
So there is association withthat,
Speaker 2 (03:11):
But not everybody.
'cause like you just said, 80%of us have Epstein bar virus
and we, 80% of us do not havems. Yeah.
Speaker 3 (03:18):
So there's other theories. One of the theories
is, for example, like vitamin Dbeing low is involved in like ,
for example the Epstein barimmunity and some of our immune
signaling pathways. So that's,that's one of the other
theories. But like we don'tknow exactly a hundred percent
the cause. Like even in termsof genetics, like even if
you're identical twin, thechances of you getting MS if
(03:40):
your twin has like , like 30%percent still. So,
Speaker 2 (03:42):
And you shared your DNA . So
Speaker 3 (03:44):
Exactly.
Speaker 2 (03:45):
That's interesting.
So what literally is happeningto that myelin that that sheath
over the nerves? What'shappening to it in ms ? So
Speaker 3 (03:53):
There is inflammation. So we have these
different cells involved in ourimmune system. So there's the
things called B cells , T cells, and microglial cells. So
these cells are causinginflammation. Okay. So they
trigger release of inflammatorymolecules and this leads to
damage to these cables or my inchief .
Speaker 2 (04:14):
Let me shift to how someone might know if they have
it. What are the symptoms? Howdo , how , how does somebody
know? That's
Speaker 3 (04:21):
A good question but also a tricky question. The
reason being is the centralnervous system can lead to many
different like manifestations.
So
Speaker 2 (04:31):
Like if the main processing computer of your
body isn't working right, lotsof stuff can happen.
Speaker 3 (04:35):
Exactly. So it's kind of a tricky question
'cause there's a lot ofdifferent things that can
present and I think it's part ,part of what you need is to
talk with your physician to tryto clarify what's going on.
'cause for example, the mostcommon things that people
present with is like they canhave what you call sensory
symptoms. So you can , peoplecan have like numbness,
tingling, feeling weirdsensations in their body. But
(04:58):
there's also different commoncauses of those symptoms more
than multiple sources .
Speaker 2 (05:03):
You can get numb fingers for a lot of reasons.
Speaker 3 (05:04):
Yeah. So people can have like pinch nerves or
neuropathies which are maybemore common than sclerosis. So
that's one of the commonmanifestations. Other common
presentation is it sometimescan cause inflammation of the,
what are called optic nerves.
So people can present with somecalled optic neuritis. So
people can have pain with theeye movements as well as visual
(05:24):
loss and problem with seeingcolors. So that's one of the,
for example, classic featuresof multiple sclerosis. If it
sometimes affects , for exampleyour spinal cord, people can
have numbness, problems withweakness, problems with
controlling their bowelbladder. Another common symptom
is just mean fatigue. So it'skind of a tricky thing 'cause a
(05:47):
lot of the symptoms can be frommany different things and they
have a lot of different causes.
But if you have to think aboutthings in the context and in
the right age and if there'smany different symptoms that
don't really fit or localizewell that's something to think
Speaker 2 (06:01):
About when you get any of these symptoms. And you
literally mentioned likeeverything that Yeah , a nerve
controls in your body, which isyour whole body . Yeah.
Um , if it's in your eyes thatyou get visual problems, if
it's in your fingers or yourtoes, you get numbness there,
you can get weakness, you getbowel problems. So you pretty
much same like everything inyour body that's controlled by
a nerve. Do when the symptomscome on, do they just stay, do
(06:23):
they get worse and worse andworse? And, and and how quickly
does all that happen?
Speaker 3 (06:27):
That's a good question too. It also depends.
Yeah. So when we classifymultiple sclerosis, there are
two main classifications thatwe use when people are
diagnosed. There's some calledrelapsing remitting sclerosis,
which is the most common typeof diagnosis. So 90% of people
have that. And there's somecalled primary progressive
multiple sclerosis, which 10%of the people have just 10.
(06:51):
Yeah, 10% people presentinitially as, so when people
have these relapses, we defineit a relapse as having a new
neurotic symptom that lastsmore than 24 hours and outside
the setting of like fever. Sosome, some people can have that
attack last a week for example.
And then they recover.
(07:12):
Sometimes they recovercompletely
Speaker 2 (07:14):
And in go just go away. Yeah.
Speaker 3 (07:16):
Sometimes it goes away. That's why sometimes it's
kind of hard to get thatdiagnosis. People say, oh I
just had numbness here. It justwent away after a week. I
didn't pay attention to it .
And then they have anotherattack like couple of years
later and then, oh there'ssomething going on. And then
they seek medical attention atthat time. So sometimes it goes
away. Sometimes it does leavelike permanent problems. So
(07:36):
let's say you had attack, yourleft arm was weak and numb.
Sometimes it just stayspermanently. And in the primary
progressive form there isn'tper se a clear cut attack. It's
more just chronic worsening ofsymptoms. Like chronically,
your left leg continues to getweaker numbered . That's more
Speaker 2 (07:57):
Primary progressive.
Yeah. So relapses and remittingprimary progressive, they both
sound like it's over a longtime though. These symptoms
might be going on for yearsbefore someone even knows they
have it.
Speaker 3 (08:07):
Yes. The primary group progressive actually the
diagnosis requires you to atleast have a year of
Speaker 2 (08:12):
Symptoms. A year of symptoms before you can even
make the diagnosis.
Speaker 3 (08:15):
Yeah. In terms of the relapsing emitting like it
, I can say it's variable butalso the term is kind of a
misnomer because people canhave neurologic inflammation
and changes on MRIs thatthey're just not noticing
'cause not in a critical area.
Speaker 2 (08:29):
So those are the tumor primary kind and and it
sounds like you can have MS fora while before you know that
you do. When do people come tosee like a specialist like you?
I assume that people are goingto their doctor, they're
telling 'em these symptoms.
What does the typical patientlook like that gets to you?
Have they already been tryingto figure out their symptoms
for a long time?
Speaker 3 (08:50):
Yeah, I think most of the referrals with right
time they go to get the MSspecialist is usually they have
an MRI that's done.
Speaker 2 (08:57):
Somebody got an MR mri .
Speaker 3 (08:57):
Yeah . Yeah. And the MRI looks like what MS looks
like.
Speaker 2 (09:01):
So you can see it on an MR mri . Uh ,
Speaker 3 (09:03):
Well it's, it's kind of tricky too, but like it
looks a certain way on M mri .
It's like the lesions look kindof like a circularly and
they're on certain areas.
Speaker 2 (09:11):
Yeah. It's interesting, you know, the
brain and the central nervoussystem is so, so amazingly
complex and we know so muchabout it and some things we
don't know so much about. ButI'm always amazed that you can
pinpoint exactly where theproblem in someone's brain is
and then maybe one day we'llfigure out what actually causes
this so we can get down to theroot cause of it. I'm gonna
(09:33):
talk about that a little bitlater. Let's talk about how
common MS is.
Speaker 3 (09:37):
It's around 1 million Americans have MS and
it's a lot. Yeah, it is a lot.
It's actually the most commondisease causing inflammation in
the brain is multiplesclerosis. There are other rare
conditions, but in terms ofinflammatory diseases of the
brain, it's the most common andit's the most common cause of
neurotic disability in youngadults. In terms of things like
(09:59):
mobility separate fromtraumatic brain injury.
Speaker 2 (10:01):
So you said young adults, is that who it hits the
most? What are what? What'syour typical patient or who in
whom is it most common?
Speaker 3 (10:07):
So in average age range of around people getting
diagnosed is around 30. 30.
Yeah. But it can happen whenpeople are young and can also
occur when people are older.
It's slightly more common womanthan men. Like many autoimmune
conditions like women have ittwo to three times more likely
than men.
Speaker 2 (10:25):
I've heard that a little bit over the course of
doing these podcasts for thelast four seasons. We talk a
lot about autoimmune illnesses.
A lot of human conditions arecaused by your immune system
attacking itself. But it seemsto be more women than men in
some of them and younger women.
Yeah , 30-year-old women. Wedid a show about lupus too. So
listeners listen, listen to theshow about lupus. That is a
more common in young women aswell. Do we know why that is?
(10:47):
Why would it be women more thanmen?
Speaker 3 (10:49):
I think I've read that there's some, the women
have an extra ex chromosomesand the ex chromosome is
involved in like the workingsof the immune system. So just
having that ex chromosomepredisposes a lot of women to
have . That's interesting .
More immune conditions.
Speaker 2 (11:04):
I bet there's loads of people doing research on the
genetic origins of things likems uh, what about
geographically? Does that makeany difference or is it just as
common or worldwide or in thiscountry? Is it, does that not
matter?
Speaker 3 (11:17):
So geographically the thought is it's related
getting to UV light exposureand like vitamin D, it's fought
that the more north for stafffrom the greater , more likely
to get multiple sclerosis
Speaker 2 (11:28):
Because of UV light.
Yeah . So in Minnesota I knowseveral people who have MS in
my personal life and obviouslyin my clinical practice. So
we're sort of in that, wellwe're in the northern half.
Yeah . Yeah . Of things . So inMinnesota might be a place
where we see more. But that'sinteresting then if you live in
equatorial places, it's maybenot quite as common 'cause UV
light is protective. Is thatwhat you're trying to say?
Yeah. Wow.
Speaker 3 (11:49):
Well it's kind of tricky too. 'cause now we're
studying like the epidemiologyof . They found out
it's like more common in blackpopulations, Asian populations
than we previously thought . Soit's something that's also
being studied. What
Speaker 2 (12:02):
About your family history? Is it genetic? I mean
do you, do you get it if you'refolks at it? So
Speaker 3 (12:06):
There is, like I said, there is that risk. So
like, like if you're twins youhave a 30% risk, but it's not a
hundred percent guarantee. Soif you have family members that
have it, that increases yourrisk of having sclerosis. But
it's a mix of environmenttriggers and family history. So
it's not, there's no guaranteethat there's no like one gene,
Hey you have this gene, you'regonna have multiple sclerosis.
Speaker 2 (12:28):
When we come back from the break, I'm gonna talk
a lot more about the impacts onpeople's lives and treatments
and how people are living withms. 'cause lots of people are
living with ms. But before I dothat, I want to talk just
briefly about diagnosis.
You've, you've, you've touchedon it , MRIs and, and I think
it involves going to a smartneurologist like you, but how
do you diagnose itdefinitively?
Speaker 3 (12:49):
So the diagnosis is not, what we use is something
called the McDonald's criteria.
McDonald? Yeah. You need tohave clinical symptoms that fit
with multiple sclerosis. Okay.
And then you need to havesupportive evidence of MRIs
showing that where the lesionsare and they need to be what
are called disseminated in timeand space. So we look at where
(13:13):
the lesions are on MRI, we lookif they're picking up dire or
not. And the other thing wesometimes use to help make the
diagnosis is a spinal tap. Sowhen we do a spinal tap, which
is taking fluid from your back,that tells, and this fluid is
what circulates around yourbrain. We sometimes see signs
of inflammation in 90% of mulsclerosis patients. So that's
(13:35):
something we use as asupportive of
Speaker 2 (13:37):
Diagnosis. You don't do that spinal tap in
everybody?
Speaker 3 (13:39):
No, no. It's sometimes you can meet the
diagnostic criteria without aspinal tap, but in certain
cases we're not sure or youneed to help confirm the
diagnosis. You do the spinaltap .
Speaker 2 (13:49):
Terrific. We've been talking with Dr. Ali Alman who
is a neurologist in HennepinHealthcare and we're talking
about multiple sclerosis. Aftera short break we're gonna
discuss treatment options and Ido wanna ask Dr. Almon, how do
people live with MS and theeffect it has on people's
lives. Stick around. We'll beright back
Speaker 4 (14:08):
When Hennepin Healthcare says we are here for
life. They mean here for you,your life and all that it
brings. Hennepin Healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find. But did youknow they also have services
like acupuncture andchiropractic care available at
(14:31):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (14:46):
And we're back talking about multiple
sclerosis, otherwise known asMS. With Dr. Ali Almo from
Hennepin Healthcare. He is aneurologist and an expert in
this condition. So in the firsthalf , Ali, you talked about
lots of symptoms and it struckme as I've had a lot of those
and I bet people listening willsay, well I had a numb foot one
day or I don't know, my visionwas a little bit conti one day
(15:08):
it went away. That's kind ofscary. Um, because they can be
due to lots of other thingstoo.
Speaker 3 (15:13):
I definitely agree and that's part of what makes
it kind of tricky. So I thinkthat the most, one of the
important things is just workwith your physician. If you
ever have any new neurologicsymptoms or physician symptoms
or concerns to get evaluated.
'cause that can help identifywhat the problem is and to
evaluate and rule out otherconditions and get you on the
right track in terms of adiagnosis.
Speaker 2 (15:35):
Sounds good. Now I wanna talk about people living
with MS treatments and, andwhat life is like. So I'm just
gonna ask you a straight upquestion. Can people live a
normal life if you havemultiple sclerosis?
Speaker 3 (15:46):
Yes, you definitely can. And that's something
that's kind of freaky about us. Like I , like I mentioned
there's a million people withit. So it's more common than
people think. There are so manypeople that you'll see walking
in the street and lookrelatively normal and they have
multiple sclerosis. One of thesegues in terms of this is I
(16:07):
think the disease in terms ofmanagement has significantly
changed in the past like 20years. Like 20 years ago we
only had like three drugs.
Speaker 2 (16:17):
When I started practicing, there were about
three things. I didn'tprescribe any of them. Yeah .
Because I wasn't a specialistbut there wasn't a time . Yeah
.
Speaker 3 (16:23):
Yeah. And now there's more than 20.
Speaker 2 (16:24):
More than 20. See the last 20 years have been
really an amazing coupledecades of I'm sure the
previous 20 were as well. ButI'm just, I'm , I've been
practicing over 20 years and wedidn't have hardly anything. So
these medications, let's getinto that a little bit. What
kind of treatments areavailable?
Speaker 3 (16:40):
So terms of treatments, the way we manage
the disease is what we calldisease modifying therapy. So
there are medications that weuse that work on your immune
system and that helps withreducing the inflammation
related to the disease. But asthe way they work, they also
(17:02):
make your body more prone tohaving things like infections.
One of the worries we have islike , like increased risk of
cancer. 'cause your body's,
Speaker 2 (17:10):
It's messing with your immune
Speaker 3 (17:11):
System. Yeah. Your immune system is important to
survey your body. For thingslike cancer,
Speaker 2 (17:16):
It'd be great if there were a medication that
tamped down your immune systemonly related to where it's
messing up like on the MS thingand the demyelinating of your
nerves, but it doesn't affectthe rest of your immune system.
But I bet that's a little bitharder in medications. Yeah,
just target it to the rightpart of your immune system.
Yeah,
Speaker 3 (17:34):
That that is tricky.
Yeah, like there'd be nice tohave a holy grail like that.
But unfortunately we have, forexample, the way we're
approaching the meds right nowis like some people, I think
most MS providers right now are, are going to call like high
efficacy route. So they'reusing more aggressive
medications early on to hit thedisease early on to prevent
further disability in thefuture. But we have some of the
(17:58):
older medications, one of themis called re acetate or
Copaxone. That one doesn'ttapper with the immune system
as much. So it has less ofthose side effects, but it's
slightly less of a effectivemedication because of that.
Speaker 2 (18:11):
When you start people, you said you treat high
efficacy drugs early, early inthe disease. So that, that
implies to me that it doesmatter then that you get at it
as soon as possible. That
Speaker 3 (18:20):
Is for sure. Yeah.
So that's something we'recurrently also studying right
now. There is some trials tosee what's the right way to
treat this.
Speaker 2 (18:27):
So not sit around and wait 10 years until it gets
bad.
Speaker 3 (18:30):
Exactly. So previously what we people used
to do is like put you on likethe safer medications and if
you start having attacks moreand more activity, they switch
you to more effectivemedications. But nowadays a lot
of 'em , MS physicians tend tostart people on higher
efficacy, stronger, moreeffective medications as some
(18:51):
of these patients have lessdisability, less r activity in
the future. And, and we hope inthe end that helps overall with
the prognosis for the patientsand preventing disability for
them in the future.
Speaker 2 (19:02):
Are there things people can do that are not the
medications that you prescribeto slow down progression? Is
there anything we know that inyour lifestyle, here's what you
ought to be doing?
Speaker 3 (19:12):
Yeah, so I, the things that are important is
just one of the things you cando that's very important for
health in general is, forexample , smoking. Smoking can
worsen inflammation. Smokingcan make MS progression worse.
And quitting smoking is one ofthe best thing you can do for
your health and multiplesclerosis. But also just having
a healthy lifestyle in general.
Healthy diet, healthy weight,controlling your risk factors
(19:35):
for, for example, havingstroke. 'cause a lot of what
happens when people get olderis they can have also damage
the same thing that would callthe white matter from having
high blood pressure, diabetes,high cholesterol, those coast
kind of silent strokes. Andthat also contributes and
confounds , uh, multiplesclerosis when people are
getting older.
Speaker 2 (19:53):
Those are good tips and um , regular listeners to
this podcast, we'll know that ,uh, if you haven't learned yet
that uh, you're not supposed tosmoke, I encourage you to
listen more carefully. Youshould not be smoking.
Um, I have a question aboutthose nerves themselves. And
since I got a neurologist hereand I've got you captive right
here in the studio, do nervesheal and in like in the MS
(20:15):
specifically or just ingenerally they're demyelinated
the sheath, the , the cable isdamaged. The nerves are damaged
here. Do they ever heal againor are you just trying to
prevent future nerves frombeing damaged?
Speaker 3 (20:28):
There is possibility of if it's just a cable that's
damaged mm-hmm .
That can heal up potentiallythey
Speaker 2 (20:35):
Don't heal quickly.
Do
Speaker 3 (20:36):
They? They don't heal quickly. It doesn't heal
quickly. But sometimes theinflammation is a lot and you
can have like permanent damageto the cable set or we call
axon loss.
Speaker 2 (20:46):
So axon loss.
Speaker 3 (20:47):
Okay. Yeah . So sometimes you can heal a bit,
but it doesn't heal perfectlysometimes either . Sometimes
the damage is permanent.
Speaker 2 (20:55):
I've often wondered that about the human body and
I'm not expecting you toactually have an answer to
this, but you know, you cutyour skin in two days later
it's healed and, and manythings in our body, it just,
your liver can practicallyregrow itself, but your nerves
don't. They just don't .
They're so dang slow , um, inhealing. And I know everybody
with spinal cord injuries andbrain things and Im , um,
(21:16):
immune damage , uh, um, fromthings like ms. Uh , know that
full well that your nerves justtake forever to heal when
they're able to. Let's talk alittle bit about the lives
people live. What, what typesof support systems are
important for people livingwith ms, particularly if it has
led to some disability, eitherphysical disability or, or
(21:39):
mobility, things like that. So
Speaker 3 (21:40):
I think it's always good to have family around you,
especially if you're having,it's not just for example, like
the physical toll and things .
Sometimes when you havedisabilities from things that
can have an emotional toll aswell. So having family to
support you both in thephysical and mental toll of
things is, is very important.
We also have, for example, relyon, for example, different
(22:03):
specialists like physicaltherapy Okay. Occupational
therapy to help people helpmanage their symptoms, help
them adapt better, walk better,use their hands better if
that's affected .
Speaker 2 (22:15):
Are there resources for like support groups and
others ? The MS Society isthere not? Yes .
Speaker 3 (22:20):
So
Speaker 2 (22:20):
What I recommend , are they , uh, still out there?
Speaker 3 (22:21):
Yeah. Yeah. What I recommend , uh, people to look
into is the National MS Societywebsite. Uh , that's the ME
American Multiple Cirrhosiswebsite. It's a very helpful
website.
Speaker 2 (22:30):
One thing we try to do on this podcast is get
people to reliable accessibleinformation. I hope, you know,
I know they're getting it fromthis podcast, but on the
internet so much of what's outthere is just garbage. But the
MS society is not it'sreliable. Correct?
Speaker 3 (22:44):
Yes . So I recommend patients look to the National
MS Society website. It's veryhelpful. Has a lot of
information, has informationwords in a nice way. It has FDA
like labels for medication andeven has like social workers
available on the website thatcan access. They're called like
MS navigators. And when peoplehave initial MS diagnosis, it
also has very usefulinformation and also links to
(23:06):
support groups and what whatnot.
Speaker 2 (23:07):
And we can get a link to the National MS Society
on the show notes for thispodcast. So listeners, you can
look , uh, where you access thepodcast, we'll put a link right
to the MS Society page there.
Let's talk about the future. Sothere's lots of new medications
, uh, that we have now and itmakes it a completely different
landscape than it was 20 yearsago. Okay, go 20 years into the
(23:28):
future. Now what is, what issome of the latest research
looking like for ms? So one
Speaker 3 (23:33):
Of the things, remember we talked about the
McDonald criteria? Yeah. Uh, sothe last time it was updated is
, was 2017. We're actuallygonna update it this year. The
new updates will hopefully makeit easier to make an earlier
diagnosis. And there's onething I didn't talk about. You
asked like how long do you havesomeone have multiples without
knowing it? Sometimes we getMRIs on people who have like
(23:56):
headaches, head trauma and itlooks like multiple sclerosis,
but the person didn't have anyclinical symptoms. Yeah. That's
something called radiologicallyisolated syndrome and we're not
, we're not sure what to do
Speaker 2 (24:06):
Fully , what to make with that . You , you got an
MRI for another reason you sawthis thing.
Speaker 3 (24:10):
Yeah. So hopefully the new guidelines will shed
light on. Like how can wediagnose people with mastros
and how to put these people onmedications
Speaker 2 (24:18):
Even before you maybe are having some symptoms.
Yes.
Speaker 3 (24:22):
Yeah. So it , it , the goal is to have earlier
diagnosis. The other thingthat's , uh, big into clinical
trials right now, which is theway pharma companies test new
drugs is there's a new class ofdrugs being tested called
Bruton terin kinase inhibitors.
It's used in easy
Speaker 2 (24:38):
For you to say sorry.
Speaker 3 (24:40):
Yeah . Yeah. It's used to
Speaker 2 (24:41):
Could you say that again? What are they called?
Uh,
Speaker 3 (24:43):
Uh , bru . Terin kinase inhibitors. Okay . BTK
inhibitors. They're used inlike other, other fields like ,
uh, like for cancer. And thesedrugs are currently being
studied from multiple sclerosisand we're expecting results of
the newer clinical trial soonand we'll see if these drugs
can get into the market.
Speaker 2 (25:01):
Yeah. Um , I just, hats off to the research
community. We have a bigresearch community at , at
Hennepin, but uh, for all thoseresearchers around the globe
who are working on ms , um,there's some optimism that
there's some new things comingdown the road and, and there's
not a cure though, is there?
Speaker 3 (25:16):
Unfortunately, there's no cure yet. That would
be amazing. But unfortunatelywe don't have a cure these
medications. What they do isthey reduced inflammation, they
reduce MRI activity, but itdoesn't remove the inflammation
process complete . There's nocomplete cure for the disease
just
Speaker 2 (25:36):
To stop it and be done with it. Yeah.
Speaker 3 (25:38):
The medications don't reverse whatever damage
that's been done prior to themedications. We don't have
specific medications to do thatyet. That's something that's
also being looked into, but wedon't have specific medications
to repair those cables ormyelin .
Speaker 2 (25:52):
Yeah, maybe someday down the road. You know ,
people don't often uh ,understand that. But it's
something that, that took memaybe a decade or two to , to
learn is that much of medicinedoesn't have a cure. Much of
what I do. Very little of whatI do in internal medicine has a
straight up cure, I guess strepthroat, we can cure that with
penicillin, but heart failureand high blood pressure and
diabetes and all the otherspecialists I have in the show
(26:14):
and in this case, multiplesclerosis. That does not mean
there aren't treatments though,to make it so that you can live
your life, lead a normal lifeand do all the things you want
to do even in the absence of acure. So sometimes people get
kind of depressed when theyhear, oh , there's no cure. You
, maybe not, but there areeffective treatments to allow
you to live a fulfilling,satisfying, long life with many
(26:35):
of these things, including ms.
Thank you for being on the showtoday, Dr. Al Moen .
Speaker 3 (26:39):
Thank you.
Speaker 2 (26:40):
It's great to have you. Ali . We've been talking
with Dr. Ali Al Moen . He is aneurologist at Hennepin
Healthcare. We've been talkingabout multiple sclerosis and
just know that there is helpavailable, there are treatment
options. It's getting betterevery day than there is hope
for the future. Be sure tocheck us out in two weeks time
for our next show. And in themeantime, be healthy and be
well.
Speaker 1 (26:58):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(27:21):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern . Until next
(27:42):
time , be healthy and be well .
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Den .
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilden , your host of
the Healthy Matters podcast andwelcome to the show. Today we
are gonna talk about multiplesclerosis. It's an illness that
many of you maybe have heardof, maybe you even know
somebody or have a loved onewho is living with ms. But do
you really know what it istoday? I invited a colleague of
mine at Hennepin Healthcare indowntown Minneapolis, Dr. Ali
(00:41):
Alman. He is a neurologist anda physician who treats and
diagnoses multiple sclerosis.
Ali, welcome to the show. Thank
Speaker 3 (00:49):
You so much. It's
Speaker 2 (00:49):
Great to have you here. I want to , if you could
just start right out for us,what is multiple sclerosis?
Speaker 3 (00:55):
So multiple sclerosis is a immune-mediated
inflammatory disease of thecentral nervous system. When
you say immune-mediatedinflammatory, it means like the
body is attacking itself andaffects part of the central
nervous system called the whitematter predominantly. So what
is the white matter of thebrain? So the brain is divided
(01:15):
into gray matter and whitematter. The gray matter has
these cells that are remaincalled neurons and then they
have these cables or a axons,they're covered by something
called myelin . So, which islike the kind of like the
outside covering of cables. Andby attacking the , the lin can
cause like differentmanifestations and different
(01:37):
symptoms. So it can affect yourbrain, your spinal cord and the
covering around part of youreyes called the optic nerve.
Speaker 2 (01:45):
So the myelin this, I like that description. It's
like the covering of a cable.
Speaker 3 (01:49):
That's what it is.
Let's ,
Speaker 2 (01:51):
I really like that.
Yeah . Um , and that's thewhite matter. And apparently
it's quite important for yourbody's neurologic function,
right? What , uh, what , what ,what exactly does this
covering, this myelin do?
Speaker 3 (02:02):
So basically the way your brain communicates and
your nervous systemcommunicates, it sends signals
through these cables. And ifthese cables are damaged, the
signals are not sent properlyand can lead to problems and
dysfunction because of that.
Speaker 2 (02:16):
Okay. So that's the basic thing is that your body's
attacking the white matter ofyour central nervous system.
The covering on the cables, themyelin, I really do like that
Speaker 3 (02:28):
We are not a hundred percent sure exactly what
causes it. There is differenttheories on what's causing it.
One of the theories is it'ssomething called a common virus
in the population that affectslike 80 90% of people call
Epstein bar virus,
Speaker 2 (02:43):
Epstein Bar ,
Speaker 3 (02:44):
It's a common virus that's
Speaker 2 (02:46):
Everywhere. Epstein bar virus is everywhere.
Speaker 3 (02:48):
Yeah, exactly. So like 18 90% of people have it.
Uh, but in some people it's farto be involved in triggering
this immune attack. So therewas a study done at the VA and
they noticed that pretty mucheveryone who had MS had Epstein
bar and the people who weren'tinitially diagnosed with
Epstein bar and developed MSended up having Epstein Bar .
(03:09):
So there is association withthat,
Speaker 2 (03:11):
But not everybody.
'cause like you just said, 80%of us have Epstein bar virus
and we, 80% of us do not havems. Yeah.
Speaker 3 (03:18):
So there's other theories. One of the theories
is, for example, like vitamin Dbeing low is involved in like ,
for example the Epstein barimmunity and some of our immune
signaling pathways. So that's,that's one of the other
theories. But like we don'tknow exactly a hundred percent
the cause. Like even in termsof genetics, like even if
you're identical twin, thechances of you getting MS if
(03:40):
your twin has like , like 30%percent still. So,
Speaker 2 (03:42):
And you shared your DNA . So
Speaker 3 (03:44):
Exactly.
Speaker 2 (03:45):
That's interesting.
So what literally is happeningto that myelin that that sheath
over the nerves? What'shappening to it in ms ? So
Speaker 3 (03:53):
There is inflammation. So we have these
different cells involved in ourimmune system. So there's the
things called B cells , T cells, and microglial cells. So
these cells are causinginflammation. Okay. So they
trigger release of inflammatorymolecules and this leads to
damage to these cables or my inchief .
Speaker 2 (04:14):
Let me shift to how someone might know if they have
it. What are the symptoms? Howdo , how , how does somebody
know? That's
Speaker 3 (04:21):
A good question but also a tricky question. The
reason being is the centralnervous system can lead to many
different like manifestations.
So
Speaker 2 (04:31):
Like if the main processing computer of your
body isn't working right, lotsof stuff can happen.
Speaker 3 (04:35):
Exactly. So it's kind of a tricky question
'cause there's a lot ofdifferent things that can
present and I think it's part ,part of what you need is to
talk with your physician to tryto clarify what's going on.
'cause for example, the mostcommon things that people
present with is like they canhave what you call sensory
symptoms. So you can , peoplecan have like numbness,
tingling, feeling weirdsensations in their body. But
(04:58):
there's also different commoncauses of those symptoms more
than multiple sources .
Speaker 2 (05:03):
You can get numb fingers for a lot of reasons.
Speaker 3 (05:04):
Yeah. So people can have like pinch nerves or
neuropathies which are maybemore common than sclerosis. So
that's one of the commonmanifestations. Other common
presentation is it sometimescan cause inflammation of the,
what are called optic nerves.
So people can present with somecalled optic neuritis. So
people can have pain with theeye movements as well as visual
(05:24):
loss and problem with seeingcolors. So that's one of the,
for example, classic featuresof multiple sclerosis. If it
sometimes affects , for exampleyour spinal cord, people can
have numbness, problems withweakness, problems with
controlling their bowelbladder. Another common symptom
is just mean fatigue. So it'skind of a tricky thing 'cause a
(05:47):
lot of the symptoms can be frommany different things and they
have a lot of different causes.
But if you have to think aboutthings in the context and in
the right age and if there'smany different symptoms that
don't really fit or localizewell that's something to think
Speaker 2 (06:01):
About when you get any of these symptoms. And you
literally mentioned likeeverything that Yeah , a nerve
controls in your body, which isyour whole body
Um , if it's in your eyes thatyou get visual problems, if
it's in your fingers or yourtoes, you get numbness there,
you can get weakness, you getbowel problems. So you pretty
much same like everything inyour body that's controlled by
a nerve. Do when the symptomscome on, do they just stay, do
(06:23):
they get worse and worse andworse? And, and and how quickly
does all that happen?
Speaker 3 (06:27):
That's a good question too. It also depends.
Yeah. So when we classifymultiple sclerosis, there are
two main classifications thatwe use when people are
diagnosed. There's some calledrelapsing remitting sclerosis,
which is the most common typeof diagnosis. So 90% of people
have that. And there's somecalled primary progressive
multiple sclerosis, which 10%of the people have just 10.
(06:51):
Yeah, 10% people presentinitially as, so when people
have these relapses, we defineit a relapse as having a new
neurotic symptom that lastsmore than 24 hours and outside
the setting of like fever. Sosome, some people can have that
attack last a week for example.
And then they recover.
(07:12):
Sometimes they recovercompletely
Speaker 2 (07:14):
And in go just go away. Yeah.
Speaker 3 (07:16):
Sometimes it goes away. That's why sometimes it's
kind of hard to get thatdiagnosis. People say, oh I
just had numbness here. It justwent away after a week. I
didn't pay attention to it .
And then they have anotherattack like couple of years
later and then, oh there'ssomething going on. And then
they seek medical attention atthat time. So sometimes it goes
away. Sometimes it does leavelike permanent problems. So
(07:36):
let's say you had attack, yourleft arm was weak and numb.
Sometimes it just stayspermanently. And in the primary
progressive form there isn'tper se a clear cut attack. It's
more just chronic worsening ofsymptoms. Like chronically,
your left leg continues to getweaker numbered . That's more
Speaker 2 (07:57):
Primary progressive.
Yeah. So relapses and remittingprimary progressive, they both
sound like it's over a longtime though. These symptoms
might be going on for yearsbefore someone even knows they
have it.
Speaker 3 (08:07):
Yes. The primary group progressive actually the
diagnosis requires you to atleast have a year of
Speaker 2 (08:12):
Symptoms. A year of symptoms before you can even
make the diagnosis.
Speaker 3 (08:15):
Yeah. In terms of the relapsing emitting like it
, I can say it's variable butalso the term is kind of a
misnomer because people canhave neurologic inflammation
and changes on MRIs thatthey're just not noticing
'cause not in a critical area.
Speaker 2 (08:29):
So those are the tumor primary kind and and it
sounds like you can have MS fora while before you know that
you do. When do people come tosee like a specialist like you?
I assume that people are goingto their doctor, they're
telling 'em these symptoms.
What does the typical patientlook like that gets to you?
Have they already been tryingto figure out their symptoms
for a long time?
Speaker 3 (08:50):
Yeah, I think most of the referrals with right
time they go to get the MSspecialist is usually they have
an MRI that's done.
Speaker 2 (08:57):
Somebody got an MR mri .
Speaker 3 (08:57):
Yeah . Yeah. And the MRI looks like what MS looks
like.
Speaker 2 (09:01):
So you can see it on an MR mri . Uh ,
Speaker 3 (09:03):
Well it's, it's kind of tricky too, but like it
looks a certain way on M mri .
It's like the lesions look kindof like a circularly and
they're on certain areas.
Speaker 2 (09:11):
Yeah. It's interesting, you know, the
brain and the central nervoussystem is so, so amazingly
complex and we know so muchabout it and some things we
don't know so much about. ButI'm always amazed that you can
pinpoint exactly where theproblem in someone's brain is
and then maybe one day we'llfigure out what actually causes
this so we can get down to theroot cause of it. I'm gonna
(09:33):
talk about that a little bitlater. Let's talk about how
common MS is.
Speaker 3 (09:37):
It's around 1 million Americans have MS and
it's a lot. Yeah, it is a lot.
It's actually the most commondisease causing inflammation in
the brain is multiplesclerosis. There are other rare
conditions, but in terms ofinflammatory diseases of the
brain, it's the most common andit's the most common cause of
neurotic disability in youngadults. In terms of things like
(09:59):
mobility separate fromtraumatic brain injury.
Speaker 2 (10:01):
So you said young adults, is that who it hits the
most? What are what? What'syour typical patient or who in
whom is it most common?
Speaker 3 (10:07):
So in average age range of around people getting
diagnosed is around 30. 30.
Yeah. But it can happen whenpeople are young and can also
occur when people are older.
It's slightly more common womanthan men. Like many autoimmune
conditions like women have ittwo to three times more likely
than men.
Speaker 2 (10:25):
I've heard that a little bit over the course of
doing these podcasts for thelast four seasons. We talk a
lot about autoimmune illnesses.
A lot of human conditions arecaused by your immune system
attacking itself. But it seemsto be more women than men in
some of them and younger women.
Yeah , 30-year-old women. Wedid a show about lupus too. So
listeners listen, listen to theshow about lupus. That is a
more common in young women aswell. Do we know why that is?
(10:47):
Why would it be women more thanmen?
Speaker 3 (10:49):
I think I've read that there's some, the women
have an extra ex chromosomesand the ex chromosome is
involved in like the workingsof the immune system. So just
having that ex chromosomepredisposes a lot of women to
have . That's interesting .
More immune conditions.
Speaker 2 (11:04):
I bet there's loads of people doing research on the
genetic origins of things likems uh, what about
geographically? Does that makeany difference or is it just as
common or worldwide or in thiscountry? Is it, does that not
matter?
Speaker 3 (11:17):
So geographically the thought is it's related
getting to UV light exposureand like vitamin D, it's fought
that the more north for stafffrom the greater , more likely
to get multiple sclerosis
Speaker 2 (11:28):
Because of UV light.
Yeah . So in Minnesota I knowseveral people who have MS in
my personal life and obviouslyin my clinical practice. So
we're sort of in that, wellwe're in the northern half.
Yeah . Yeah . Of things . So inMinnesota might be a place
where we see more. But that'sinteresting then if you live in
equatorial places, it's maybenot quite as common 'cause UV
light is protective. Is thatwhat you're trying to say?
Yeah. Wow.
Speaker 3 (11:49):
Well it's kind of tricky too. 'cause now we're
studying like the epidemiologyof
it's like more common in blackpopulations, Asian populations
than we previously thought . Soit's something that's also
being studied. What
Speaker 2 (12:02):
About your family history? Is it genetic? I mean
do you, do you get it if you'refolks at it? So
Speaker 3 (12:06):
There is, like I said, there is that risk. So
like, like if you're twins youhave a 30% risk, but it's not a
hundred percent guarantee. Soif you have family members that
have it, that increases yourrisk of having sclerosis. But
it's a mix of environmenttriggers and family history. So
it's not, there's no guaranteethat there's no like one gene,
Hey you have this gene, you'regonna have multiple sclerosis.
Speaker 2 (12:28):
When we come back from the break, I'm gonna talk
a lot more about the impacts onpeople's lives and treatments
and how people are living withms. 'cause lots of people are
living with ms. But before I dothat, I want to talk just
briefly about diagnosis.
You've, you've, you've touchedon it , MRIs and, and I think
it involves going to a smartneurologist like you, but how
do you diagnose itdefinitively?
Speaker 3 (12:49):
So the diagnosis is not, what we use is something
called the McDonald's criteria.
McDonald? Yeah. You need tohave clinical symptoms that fit
with multiple sclerosis. Okay.
And then you need to havesupportive evidence of MRIs
showing that where the lesionsare and they need to be what
are called disseminated in timeand space. So we look at where
(13:13):
the lesions are on MRI, we lookif they're picking up dire or
not. And the other thing wesometimes use to help make the
diagnosis is a spinal tap. Sowhen we do a spinal tap, which
is taking fluid from your back,that tells, and this fluid is
what circulates around yourbrain. We sometimes see signs
of inflammation in 90% of mulsclerosis patients. So that's
(13:35):
something we use as asupportive of
Speaker 2 (13:37):
Diagnosis. You don't do that spinal tap in
everybody?
Speaker 3 (13:39):
No, no. It's sometimes you can meet the
diagnostic criteria without aspinal tap, but in certain
cases we're not sure or youneed to help confirm the
diagnosis. You do the spinaltap .
Speaker 2 (13:49):
Terrific. We've been talking with Dr. Ali Alman who
is a neurologist in HennepinHealthcare and we're talking
about multiple sclerosis. Aftera short break we're gonna
discuss treatment options and Ido wanna ask Dr. Almon, how do
people live with MS and theeffect it has on people's
lives. Stick around. We'll beright back
Speaker 4 (14:08):
When Hennepin Healthcare says we are here for
life. They mean here for you,your life and all that it
brings. Hennepin Healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find. But did youknow they also have services
like acupuncture andchiropractic care available at
(14:31):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (14:46):
And we're back talking about multiple
sclerosis, otherwise known asMS. With Dr. Ali Almo from
Hennepin Healthcare. He is aneurologist and an expert in
this condition. So in the firsthalf , Ali, you talked about
lots of symptoms and it struckme as I've had a lot of those
and I bet people listening willsay, well I had a numb foot one
day or I don't know, my visionwas a little bit conti one day
(15:08):
it went away. That's kind ofscary. Um, because they can be
due to lots of other thingstoo.
Speaker 3 (15:13):
I definitely agree and that's part of what makes
it kind of tricky. So I thinkthat the most, one of the
important things is just workwith your physician. If you
ever have any new neurologicsymptoms or physician symptoms
or concerns to get evaluated.
'cause that can help identifywhat the problem is and to
evaluate and rule out otherconditions and get you on the
right track in terms of adiagnosis.
Speaker 2 (15:35):
Sounds good. Now I wanna talk about people living
with MS treatments and, andwhat life is like. So I'm just
gonna ask you a straight upquestion. Can people live a
normal life if you havemultiple sclerosis?
Speaker 3 (15:46):
Yes, you definitely can. And that's something
that's kind of freaky about us. Like I , like I mentioned
there's a million people withit. So it's more common than
people think. There are so manypeople that you'll see walking
in the street and lookrelatively normal and they have
multiple sclerosis. One of thesegues in terms of this is I
(16:07):
think the disease in terms ofmanagement has significantly
changed in the past like 20years. Like 20 years ago we
only had like three drugs.
Speaker 2 (16:17):
When I started practicing, there were about
three things. I didn'tprescribe any of them. Yeah .
Because I wasn't a specialistbut there wasn't a time . Yeah
.
Speaker 3 (16:23):
Yeah. And now there's more than 20.
Speaker 2 (16:24):
More than 20. See the last 20 years have been
really an amazing coupledecades of I'm sure the
previous 20 were as well. ButI'm just, I'm , I've been
practicing over 20 years and wedidn't have hardly anything. So
these medications, let's getinto that a little bit. What
kind of treatments areavailable?
Speaker 3 (16:40):
So terms of treatments, the way we manage
the disease is what we calldisease modifying therapy. So
there are medications that weuse that work on your immune
system and that helps withreducing the inflammation
related to the disease. But asthe way they work, they also
(17:02):
make your body more prone tohaving things like infections.
One of the worries we have islike , like increased risk of
cancer. 'cause your body's,
Speaker 2 (17:10):
It's messing with your immune
Speaker 3 (17:11):
System. Yeah. Your immune system is important to
survey your body. For thingslike cancer,
Speaker 2 (17:16):
It'd be great if there were a medication that
tamped down your immune systemonly related to where it's
messing up like on the MS thingand the demyelinating of your
nerves, but it doesn't affectthe rest of your immune system.
But I bet that's a little bitharder in medications. Yeah,
just target it to the rightpart of your immune system.
Yeah,
Speaker 3 (17:34):
That that is tricky.
Yeah, like there'd be nice tohave a holy grail like that.
But unfortunately we have, forexample, the way we're
approaching the meds right nowis like some people, I think
most MS providers right now are, are going to call like high
efficacy route. So they'reusing more aggressive
medications early on to hit thedisease early on to prevent
further disability in thefuture. But we have some of the
(17:58):
older medications, one of themis called re acetate or
Copaxone. That one doesn'ttapper with the immune system
as much. So it has less ofthose side effects, but it's
slightly less of a effectivemedication because of that.
Speaker 2 (18:11):
When you start people, you said you treat high
efficacy drugs early, early inthe disease. So that, that
implies to me that it doesmatter then that you get at it
as soon as possible. That
Speaker 3 (18:20):
Is for sure. Yeah.
So that's something we'recurrently also studying right
now. There is some trials tosee what's the right way to
treat this.
Speaker 2 (18:27):
So not sit around and wait 10 years until it gets
bad.
Speaker 3 (18:30):
Exactly. So previously what we people used
to do is like put you on likethe safer medications and if
you start having attacks moreand more activity, they switch
you to more effectivemedications. But nowadays a lot
of 'em , MS physicians tend tostart people on higher
efficacy, stronger, moreeffective medications as some
(18:51):
of these patients have lessdisability, less r activity in
the future. And, and we hope inthe end that helps overall with
the prognosis for the patientsand preventing disability for
them in the future.
Speaker 2 (19:02):
Are there things people can do that are not the
medications that you prescribeto slow down progression? Is
there anything we know that inyour lifestyle, here's what you
ought to be doing?
Speaker 3 (19:12):
Yeah, so I, the things that are important is
just one of the things you cando that's very important for
health in general is, forexample , smoking. Smoking can
worsen inflammation. Smokingcan make MS progression worse.
And quitting smoking is one ofthe best thing you can do for
your health and multiplesclerosis. But also just having
a healthy lifestyle in general.
Healthy diet, healthy weight,controlling your risk factors
(19:35):
for, for example, havingstroke. 'cause a lot of what
happens when people get olderis they can have also damage
the same thing that would callthe white matter from having
high blood pressure, diabetes,high cholesterol, those coast
kind of silent strokes. Andthat also contributes and
confounds , uh, multiplesclerosis when people are
getting older.
Speaker 2 (19:53):
Those are good tips and um , regular listeners to
this podcast, we'll know that ,uh, if you haven't learned yet
that uh, you're not supposed tosmoke, I encourage you to
listen more carefully. Youshould not be smoking
Um, I have a question aboutthose nerves themselves. And
since I got a neurologist hereand I've got you captive right
here in the studio, do nervesheal and in like in the MS
(20:15):
specifically or just ingenerally they're demyelinated
the sheath, the , the cable isdamaged. The nerves are damaged
here. Do they ever heal againor are you just trying to
prevent future nerves frombeing damaged?
Speaker 3 (20:28):
There is possibility of if it's just a cable that's
damaged mm-hmm
That can heal up potentiallythey
Speaker 2 (20:35):
Don't heal quickly.
Do
Speaker 3 (20:36):
They? They don't heal quickly. It doesn't heal
quickly. But sometimes theinflammation is a lot and you
can have like permanent damageto the cable set or we call
axon loss.
Speaker 2 (20:46):
So axon loss.
Speaker 3 (20:47):
Okay. Yeah . So sometimes you can heal a bit,
but it doesn't heal perfectlysometimes either . Sometimes
the damage is permanent.
Speaker 2 (20:55):
I've often wondered that about the human body and
I'm not expecting you toactually have an answer to
this, but you know, you cutyour skin in two days later
it's healed and, and manythings in our body, it just,
your liver can practicallyregrow itself, but your nerves
don't. They just don't .
They're so dang slow , um, inhealing. And I know everybody
with spinal cord injuries andbrain things and Im , um,
(21:16):
immune damage , uh, um, fromthings like ms. Uh , know that
full well that your nerves justtake forever to heal when
they're able to. Let's talk alittle bit about the lives
people live. What, what typesof support systems are
important for people livingwith ms, particularly if it has
led to some disability, eitherphysical disability or, or
(21:39):
mobility, things like that. So
Speaker 3 (21:40):
I think it's always good to have family around you,
especially if you're having,it's not just for example, like
the physical toll and things .
Sometimes when you havedisabilities from things that
can have an emotional toll aswell. So having family to
support you both in thephysical and mental toll of
things is, is very important.
We also have, for example, relyon, for example, different
(22:03):
specialists like physicaltherapy Okay. Occupational
therapy to help people helpmanage their symptoms, help
them adapt better, walk better,use their hands better if
that's affected .
Speaker 2 (22:15):
Are there resources for like support groups and
others ? The MS Society isthere not? Yes .
Speaker 3 (22:20):
So
Speaker 2 (22:20):
What I recommend , are they , uh, still out there?
Speaker 3 (22:21):
Yeah. Yeah. What I recommend , uh, people to look
into is the National MS Societywebsite. Uh , that's the ME
American Multiple Cirrhosiswebsite. It's a very helpful
website.
Speaker 2 (22:30):
One thing we try to do on this podcast is get
people to reliable accessibleinformation. I hope, you know,
I know they're getting it fromthis podcast, but on the
internet so much of what's outthere is just garbage. But the
MS society is not it'sreliable. Correct?
Speaker 3 (22:44):
Yes . So I recommend patients look to the National
MS Society website. It's veryhelpful. Has a lot of
information, has informationwords in a nice way. It has FDA
like labels for medication andeven has like social workers
available on the website thatcan access. They're called like
MS navigators. And when peoplehave initial MS diagnosis, it
also has very usefulinformation and also links to
(23:06):
support groups and what whatnot.
Speaker 2 (23:07):
And we can get a link to the National MS Society
on the show notes for thispodcast. So listeners, you can
look , uh, where you access thepodcast, we'll put a link right
to the MS Society page there.
Let's talk about the future. Sothere's lots of new medications
, uh, that we have now and itmakes it a completely different
landscape than it was 20 yearsago. Okay, go 20 years into the
(23:28):
future. Now what is, what issome of the latest research
looking like for ms? So one
Speaker 3 (23:33):
Of the things, remember we talked about the
McDonald criteria? Yeah. Uh, sothe last time it was updated is
, was 2017. We're actuallygonna update it this year. The
new updates will hopefully makeit easier to make an earlier
diagnosis. And there's onething I didn't talk about. You
asked like how long do you havesomeone have multiples without
knowing it? Sometimes we getMRIs on people who have like
(23:56):
headaches, head trauma and itlooks like multiple sclerosis,
but the person didn't have anyclinical symptoms. Yeah. That's
something called radiologicallyisolated syndrome and we're not
, we're not sure what to do
Speaker 2 (24:06):
Fully , what to make with that . You , you got an
MRI for another reason you sawthis thing.
Speaker 3 (24:10):
Yeah. So hopefully the new guidelines will shed
light on. Like how can wediagnose people with mastros
and how to put these people onmedications
Speaker 2 (24:18):
Even before you maybe are having some symptoms.
Yes.
Speaker 3 (24:22):
Yeah. So it , it , the goal is to have earlier
diagnosis. The other thingthat's , uh, big into clinical
trials right now, which is theway pharma companies test new
drugs is there's a new class ofdrugs being tested called
Bruton terin kinase inhibitors.
It's used in easy
Speaker 2 (24:38):
For you to say sorry.
Speaker 3 (24:40):
Yeah . Yeah. It's used to
Speaker 2 (24:41):
Could you say that again? What are they called?
Uh,
Speaker 3 (24:43):
Uh , bru . Terin kinase inhibitors. Okay . BTK
inhibitors. They're used inlike other, other fields like ,
uh, like for cancer. And thesedrugs are currently being
studied from multiple sclerosisand we're expecting results of
the newer clinical trial soonand we'll see if these drugs
can get into the market.
Speaker 2 (25:01):
Yeah. Um , I just, hats off to the research
community. We have a bigresearch community at , at
Hennepin, but uh, for all thoseresearchers around the globe
who are working on ms , um,there's some optimism that
there's some new things comingdown the road and, and there's
not a cure though, is there?
Speaker 3 (25:16):
Unfortunately, there's no cure yet. That would
be amazing. But unfortunatelywe don't have a cure these
medications. What they do isthey reduced inflammation, they
reduce MRI activity, but itdoesn't remove the inflammation
process complete . There's nocomplete cure for the disease
just
Speaker 2 (25:36):
To stop it and be done with it. Yeah.
Speaker 3 (25:38):
The medications don't reverse whatever damage
that's been done prior to themedications. We don't have
specific medications to do thatyet. That's something that's
also being looked into, but wedon't have specific medications
to repair those cables ormyelin .
Speaker 2 (25:52):
Yeah, maybe someday down the road. You know ,
people don't often uh ,understand that. But it's
something that, that took memaybe a decade or two to , to
learn is that much of medicinedoesn't have a cure. Much of
what I do. Very little of whatI do in internal medicine has a
straight up cure, I guess strepthroat, we can cure that with
penicillin, but heart failureand high blood pressure and
diabetes and all the otherspecialists I have in the show
(26:14):
and in this case, multiplesclerosis. That does not mean
there aren't treatments though,to make it so that you can live
your life, lead a normal lifeand do all the things you want
to do even in the absence of acure. So sometimes people get
kind of depressed when theyhear, oh , there's no cure. You
, maybe not, but there areeffective treatments to allow
you to live a fulfilling,satisfying, long life with many
(26:35):
of these things, including ms.
Thank you for being on the showtoday, Dr. Al Moen .
Speaker 3 (26:39):
Thank you.
Speaker 2 (26:40):
It's great to have you. Ali . We've been talking
with Dr. Ali Al Moen . He is aneurologist at Hennepin
Healthcare. We've been talkingabout multiple sclerosis and
just know that there is helpavailable, there are treatment
options. It's getting betterevery day than there is hope
for the future. Be sure tocheck us out in two weeks time
for our next show. And in themeantime, be healthy and be
well.
Speaker 1 (26:58):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(27:21):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern . Until next
(27:42):
time , be healthy and be well .
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