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Introduction: In our ongoing efforts to educate and communicate, we feature our healthcare providers in conversation on Shepherd Center Radio. Here's Melanie Cole.

Melanie Cole: Welcome to Shepherd Center Radio I'm Melanie Cole. And today we're debunking common myths about multiple sclerosis. Joining me is Dr. Jacqueline Rosenthal. She's a Neurologist at Andrew C Carlos Multiple Sclerosis Institute with Shepherd Center. Dr. Rosenthal, it's a pleasure to have you with us today before we get into some myths and debunking them. Tell us a little bit about what MS is. Do we know the cause, the different types? Give us just a brief overview.

Dr. Rosenthal: So multiple sclerosis is an autoimmune condition where the central nervous system, the brain and the spinal cord are affected that can cause various symptoms. And there are a couple of different types of multiple sclerosis, mainly relapsing remitting, MS. Which is the most common type of MS. And that type patients tend to present with episodes of symptoms that will occur and then may improve partially or completely afterwards. And then there's also a progressive type of MS. Whereby symptoms are really sort of just progressing over time from the very onset of the disease.

Host: So, then let's clear up some myths because someone gets a diagnosis. It can be very, very scary. And for other people that don't really understand the condition again, it can be very scary. So let's clear up some of these myths and the first one is that it's a fatal or terminal disease.

Dr. Rosenthal: That's unfortunately a common myth that is out there. And the truth is that it's usually nearly all the time, not majority of folks with multiple sclerosis have a normal lifespan. So while in very rare cases of multiple sclerosis, there can be a risk of death just in the sense of a higher risk of death occurring in the sense of some of the complications that can occur in severe MS. The vast majority of people with MS do experience a normal lifespan.

Host: Let's just kind of go through this list. Another one that I've heard a lot is that it always causes significant physical disabilities and that everyone with MS eventually ends up in a wheelchair, right?

Dr. Rosenthal: That's another really common myth. And the truth is that the majority of people with MS, do not end up in a wheelchair and do not have any significant gait impairment. And it's really hard sometimes when you have MS to remember that the symptoms and disease course that you may experience is going to be completely different from someone else with MS. It's such a variable disease, and you really can't compare your symptoms to anyone else's because it's just always different. Different symptoms are involved, different severity of symptoms, different frequency of symptoms. And so the other thing to in mind is that the treatments for MS have changed significantly over the past 10, 20 years. And so we are really good now at, you know, shutting down MS with regard to relapses and trying to prevent additional symptoms from accruing. And so when patients are able to come in, especially early on and get on treatment, a lot of the time they are able to lead a fairly normal life with regard to how they are able to get around and function, working, family, and a lot of other various like functional activities.

Host: You answered a couple of the other myths in that answer. And thank you so much, Dr. Rosenthal, that MS is the same for everyone, which you just said, it's not. And you talked about how recently there's really been an explosion of new treatments. Tell us about the myth that there are no cures or effective treatments for MS.

Dr. Rosenthal: So right. You know, there, there is no cure for MS right now, meaning that we can't make the disease completely go away. It is something that, you know, as a patient you would have to live with, but that doesn't mean that we can't stop the symptoms and treat the symptoms. And so again, we have medications that are really good at, and often times, for a lot of patients stopping MS attacks. We also have treatment for MS symptoms. So, you know, when we look at MS treatment, there's, you know, one category is disease modifying treatments where we are trying to prevent someone from accruing additional lesions and demodulating attacks. And then sometimes when someone has symptoms from prior attacks, whether it be pain or spasticity we have symptoms for that as well. And that's really to just help someone to feel better, quality of life issues. So we really are equipped to address a lot of these. And for that reason, absolutely. It's a big myth that we don't have treatment cause we certainly do.

Host: And what about for women with MS? Can they have children or should they not have children if they have MS?

Dr. Rosenthal: Right. And so this is another important issue that I like to address with a lot of my patients and it comes up a lot just because, you know, a lot of women are of that age, childbearing age when they maybe first diagnosed. And again, that's another myth. And so women can get pregnant with MS. Having MS in and of itself is not going to cause harm to your child. It just takes planning. It's something that, you know, we encourage families to discuss with their neurologist. The truth of the matter is that when during pregnancy women with MS tend to do well, the immune system wants to behave a little better. And so they do pretty well off of treatment it's during the few months following delivery that sometimes the MS can become a little bit more active. And so that's when, again, you know, with really good communication between the patient and the neurologist pregnancy is something that can be achieved and the MS can be controlled.

Host: Well along those lines, then some people feel if they have MS. They can not have a sex life. And you've just debunked that myth. Yes?

Dr. Rosenthal: Correct.

Host: So now I've heard other ones that treatment isn't necessarily needed for milder cases, is that true?

Dr. Rosenthal: In rare cases that may be true. And again, that kind of goes along with the myth that MS is the same for everyone. I try, you know, I tell patients that sometimes MS can be extremely mild with such infrequent symptoms that you may look back after so many years and you have to ask yourself, do I even have this disease? And that's possible. It can be, you know, very, very mild in that regard. And then on the other hand, it can be very aggressive with a lot of symptoms. Now, the vast majority of people do require treatment, but in rare cases, if the disease is very inactive treatment may not be required. If you're able to show through monitoring that there hasn't been any additional symptoms. And then on the other hand, as well, sometimes after someone has had MS for quite some time the MS in itself doesn't really present with as many symptoms. And for that reason, treatments may not be required at that time, but it's a very individualized topic that needs to be taken on a case by case basis.

Host: Well, thank you for that answer. So what about having an exacerbation? Does that mean your medication or your treatment is no longer working?

Dr. Rosenthal: It would be for some people, and again, and I keep saying this over and over again, that, you know, we look at everything individually. Some people who have maybe very active disease, where they're having a lot of relapses in a short period of time with treatment, they may go from having, you know, five or six relapses a year to less than one. And in which case you may say that the treatment is working. And on the other hand, someone may not have relapses it's frequently. And so when they do have one that is maybe a little bit of a stronger indication to change treatments. None of the medications are perfect, so it is possible to still have disease activity while you are on treatment. The main purpose again, is to reduce it. And our goal was always to stop it completely. We have enough, I would say, you know, disease modifying treatments that are available now, where I, you know, a lot of providers, their threshold to change treatments is a lot lower than it has been in the past.

Host: So as we wrap up, I'd love for you because I'm so glad that you cleared up so many of those important myths, I'd love for you to discuss maintaining a healthy lifestyle, living with MS, and what patients can expect as far as living that lifestyle, managing their expectation? And what you feel it's important for them to know about exercise nutrition and managing their mental health?

Dr. Rosenthal: Right. Those are all really important with MS. You know, I talked about symptomatic management and disease modifying treatment, but wellness is another important aspect of treatment and quality of life. And so we absolutely encourage our patients to exercise. That's probably one of the most important things you can do for yourself. There are so many benefits associated with it. It can certainly help with symptoms like having low energy, it could also help with mood and fatigue and just mobility. And so we absolutely encourage our patients to do that. And then, you know, another myth that's sometimes associated with MS is that you shouldn't exercise. And again, we want people to do that obviously within measures that are safe. So that's important. With regard to diet right now, there's so much literature out there about different diets that have been looked at for multiple sclerosis. At this point, we really just encourage patients to eat a heart healthy diet. And then the last thing I think you mentioned was with regard to mood, and that is another important factor that we address with our MS Patients. There is a higher incidence of mood disorders that we will see in MS Patients. And we know that when we address those people tend to do better. It also relates to kind of how active you are. It's important that patients, you know, try to stay socially active, whether it's, you know, through work or volunteering again, that all contributes to just wellness and quality of life.

Host: And do you have any final thoughts, give us some hope, maybe some research that you know about as far as looking forward to the future for people living with MS.

Dr. Rosenthal: Absolutely. I think one of the biggest areas of research that we are really interested in right now is looking at a way to repair. Again, like I mentioned, we're PR you know, we're good at treating some of the symptoms and trying to stop attacks, but we don't really have a good way to go back and fix areas that have been damaged previously. And so looking at, you know, different literature, there's different studies that have been looking at re myelination that definitely is giving us some hope. That's again, an area of MS, which we don't have adequate treatment for, but folks are really working hard toward this. And I'm hopeful that eventually that will be something that we are able to offer to patients as well.

Host: Thank you so much, Dr. Rosenthal for joining us today and sharing with us some real good facts about MS and giving us hope for the future. Thank you again. And that wraps up this episode of Shepherd Center Radio, please visit our website at shepard.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Shepherd Center Podcasts. I'm Melanie Cole.