Multiple Sclerosis – Transcript
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[00:00:00] Pete Waggoner: This is Neurology Now, the podcast that explores the fascinating and complex world of neurology. Join us as we explore the human brain and beyond with expert guests who share their knowledge and insights. Welcome to the Neurology Now podcast.
[00:00:16] Pete Waggoner: On today’s show, we welcome in Dr. Jessica L. Stulc for the Minneapolis Clinic of Neurology.
[00:00:24] Pete Waggoner: Dr. Stulc specializes in multiple sclerosis and other neurological inflammatory conditions. Dr. Stulc, we had a nice chat before this podcast started, so I know you’re busy with a lot of things that you’re doing with patients and having some great things happen. So thanks for joining us here today and taking your time.
[00:00:43] Jessica Stulc: Yeah, happy to be here. Excited to talk about Multiple Sclerosis today.
[00:00:47] Pete Waggoner: Well, there’s so many things to get into and so many exciting things that are happening around it too, as well. And you know, before we get there, I’d just like to kind of talk a little bit about you. What drove you to this area of the [00:01:00] practice and why does it matter to you?
[00:01:02] Jessica Stulc: You know, when I was in neurology doing my neurology training, I initially thought that I wanted to do stroke. And that was because of all the exciting research around stroke. But I liked having the relationship with my patients. And lots of times in stroke, you see them in the hospital, but lots of times as the neurologist, you’re not the one who follows with them as an outpatient.
[00:01:27] Jessica Stulc: That lots of times ends up being more of their primary care doctor with the management. And I was a little bit worried I would miss that. And so in talking with my professors, they kind of said, oh, there’s a lot of research happening with MS. Why don’t you come be a part of the clinical trial and be one of the MS writers?
[00:01:45] Jessica Stulc: And that was actually one of my first exposures. And so it was really exciting with some of the development that was already happening, even back during my training. The other kind of thing I realized that I had to feel comfortable with the disease process is even though [00:02:00] there’s a lot of advancements that were really able to help our patients suffering with the disease, I also realized that you had to be comfortable with just meeting at people where they were and helping with them sometimes saying, Hey, sometimes I really don’t have a pill or something to fix this, but we can work through ways to how to make your quality of life better, even if I might not be able to fix everything completely.
[00:02:23] Jessica Stulc: And being comfortable with that as a physician is something that, you know, I kind of realize that you have to also manage the patient’s expectations in terms of where can I meet you to help you, even if we might not have all the technology available today.
[00:02:41] Pete Waggoner: So, and we’ll get into that deeper too about how things have evolved and how things are working, which is outstanding.
[00:02:47] Pete Waggoner: But let’s kind of get into what Multiple Sclerosis (MS) is. And how it does affect the nervous system. I know a lot of what’s discussed is neurological inflammation. Can you kind of just start from the very [00:03:00] beginning and say, what really is that? And then get into the next part of the question.
[00:03:05] Jessica Stulc: So multiple sclerosis is an autoimmune demyelinating disorder of the central nervous system.
[00:03:14] Jessica Stulc: So, okay, we’ll break that down. So autoimmune meaning your immune system gets confused and attacks things it shouldn’t. So kind of like an allergy, your immune system thinks a peanut is dangerous and an autoimmune disorder, your immune system thinks yourself is dangerous. So what does the immune system thinks is dangerous in multiple sclerosis?
[00:03:38] Jessica Stulc: So the next word is demyelinating. So it attacks the myelin sheath in your central nervous system. So the myelin sheath is the specific connection that helps your nerves talk to each other.
[00:03:53] Jessica Stulc: So I kind of like to think of it as kind of a coating on a wire. So that’s kind of in [00:04:00] your nervous system, as kind of that electrical system. And the myelin is what helps those signals get from one place to another.
[00:04:07] Jessica Stulc: So when your immune system attacks that coating, it makes it so that the signals going from one place to another get disrupted. So those myelin sheaths are specifically located in your brain and spinal cord.
[00:04:22] Jessica Stulc: So to put it all together. It’s an autoimmune disease that it causes attacks or inflammation in the brain and spinal cord specifically affecting those myelin sheaths. Does that all make sense?
[00:04:35] Pete Waggoner: Absolutely. And you know what? You sparked another question. So here we go. So is there an event that could cause that? Is it genetic? Where does that begin and how does that occur?
[00:04:46] Jessica Stulc: So there’s kind of multiple risk factors in terms of we think increase your risk of developing MS. We think there’s both genetic and environmental risk factors. So in terms of the [00:05:00] genetic risk factors, like an identical twin.
[00:05:03] Jessica Stulc: So having the same genetics, an identical twin has about a 25% risk of also developing MS. First degree relative. So like a parent or a sibling only has about a 2%. So there is a lot of environmental risk factors that are kind of associated with the risk of developing MS too.
[00:05:25] Jessica Stulc: Some of the environmental risk factors are both kind of exposure to other potential immune pathogens. So like, for example, there’s been a lot of news coverage this year, particularly about exposure to Epstein Barr in developing risk of multiple sclerosis.
[00:05:42] Jessica Stulc: The tricky piece of that as well, a lot of the population, over 90% of the population will test positive for Epstein-Barr, where obviously, not 90% of the population develops MS. But there’s a high correlation of that. You need to [00:06:00] had exposure to Epstein-Barr virus to develop ms.
[00:06:04] Jessica Stulc: We think actually having Epstein-Barr as in late in adolescence or adulthood, or having actual mono associated with your Epstein-Barr infection increases your risk of developing MS.
[00:06:18] Jessica Stulc: Actually having low levels of vitamin D increase your risk of developing MS. Obesity in childhood and adolescence increases your risk of developing MS. And so does smoking.
[00:06:30] Jessica Stulc: So it’s kind of a complex interplay of both environment and genetics. But there are some real things that you can do in terms of not smoking, making sure that you have normal vitamin D levels and kind of controlling weight.
[00:06:45] Jessica Stulc: And childhood can be, you know, as much as you can kind of do that in adolescence and kind of as an adult can help reduce your risk factors for developing MS.
[00:06:56] Pete Waggoner: Do you have at your fingertips a rough number or percentage of [00:07:00] the population that has MS?
[00:07:02] Jessica Stulc: Yeah. So nowadays both in terms of just increased risk, we’re doing a better job at labeling MS and diagnosing it. And then the prevalence just of autoimmune disorders in general has been going up. So right now in terms of in the United States, we’re kind of closer to a 1 million mark in terms of the number of people living with MS today.
[00:07:27] Jessica Stulc: Versus in the 1990s we almost like estimated closer to 300,000.
[00:07:33] Pete Waggoner: Wow.
[00:07:33] Jessica Stulc: So really, both the incidences going up and probably our ability to diagnose is improving.
[00:07:40] Pete Waggoner: So speaking of diagnosis that comes along with symptoms, what are some of the early symptoms signs? What are things people should be watching out for to come get looked at by you?
[00:07:51] Jessica Stulc: So like we were talking about with what is multiple sclerosis, it’s really a problem of signaling where communication in the brain and spinal cord [00:08:00] doesn’t get to the rest of the body. So lots of times those early symptoms can be very variable. People can have problems with numbness, tingling, weakness, bowel and bladder.
[00:08:10] Jessica Stulc: So it can be kind of variable. But one of the more common scenarios is when people have what we call a clinical attack or a relapse or an episode or an exacerbation, is lots of times the terminology that’s used. One of the more common episodes for clinical attacks is actually optic neuritis, where people can get inflammation in the eye that cause sudden vision loss.
[00:08:34] Jessica Stulc: Another common one is transverse myelitis, which means inflammation in the spinal cord. Which can cause weakness or numbness to either parts of the body, so like your hand or leg. So lots of people will kind of take, oh, I had numbness in my hand for a few days. It came on all of a sudden, and sometimes those episodes can actually go away fairly quickly and resolve themselves.
[00:08:57] Jessica Stulc: So lots of people in the beginning will think that, oh, [00:09:00] this was just a pinched nerve. And especially if the symptoms get better, they kind of go, oh, that went away. And don’t think much of them. Occasionally those attacks can persist where the damage to the nerve or that electrical signaling was severe enough that the attack, well, improves. That numbness never really goes away.
[00:09:19] Jessica Stulc: And lots of those times then that’s where they’ll seek medical attention. But I will say having numbness, tingling, weakness, those types of symptoms is not really normal. So at some point you should go in and be seen. Because even having a pinched nerve really isn’t normal. You should figure out what it is.
[00:09:37] Pete Waggoner: It’s easy to always kind of uh, just dismiss those things and say, ah, it’s just this, it’s just that. Mm-hmm. But it’s just a problem if you don’t go do something more about it, that becomes worse. One of the things that you hear that we’re made aware of is that it, it is unpredictable in nature. And there are different forms of MS. Can you go into those and talk about how they progress over time?
[00:09:57] Jessica Stulc: Yeah, and that’s kind of going back to [00:10:00] even how it presents. You know, some people can get those attacks or episodes, they can be more minor where, oh, I did just have some numbness and tingling that was only there for a couple weeks and got better.
[00:10:11] Jessica Stulc: Other people can have it be more dramatic where the numbness and weakness is so severe that they couldn’t walk or couldn’t lift their arm or leg, which is gonna obviously make them seek medical attention more quickly. Other people can have those attacks where they have one every few months, or it can be a few years in between.
[00:10:30] Jessica Stulc: So sometimes it’s really hard to put that story together and kind of see if there’s one unifying cause to the different symptoms people are having, especially when it can be vague symptoms, even like fatigue or some of these other things that can sometimes be hard to put together. But in terms of the types of multiple sclerosis, the most common form is what we call relapsing remitting, and about 80% of people with an MS diagnosis will be diagnosed with relapsing [00:11:00] remitting multiple sclerosis.
[00:11:01] Jessica Stulc: And that’s where you do get these sudden attacks. And the relapsing remitting to me has always been a little bit of a confusing term for patients to understand. Because it doesn’t mean that MS itself goes away or that the disease process goes away. It’s more talking about those symptoms that you get this acute onset, which is driven by that inflammation where your immune system is attacking your brain and spinal cord.
[00:11:27] Jessica Stulc: And then that acute inflammation can heal over time, but you do remain at risk to have another episode. So most people, in terms of, like I said, will be diagnosed with that relapsing remitting course, but those frequency of those events of having those episodes of that acute inflammation can vary from person to person.
[00:11:48] Jessica Stulc: We used to say that the natural history of multiple sclerosis was such that 10 to 15 years after a relapsing remitting diagnosis, you could enter more secondary [00:12:00] progressive MS. Which means that instead of having these acute attacks, Your symptoms just kind of gradually get worse, and that’s driven more by neurodegeneration where you’ve had enough nerve damage, where you kind of, it’s driven more by chronic nerve degeneration. Kind of your neuro reserve just can’t keep up. Versus acute inflammation of the attacks.
[00:12:26] Jessica Stulc: The good news today is now that we have drugs called disease modifying therapy that try to prevent those nerve, those clinical attacks from happening, which try to prevent more nerve damage from happening. So I kind of call those medications sunscreen. And right now, in terms of MS, our best prevention is putting your sunscreen on so you don’t get more nerve damage.
[00:12:51] Jessica Stulc: Kind of the way I explain it to patients is if we prevent sunburns, we don’t get as many wrinkles. And that’s kind of the way that I kind of [00:13:00] explain kind of the hope in terms of what we have for new treatments in multiple sclerosis.
[00:13:05] Pete Waggoner: I love it. So, you know, now we’re getting into a lot of the research and advanced understanding of all of this. And there are some promising treatments on the horizon, but we’ve got a little bit of an area to cover here because, you know, as we were mentioning before we jumped on the podcast, you were saying that as of 1990, there wasn’t really anything and the lifestyle was completely different prior to then.
[00:13:32] Pete Waggoner: And since then, especially over the last 10 years, but for let’s say a 30 to 33 year period, there’s been some huge advancements. Can you just open up the vault on that and share with us what you know and have?
[00:13:44] Jessica Stulc: Yeah, so we’ve really had this advancement in multiple sclerosis care with now multiple disease modifying therapies on the market with multiple different classes of disease modifying therapies.
[00:13:58] Jessica Stulc: So to kind of go back and [00:14:00] expand on what we were talking about before, so a disease modifying therapy is kind of named that because we hope that it does actually change the disease course in terms of multiple sclerosis.
[00:14:12] Jessica Stulc: The idea of most of the disease modifying therapies is they actually alter the immune system. And the idea there is that they change the immune system and that in such a way that we try to keep the immune system from attacking the brain and spinal cord.
[00:14:28] Jessica Stulc: So that’s really the hallmark of the treatment, is we try to prevent these clinical attacks or these episodes of inflammation from happening.
[00:14:37] Jessica Stulc: So they kind of work as a protector or kind of preventer from having more nerve damage happen down the road, which hopefully then prevents accumulation of disability in terms of the progression of chronic symptoms, in terms of the advancement in terms of the more progressive stages of MS.
[00:14:57] Pete Waggoner: So now this has vastly changed [00:15:00] the progression of someone’s lifestyle. Because it, you know, back when I grew up, we’d watch people end up in wheelchairs and then end up dying. And then now we’re aware of people that are living full lives, raising families, working their jobs, and doing their things.
[00:15:17] Pete Waggoner: I mean, the difference is astounding, isn’t it?
[00:15:20] Jessica Stulc: Yeah, and so that’s really a lot of my patients who come in with a new diagnosis. Obviously, the exposure that they’ve had through either, you know, friends or family members, or even just the media in terms of what does multiple sclerosis mean. When you get that news and when you get that label and when you’ve been having these symptoms that are scary and are affecting your ability of your body to function. Obviously it can be quite overwhelming as a new patient.
[00:15:49] Jessica Stulc: And I always have a discussion with them. What does this mean for you? And really the good news right now is in terms of the treatments that are available, really right now the [00:16:00] prognosis for most of our patients who are diagnosed with relapsing remitting disease is very good.
[00:16:05] Jessica Stulc: Most of our patients, we can get control within the first couple years, and the data right now is showing that if we get control within the first couple of years, your prognosis of preventing future disability and progression is very good.
[00:16:18] Jessica Stulc: And so right now, in terms of people, I kind of say, Hey, this isn’t a disease you really wanna sign up for. You don’t really want to be in my office. I get that. But in terms of now, it’s one that really, there’s a term that we use in research called NEDA.
[00:16:34] Jessica Stulc: No evidence of disease activity.
[00:16:36] Jessica Stulc: And before, that was kind of like, hmm, like this is not really a goal we should be shooting for. And now I tell patients that is my goal. Meaning I don’t see new lesions on an MRI, you are not experiencing new clinical symptoms, and we are not seeing new disability progression with you on your exam.
[00:16:56] Jessica Stulc: And really that is the goal that I hope we can achieve that or at [00:17:00] least try to achieve that for most of our patients.
[00:17:03] Pete Waggoner: That must be really an exciting thing for you having gone into this to know that you can look at this now based, you know, from when you first started this, to how you can say the things that you’re saying to your patients.
[00:17:16] Pete Waggoner: I don’t know. I think that must be fun to go to work every day.
[00:17:19] Jessica Stulc: Yeah, it is exciting, especially for patients who are diagnosed you know as a new diagnosis to be able to kind of, Hey, this can be a disease that you can live with the goals you wanted to do before.
[00:17:32] Jessica Stulc: My job is to help make sure that all those goals you want are still available to you. If you wanna raise a family, if you wanna have a career, if you wanna be active in sports. All of those are things that we can hope that we can still achieve.
[00:17:45] Jessica Stulc: You know, I do wanna talk a little bit about the people who are in the more advanced stages, who are already in progressive disease. Right now we’ve really made huge advancements with the disease modifying therapies, with having lots [00:18:00] more choices, having lots more effective therapies, having a lot of different options to make sure people can tolerate therapies.
[00:18:07] Jessica Stulc: But really right now there is a lot going on in terms of advancement of trying to help those people with the more progressive stages of the disease. And looking at can we actually, besides just preventing these attacks, can we actually remyelinate or can we actually repair.
[00:18:24] Jessica Stulc: So instead of just having a sunscreen, you know, can I actually have a form of like Aloe Vera that would help heal? And right now we don’t really have that, but there’s a lot of research going on to try to help with that and help the patients right now who are more advanced in their disease process.
[00:18:43] Jessica Stulc: Particularly right now, we’re actual hopeful is could we actually come up with an anti-wrinkle cream? So instead of just preventing lesions from forming, could we help slow that rate of progression when lesions aren’t forming, help prevent neurodegeneration from [00:19:00] happening from people who’ve already had nerve damage besides just remyelination and repair.
[00:19:58] Jessica Stulc: Right now, I kind of really [00:20:00] encourage patients to get on a disease modifying therapy early. Because that can really help change the progression of your disease long-term.
[00:20:08] Jessica Stulc: And so, you know, a lot of these medications can kind of sound scary because they do change your immune system and obviously just going through the pandemic. Here, I’m gonna lower your immune system while you’re, while we’re going through a global pandemic, you know?
[00:20:23] Jessica Stulc: But in terms of understanding those risks and benefits and now having a lot more options of the drugs available, I think has really give patients a lot more options and a lot more control and choice in their disease process.
[00:20:36] Pete Waggoner: What role does physical therapy play?
[00:20:39] Jessica Stulc: Yeah, you know, especially in terms of patients when we were talking about choice. You know, lots of times when you get one of these labels or diagnosis, you kind of feel like there’s things that you have to do to your body to stay well, and physical therapy is one of the things that you can do for your body to stay well.
[00:20:57] Jessica Stulc: And so it’s one of the things that patients can take [00:21:00] an active role in, in terms of really helping themselves, in terms of being able to help with both strengthening, stretching, balance, all of those things. When we talk about those pathways, it’s really the connection between the brain sending those signals to the rest of the body.
[00:21:17] Jessica Stulc: So for patients in terms of physical therapy, it really helps keep those connections going. If you don’t use those connections, that pathway can become weaker. So having those pathways be as strong as they can be can be really helpful.
[00:21:32] Jessica Stulc: Just to put a plugin at Minneapolis Clinic of Neurology, we actually have multiple physical therapists who’ve taken the time to get special certification and training in multiple sclerosis. To really be able to help our patients who come to our clinic.
[00:21:46] Jessica Stulc: Because there really is a lot of different modalities that are needed to help MS patients. Balance can be affected. So working on balance, working on stretching. You can get tight muscles when your muscles are weaker and that stretching can really [00:22:00] help with not only movement, but with management of pain.
[00:22:04] Jessica Stulc: And then also strengthening in terms of, so there’s lots of different ways that physical therapy can really help, not just with the mobility, but also even with pain and some of the other kind of chronic symptoms with dealing with MS.
[00:22:18] Pete Waggoner: Are these things that a patient would take with them to do at home or on their own?
[00:22:22] Jessica Stulc: Exactly. Lots of times physical therapy, it’s really education on how can you then take those resources and exercises and movements to incorporate them into your daily living. And that’s really where, you know, hey, that’s where the key is in terms of being able to do all those things on your own.
[00:22:41] Pete Waggoner: So you’ve mentioned some cognitive functional things and how it all interacts and I’m sure many people with MS experience some forms of cognitive changes as well.
[00:22:52] Pete Waggoner: Are there strategies to maintain that function cognitively and to deal with those challenges that may arise?
[00:22:58] Jessica Stulc: The most common symptoms [00:23:00] that multiple sclerosis patients face in terms of cognition are actually attention and processing speed. So in this world, you know, I just the other day had a patient kind of say like, oh, I ended up like leaving my groceries at the grocery store by the time I got to my car.
[00:23:16] Jessica Stulc: And I said, well, what were you doing when you were at the grocery store? I’m like, were you on your phone too? Yeah. You know, so in terms of, for a lot of patients, it’s just understanding what are all the different inputs that now we’re having to deal with?
[00:23:29] Jessica Stulc: Okay, now we’re trying to text while we’re also listening to music, while we’re also doing our banking, while we’re also checking out.
[00:23:37] Jessica Stulc: You know? So nobody was designed to function like that. And so for a lot of people, in terms of sometimes kind of just taking an assessment of how am I doing certain things in my life that maybe I wasn’t necessarily even doing those five to 10 years ago. And how can I simplify some of those tasks and how can I, you know, when I am having an important conversation, am I [00:24:00] actually having that face-to-face?
[00:24:02] Jessica Stulc: Are we sitting down? Are we doing it with intent? And so a lot of people, or having some cognitive struggles. Most people, they’re pretty mild. And actually looking at how can I make simple changes in my life to be more organized, to be more functional, and to tune out some of the multitasking that now has just become so commonplace can be really helpful.
[00:24:23] Jessica Stulc: We also have occupational therapy for people who need a little bit more help in kind of looking at some of those different things. And even formal neuropsych testing to kind of identify some of those strengths and weaknesses to kind of help people. But the biggest thing is kind of the key is to stay active in terms of you know, staying mentally fit, just the way staying physically fit.
[00:24:46] Pete Waggoner: It all plays together, doesn’t it? You know, you mentioned earlier about it’s not ideal to have to live with this, obviously. And that can bring on challenges physically and emotionally.
[00:24:56] Pete Waggoner: Are there coping strategies that you share with people [00:25:00] or resources that patients and families can use to manage the disease a little bit better?
[00:25:05] Jessica Stulc: Yeah, so I’ll put a plug in. Both the Multiple Sclerosis Society of America and the National MS Society have really great websites and resources for patients, families and caregivers. Both in terms of even just the broad spectrum of resources for patients and families. Even diet, exercise, management.
[00:25:25] Jessica Stulc: But for a lot of patients it is kind of being, you know, mentally connected, socially connected. All of those things you know, for a lot of people in terms of having control over their disease process in terms of their ability to function day to day.
[00:25:41] Jessica Stulc: And so for a lot of that it’s staying connected as an active member of their community, both in terms of being able to manage both, being able to be part of their family, part of their employer.
[00:25:52] Jessica Stulc: And obviously when you’re dealing with more challenges, being able to weigh all of that is hard. And so I think lots of times, you know, I even [00:26:00] talk about coming up with some things that, hey, how do you take time out?
[00:26:04] Jessica Stulc: Even, is it meditation? How do you manage stress and having a specific way to do that if it’s exercise and now that’s harder, what is a way that you can kind of come up?
[00:26:16] Jessica Stulc: And I think, that’s really important in terms of general health for a lot of people is coming up with some of those different particular coping strategies in terms of, how do you manage, trying to be an active, busy person, even also trying to be an active, busy person who also has a chronic health condition.
[00:26:35] Pete Waggoner: Are there any dietary things that play into this? I’m off the grid here. It’s not, I don’t know what we discussed, but I obviously, it seems to play such a key factor in so many things. Are there things that can help in this process or hurt with your diet?
[00:26:51] Jessica Stulc: So diet’s a real hot button issue in multiple sclerosis.
[00:26:56] Jessica Stulc: I think if you Google, you could probably see like the 30 top [00:27:00] bestselling books with multiple sclerosis, have some sort of diet included.
[00:27:05] Jessica Stulc: And so right now, in terms of ms, you can kind of make any sort of diet claim and you could kind of try to support it. But in terms of the best advice that I kind of give my patients, is, we had talked about that obesity can kind of be a risk factor for multiple sclerosis.
[00:27:22] Jessica Stulc: So number one is, weight loss can be good for multiple sclerosis. If you are kind of having some extra weight that you would need to lose. So that is good, especially if you are having some weakness, so that is a good goal to have.
[00:27:36] Jessica Stulc: The second one is just kind of what are some risk factors in terms of, affecting the immune system in terms of diet. Right now, what we have in terms of the best evidence for multiple sclerosis is low fat and low salt.
[00:27:51] Jessica Stulc: And so lots of times I talk about the DASH diet for my MS patients, which is the American Heart Association Diet, which kind of [00:28:00] focuses on low salt and low fat. Other things in terms of, lots of people will look for specific food triggers, gluten-free or some other different diets, and I kind of tell my patients if you feel better on those diets more power to you, but we have less evidence for more specialized diets.
[00:28:17] Jessica Stulc: Low salt, and low fat is what we have the best evidence for. So they’re even in animal models. Intermittent fasting has been shown to be helpful in MS. But for a lot of my patients who are more sensitive in terms of, you know, if you get muscle tone problems. Trying to do the intermittent fasting can be harder to implement for people.
[00:28:38] Jessica Stulc: So for a lot of my patients, I kind of say, Hey, let’s just keep it simple in the beginning. A healthier diet with more healthier food choices such as a Mediterranean diet or the DASH diet is what I have people start with.
[00:28:51] Pete Waggoner: There you go. That was what I probably suspected I would hear, but, the specifics is even better.
[00:28:56] Pete Waggoner: So advocacy and awareness play crucial [00:29:00] roles in all communities, such as MS. Obviously, there’s places people can go. How can they get involved in support for those that are affected by MS as actually the individual with it and family slash caregivers?
[00:29:14] Jessica Stulc: Yeah, so I already mentioned probably in our area in Minneapolis, the two societies that I kind of view as pretty active, the Multiple Sclerosis Society of America and the National MS Society. Both of them have events. There’s a bike ride across Minnesota, there’s walks. And so there is a lot of fundraising and a lot of those events both go directly towards research for advancement in terms of available treatment options, but also in terms of direct support of patients and their family.
[00:29:43] Jessica Stulc: For example, the Multiple Sclerosis Association of America helps with cost of MRIs for patients who can’t afford to have the MRIs to help with an aid in diagnosis and treatment options for patients.
[00:29:55] Jessica Stulc: So both of those funds both help in terms of both actually advancing research [00:30:00] and actually direct aid in terms of helping patients help with their medical costs and needs.
[00:30:06] Pete Waggoner: Great stuff there. Final question for you.
[00:30:09] Pete Waggoner: If you were to look out over your career, and we’ve somewhat talked about this in the early going, what are some of the biggest takeaways that you, Jessica, Dr. Stulc, have personally taken with you in this journey?
[00:30:24] Jessica Stulc: For me it’s really been seeing the change in terms of what’s been available for treatments. In the beginning, in the late 1990s, when drugs started to become available, it was really exciting for patients. But oftentimes, there were only a couple treatment options available.
[00:30:40] Jessica Stulc: So if you had side effects or had issues with those medications, and now really we have multiple, multiple drugs almost to the point where that conversation of which drug should I start can be overwhelming. And for me, lots of times with patients, I’m like, just pick one and then we can go from there. You can date it, you don’t have to marry [00:31:00] it.
[00:31:00] Jessica Stulc: And then I can worry about what we do next. And so lots of people, you know, it’s a good problem to have that we have choice now. But sometimes that choice can be overwhelming. But for me, for my patients, that’s kind of the statement of we now have drug available.
[00:31:15] Jessica Stulc: And to get on it early is really my recommendation. And to watch that change, I’ve now been at Minneapolis Clinical Neurology for nine years, and I’ve watched people come in with new diagnosis as very young, coming in and as a college aged kid. And I’ve now watched them finish college, get married, have kids, and have a career. And really not have progression of their disease process.
[00:31:41] Jessica Stulc: And watch them come in from when their parents were scared in terms of what they could do as the future. And now they’re coming in with their young kids going, Hey, what do we do next? Here we go. Yeah. You know, having this be old hat and really seeing that sea change in terms of this new generation that’s [00:32:00] had drug available.
[00:32:01] Jessica Stulc: And I think the hope on the horizon is for the generation prior. Can we help that generation that hasn’t had drug as early as the newer patients being diagnosed. And I think we are gonna come a long way in terms of helping people with the more progressive symptoms.
[00:32:18] Jessica Stulc: But right now what we got is we got the sunscreen and putting your sunscreen on early is still the best. Is still what we have for multiple sclerosis right now.
[00:32:27] Jessica Stulc: Really, in terms of our advancements of treatment, we’ve come a long way in a few years.
[00:32:34] Pete Waggoner: What’s been great is you are looking at the full scope of MS no matter where you’re at in the process. And it’s so encouraging to see how things have come together.
[00:32:44] Pete Waggoner: Dr. Stulc, you’re a professional, you’re really good at this, and it was great to have you on the show today.
[00:32:50] Pete Waggoner: Thanks for sharing all of your insights and experience and all the knowledge that you have and the things that you’re giving the patients is absolutely tremendous.
[00:32:58] Pete Waggoner: So thank you for joining us today. [00:33:00]
[00:33:00] Jessica Stulc: Yeah, thanks for having me.
[00:33:02] Pete Waggoner: It was a pleasure.
[00:33:03] Pete Waggoner: That’s gonna do it for today’s show. Thank you for joining us on this episode of Neurology Now. We hope you found it informative, engaging, and if you’ve enjoyed this episode, please subscribe to our podcast to stay up to date and help us educate our community and beyond.
[00:33:18] Pete Waggoner: We welcome your feedback, comments, and suggestions for future topics. So please feel free to reach out to us through our website or social media channels. That’s gonna do it for today’s show, for Dr. Stulc. I’m Pete Waggoner.
[00:33:30] Pete Waggoner: So long everybody.
[00:00:00] Pete Waggoner: This is Neurology Now, the podcast that explores the fascinating and complex world of neurology. Join us as we explore the human brain and beyond with expert guests who share their knowledge and insights. Welcome to the Neurology Now podcast.
[00:00:16] Pete Waggoner: On today’s show, we welcome in Dr. Jessica L. Stulc for the Minneapolis Clinic of Neurology.
[00:00:24] Pete Waggoner: Dr. Stulc specializes in multiple sclerosis and other neurological inflammatory conditions. Dr. Stulc, we had a nice chat before this podcast started, so I know you’re busy with a lot of things that you’re doing with patients and having some great things happen. So thanks for joining us here today and taking your time.
[00:00:43] Jessica Stulc: Yeah, happy to be here. Excited to talk about Multiple Sclerosis today.
[00:00:47] Pete Waggoner: Well, there’s so many things to get into and so many exciting things that are happening around it too, as well. And you know, before we get there, I’d just like to kind of talk a little bit about you. What drove you to this area of the [00:01:00] practice and why does it matter to you?
[00:01:02] Jessica Stulc: You know, when I was in neurology doing my neurology training, I initially thought that I wanted to do stroke. And that was because of all the exciting research around stroke. But I liked having the relationship with my patients. And lots of times in stroke, you see them in the hospital, but lots of times as the neurologist, you’re not the one who follows with them as an outpatient.
[00:01:27] Jessica Stulc: That lots of times ends up being more of their primary care doctor with the management. And I was a little bit worried I would miss that. And so in talking with my professors, they kind of said, oh, there’s a lot of research happening with MS. Why don’t you come be a part of the clinical trial and be one of the MS writers?
[00:01:45] Jessica Stulc: And that was actually one of my first exposures. And so it was really exciting with some of the development that was already happening, even back during my training. The other kind of thing I realized that I had to feel comfortable with the disease process is even though [00:02:00] there’s a lot of advancements that were really able to help our patients suffering with the disease, I also realized that you had to be comfortable with just meeting at people where they were and helping with them sometimes saying, Hey, sometimes I really don’t have a pill or something to fix this, but we can work through ways to how to make your quality of life better, even if I might not be able to fix everything completely.
[00:02:23] Jessica Stulc: And being comfortable with that as a physician is something that, you know, I kind of realize that you have to also manage the patient’s expectations in terms of where can I meet you to help you, even if we might not have all the technology available today.
[00:02:41] Pete Waggoner: So, and we’ll get into that deeper too about how things have evolved and how things are working, which is outstanding.
[00:02:47] Pete Waggoner: But let’s kind of get into what Multiple Sclerosis (MS) is. And how it does affect the nervous system. I know a lot of what’s discussed is neurological inflammation. Can you kind of just start from the very [00:03:00] beginning and say, what really is that? And then get into the next part of the question.
[00:03:05] Jessica Stulc: So multiple sclerosis is an autoimmune demyelinating disorder of the central nervous system.
[00:03:14] Jessica Stulc: So, okay, we’ll break that down. So autoimmune meaning your immune system gets confused and attacks things it shouldn’t. So kind of like an allergy, your immune system thinks a peanut is dangerous and an autoimmune disorder, your immune system thinks yourself is dangerous. So what does the immune system thinks is dangerous in multiple sclerosis?
[00:03:38] Jessica Stulc: So the next word is demyelinating. So it attacks the myelin sheath in your central nervous system. So the myelin sheath is the specific connection that helps your nerves talk to each other.
[00:03:53] Jessica Stulc: So I kind of like to think of it as kind of a coating on a wire. So that’s kind of in [00:04:00] your nervous system, as kind of that electrical system. And the myelin is what helps those signals get from one place to another.
[00:04:07] Jessica Stulc: So when your immune system attacks that coating, it makes it so that the signals going from one place to another get disrupted. So those myelin sheaths are specifically located in your brain and spinal cord.
[00:04:22] Jessica Stulc: So to put it all together. It’s an autoimmune disease that it causes attacks or inflammation in the brain and spinal cord specifically affecting those myelin sheaths. Does that all make sense?
[00:04:35] Pete Waggoner: Absolutely. And you know what? You sparked another question. So here we go. So is there an event that could cause that? Is it genetic? Where does that begin and how does that occur?
[00:04:46] Jessica Stulc: So there’s kind of multiple risk factors in terms of we think increase your risk of developing MS. We think there’s both genetic and environmental risk factors. So in terms of the [00:05:00] genetic risk factors, like an identical twin.
[00:05:03] Jessica Stulc: So having the same genetics, an identical twin has about a 25% risk of also developing MS. First degree relative. So like a parent or a sibling only has about a 2%. So there is a lot of environmental risk factors that are kind of associated with the risk of developing MS too.
[00:05:25] Jessica Stulc: Some of the environmental risk factors are both kind of exposure to other potential immune pathogens. So like, for example, there’s been a lot of news coverage this year, particularly about exposure to Epstein Barr in developing risk of multiple sclerosis.
[00:05:42] Jessica Stulc: The tricky piece of that as well, a lot of the population, over 90% of the population will test positive for Epstein-Barr, where obviously, not 90% of the population develops MS. But there’s a high correlation of that. You need to [00:06:00] had exposure to Epstein-Barr virus to develop ms.
[00:06:04] Jessica Stulc: We think actually having Epstein-Barr as in late in adolescence or adulthood, or having actual mono associated with your Epstein-Barr infection increases your risk of developing MS.
[00:06:18] Jessica Stulc: Actually having low levels of vitamin D increase your risk of developing MS. Obesity in childhood and adolescence increases your risk of developing MS. And so does smoking.
[00:06:30] Jessica Stulc: So it’s kind of a complex interplay of both environment and genetics. But there are some real things that you can do in terms of not smoking, making sure that you have normal vitamin D levels and kind of controlling weight.
[00:06:45] Jessica Stulc: And childhood can be, you know, as much as you can kind of do that in adolescence and kind of as an adult can help reduce your risk factors for developing MS.
[00:06:56] Pete Waggoner: Do you have at your fingertips a rough number or percentage of [00:07:00] the population that has MS?
[00:07:02] Jessica Stulc: Yeah. So nowadays both in terms of just increased risk, we’re doing a better job at labeling MS and diagnosing it. And then the prevalence just of autoimmune disorders in general has been going up. So right now in terms of in the United States, we’re kind of closer to a 1 million mark in terms of the number of people living with MS today.
[00:07:27] Jessica Stulc: Versus in the 1990s we almost like estimated closer to 300,000.
[00:07:33] Pete Waggoner: Wow.
[00:07:33] Jessica Stulc: So really, both the incidences going up and probably our ability to diagnose is improving.
[00:07:40] Pete Waggoner: So speaking of diagnosis that comes along with symptoms, what are some of the early symptoms signs? What are things people should be watching out for to come get looked at by you?
[00:07:51] Jessica Stulc: So like we were talking about with what is multiple sclerosis, it’s really a problem of signaling where communication in the brain and spinal cord [00:08:00] doesn’t get to the rest of the body. So lots of times those early symptoms can be very variable. People can have problems with numbness, tingling, weakness, bowel and bladder.
[00:08:10] Jessica Stulc: So it can be kind of variable. But one of the more common scenarios is when people have what we call a clinical attack or a relapse or an episode or an exacerbation, is lots of times the terminology that’s used. One of the more common episodes for clinical attacks is actually optic neuritis, where people can get inflammation in the eye that cause sudden vision loss.
[00:08:34] Jessica Stulc: Another common one is transverse myelitis, which means inflammation in the spinal cord. Which can cause weakness or numbness to either parts of the body, so like your hand or leg. So lots of people will kind of take, oh, I had numbness in my hand for a few days. It came on all of a sudden, and sometimes those episodes can actually go away fairly quickly and resolve themselves.
[00:08:57] Jessica Stulc: So lots of people in the beginning will think that, oh, [00:09:00] this was just a pinched nerve. And especially if the symptoms get better, they kind of go, oh, that went away. And don’t think much of them. Occasionally those attacks can persist where the damage to the nerve or that electrical signaling was severe enough that the attack, well, improves. That numbness never really goes away.
[00:09:19] Jessica Stulc: And lots of those times then that’s where they’ll seek medical attention. But I will say having numbness, tingling, weakness, those types of symptoms is not really normal. So at some point you should go in and be seen. Because even having a pinched nerve really isn’t normal. You should figure out what it is.
[00:09:37] Pete Waggoner: It’s easy to always kind of uh, just dismiss those things and say, ah, it’s just this, it’s just that. Mm-hmm. But it’s just a problem if you don’t go do something more about it, that becomes worse. One of the things that you hear that we’re made aware of is that it, it is unpredictable in nature. And there are different forms of MS. Can you go into those and talk about how they progress over time?
[00:09:57] Jessica Stulc: Yeah, and that’s kind of going back to [00:10:00] even how it presents. You know, some people can get those attacks or episodes, they can be more minor where, oh, I did just have some numbness and tingling that was only there for a couple weeks and got better.
[00:10:11] Jessica Stulc: Other people can have it be more dramatic where the numbness and weakness is so severe that they couldn’t walk or couldn’t lift their arm or leg, which is gonna obviously make them seek medical attention more quickly. Other people can have those attacks where they have one every few months, or it can be a few years in between.
[00:10:30] Jessica Stulc: So sometimes it’s really hard to put that story together and kind of see if there’s one unifying cause to the different symptoms people are having, especially when it can be vague symptoms, even like fatigue or some of these other things that can sometimes be hard to put together. But in terms of the types of multiple sclerosis, the most common form is what we call relapsing remitting, and about 80% of people with an MS diagnosis will be diagnosed with relapsing [00:11:00] remitting multiple sclerosis.
[00:11:01] Jessica Stulc: And that’s where you do get these sudden attacks. And the relapsing remitting to me has always been a little bit of a confusing term for patients to understand. Because it doesn’t mean that MS itself goes away or that the disease process goes away. It’s more talking about those symptoms that you get this acute onset, which is driven by that inflammation where your immune system is attacking your brain and spinal cord.
[00:11:27] Jessica Stulc: And then that acute inflammation can heal over time, but you do remain at risk to have another episode. So most people, in terms of, like I said, will be diagnosed with that relapsing remitting course, but those frequency of those events of having those episodes of that acute inflammation can vary from person to person.
[00:11:48] Jessica Stulc: We used to say that the natural history of multiple sclerosis was such that 10 to 15 years after a relapsing remitting diagnosis, you could enter more secondary [00:12:00] progressive MS. Which means that instead of having these acute attacks, Your symptoms just kind of gradually get worse, and that’s driven more by neurodegeneration where you’ve had enough nerve damage, where you kind of, it’s driven more by chronic nerve degeneration. Kind of your neuro reserve just can’t keep up. Versus acute inflammation of the attacks.
[00:12:26] Jessica Stulc: The good news today is now that we have drugs called disease modifying therapy that try to prevent those nerve, those clinical attacks from happening, which try to prevent more nerve damage from happening. So I kind of call those medications sunscreen. And right now, in terms of MS, our best prevention is putting your sunscreen on so you don’t get more nerve damage.
[00:12:51] Jessica Stulc: Kind of the way I explain it to patients is if we prevent sunburns, we don’t get as many wrinkles. And that’s kind of the way that I kind of [00:13:00] explain kind of the hope in terms of what we have for new treatments in multiple sclerosis.
[00:13:05] Pete Waggoner: I love it. So, you know, now we’re getting into a lot of the research and advanced understanding of all of this. And there are some promising treatments on the horizon, but we’ve got a little bit of an area to cover here because, you know, as we were mentioning before we jumped on the podcast, you were saying that as of 1990, there wasn’t really anything and the lifestyle was completely different prior to then.
[00:13:32] Pete Waggoner: And since then, especially over the last 10 years, but for let’s say a 30 to 33 year period, there’s been some huge advancements. Can you just open up the vault on that and share with us what you know and have?
[00:13:44] Jessica Stulc: Yeah, so we’ve really had this advancement in multiple sclerosis care with now multiple disease modifying therapies on the market with multiple different classes of disease modifying therapies.
[00:13:58] Jessica Stulc: So to kind of go back and [00:14:00] expand on what we were talking about before, so a disease modifying therapy is kind of named that because we hope that it does actually change the disease course in terms of multiple sclerosis.
[00:14:12] Jessica Stulc: The idea of most of the disease modifying therapies is they actually alter the immune system. And the idea there is that they change the immune system and that in such a way that we try to keep the immune system from attacking the brain and spinal cord.
[00:14:28] Jessica Stulc: So that’s really the hallmark of the treatment, is we try to prevent these clinical attacks or these episodes of inflammation from happening.
[00:14:37] Jessica Stulc: So they kind of work as a protector or kind of preventer from having more nerve damage happen down the road, which hopefully then prevents accumulation of disability in terms of the progression of chronic symptoms, in terms of the advancement in terms of the more progressive stages of MS.
[00:14:57] Pete Waggoner: So now this has vastly changed [00:15:00] the progression of someone’s lifestyle. Because it, you know, back when I grew up, we’d watch people end up in wheelchairs and then end up dying. And then now we’re aware of people that are living full lives, raising families, working their jobs, and doing their things.
[00:15:17] Pete Waggoner: I mean, the difference is astounding, isn’t it?
[00:15:20] Jessica Stulc: Yeah, and so that’s really a lot of my patients who come in with a new diagnosis. Obviously, the exposure that they’ve had through either, you know, friends or family members, or even just the media in terms of what does multiple sclerosis mean. When you get that news and when you get that label and when you’ve been having these symptoms that are scary and are affecting your ability of your body to function. Obviously it can be quite overwhelming as a new patient.
[00:15:49] Jessica Stulc: And I always have a discussion with them. What does this mean for you? And really the good news right now is in terms of the treatments that are available, really right now the [00:16:00] prognosis for most of our patients who are diagnosed with relapsing remitting disease is very good.
[00:16:05] Jessica Stulc: Most of our patients, we can get control within the first couple years, and the data right now is showing that if we get control within the first couple of years, your prognosis of preventing future disability and progression is very good.
[00:16:18] Jessica Stulc: And so right now, in terms of people, I kind of say, Hey, this isn’t a disease you really wanna sign up for. You don’t really want to be in my office. I get that. But in terms of now, it’s one that really, there’s a term that we use in research called NEDA.
[00:16:34] Jessica Stulc: No evidence of disease activity.
[00:16:36] Jessica Stulc: And before, that was kind of like, hmm, like this is not really a goal we should be shooting for. And now I tell patients that is my goal. Meaning I don’t see new lesions on an MRI, you are not experiencing new clinical symptoms, and we are not seeing new disability progression with you on your exam.
[00:16:56] Jessica Stulc: And really that is the goal that I hope we can achieve that or at [00:17:00] least try to achieve that for most of our patients.
[00:17:03] Pete Waggoner: That must be really an exciting thing for you having gone into this to know that you can look at this now based, you know, from when you first started this, to how you can say the things that you’re saying to your patients.
[00:17:16] Pete Waggoner: I don’t know. I think that must be fun to go to work every day.
[00:17:19] Jessica Stulc: Yeah, it is exciting, especially for patients who are diagnosed you know as a new diagnosis to be able to kind of, Hey, this can be a disease that you can live with the goals you wanted to do before.
[00:17:32] Jessica Stulc: My job is to help make sure that all those goals you want are still available to you. If you wanna raise a family, if you wanna have a career, if you wanna be active in sports. All of those are things that we can hope that we can still achieve.
[00:17:45] Jessica Stulc: You know, I do wanna talk a little bit about the people who are in the more advanced stages, who are already in progressive disease. Right now we’ve really made huge advancements with the disease modifying therapies, with having lots [00:18:00] more choices, having lots more effective therapies, having a lot of different options to make sure people can tolerate therapies.
[00:18:07] Jessica Stulc: But really right now there is a lot going on in terms of advancement of trying to help those people with the more progressive stages of the disease. And looking at can we actually, besides just preventing these attacks, can we actually remyelinate or can we actually repair.
[00:18:24] Jessica Stulc: So instead of just having a sunscreen, you know, can I actually have a form of like Aloe Vera that would help heal? And right now we don’t really have that, but there’s a lot of research going on to try to help with that and help the patients right now who are more advanced in their disease process.
[00:18:43] Jessica Stulc: Particularly right now, we’re actual hopeful is could we actually come up with an anti-wrinkle cream? So instead of just preventing lesions from forming, could we help slow that rate of progression when lesions aren’t forming, help prevent neurodegeneration from [00:19:00] happening from people who’ve already had nerve damage besides just remyelination and repair.
[00:19:58] Jessica Stulc: Right now, I kind of really [00:20:00] encourage patients to get on a disease modifying therapy early. Because that can really help change the progression of your disease long-term.
[00:20:08] Jessica Stulc: And so, you know, a lot of these medications can kind of sound scary because they do change your immune system and obviously just going through the pandemic. Here, I’m gonna lower your immune system while you’re, while we’re going through a global pandemic, you know?
[00:20:23] Jessica Stulc: But in terms of understanding those risks and benefits and now having a lot more options of the drugs available, I think has really give patients a lot more options and a lot more control and choice in their disease process.
[00:20:36] Pete Waggoner: What role does physical therapy play?
[00:20:39] Jessica Stulc: Yeah, you know, especially in terms of patients when we were talking about choice. You know, lots of times when you get one of these labels or diagnosis, you kind of feel like there’s things that you have to do to your body to stay well, and physical therapy is one of the things that you can do for your body to stay well.
[00:20:57] Jessica Stulc: And so it’s one of the things that patients can take [00:21:00] an active role in, in terms of really helping themselves, in terms of being able to help with both strengthening, stretching, balance, all of those things. When we talk about those pathways, it’s really the connection between the brain sending those signals to the rest of the body.
[00:21:17] Jessica Stulc: So for patients in terms of physical therapy, it really helps keep those connections going. If you don’t use those connections, that pathway can become weaker. So having those pathways be as strong as they can be can be really helpful.
[00:21:32] Jessica Stulc: Just to put a plugin at Minneapolis Clinic of Neurology, we actually have multiple physical therapists who’ve taken the time to get special certification and training in multiple sclerosis. To really be able to help our patients who come to our clinic.
[00:21:46] Jessica Stulc: Because there really is a lot of different modalities that are needed to help MS patients. Balance can be affected. So working on balance, working on stretching. You can get tight muscles when your muscles are weaker and that stretching can really [00:22:00] help with not only movement, but with management of pain.
[00:22:04] Jessica Stulc: And then also strengthening in terms of, so there’s lots of different ways that physical therapy can really help, not just with the mobility, but also even with pain and some of the other kind of chronic symptoms with dealing with MS.
[00:22:18] Pete Waggoner: Are these things that a patient would take with them to do at home or on their own?
[00:22:22] Jessica Stulc: Exactly. Lots of times physical therapy, it’s really education on how can you then take those resources and exercises and movements to incorporate them into your daily living. And that’s really where, you know, hey, that’s where the key is in terms of being able to do all those things on your own.
[00:22:41] Pete Waggoner: So you’ve mentioned some cognitive functional things and how it all interacts and I’m sure many people with MS experience some forms of cognitive changes as well.
[00:22:52] Pete Waggoner: Are there strategies to maintain that function cognitively and to deal with those challenges that may arise?
[00:22:58] Jessica Stulc: The most common symptoms [00:23:00] that multiple sclerosis patients face in terms of cognition are actually attention and processing speed. So in this world, you know, I just the other day had a patient kind of say like, oh, I ended up like leaving my groceries at the grocery store by the time I got to my car.
[00:23:16] Jessica Stulc: And I said, well, what were you doing when you were at the grocery store? I’m like, were you on your phone too? Yeah. You know, so in terms of, for a lot of patients, it’s just understanding what are all the different inputs that now we’re having to deal with?
[00:23:29] Jessica Stulc: Okay, now we’re trying to text while we’re also listening to music, while we’re also doing our banking, while we’re also checking out.
[00:23:37] Jessica Stulc: You know? So nobody was designed to function like that. And so for a lot of people, in terms of sometimes kind of just taking an assessment of how am I doing certain things in my life that maybe I wasn’t necessarily even doing those five to 10 years ago. And how can I simplify some of those tasks and how can I, you know, when I am having an important conversation, am I [00:24:00] actually having that face-to-face?
[00:24:02] Jessica Stulc: Are we sitting down? Are we doing it with intent? And so a lot of people, or having some cognitive struggles. Most people, they’re pretty mild. And actually looking at how can I make simple changes in my life to be more organized, to be more functional, and to tune out some of the multitasking that now has just become so commonplace can be really helpful.
[00:24:23] Jessica Stulc: We also have occupational therapy for people who need a little bit more help in kind of looking at some of those different things. And even formal neuropsych testing to kind of identify some of those strengths and weaknesses to kind of help people. But the biggest thing is kind of the key is to stay active in terms of you know, staying mentally fit, just the way staying physically fit.
[00:24:46] Pete Waggoner: It all plays together, doesn’t it? You know, you mentioned earlier about it’s not ideal to have to live with this, obviously. And that can bring on challenges physically and emotionally.
[00:24:56] Pete Waggoner: Are there coping strategies that you share with people [00:25:00] or resources that patients and families can use to manage the disease a little bit better?
[00:25:05] Jessica Stulc: Yeah, so I’ll put a plug in. Both the Multiple Sclerosis Society of America and the National MS Society have really great websites and resources for patients, families and caregivers. Both in terms of even just the broad spectrum of resources for patients and families. Even diet, exercise, management.
[00:25:25] Jessica Stulc: But for a lot of patients it is kind of being, you know, mentally connected, socially connected. All of those things you know, for a lot of people in terms of having control over their disease process in terms of their ability to function day to day.
[00:25:41] Jessica Stulc: And so for a lot of that it’s staying connected as an active member of their community, both in terms of being able to manage both, being able to be part of their family, part of their employer.
[00:25:52] Jessica Stulc: And obviously when you’re dealing with more challenges, being able to weigh all of that is hard. And so I think lots of times, you know, I even [00:26:00] talk about coming up with some things that, hey, how do you take time out?
[00:26:04] Jessica Stulc: Even, is it meditation? How do you manage stress and having a specific way to do that if it’s exercise and now that’s harder, what is a way that you can kind of come up?
[00:26:16] Jessica Stulc: And I think, that’s really important in terms of general health for a lot of people is coming up with some of those different particular coping strategies in terms of, how do you manage, trying to be an active, busy person, even also trying to be an active, busy person who also has a chronic health condition.
[00:26:35] Pete Waggoner: Are there any dietary things that play into this? I’m off the grid here. It’s not, I don’t know what we discussed, but I obviously, it seems to play such a key factor in so many things. Are there things that can help in this process or hurt with your diet?
[00:26:51] Jessica Stulc: So diet’s a real hot button issue in multiple sclerosis.
[00:26:56] Jessica Stulc: I think if you Google, you could probably see like the 30 top [00:27:00] bestselling books with multiple sclerosis, have some sort of diet included.
[00:27:05] Jessica Stulc: And so right now, in terms of ms, you can kind of make any sort of diet claim and you could kind of try to support it. But in terms of the best advice that I kind of give my patients, is, we had talked about that obesity can kind of be a risk factor for multiple sclerosis.
[00:27:22] Jessica Stulc: So number one is, weight loss can be good for multiple sclerosis. If you are kind of having some extra weight that you would need to lose. So that is good, especially if you are having some weakness, so that is a good goal to have.
[00:27:36] Jessica Stulc: The second one is just kind of what are some risk factors in terms of, affecting the immune system in terms of diet. Right now, what we have in terms of the best evidence for multiple sclerosis is low fat and low salt.
[00:27:51] Jessica Stulc: And so lots of times I talk about the DASH diet for my MS patients, which is the American Heart Association Diet, which kind of [00:28:00] focuses on low salt and low fat. Other things in terms of, lots of people will look for specific food triggers, gluten-free or some other different diets, and I kind of tell my patients if you feel better on those diets more power to you, but we have less evidence for more specialized diets.
[00:28:17] Jessica Stulc: Low salt, and low fat is what we have the best evidence for. So they’re even in animal models. Intermittent fasting has been shown to be helpful in MS. But for a lot of my patients who are more sensitive in terms of, you know, if you get muscle tone problems. Trying to do the intermittent fasting can be harder to implement for people.
[00:28:38] Jessica Stulc: So for a lot of my patients, I kind of say, Hey, let’s just keep it simple in the beginning. A healthier diet with more healthier food choices such as a Mediterranean diet or the DASH diet is what I have people start with.
[00:28:51] Pete Waggoner: There you go. That was what I probably suspected I would hear, but, the specifics is even better.
[00:28:56] Pete Waggoner: So advocacy and awareness play crucial [00:29:00] roles in all communities, such as MS. Obviously, there’s places people can go. How can they get involved in support for those that are affected by MS as actually the individual with it and family slash caregivers?
[00:29:14] Jessica Stulc: Yeah, so I already mentioned probably in our area in Minneapolis, the two societies that I kind of view as pretty active, the Multiple Sclerosis Society of America and the National MS Society. Both of them have events. There’s a bike ride across Minnesota, there’s walks. And so there is a lot of fundraising and a lot of those events both go directly towards research for advancement in terms of available treatment options, but also in terms of direct support of patients and their family.
[00:29:43] Jessica Stulc: For example, the Multiple Sclerosis Association of America helps with cost of MRIs for patients who can’t afford to have the MRIs to help with an aid in diagnosis and treatment options for patients.
[00:29:55] Jessica Stulc: So both of those funds both help in terms of both actually advancing research [00:30:00] and actually direct aid in terms of helping patients help with their medical costs and needs.
[00:30:06] Pete Waggoner: Great stuff there. Final question for you.
[00:30:09] Pete Waggoner: If you were to look out over your career, and we’ve somewhat talked about this in the early going, what are some of the biggest takeaways that you, Jessica, Dr. Stulc, have personally taken with you in this journey?
[00:30:24] Jessica Stulc: For me it’s really been seeing the change in terms of what’s been available for treatments. In the beginning, in the late 1990s, when drugs started to become available, it was really exciting for patients. But oftentimes, there were only a couple treatment options available.
[00:30:40] Jessica Stulc: So if you had side effects or had issues with those medications, and now really we have multiple, multiple drugs almost to the point where that conversation of which drug should I start can be overwhelming. And for me, lots of times with patients, I’m like, just pick one and then we can go from there. You can date it, you don’t have to marry [00:31:00] it.
[00:31:00] Jessica Stulc: And then I can worry about what we do next. And so lots of people, you know, it’s a good problem to have that we have choice now. But sometimes that choice can be overwhelming. But for me, for my patients, that’s kind of the statement of we now have drug available.
[00:31:15] Jessica Stulc: And to get on it early is really my recommendation. And to watch that change, I’ve now been at Minneapolis Clinical Neurology for nine years, and I’ve watched people come in with new diagnosis as very young, coming in and as a college aged kid. And I’ve now watched them finish college, get married, have kids, and have a career. And really not have progression of their disease process.
[00:31:41] Jessica Stulc: And watch them come in from when their parents were scared in terms of what they could do as the future. And now they’re coming in with their young kids going, Hey, what do we do next? Here we go. Yeah. You know, having this be old hat and really seeing that sea change in terms of this new generation that’s [00:32:00] had drug available.
[00:32:01] Jessica Stulc: And I think the hope on the horizon is for the generation prior. Can we help that generation that hasn’t had drug as early as the newer patients being diagnosed. And I think we are gonna come a long way in terms of helping people with the more progressive symptoms.
[00:32:18] Jessica Stulc: But right now what we got is we got the sunscreen and putting your sunscreen on early is still the best. Is still what we have for multiple sclerosis right now.
[00:32:27] Jessica Stulc: Really, in terms of our advancements of treatment, we’ve come a long way in a few years.
[00:32:34] Pete Waggoner: What’s been great is you are looking at the full scope of MS no matter where you’re at in the process. And it’s so encouraging to see how things have come together.
[00:32:44] Pete Waggoner: Dr. Stulc, you’re a professional, you’re really good at this, and it was great to have you on the show today.
[00:32:50] Pete Waggoner: Thanks for sharing all of your insights and experience and all the knowledge that you have and the things that you’re giving the patients is absolutely tremendous.
[00:32:58] Pete Waggoner: So thank you for joining us today. [00:33:00]
[00:33:00] Jessica Stulc: Yeah, thanks for having me.
[00:33:02] Pete Waggoner: It was a pleasure.
[00:33:03] Pete Waggoner: That’s gonna do it for today’s show. Thank you for joining us on this episode of Neurology Now. We hope you found it informative, engaging, and if you’ve enjoyed this episode, please subscribe to our podcast to stay up to date and help us educate our community and beyond.
[00:33:18] Pete Waggoner: We welcome your feedback, comments, and suggestions for future topics. So please feel free to reach out to us through our website or social media channels. That’s gonna do it for today’s show, for Dr. Stulc. I’m Pete Waggoner.
[00:33:30] Pete Waggoner: So long everybody.