MS AWARENESS | MICHELLE FABIAN, M.D.

[Music] [Music] hey guys montauk here and thanks so much for tuning into this edition of free thinking with my top and the day i'm so excited about having a guest on that i haven't i you just don't know i've wanted to have around since the very beginning of free thinking and i haven't got her so really really happy and uh we're here to talk a little bit today about multiple sclerosis multiple sclerosis can be a particularly debilitating disorder because your body is essentially attacking itself but you can learn to cope during the attacks so what causes multiple sclerosis well multiple sclerosis or ms is a disease in which your body's own immune system eats away at the protective coating that the sheath that covers your nerves and it sort of disrupts the communication signals between your brain and the rest of your body meaning that your nerve signals slow down or stop and we don't know exactly why this happens the most common thought is that it's a virus or a gene defect or both are to blame environmental factors may even play a role and we do know that disorder affects more people more women than it does men that you may get the disorder if you have a family history of ms or if you live in an area that is of higher risk in a particular area of the world where ms is more common it's typically diagnosed between the ages of 20 and 40 but we've seen the disorder at any age now you may ask yourself well how do you know if you have multiple sclerosis well here to talk about it with me today is one of the most foremost experts in treating patients on ms and other neuro immune disorders she's an assistant professor of neurology and an attending musician at karine goldsmith dickinson center for multiple sclerosis the center and she's also received a bachelor's of science degree in chemistry from the university of notre dame and an md degree from case western reserve university she's completed her neurology residency at mount sinai hospital where she served as chief resident and at night she in 2009 she was named the mount sinai hospital resident of the year she was also the recipient of the 2009-2011 sylvia laurie found a fellowship from the national ms society which she joined the cgd faculty in 2011. she is one of my favorite ms doctors in the world and she happens to be my own personal doctor as well so you know please please dr michelle fabian thank you so much for joining me today on free thank you with my time thank you for having me absolutely and i really do mean that when i say and i say it to the world that you are my favorite doctor that i've ever had dealt with when it comes to ms so doctor you're an ms mu and neuroimmune specialist why did you pick this field to go into so there are many choices in neurology when you're a resident what specialty to study and really the reason i chose ms i i was fortunate enough to work with really one of the foremost ms experts in the world dr loveland who's a director of our center here and it really of course the research was so exciting the breakthroughs were there but really was about that connection with patients that he demonstrated with his own patients and really told me if i entered this field this would be a chance for me to have uh patient relationships that that really span decades well you know ms is one of those diseases that i had to tell you you know though there may have been breakthroughs in the last few years some slight breakthroughs you know diagnostics techniques for ms haven't really changed that much since uh 21 years ago when i was diagnosed so how do you diagnose a patient with ms well the most important way to diagnose a patient it doesn't require any fancy technology it's listening to the patient so to have a diagnosis of ms a patient must have clinical symptoms that correlate with ms lesions and so really it's about when i first meet a patient just sitting there listening to their story and hearing if they've had symptoms that are consistent with ms of course no god okay um of course you know there are symptoms that overlap with many other conditions so once we we verify that a patient has symptoms that you know sound like they could be ms then we do move on to mri which is very sensitive in picking up ms lesions and so that was the breakthrough which started in the early 80s realizing that a person with ms there is a character characteristic fingerprint in the brain and the spinal cord um so we can see it you know on the mri and your ms being when you have the lesions in the brain lateral closes when you have lesions in the spine but now let's talk a little bit about and then we i know for a fact and you know and i want all of our viewers to make sure they understand that not any individual with ms seems to have the exact same symptoms but there are some core symptoms that seem to be recognizable i know uh when my ms started in me i went through a whole series of just extreme eye issues you know if i'm from octoberitis optic neuropathy i had an affair a pupillary defect i had it just came out of nowhere no one could explain it i was in the military at the time and literally went 20 years being misdiagnosed which i find crazy but maybe if you could get out of just a couple of core symptoms that people could think about you know going to talk to their doctor about make sure they explain it to them sure so one thing that's really important before we talk about the symptoms with ms is that they do have to last longer than 24 hours because all of us have neurological symptoms from time to time sit a certain way your leg goes a little numb you know things can happen like that but if they don't last 24 hours then it's very unlikely that it's from ms so i always tell my patients to really um when they're monitoring their symptoms to remember that too um and it as you talked about with the object neuropathy where the lesion is does make a difference and so the classic symptoms of ms would be a decrease in vision so that would be optic neuritis double vision is another one numbness and the numbness could be on the face or it could be you know on half of the body or in the legs weakness and again like on half of the body or in the legs and people can also have bowel and bladder issues and let me ask you a question now i mean in some of these cases like you said some of these symptoms also are associated with other illnesses but there seems to be even within the ms diagnosis there seems to be like two separate types of disease i i i've often wondered are you know are we diagnosing multiple diseases and putting them under the same moniker or are they really the single disease but just having different exacerbating symptoms yeah i mean i think that's a question that every doctor as they go through their training asks ourselves as well are we seeing many different diseases you know in in this clinic and calling it calling them all ms and that's where the mri does help us because people do have different symptoms you know and it's it's based on probably where the lesion is how many lesions they have but at the same time you know their mris have that characteristic finding and really i have to tell you after you see more and more patients you realize that um people are more similar than different but everybody you know may have their individual symptom profile and then what what is the factor that determines you know the severity of the illness i mean i know people who you know are diagnosed and then a month later they're in a wheelchair and uh maybe two months later they're incapacitated to the point that they literally can't leave their home and other people like myself you know and and others uh it seems i hope i'm keep knocking on the wood that it stays this way but you know um it seems like it's very very slow long duration of degradation yeah and it's a it's a really good question um and it's very frustrating for me to tell you we don't know for sure why people may have different onset to their condition like that it does matter where the lesions are and so a person thankfully is a very rare um situation when a person's in a wheelchair that quickly but it you know it may be one lesion in a certain location that can cause something like that to happen um and again it's that's very rare um but we do know that other people have many many lesions throughout their brain and spinal cord and they're basically normal and so there are a lot of different factors that probably play into how one person manifests compared to another and there are a lot of different factors that play into how each individual patient should manage their illness i.e you know managing it with medicine managing with lifestyle changes exercise uh managing the stress right yes well i would say that a patient typically should should do all of those things patients come to me often and they ask me about the holistic approach and i'm all about the holistic approach and i use it in a slightly different way but holistic with the w the whole approach so for most people with ms that would include a medication not for everybody but for most people but you and i both know that the medication by itself is not really going to help a person live the best life they can live and so really you have to combine that approach with uh you know the wellness um um the wellness i call them like foundations wellness you know the building blocks um so like you said you know nutrition is key um to being healthy to feeling healthy exercise um you know emotional wellness maybe seeing a therapist being in a support group all of these things are important in order to feel as good as you can feel well now especially right now during this last full crazy year of cobit i mean i think you know it's it's put stress on everyone a bit no matter you know what your titan life is but i think that for people with ms especially i heard recently that you know uh you know colbit affects people with ms differently than the regular population is that true is that false so um thankfully from what we could see most people actually with ms their risk is not higher than people without ms in terms of getting covet or severe covet that being said people that are older and use a wheelchair to get around they may be at higher risk yes gotcha and stress being one of the biggest factors is it not when it comes to ms attacks well stress is a really complicated topic and the reason why is because when people have an ms relapse the first thing they do and it's just human nature is you look around and you say what caused it and the truth of life is that there is always stress around us so then people look and they say oh that was the stress and true true and unrelated we don't know there are some studies out there that really have not been able to link high stress with uh ms onset but you know my patients certainly tell me at times like i know why that happened it was really stressful at that point in time so it's hard to know for sure very interesting when it comes to whether or not it's genetically predisposed i mean like i'm a person and in my family we have no one that i know of with a family history of any neurological disorder and then bingo bango here i come but i also know i look back in my past you know i uh literally was born you know and and raised for the first five years of my life about you know less than a block and a half away from the baltimore city dump which was one of the first hazardous waste cleanup sites uh that was a super fun clinic site because of you know uh bethlehem steel and all that that they did so there was all kinds of ridiculous chemicals in that that dump and i used to as a child and so did all the child children who lived in that ghetto used to play in that dump used to play in the trash around that dump so i look back in my life and i think myself well if there was environmental reasons that would be one of those that probably was what triggered in me but we still don't know exactly what triggers in individuals do we yeah i mean when i was training uh one time one of my teachers said if a person you know if you're looking at a patient thinking if they have ms and somebody in their family has ms then you have the wrong diagnosis for the patient you're treating because they you know it the old thinking was that it was so unrelated um genetically but we are finding more and more that there is a genetic predisposition it's it's not a hundred percent you know it's not one of these um things like these diseases that are passed down generation to generation um but there are some um some factors but you're right you know people's diet toxins they may be exposed to smoking all of these things probably also play a role wow well you know now i i i know there are some have been in the last couple of years some pretty tremendous breakthroughs i mean when i was diagnosed heck there were only three drugs they called the abc drugs back then and and you know i've had success with one of those uh for now 20 years but um there now must be at least 14 or 15 different in uh drugs out there right there are and i have to tell you i should have counted um before i came on here um but there's that many that actually you have to count now um and uh really it's a different world and that's one thing i want to say today is it is a different world even than 10 years ago when i started as an ms doctor and and people need to understand that though they may talk to one person and they say well i happen to be on xyz regimen that doesn't necessarily mean could be the regimen that would work for them that's exactly right yeah it's really it's a um experience and one of the frustrations right because you can't just take the same treatment plan from patient to patient to patient um because people have different side effects and you know um and different preferences so it's really it's individual well can you talk a little bit about the differences in some of those therapies i mean all of them are in a sense autoimmune modifiers right yes yes so our oldest drugs are we used to call them and still do the abc drugs they are injections that a patient gives to themselves and one class of drugs is called interferon so interferon is actually a chemical that your body makes itself uh during something like the flu and so people on those drugs would often get flu side effects from them but they were our first drug that we had for ms so that was the first sign of hope in really controlling the condition for people and we should say that those interferons weren't necessarily developed for ms they were developed before and that well before they started they developed it for a different illness and then figured out that it had some impact on ms right yes they've been studying in multiple illnesses yes and are still used in other illnesses as well there's other types of interferons too like for hepatitis c there's interferon so um and it's a broad mechanism of action like you're saying so it wasn't that people were looking specifically to ms and in designing a drug for it it was just something that thankfully did work to some degree for ms patients um interestingly they're actually uh have been possibly shown to be a benefit in kovitz so um you know most people aren't on interferons anymore but um yeah they were they were brought back in covid research and then i understand a couple of one of the other drugs was literally a drug that was developed to help um spark ms symptoms in primates and that drug then was refined and tuned and we realized that it did i guess modify the immune system enough to help the immune system attack right that's right that that is glutamar acetate and that it was a very interesting story as you said really trying to promote uh the condition in animals for research and but the animals did not get the ms and the researchers were frustrated by that and finally they realized it was because that that medication was actually helping prevent it from from starting so um and it's a very old medication i call it tried and true it's very safe which is great but again it's that broad mechanism of action so it works amazingly well for some people but it's not the most powerful medicine out there these days for for others and now there are now after first the abc drugs now we've created a whole family of drugs that were developed specifically for ms correct that's right that's right um so there are um pills there's a there's a whole bunch of pills now and those pills interestingly they have been used in other conditions as well um so you know one of our pills was first used in psoriasis one of our pills has been studied for organ transplant and for crohn's disease and then another one actually is a twin of a drug used in rheumatoid arthritis so i think that's really smart you know if you can look to the specialties around you and if things are working for other autoimmune conditions to bring it into your own condition um that's that's really smart uh science so yeah well you know i mean i i know i was uh very instrumental in helping to fund a study at the carolina institute that you know if you talk to uh swedes they like to claim that ms is a viking disease and uh they found some thin line association between ms and rheumatoid arthritis is that true there is a shared characteristic there you know the the genetics instead of really people having a predisposition to other neurological diseases in their family you will see actually people have other autoimmune diseases in their family so rheumatoid arthritis would be one of them that you know patients relatives may have wow and i mean this is really truly all about trying to help you know a person's quality of life these these drugs seem to lengthen the time between exacerbations or does it seem to help put the disease in check what does it do so our goal um 2021 is very clear and it's really to just stop anything new from happening with a patient so that means no new lesions from developing when we check an mri which is usually once a year it's no new relapses for sure you know remember that there's nine times as many silent lesions usually in ms than you know compared to lesions that cause a relapse so we want to stop all the lesions we want to stop the relapse and then we want a patient to look the same from time to time on their exam that their walking speeds is saying that everything is just as healthy as the last time so thankfully because we have so many treatments we achieved that goal with many many of our patients now where we really control the ms um in any way that we can measure and what's what's new what's coming down the pike i i had a long conversation with dr weiner i don't know if you know who he is dr weiner at harvard and i'm involved with the uh you know the brigham and women's uh ms foundation that ann romney started neurological foundation they started um but what's new coming down the pike well before we talk about what's new the new s medications that are fda approved are medications that are infusion medications you are asking me about medications that are very specific for ms so i just wanted to point out that we do have now multiple of those as well patient usually goes to the infusion center and gets a iv treatment and those treatments are really the the most effective and they really for most people stop any new ms activity at all so that's been i think those infusion medications it really has been the revolution in uh in treatment for a lot of our patients and is that once a year uh infusion once a month what is that it depends on the treatments um we have ones that are monthly uh one that's every uh six months and then one that's once a year for two years wow i i i had not heard of that that's really that's incredible yeah and and now does it depend on the the type of and have we have we now i mean there was a while where there were categories of ms if we changed that and just now just call it ms or are there still categories there's reading relapsing there's you know uh primary progressive there's you know progressive have we changed all that yeah no we still have those categories and really what those categories are taking us back to me telling you that uh really it's about listening to the patient and how their ms has presented so patients that have relapses those are symptoms that come on over days and weeks those are people that have relapsing remitting ms progressive ms is really completely different and those are people that just have a worsening of their symptoms usually it's like a motor weakness for months and years and they just like when you listen to the story of a patient you can see right away if a person's having more of a relapsing type of disease that's where our treatments work the best is for relapsing disease we really can just stop that in most people progressive ms is more difficult to treat wow now do you think that uh possibly there could be a cure coming in the pipe in the next five to ten years i hope that there will be a cure i think that five to ten years um and of course my patients ask me and they say i'm not getting any younger doc i need the cure and um i think one thing to you know really consider is the difference between complete control over the disease and cure right so cure means i can give a patient a treatment and then the ms is gone and i hope for that you know and people have looked at different strategies uh for that and still are studying different strategies um but we're not quite there yet um and so really it's more about complete control at this point control and controlling ain't stopping the exacerbation stopping the rape the remaining okay got it yeah and and you know i know that you know for most people who have this illness it's really more about you know if you can dealing with what you have and so what what would be some advice that you get the people in that regard to you know again we've already talked about exercise diet making sure that you i guess starting a medication as soon as possible would be part of that but then you know um the day to day what do you suggest for people well of course it is different for every person so one thing i've learned is i can't really just uh foist upon somebody else my ideas of what they should do for their own wellness right so it works best when people really do feel it in their heart and they say this is going to be good for me and they feel motivated and they stick with it and it's hard sometimes to get to the place where people know what's going to help them the most but i love those visits because when they do they come back and they say you know i feel so much better and you could just tell it's a real change um yeah so one thing that might help is talking to other people with ms and i i just had a new patient diagnosed last week and she didn't know but one of her high school friends also has ms for like 10 years and her friend called her and said you know i have this and look at me i've lived my life for the last 10 years and you could tell that that patient was ready to really face a challenge after hearing that from somebody else right and and maybe also could you speak a little bit about how important family is to you know the person who has the illness i mean you know a lot of times you know people who i was speaking to someone yesterday who was dealing with you know a very early onset [Music] diagnosis of parkinson's and you know he hid the disease from his own family for seven years and where because he didn't recognize that they would be as supportive as they have been and it's a family his family has literally helped to help him get his disease not in check but at least be able to cope with to deal with and work with you know a lot of people with ms also you know i suffered in silence for about seven months i didn't tell anybody how important is it for people to recognize that they should reach out and get the help from their family if they need it that's a really good and important question i have to say um so all of us have a condition at some point in our lives you know and neurology for some reason when people have neurological conditions of course it is such a it's such a personal um you know experience because people worry that it's going to change the way that other people i think view them and i've had many patients over the years that do hide the condition like you say and i think that it does um it impacts them negatively as time goes on um you know one thing i think that's really important is to tell your children you know if people have children i've had some patients who they don't want their children to worry about them you know is really the reason they'll tell me that they don't tell their children but i have a different view on it and it's that the child will see that they're living with ms and they still are continuing in the world and then they don't feel like they're obviously keeping something from them as well and really every time that a patient goes to their family and reveals the diagnosis they come back to me feeling relieved that they did that's excellent well i know you know you're very busy yet i can't thank you enough for being a part of this uh you know our free thinking show today and i think people who are trying to understand why i say you're my favorite doctor because it's just from a personality standpoint i wish there were so many more ms doctors like you wow it's my privilege yeah it's a you're amazing very very calming and and you know um anything new new coming down the pike and i asked that question this sense of not just from a standpoint of you know medications but you know any new insights that you may think of or that people should just stop and think about well i mean i do think that we have so many medications that can stop relapses now um but it's working on the repair of the myelin and actually the the nerve itself um so that is happening um and thankfully during covet the research continued you know um so repair and then of course um protection of the nervous system so hopefully in the near future we are going to see that we have stem cell trials going now um and there's two types of stem cells i know that's a whole different topic but there are stem cell studies going about repair and protection that's very exciting to me and i'm really hopeful for those that's really exciting to me too i i you know i think um you know a lot of us who have ms have symptoms that you know are just continuous that they've never gone away and i would love to figure out a way to to get involved and are there studies out there that people should know about they are small studies right now um but they are um enrolled and uh going you know these studies are usually about 50 to 100 people at a time but all we need is one positive result i think for that study to become a really big study yeah absolutely i'm tight that's really exciting that gives hope and i think that's what the one thing that people need to have is hope so i can't thank you enough for being here and sharing that hope dr fabian and good luck to you and and please i hope you stay well uh you know i you got your vaccine didn't you i did there you go you know as soon as i can get a chance to fly a little bit i think i'm gonna come up there and see you that sounds perfect okay for sure will you be well you stay well and make sure you all tune in to our next free thank you with mattel thank you so much for being here dr baby thanks for joining me our free thank you with montal please make sure you're subscribed and hit the bell to be notified when new episodes post each week we'd love to hear your feedback so please send us your comments [Music] foreign

Channel: FREE THINKING with Montel

Views: 372

Rating: 5 out of 5

Keywords: news, health, montel williams, usa, america, Politics, us, BLM, wellness, together, information, vetrans

Id: tZCZc27BqmI

Length: 30min 59sec (1859 seconds)

Published: Wed Mar 10 2021