WEBVTT 1 00:00:00.240 --> 00:00:01.960 Oh hey, it's a cough drop in your purse that 2 00:00:02.040 --> 00:00:05.000 you don't want to unwrap, but you desperately want to unwrapped. 3 00:00:05.040 --> 00:00:08.199 Ali ward with an episode. It's close to my heart 4 00:00:08.199 --> 00:00:10.080 and there's a chance that you or someone you love 5 00:00:10.199 --> 00:00:12.560 may have been affected by it. And the verdict is 6 00:00:12.679 --> 00:00:15.279 it's not fun and a lot of people don't really 7 00:00:15.320 --> 00:00:18.320 get what it is. This one's on multiple sclerosis, so 8 00:00:18.440 --> 00:00:21.839 if you like to understand how your body routes messages 9 00:00:21.879 --> 00:00:24.079 to itself, this is also a great one to get 10 00:00:24.079 --> 00:00:26.480 a grasp on that. So this topic is close to 11 00:00:26.519 --> 00:00:29.719 my family as my mom. You're Fancy Nancy who originated 12 00:00:29.800 --> 00:00:32.960 the categories insomnia buster that we talked about in the 13 00:00:32.960 --> 00:00:36.000 Somnology episodes on sleep y'all love her, you love that. 14 00:00:36.479 --> 00:00:39.079 So my mom was diagnosed with multiple sclerosis over twenty 15 00:00:39.159 --> 00:00:41.799 years ago and our family has had to go from 16 00:00:41.920 --> 00:00:44.920 like what is this? To how can I seek out 17 00:00:45.039 --> 00:00:47.679 the world's foremost expert on this and ask all of 18 00:00:47.679 --> 00:00:50.640 our questions on behalf of people with MS. So that's 19 00:00:50.640 --> 00:00:53.320 what we did here. So this expert did their undergrad 20 00:00:53.320 --> 00:00:56.200 at Oberlin College, got an MD at the University of 21 00:00:56.200 --> 00:00:58.399 Cincinnati College of medicine and then hopped over to the 22 00:00:58.479 --> 00:01:02.920 University of Michigan for their resident and internship programs before 23 00:01:03.000 --> 00:01:06.200 another two year fellowship. And they are a Board certified 24 00:01:06.239 --> 00:01:11.640 neurologist specializing in multiple sclerosis and founded the Boster Center 25 00:01:11.719 --> 00:01:15.599 for MS. They've been involved with a ton of clinical trials, 26 00:01:15.680 --> 00:01:19.519 They've had so many papers published, and also does awesome 27 00:01:19.560 --> 00:01:22.599 outreach to the public and people of MS via their 28 00:01:22.599 --> 00:01:26.519 YouTube channel, which has nearly one hundred thousand subscribers. They're 29 00:01:26.519 --> 00:01:28.840 pretty much the goat when it comes to MS. So 30 00:01:28.879 --> 00:01:30.319 we're going to talk to them in a moment. But first, 31 00:01:30.319 --> 00:01:31.959 thank you to all the listeners who are signed up 32 00:01:31.959 --> 00:01:34.719 at Patreon dot com slash ologies who support the show 33 00:01:34.840 --> 00:01:37.120 for a dollar or more a month and also submit 34 00:01:37.120 --> 00:01:40.599 their questions for episodes. Thanks to everyone wearing Ologiesmirch from 35 00:01:40.640 --> 00:01:44.040 ologiesmeirch dot com and of course also for zero dollars. 36 00:01:44.120 --> 00:01:47.000 You can support ologies by leaving a review, which keeps 37 00:01:47.079 --> 00:01:49.599 us up in the charts and as proof that I 38 00:01:49.640 --> 00:01:51.920 do read all of them. I pick one each week 39 00:01:51.920 --> 00:01:54.040 and this one is from our j LeCount who wrote 40 00:01:54.200 --> 00:01:56.719 Nerds Unite love this show so much and the merch 41 00:01:56.879 --> 00:01:59.640 is an absolute nerd magnet. They wore their Ologies shirt 42 00:01:59.640 --> 00:02:01.760 when they're at the hospital all day and got more 43 00:02:01.799 --> 00:02:04.879 compliments from medical staff than they have on anything they've worn. 44 00:02:04.959 --> 00:02:08.479 They wrote, so our j Leacount, thank you for wrapping us. Also, 45 00:02:08.800 --> 00:02:12.319 hospitals great place to meet other Ologites can a test 46 00:02:12.560 --> 00:02:15.280 ten out of ten. Also, if you have little ones 47 00:02:15.280 --> 00:02:18.360 and you're looking for any classroom save versions of Ologies, 48 00:02:18.639 --> 00:02:21.520 we release them every week for free in their own feed. 49 00:02:21.599 --> 00:02:25.960 It's called Smologies Smologies. You can find anywhere to get 50 00:02:26.000 --> 00:02:29.120 podcasts classroom safegy rated. That's also linked to the show 51 00:02:29.159 --> 00:02:31.080 notes and thanks of course to sponsors of the show 52 00:02:31.120 --> 00:02:33.439 who make it possible to donate to a cause of 53 00:02:33.520 --> 00:02:37.960 the ologists choosing each week. Okay onward, just to get 54 00:02:38.039 --> 00:02:39.879 legal about it for a sec. This podcast is not 55 00:02:39.919 --> 00:02:43.000 intended to treat or diagnose and is for informational purposes 56 00:02:43.039 --> 00:02:46.000 only because this is a podcast and it is not 57 00:02:46.120 --> 00:02:49.439 your doctor. So let's hear all about how nerve tissue works, 58 00:02:49.680 --> 00:02:52.879 how your spinal cord is like a holiday decoration, The 59 00:02:53.039 --> 00:02:57.159 five strategies anyone can use to feel better, novel testing 60 00:02:57.240 --> 00:03:02.000 methods for MS. Public figures who are raised awareness about MS, 61 00:03:02.280 --> 00:03:05.840 some past, some future, and some tips for loved ones 62 00:03:05.919 --> 00:03:10.800 and people who have multiple sclerosis with neurologist MS expert 63 00:03:10.919 --> 00:03:33.240 and neuropatho immunologist doctor Aaron Foster. The first thing I'm 64 00:03:33.240 --> 00:03:34.560 gonna have you do is if you could say your 65 00:03:34.560 --> 00:03:36.599 first and last name and tell me what pronounce you use. 66 00:03:37.080 --> 00:03:38.759 With pleasure Aaron Boster. 67 00:03:39.240 --> 00:03:45.319 He him his doctor Boster. Of course, as the internet 68 00:03:45.360 --> 00:03:48.479 knows you, there you go. I feel like in terms 69 00:03:48.479 --> 00:03:53.039 of people doing outreaching communication about multiple sclerosis, I feel 70 00:03:53.080 --> 00:03:56.360 like I don't see many people communicating the way that 71 00:03:56.439 --> 00:04:00.319 you do, so thoroughly and so friendly for patients. It's 72 00:04:00.360 --> 00:04:02.840 really lovely to see. I've sent my mom so many 73 00:04:02.879 --> 00:04:04.719 of your videos. My mom knows of your work. She 74 00:04:04.759 --> 00:04:07.120 has a mess thank you? So yeah. Did you always 75 00:04:07.159 --> 00:04:09.080 want to communicate what you were doing? Or did you 76 00:04:09.120 --> 00:04:10.960 just want a doctor? When did you decide because being 77 00:04:11.000 --> 00:04:12.240 a doctor's had enough of a job. 78 00:04:13.120 --> 00:04:16.720 So I'm a bit of a weirdo. I decided to 79 00:04:16.759 --> 00:04:19.279 be an MS doc when I was twelve. My uncle 80 00:04:19.279 --> 00:04:22.000 Mark had a mess. Since my I don't remember a 81 00:04:22.040 --> 00:04:24.839 memory when my uncle didn't have a mess, so I 82 00:04:24.879 --> 00:04:27.199 knew what it meant to have to disunpack someone I 83 00:04:27.279 --> 00:04:29.519 knew what it meant when you had to help someone eat. 84 00:04:29.800 --> 00:04:33.759 Long before I knew like what neuroimmunology was. And I remember, 85 00:04:33.839 --> 00:04:36.240 like rather vividly. I was at my grandmother's house. My 86 00:04:36.279 --> 00:04:38.720 grandmother or my mother were in the kitchen. My uncle 87 00:04:38.800 --> 00:04:40.519 was where he always was, watching TV in the other 88 00:04:40.560 --> 00:04:43.399 room in his wheelchair. My mother and grandmother were crying. 89 00:04:43.480 --> 00:04:45.600 They were holding hands, and they weren't crying because my 90 00:04:45.639 --> 00:04:47.199 uncle had a mess. They were crying because they couldn't 91 00:04:47.199 --> 00:04:50.279 get a hold of their freaking doctor. And this predates 92 00:04:50.319 --> 00:04:54.079 the interwebs. This predates like things like YouTube. And I 93 00:04:54.160 --> 00:04:55.959 told my mom that I would learn to do it 94 00:04:56.000 --> 00:04:58.360 better now. I didn't know what I was telling my mom, 95 00:04:58.399 --> 00:05:00.000 Like I didn't know that I would be bald before 96 00:05:00.000 --> 00:05:02.120 before I finished my training, or that I'd have to 97 00:05:02.199 --> 00:05:05.319 learn like a weird lexicon. I just knew that nobody 98 00:05:05.319 --> 00:05:08.199 should make my family feel that scared and alone. And 99 00:05:08.279 --> 00:05:11.040 so I've been kind of mission driven, Like I was 100 00:05:11.040 --> 00:05:12.439 a weirdo in high school that said I want to 101 00:05:12.439 --> 00:05:15.199 be an MS doc, and I sought out my education 102 00:05:15.399 --> 00:05:18.639 in a very directed fashion, really just with the goal 103 00:05:18.680 --> 00:05:22.800 of like educating and empowering and energizing families impacted by MS, 104 00:05:23.399 --> 00:05:25.720 because somebody should have done that for my family, and 105 00:05:25.800 --> 00:05:27.920 I can't help them, you know, they've passed on. But 106 00:05:28.360 --> 00:05:31.439 then if I can help someone else's family, that really 107 00:05:31.480 --> 00:05:34.279 fills a bucket for me. And I was I think 108 00:05:34.319 --> 00:05:37.319 it was like twenty fifteen and I was in clinic 109 00:05:37.360 --> 00:05:39.680 with my fellow. I was training this fellow and someone 110 00:05:39.720 --> 00:05:41.600 didn't show up, and I got all pissed off, and 111 00:05:41.639 --> 00:05:43.879 so I handed on my phone and I said record this, 112 00:05:44.439 --> 00:05:46.639 and I just recorded what I was going to say 113 00:05:46.680 --> 00:05:47.279 to the patient. 114 00:05:47.519 --> 00:05:50.879 Doctor Broster started uploading videos to YouTube when he realized 115 00:05:50.920 --> 00:05:53.279 that patients, the ones in his care or people he 116 00:05:53.279 --> 00:05:56.600 would never even meet, could learn more and educate their 117 00:05:56.600 --> 00:05:59.879 loved ones or use the video for reference later, because 118 00:06:00.000 --> 00:06:02.920 in a doctor's office it can be information overload. 119 00:06:03.279 --> 00:06:05.360 You may have like rushed through traffic, or you may 120 00:06:05.399 --> 00:06:08.120 be really scared, or who knows. So if I can 121 00:06:08.279 --> 00:06:11.839 convey that same snippet of information and put it on 122 00:06:11.879 --> 00:06:14.480 the interwebs, then you can watch it like at three 123 00:06:14.480 --> 00:06:16.800 in the morning in your bathrobe. That's the right time 124 00:06:16.839 --> 00:06:19.920 for you. And sometimes with MS, like you know, you 125 00:06:20.040 --> 00:06:21.680 might not take it all in the first time. So 126 00:06:21.759 --> 00:06:24.480 then you can watch it again, and it just seems 127 00:06:24.519 --> 00:06:28.120 like a really solid way of trying to convey information 128 00:06:28.720 --> 00:06:29.839 in a meaningful fashion. 129 00:06:30.439 --> 00:06:33.360 How many people have MS? Because my mom's had it 130 00:06:33.399 --> 00:06:35.439 for she got diagnosed twenty years ago, but she had 131 00:06:35.480 --> 00:06:37.399 it for years before that without the doctor's knowing what 132 00:06:37.519 --> 00:06:37.800 it was. 133 00:06:38.079 --> 00:06:40.600 So it's a really interesting point you bring up. Until 134 00:06:40.720 --> 00:06:44.480 very recently twenty nineteen, we thought that there were about 135 00:06:44.519 --> 00:06:46.839 four hundred thousand people in the United States with MS, 136 00:06:47.120 --> 00:06:49.920 and it wasn't until twenty nineteen when there were some 137 00:06:50.000 --> 00:06:53.079 proper epidemial logic studies done in the United States that 138 00:06:53.120 --> 00:06:55.360 they realized that we were really wrong and there's a 139 00:06:55.439 --> 00:06:58.639 million people in the United States alone that have MS. 140 00:06:59.120 --> 00:06:59.560 Wow. 141 00:06:59.639 --> 00:07:02.639 What Yeah, And so it's not a rare condition and 142 00:07:03.279 --> 00:07:06.959 something really culturally cool has happened, at least from my perspective. 143 00:07:07.519 --> 00:07:10.639 We've started to see MS enter into the mainstream. You know. 144 00:07:10.680 --> 00:07:13.160 So there was the West Wing TV show where a 145 00:07:13.279 --> 00:07:15.199 character on the West Wing, the person who played the 146 00:07:15.399 --> 00:07:18.040 had MS. And I can't tell you how many people 147 00:07:18.279 --> 00:07:21.319 with MS it helped normalize. Like I've had people tell 148 00:07:21.319 --> 00:07:23.639 me I used to inject each week with the President. 149 00:07:25.319 --> 00:07:29.199 Just seeing MS on TV helps normalize it, and so 150 00:07:29.240 --> 00:07:32.040 I think that it's become a little bit less stigmatized 151 00:07:32.439 --> 00:07:34.879 and a little bit more mainstream than it was even 152 00:07:34.959 --> 00:07:36.399 you know, when we were kids. 153 00:07:36.480 --> 00:07:40.519 And Sma Blair, Christina Applegate, people that my our generation 154 00:07:40.759 --> 00:07:44.319 maybe Gen xers boomers grew up with, now are seeing 155 00:07:44.319 --> 00:07:47.600 people that they watched as teenagers who are diagnosed. 156 00:07:47.680 --> 00:07:50.519 That's exactly right, you're right, you know, and the famous 157 00:07:50.519 --> 00:07:54.000 people with MS of the last generation didn't have access 158 00:07:54.040 --> 00:07:57.319 to care, Richard pryor, you know, the Mickey Mouse Club. 159 00:07:57.360 --> 00:08:00.480 Anette Funicello was a mouse katier and a star of 160 00:08:00.600 --> 00:08:03.959 nineteen sixties beach party movies, and she kept her MS 161 00:08:04.000 --> 00:08:08.720 diagnosis private for years until rumors swirled that her balance 162 00:08:08.800 --> 00:08:12.199 issues were due to alcoholism. So she was like, no, jerks, 163 00:08:12.240 --> 00:08:15.519 I have MS. And she later established the Annett Funicello 164 00:08:15.600 --> 00:08:19.600 Fund for Neurological Disorders. But this was forty years ago. 165 00:08:20.120 --> 00:08:23.199 Like, these folks went through what we unfortunately call the 166 00:08:23.279 --> 00:08:25.439 natural history of multiple strosses, like what happens if you 167 00:08:25.439 --> 00:08:28.199 don't treat, And so we're now seeing a generation of 168 00:08:28.240 --> 00:08:31.560 people treated, and it's a very very different set of variables. 169 00:08:31.560 --> 00:08:33.519 It's a very different condition in that regard. 170 00:08:33.639 --> 00:08:35.440 And now that we know about how many people have it, Okay, 171 00:08:35.879 --> 00:08:38.000 we know it is, but how do you describe it 172 00:08:38.000 --> 00:08:39.960 to people who may be first diagnosed they don't know 173 00:08:40.000 --> 00:08:42.600 what it is, or someone who asks you what you 174 00:08:43.200 --> 00:08:43.960 specialize in? 175 00:08:44.600 --> 00:08:46.879 Right on, So I explained to people that in order 176 00:08:46.919 --> 00:08:50.759 to understand MS, we have to think about the immune system. Right. So, 177 00:08:50.759 --> 00:08:52.960 there's all these organ systems in the body, like you know, 178 00:08:53.000 --> 00:08:55.519 the cardiovascar system pumps blood all over the place, and 179 00:08:56.120 --> 00:08:58.440 the immune system is the part of your body that 180 00:08:58.480 --> 00:09:01.399 fights off bad guys like foreign and so when some 181 00:09:01.519 --> 00:09:03.279 kid coughs on you and gives you a virus, the 182 00:09:03.320 --> 00:09:06.000 immune system identifies it as a bad guy and whoops it. 183 00:09:06.279 --> 00:09:07.799 You cover your mouth when you coughing. 184 00:09:08.080 --> 00:09:11.759 And the immune system is not supposed to attack yourself, 185 00:09:12.039 --> 00:09:14.360 and so if the immune system sees part of you, 186 00:09:14.480 --> 00:09:17.759 it should just be like hey me and leave you alone. Now, 187 00:09:17.840 --> 00:09:21.240 sometimes the immune system makes an error in judgment and 188 00:09:21.279 --> 00:09:24.159 it identifies part of your body as a foreign invader, 189 00:09:24.480 --> 00:09:27.480 and so that's called an autoimmune condition. And there's a 190 00:09:27.480 --> 00:09:29.919 lot of autoimmune conditions that people are pretty familiar with. So, 191 00:09:29.960 --> 00:09:32.879 for example, if the immune system beats up on the pancreas. 192 00:09:32.879 --> 00:09:34.240 We call that childhood diabetes. 193 00:09:34.600 --> 00:09:37.840 And this was called childhood or juvenile diabetes because the 194 00:09:37.919 --> 00:09:41.559 onset and the diagnoses of this autoimmune condition tends to 195 00:09:41.600 --> 00:09:43.840 happen early in life. But we now call it type one, 196 00:09:44.240 --> 00:09:46.120 or you can call it TD one. If you're cool, 197 00:09:46.440 --> 00:09:49.120 you can check out our two part diabetology episode with 198 00:09:49.320 --> 00:09:53.360 self described diabetic diabatologist doctor Mike Natter. Oh, we also 199 00:09:53.399 --> 00:09:56.159 have a long COVID two parter with doctor Wes Ely, 200 00:09:56.360 --> 00:09:58.600 and we'll link those for you in the show notes. 201 00:09:58.679 --> 00:10:01.840 But yeah, lots of ways to have an autoimmune issue. 202 00:10:02.159 --> 00:10:04.080 Or if the immune system beats up on the joints 203 00:10:04.080 --> 00:10:06.639 of the hands and feet, we call that rheumatoid arthritis. 204 00:10:07.320 --> 00:10:10.399 So I explain that multiple sclerosis is an autoimmune condition 205 00:10:10.480 --> 00:10:13.679 where the immune system unfortunately attacks the holiest of holies, 206 00:10:13.720 --> 00:10:16.519 the supercomputer that runs the body, the brain, and the 207 00:10:16.559 --> 00:10:19.240 super highway the spinal cord that takes the information up 208 00:10:19.240 --> 00:10:22.840 and down. And depending on where that attack occurs, determines 209 00:10:22.879 --> 00:10:26.240 what the human being experiences. So if the immune system 210 00:10:26.240 --> 00:10:29.399 attacks the nerve that runs the left eye, that human 211 00:10:29.480 --> 00:10:31.000 unfortunately is not going to see very well. And it's 212 00:10:31.039 --> 00:10:32.799 going to hurt like the dickens when they move their eye. 213 00:10:32.919 --> 00:10:35.679 It's called an optic neuritis. Or if the immune system 214 00:10:35.720 --> 00:10:38.519 attacks the spinal cord, then the legs may be numb 215 00:10:38.559 --> 00:10:40.600 and tingly or weak, and the down theres the bow 216 00:10:40.639 --> 00:10:43.039 bladder bedroom part of our bodies don't work very well. 217 00:10:43.320 --> 00:10:45.679 So in a nutshell, that's how I like to try 218 00:10:45.679 --> 00:10:47.759 to help introduce MS to somebody. 219 00:10:48.080 --> 00:10:50.879 And so with MS, there are said to be different subtypes. 220 00:10:51.080 --> 00:10:54.000 There's relapsing remitting, which means it can come and go 221 00:10:54.240 --> 00:10:59.080 in severity or episodes. There's primary progressive, which means kind 222 00:10:59.120 --> 00:11:03.480 of a stable worsening of symptoms and lesions, and secondary 223 00:11:03.519 --> 00:11:07.440 progressive can relapse and remit, but gradually does worsen. And 224 00:11:07.480 --> 00:11:10.960 these classifications have changed over the years since my mom 225 00:11:11.039 --> 00:11:14.519 was diagnosed, which gets confusing, but my family always kept 226 00:11:14.559 --> 00:11:16.480 an eye out because we would hear that there were 227 00:11:16.480 --> 00:11:20.399 different clinical trials for different types, or certain medications were 228 00:11:20.399 --> 00:11:23.840 only recommended for, say, relapsing remitting, and my mom has 229 00:11:23.919 --> 00:11:24.879 primary progressive. 230 00:11:25.480 --> 00:11:29.360 So there are different camps of MS neurologists. I'm in 231 00:11:29.440 --> 00:11:33.759 the camp I believe it's actually one condition with different phenotypes. Oh, okay, 232 00:11:33.840 --> 00:11:36.480 although you could talk to somebody else who would say nuh, 233 00:11:36.519 --> 00:11:38.720 you know, but you're stuck talking to me. And when 234 00:11:38.759 --> 00:11:42.039 we talk about primary progressive MS, what we're really saying 235 00:11:42.120 --> 00:11:46.399 is the human being, typically around their forties, started to 236 00:11:46.440 --> 00:11:49.600 have a slow, steady decline and neurological function and they 237 00:11:49.639 --> 00:11:53.399 never had any clear cut so called attacks where they 238 00:11:53.440 --> 00:11:55.559 got really bad over a couple days and then it 239 00:11:55.639 --> 00:11:58.279 lasted for a couple of weeks, and we call that 240 00:11:58.679 --> 00:12:03.720 primary progressive MS. If the human instead had a so 241 00:12:03.799 --> 00:12:08.559 called attack flare, exacerbation, relapse first, and that's where you 242 00:12:08.639 --> 00:12:10.600 lose a neurological function and you try to hide it 243 00:12:10.600 --> 00:12:12.039 from your family, and after a couple days you got 244 00:12:12.159 --> 00:12:14.360 to come clean, like you can't fill your leg. Well. 245 00:12:14.440 --> 00:12:17.720 Then we call that a relapse, and that person is 246 00:12:17.759 --> 00:12:20.679 said to have relapsing forms of MS. Here's the thing. 247 00:12:21.200 --> 00:12:24.759 If you follow the relapsing MS patient ten years, they 248 00:12:24.840 --> 00:12:28.039 start to have a progression of disability, which perfectly matches 249 00:12:28.279 --> 00:12:31.679 primary progressive MS. So there are those of us that 250 00:12:31.759 --> 00:12:35.320 believe that the form frust of MS is this slow 251 00:12:35.320 --> 00:12:40.000 study decline and that some patients skip or avoid the 252 00:12:40.360 --> 00:12:43.399 early relapsing phase, which is kind of like noise on 253 00:12:43.480 --> 00:12:45.480 top of the actual real disease. 254 00:12:46.000 --> 00:12:46.399 Got it. 255 00:12:46.440 --> 00:12:49.919 And that's a concept that is not ubiquitously accepted by 256 00:12:49.960 --> 00:12:53.360 all MS neurologists. But you know they're wrong. 257 00:12:54.759 --> 00:12:58.399 What about the eteology you mentioned, like your body or 258 00:12:58.639 --> 00:13:03.679 immune system, it's overactive, it starts attacking neurological tissue and 259 00:13:04.039 --> 00:13:07.200 the multiple and multiple sclerosis, can you talk a little 260 00:13:07.200 --> 00:13:08.759 bit about what that means? 261 00:13:08.879 --> 00:13:13.159 Absolutely? So the word sclerosis is Greek for scar, because 262 00:13:13.159 --> 00:13:15.240 god forbid we use like standard language. It would be 263 00:13:15.240 --> 00:13:18.320 way too easy for everybody to UNDERSTANDS. So multiple sclerosis 264 00:13:18.399 --> 00:13:20.519 is really a reference to back in the ancient days 265 00:13:20.519 --> 00:13:22.919 of yesteryear, where people did like autazis and they would say, 266 00:13:22.960 --> 00:13:26.879 oh my gosh, there are multiple scars here. So if 267 00:13:26.919 --> 00:13:30.600 you think about our understanding of what causes MS is fledgling. 268 00:13:31.120 --> 00:13:33.799 So what we think happens in MS is not a 269 00:13:33.919 --> 00:13:38.000 classic genetic condition. So most people listening might think of 270 00:13:38.080 --> 00:13:41.039 like a genetic condition as like cystic fibrosis or like 271 00:13:41.080 --> 00:13:43.639 sickle cell anemia, where if you have it, a certain 272 00:13:43.679 --> 00:13:46.200 number of your kids are gonna have it, and in 273 00:13:46.399 --> 00:13:49.480 MS it's not so straightforward. But what it does mean 274 00:13:49.559 --> 00:13:53.320 is you probably have certain haplotypes of genes that encode 275 00:13:53.360 --> 00:13:56.200 for your immune system that you share with that greater population. 276 00:13:57.279 --> 00:14:00.759 Then we believe that there's certain environmental risks factors which 277 00:14:00.840 --> 00:14:04.679 might increase or decrease giving humans risk to develop MS. 278 00:14:05.120 --> 00:14:09.200 For example, exposure to smoke, so firsthand or secondhand smoke 279 00:14:09.320 --> 00:14:12.320 can literally double an individual's risk to develop MS. 280 00:14:12.480 --> 00:14:12.960 Wow. 281 00:14:13.159 --> 00:14:17.000 And so low levels of vitamin D pre puberty also 282 00:14:17.159 --> 00:14:20.879 changed the risk. We then think that your body sees 283 00:14:20.919 --> 00:14:23.320 an infection and we think we've nailed it down to 284 00:14:23.639 --> 00:14:29.120 the kissing flu to you know, mononucleosis EBV. Yeah, and 285 00:14:29.480 --> 00:14:32.879 your body contracts EBV and your immune system identifies it 286 00:14:32.879 --> 00:14:35.279 as a bad guy, and your immune system makes an 287 00:14:35.440 --> 00:14:38.840 arsenal of T cells in B cells that make antibodies 288 00:14:38.879 --> 00:14:39.720 against EBV. 289 00:14:40.000 --> 00:14:42.360 Okay, So it's like Mono, you're out of here. I 290 00:14:42.480 --> 00:14:45.480 got you. Yeah, and I had Mono that landed me 291 00:14:45.559 --> 00:14:46.279 in the hospital. 292 00:14:46.480 --> 00:14:50.720 So amen, yep, that's exactly right. And so you survived 293 00:14:50.759 --> 00:14:54.200 mono because your immune system cleared it, and you keep 294 00:14:54.320 --> 00:14:56.639 an arsenal against mono the rest of your life. But 295 00:14:56.799 --> 00:15:00.600 in some people, those same cells that identify mono by 296 00:15:00.679 --> 00:15:04.639 accident now identify your brain as mono, and so that's 297 00:15:04.679 --> 00:15:07.840 called cross reactivity, like where the antibody binds to something 298 00:15:07.840 --> 00:15:10.440 it's not supposed to, and when that happens, when that 299 00:15:10.480 --> 00:15:12.559 gets set up, we don't know how to undo it. 300 00:15:13.080 --> 00:15:16.039 Now it's really a little bit interesting because we've known 301 00:15:16.120 --> 00:15:19.960 that mono could have potentially been requisite to develop MS. 302 00:15:20.440 --> 00:15:22.840 But they did a really cool study with the Veteran's 303 00:15:22.840 --> 00:15:27.159 Administration Hospital with ten million Americans, like a lot of Americans, 304 00:15:27.519 --> 00:15:29.879 and what they found was ninety five percent of that 305 00:15:29.919 --> 00:15:32.279 population has been exposed to mono. You have, I have, 306 00:15:32.919 --> 00:15:36.519 but of the eight hundred people in the study with MS, 307 00:15:36.919 --> 00:15:39.080 all of them but one had been exposed to mono, 308 00:15:39.240 --> 00:15:43.759 And so those numbers are actually highly statistically significant, and 309 00:15:43.799 --> 00:15:47.399 it sort of reinforces this concept that mono may be 310 00:15:47.559 --> 00:15:51.519 a requirement to develop MS. Now, that doesn't mean that 311 00:15:51.559 --> 00:15:54.080 a pasty white kid who was around some smoke and 312 00:15:54.159 --> 00:15:55.960 didn't have a high vitamin D and got mono is 313 00:15:55.960 --> 00:15:58.799 going to get MS, not at all. But as we understand, 314 00:15:58.840 --> 00:16:01.639 those are the steps that are probably involved in later 315 00:16:01.679 --> 00:16:03.159 on going on to develop MS. 316 00:16:03.480 --> 00:16:05.519 Well, you know, I'm wondering too, because you mentioned Richard 317 00:16:05.519 --> 00:16:08.600 Pryor I'm thinking Montel Williams. Obviously it's not just people 318 00:16:08.600 --> 00:16:13.480 of European descent. But if you're genetically historically have evolved 319 00:16:13.480 --> 00:16:16.960 to handle high amounts of UV radiation and then say 320 00:16:17.200 --> 00:16:20.600 your family gets stolen and moved to a different continent 321 00:16:20.600 --> 00:16:23.840 and you live in you know, Michigan or something, to 322 00:16:24.000 --> 00:16:28.080 those levels of vitamin D not being really on par 323 00:16:28.200 --> 00:16:30.559 with what your evolution has been, like, like, does that 324 00:16:30.600 --> 00:16:31.399 have any correlation. 325 00:16:31.960 --> 00:16:35.360 It's a really interesting discussion. You know, I was trained 326 00:16:35.480 --> 00:16:38.440 in Detroit, Michigan, where there's a very large population of 327 00:16:38.480 --> 00:16:40.679 African Americans that live in Detroit, and as a result, 328 00:16:40.720 --> 00:16:43.159 there was a very large African American MS population that 329 00:16:43.200 --> 00:16:45.480 we saw. And when I was coming up through the ranks, 330 00:16:45.559 --> 00:16:48.480 I was taught incorrectly that MS was a disease of 331 00:16:48.559 --> 00:16:52.159 young white women and that ethnic minorities were less likely 332 00:16:52.240 --> 00:16:55.799 to develop MS. And that's false. And so it turns 333 00:16:55.799 --> 00:16:59.639 out that the percentages of MS amongst African Americans, Hispanic 334 00:16:59.639 --> 00:17:02.879 Americans are the same as white people. There's just more 335 00:17:02.919 --> 00:17:05.799 white people in the United States. Now, what's very very 336 00:17:05.880 --> 00:17:09.480 important is that unfortunately, if you are an ethnic minority 337 00:17:09.480 --> 00:17:12.799 and you get MS, the disease is driven faster, so 338 00:17:13.039 --> 00:17:15.240 after Americans with MS tend to have a much more 339 00:17:15.279 --> 00:17:18.559 aggressive disease course, Hispanic Americans tend to have a much 340 00:17:18.599 --> 00:17:22.039 more aggressive disease course, and that factors into our thinking 341 00:17:22.079 --> 00:17:23.960 about how aggressive we are with therapies, etc. 342 00:17:25.039 --> 00:17:28.359 Is that also have anything to do just with systemic 343 00:17:28.440 --> 00:17:30.960 factors like who has access to care and who is 344 00:17:30.960 --> 00:17:33.880 getting seen by doctors, who's getting listened to. 345 00:17:34.559 --> 00:17:37.079 It doesn't appear to be now. Of course, there are 346 00:17:37.359 --> 00:17:40.400 some very serious concerns about access to care which we 347 00:17:40.680 --> 00:17:43.200 I don't want to gloss over. However, there's some beautiful 348 00:17:43.200 --> 00:17:46.759 studies done mostly out of UCSF which try to parse 349 00:17:46.839 --> 00:17:51.000 that out in separate from those issues just the ethnicity alone, 350 00:17:51.039 --> 00:17:54.000 there is a difference in severity of disease even when 351 00:17:54.039 --> 00:17:56.799 you parse out like socioeconomic things and the like. 352 00:17:57.079 --> 00:18:00.000 And for anyone living with MS, where is the fatigue 353 00:18:00.079 --> 00:18:02.960 coming from? Well, for people who don't have MS, Aaron 354 00:18:03.000 --> 00:18:06.119 helps visualize what it's like to be in their shoes. 355 00:18:06.640 --> 00:18:08.559 So if you and I were to go for a 356 00:18:08.680 --> 00:18:12.440 stroll and I attached weights to your feet and you 357 00:18:12.599 --> 00:18:14.799 kept time with me, so we're walking in step together 358 00:18:15.400 --> 00:18:17.279 at the end of our stroll and you finished at 359 00:18:17.279 --> 00:18:19.960 the same time I did. You're exhausted, way more tired 360 00:18:19.960 --> 00:18:22.519 than I am, because you were dragging weights behind the 361 00:18:22.519 --> 00:18:25.519 whole time we were walking. When you look at where 362 00:18:25.599 --> 00:18:28.599 the brain damage occurs in the setting of multiple sclerosis, 363 00:18:29.119 --> 00:18:32.440 it's most commonly in the so called white matter. Now, 364 00:18:32.480 --> 00:18:35.160 the white matter are the wires connecting the parts of 365 00:18:35.200 --> 00:18:38.720 the computer. So when one side of the brain, the cortex, 366 00:18:38.799 --> 00:18:41.960 the thinking part, wants to communicate with the other side, 367 00:18:42.079 --> 00:18:45.400 it sends electrical messages through the wires the white matter. 368 00:18:46.000 --> 00:18:49.720 And when you have new lesions that's a doctor term 369 00:18:49.759 --> 00:18:52.000 for like the white spot, the area of brain damage 370 00:18:52.000 --> 00:18:55.319 that you can see on the MRI, the brain rewires 371 00:18:55.480 --> 00:18:58.720 around it. Oh and so yeah, what ends up happening 372 00:18:58.799 --> 00:19:01.799 is the brain repairs itself to the best of its ability, 373 00:19:01.839 --> 00:19:04.440 and the human being can continue to do whatever function 374 00:19:04.480 --> 00:19:07.359 that is, but they use a boatload more brain to 375 00:19:07.359 --> 00:19:10.400 get the job done. To make that point, A long 376 00:19:10.400 --> 00:19:13.119 time ago, I was an assistant professor at a university 377 00:19:13.400 --> 00:19:15.640 and we were doing a really cool study where we 378 00:19:15.759 --> 00:19:18.599 put people into a functional MRI machine and we have 379 00:19:18.720 --> 00:19:22.079 them wiggle their finger and if a quote healthy control 380 00:19:22.119 --> 00:19:25.200 wiggle their finger. You would see the contralateral motor cortex 381 00:19:25.279 --> 00:19:28.160 light up like in the textbook, like normal stuff. When 382 00:19:28.160 --> 00:19:30.880 someone with MS wiggled their finger, both sides of the 383 00:19:30.880 --> 00:19:33.640 brain lit up like a Christmas tree. They were using 384 00:19:33.839 --> 00:19:36.960 tremendous amounts of brain to get the job done. Now, 385 00:19:37.160 --> 00:19:39.359 many of them were able to do it just as fast, 386 00:19:39.400 --> 00:19:42.880 just as accurately as a healthy control. But coming back 387 00:19:42.920 --> 00:19:45.720 to this fatigue thing, it's my opinion, at least to 388 00:19:45.799 --> 00:19:48.240 some degree, that the reason that someone with MS suffers 389 00:19:48.240 --> 00:19:51.000 from such profound fatigue the most common symptom in MS, 390 00:19:51.480 --> 00:19:53.440 is because in order for them to get the job done, 391 00:19:53.480 --> 00:19:56.400 they're using a lot more brain. You know, they're using 392 00:19:56.440 --> 00:19:57.480 a lot more real estate. 393 00:19:58.319 --> 00:20:00.039 Which is such a good point. I think when we reach 394 00:20:00.119 --> 00:20:04.279 about chronically ill people and disabled folks who have what's 395 00:20:04.319 --> 00:20:08.599 called invisible illness, they're wiggling their figure, but they can't 396 00:20:08.599 --> 00:20:11.160 do it for longer, and no one understands exactly what 397 00:20:11.200 --> 00:20:13.200 it's taking for them. They might not understand my mom 398 00:20:13.240 --> 00:20:16.640 probably doesn't understand exactly how much brain power she's using 399 00:20:16.680 --> 00:20:17.359 to get through a day. 400 00:20:17.960 --> 00:20:19.759 It's such a good point. I'm really glad that you 401 00:20:19.839 --> 00:20:22.559