← MS Living Well: Key Info from Multiple Sclerosis Experts
MS Living Well: Key Info from Multiple Sclerosis Experts
Boosting Brain Health: Blueprint for MS
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- [00:03]
A
Hello, everyone. Welcome Back to the Ms. Living well podcast. I'm your host, Dr. Barry Singer, director of the Ms. Center for Innovations in Care at Missouri Baptist Medical center in St. Louis. And today's episode is Boosting Brain Health Blueprint for Ms. This episode is sponsored by TG Therapeutics. If you're living with multiple sclerosis, protecting your brain health isn't just important, it's essential to feeling and functioning your best. Thanks to powerful new treatments, we've seen incredible progress in slowing disease progression. But medication is only one piece of the puzzle. Brain health is deeply influenced by how we live day to day, and that means you have more control than you might think. Many people with Ms. Aren't told that lifestyle choices like what you eat, how you move, how well you sleep, and how you handle stress can have a real impact on brain function and long term resilience. In today's episode, we'll unpack what brain health really means in the context of Ms. And explore everyday habits that can help you strengthen your brain, improve your energy, and feel more in charge of your future. Later in the show, I'll talk with Dr. Lisa Doggett, who's a lifestyle medicine physician living with multiple sclerosis. But first, I'd like to introduce Dr. Miravalli. Dr. Augusto Miravalli is chief of the Multiple Sclersis center and professor in the Department of Neurologic Sciences at Rush University in Chicago. He completed his neurology residency at Loyola University Medical center in Chicago, followed by a fellowship in neuroimmunology at Harvard University's Beth Israel Deaconess Medical center in Boston. Dr. Miravalli, welcome to the Ms. Living well podcast.
- [01:55]
B
Thank you, Dr. Singer, for the invitation.
- [01:57]
A
Wonderful. So what really is brain health and what does it matter to someone living with ms?
- [02:03]
B
The current definition describes brain health as this process of attaining and maintaining the optimal function of the brain to best support one's physical, cognitive and psychosocial life through every stage of life. And if we dissect that definition, which is pretty complex, there are different areas that I want to highlight. First of all, it's something that is an ongoing process of attaining, but also maintaining. And the other area that I like a lot on the definition is the last portion, which is through every stage of life. And that gives us hope because, you know, you're never too young or never too old to truly start taking the first steps of attaining brain health.
- [02:51]
A
Yeah, when you think about that, obviously over the course of someone's life, the brain changes, right? Unfortunately, I think our brains are shrinking over Time. So you really want to put that effort in early to try to help maintain that though, right?
- [03:06]
B
Absolutely. And when you look at studies, for example, that develop interventions to understand how we can impact brain health later in life, the earlier you start, perhaps the stronger those effects become. Things for example, like childhood level of education or a attainment of education early on in life, that's important. Or smoking is a negative factor for brain health. And the longer the period of smoking, but also the earlier someone start smoking will have negative effects on brain health.
- [03:37]
A
Yeah, so we're going to dive on into that lifestyle management. Let's start specifically with exercise. So is there something you can do with exercise that can help brain health? And do we have any data to support that?
- [03:51]
B
Yeah, we have now a wealth of information when it comes to the benefits of exercise on brain health, and that's with multiple sclerosis patients, but also in individuals without any neurological conditions. And I always like to kind of divide the benefits of exercise into different buckets so it's easier to understand. And so the first bucket is the benefits of exercising physical function, meaning the more you exercise, are you going to improve your endurance, your physical function? And of course, the answer is yes. And that's perhaps the easiest to get our head around. Right. So things like improved strength or mobility or endurance or balance with moderate amount of exercise, anywhere from two to three times a week for 12 weeks is enough to have that effect on physical function. Perhaps the areas that are more interesting to Ms. Patients are symptoms similarly with exercise. We are now starting to understand that patients fatigue levels improve. And, you know, sometimes it's counterproductive to think, wait a minute, I'm tired, I have fatigue, and now you're telling me that I need to exercise. How is that possible? Well, it takes some time. And that's why when you look at studies looking at exercise intervention for fatigue, usually it takes a little bit longer, anywhere from 15 weeks to 24 weeks. Because what is happening with exercise is there is this reorganization of the networks in the brain. But the longer patients exercise and the more they exercise, the better that reorganization occurs and the higher the effects on fatigue.
- [05:29]
A
That's great. And then, you know, for advice for people living with ms, I think the exercise in the morning is the way to go. I think by the end of the day, the tank is empty and it's hard to push yourself.
- [05:40]
B
Absolutely. And you know, we are fortunate now to have prescriptive guidelines for multiple sclerosis patients that recommends overall that we should be trying to aim for two and a Half hours per week and divide that into aerobic or strength training. And I roughly explained, well, just do half of that time in aerobic training and the other half in progressive strength training. And that doesn't have to be a strenuous exercise.
- [06:08]
A
Are there specific exercises that you recommend for people with ms?
- [06:12]
B
So, ideally, a patient should be seen by a physical therapist, have an assessment on their baseline physical function, and also a discussion about goals and what are you hoping to accomplish through this training, and then design a personalized plan for exercise.
- [06:29]
A
So, Agusto, how does adequate sleep affect brain health in people living with ms?
- [06:34]
B
Sleep is another of those pillars of brain health, and we get a lot of benefits from restorative sleep. Those cells that are in the brain, the microglial cells that now has a lot of interest in ms, but they also play a function as kind of like the scavengers, the ones that are cleaning up all this debris of inflammation and the consequences of whole day of work in the brain, Those are the janitors. And like in a building, the janitors usually prefer to work at night when nobody's there. So microglial cells play a crucial role in cleaning up this debris of inflammation at night during sleep. So particularly in that deep non REM sleep phase, which usually is accomplished three to four hours after we start sleeping. So when someone has interruption of their sleep patterns due to any factors, whether it's the bladder pain, spasticity, or perhaps anxiety, that's going to have a profound effect in the ability of the brain to kind of get rid of that inflammation.
- [07:36]
A
Yeah. Unfortunately, many of our patients have sleep disruption. Some people are going to the bathroom every two hours. Or anxiety, they can't go to sleep. Or restless leg syndrome or untreated sleep apnea. So we really have to work hard on that in the clinic, right?
- [07:50]
B
Absolutely. In order to truly dissect the reasons for all the symptoms a patient may experience, we truly have to take more of that comprehensive approach.
- [07:58]
A
So we know smoking is not a good thing with multiple sclerosis, and we know it increases your risk of getting Ms. If you start smoking before 17. And people with Ms. Do worse. So what's the impact on overall brain health for cigarette smoking?
- [08:15]
B
Yeah, not surprisingly, negative. Anywhere from increasing the rate of atrophy, the brain shrinks as we age in multiple sclerosis without treatment, the rate of atrophy is also accelerated. We estimate around 0.2% per year for healthy aging and 1 to 1.5% per year in Ms. Without treatment. So when you add smoking to that you're adding another reason to have more brain atrophy. And of course, that's one way to kind of look at brain health in terms of the amount of brain reserve that we have.
- [08:50]
A
Excellent. So very important information. Anything on cannabis in terms of brain health.
- [08:56]
B
I understand that cannabis has been used for the treatment of things like spasticity and to some degree, pain. But one of the concerns that I have is the negative effect on cannabis on processing speed, which is that function of the brain to be able to process information. And interestingly, it's one of those cognitive domains that gets affected with multiple sclerosis. So I always have the concern of overusing cannabis in a situation in which there might be some baseline dysfunction and processing speed. And we add another reason for the processor to be slower. So I try to stay away from it.
- [09:34]
A
So let's talk about the neurologic reserve. How does that apply to people living with ms?
- [09:40]
B
So neurologic reserve is a term that we are using as neurologists for the last, I will say, decade. And traditionally we talk about the reserve in general as the ability to functionally compensate or recover from any pathological state. And you can divide that reserve into two compartments. One is what we call the passive brain reserve. That's the structure of the brain. So if you compare your brain to a computer, that will be your hardware, and that's the number of neurons and the size of the brain. That is usually determined genetically. And there is nothing we can do to grow brain. Even though there are some areas in the brain that we have evidence of what we call synaptogenesis or neurogenesis. The area that is more fascinating is what we call the active brain reserve, which is functionally will be your software in the computer. So similarly to a computer, you can have only one program loaded into your computer, or you can have multiple programs. And the more you upload into your computer, the more functionally active that computer is going to result. So the more we challenge the brain through a very diverse menu of activities, the more complex and efficient that activities active reserve will become.
- [10:59]
A
Yeah, that's a great explanation. So why does early treatment with Ms. Make such a huge difference?
- [11:07]
B
The first step to attain maximal brain health is to stop any potential challenges to that brain health. And with highly effective therapies, particularly early on, that's our strongest tool that we have these days to truly eliminate that factor of acute and chronic inflammation. And that's why the current recommendations for brain health. One of the pillars is early access to appropriate, highly effective therapies.
- [11:34]
A
Great. So how do you measure brain health in the clinic?
- [11:38]
B
That's a challenge. So we look at brain health in different ways. So one is through the function of the brain. And so we do tests on ambulation, we do a 25 foot time walk. We work very closely with the physical therapist to do more nuanced assessment of physical function. We do a screening for cognition in every patient, and if we see a concern, we refer them pretty quickly to an abbreviated neuropsychological testing that our neuropsychologists do. And then they enroll patients into what is called a six week neuroresilience program. That's pretty much cognitive training that is being tailored to the areas of concerns. And then we have a brain health clinic which patients can actually meet with a nurse practitioner. And she goes over things like your diet, your exercise, your sleep habits, smoking, weight, comorbidities, pretty much all of the areas that we know that could either positively or negatively affect people's brain health. And then similarly establish a plan and determine with the patients what are the goals of therapy.
- [12:46]
A
Yeah, that's really phenomenal. I've been doing the simple digit modality test using an iPad in the clinic since 2019. It's kind of nice to track how people have been doing over time. So if people want to keep their brain healthy and active, especially when it comes to cognition, are there specific exercises that you think will be important to train or protect the brain?
- [13:09]
B
Yeah. So when you look at studies that try to develop interventions to improve cognition, for example, you can divide those interventions into restorative, meaning if someone has a dysfunction to begin with, you can develop an intervention that is going to improve that function, but also could be more protective. So activities that actually will help us even in the absence of dysfunction, what can we do to improve that brain? Reserve those savings accounts in my bank account. Right. Both are very similar in the principles in which says, well, you have to use your brain as much as you can and as diverse as you possibly can. And that means increase your physical activity, increase your cognitive stimulation. So whether it's reading, writing, playing instruments, learning something new, languages is a great way to stimulate your brain reserve. But also another component which we tend to forget is social life. If you look at, for example, the negative impact of social isolation for brain health almost doubles the negative impact of smoking. And we've seen that a lot during the pandemic. So being socially active is critical in order to attain that maximal function of the brain.
- [14:25]
A
So with the rapid advances in AI, do you see any new opportunities emerging to enhance brain health.
- [14:32]
B
I am very hopeful. We know we all talk about the threats and challenges of AI, but I think there is a series of benefits that we can gain from the incorporation of artificial intelligence that allows us to look at those lesions in a little bit more detail, look at the volume of lesions, see if they grow, if they shrink over time, measure the brain volume that we were talking before. Being able to have a number for that atrophy rate might be meaningful. And we are also working with an app called the iCompanion app that patients can input additional clinical information and symptoms in between visits. So I think that the incorporation of these tools may allow us to get more information and get a better picture of what is the current situation of our patients.
- [15:19]
A
Excellent. Well, thank you so much, Dr. Miravalli, for. For being a leader in the field of brain health and for sharing all your insights here with us on the Ms. Living well podcast. I really appreciate it.
- [15:30]
B
Thank you, local singer, for the invitation. It's been a pleasure.
- [15:45]
A
My next guest is Dr. Lisa Doggett. Dr. Doggett is a family and lifestyle medicine physician at UT Health, Austin's multiple Sclerosis and Neuroimmunology center, and the author of an award winning memoir, up the Down Medicine, Motherhood and Multiple Sclerosis. She attended Amherst College, Baylor College of Medicine and the University of Texas School of Public Health and completed her family medicine residency at the University of Cincinnati. Dr. Doggett, welcome to the Ms. Living well podcast.
- [16:15]
C
Thanks for having me.
- [16:17]
A
Great to have you on. So let's jump right on in. Can you share what your life was like around the time you were diagnosed with multiple sclerosis?
- [16:25]
C
Sure. I was diagnosed in 2009, so about 15 and a half years ago. And I was really busy at that time in my life. I was running a clinic for people that didn't have private insurance. It was a very challenging job. And I was also raising two daughters. My daughters were two and four. At the time of my diagnosis, I was married, I still am married, to a very busy pediatric hospital doctor who worked in the evenings and still does and weekends. And I was just completely overwhelmed.
- [16:56]
A
Yeah, that's. That's pretty crazy, adding that to the mix.
- [16:59]
C
Yeah.
- [17:00]
A
So since your diagnosis, have there been changes that you've made to manage multiple sclerosis?
- [17:07]
C
Well, you know, I was really healthy at the time of my diagnosis. I was already exercising. I followed a vegetarian diet. I rarely drank alcohol. I mean, that's part of the reason I was really surprised when I was diagnosed. I almost could have just said well, what's the point of a healthy lifestyle if I still got ms, but I actually took the opposite approach? So I realized this took some time, it wasn't instant, but I realized, you know, Ms. Is random, it's bad luck. I had weird symptoms to deal with. I had a lot of dizziness, that was my main symptom. And I realized even if I can't cure ms, I need to figure out how to manage these symptoms. And then also, I mean, I was working at a clinic where I was seeing a lot of people with chronic disease and I realized, you know, now I've got a chronic disease and one is more than enough, I don't want to get another one. That really led me to double down on a healthy lifestyle, which was like prioritizing my self care beyond what I was already doing. And I had to learn to ask for help, which I think is a tough thing for a lot of us. We want to be independent. And realizing I couldn't, I needed to get help was tough. I had to do some experiments to figure out how to sleep better, how to figure out kind of what the triggers were for my dizziness. It turned out that caffeine was a real problem for me. I also tried things like yoga and acupuncture, some different types of physical therapy. And what really helped me most was mindfulness meditation. I was real skeptical of meditation, but I had some physician friends who talked me into taking a MBSR class, which is mindfulness based stress reduction. And I learned that I could meditate and it helped really more with my symptoms than anything else. So that was a really important tool.
- [18:49]
A
Yeah, that's really amazing how you were able to figure out what made you better. Right?
- [18:53]
C
Yeah.
- [18:54]
A
I think a lot of patients out there, a lot of my patients, and a lot of people living with them must struggle to find what's really going to work for them so they can live better.
- [19:02]
C
Sure. Yeah, exactly.
- [19:03]
A
So, Lisa, you're board certified in both family and lifestyle medicine. What is lifestyle medicine? How can it help support people living with ms?
- [19:13]
C
Yeah, you know, lifestyle medicine is a newer medical specialty, but it's really based on decades of research and it's a medical approach that focuses on preventing, treating and even reversing chronic diseases. In some cases by making evidence based lifestyle changes. So rather than relying primarily on medications or surgeries, lifestyle medicine emphasizes sustainable habits that we can continue that promote long term health. Healthy habits can reduce the incidence of things like coronary artery disease by over 80% and diabetes by over 90%. Both of these Conditions and several other chronic conditions are more common in those of us who live with Ms. A lot of us with Ms. Also have symptoms, of course, like fatigue. So common sleeping difficulties, depression, pain. Lifestyle medicine can help manage and reduce symptoms. So there's six core pillars of lifestyle medicine and those are healthy eating, which is recommended by the American College of Lifestyle Medicine, is a whole food plant, predominant diet, physical activity, restorative sleep, stress management, avoidance of risky substances, and then my favorite is positive social connection.
- [20:27]
A
Yeah, that's awesome. You know, a lot of people go to an internist. I think a lot of these important aspects of, of wellness are sometimes not addressed adequately during those sessions because there's so many chronic diseases that are just being specifically managed with frankly, medications.
- [20:43]
C
Primary care physicians are often just so busy managing chronic conditions, managing acute conditions, and often really rushed. We have very little time to see large numbers of patients. A lot of times that's out of the doctor's control. And that can mean that you just don't have time to cover the bases with lifestyle medicine. And the other thing is a lot of physicians aren't adequately trained. A lot of doctors don't have the background in things like nutrition. They may not even be up to date with exercise guidelines or have time to counsel patients on sleep hygiene. So it's really a challenging thing for most doctors in primary care to be able to adequately spend the time helping patients realize where they may be having challenges and set goals. I've been able to create a program at the University of Texas at Austin Dell Medical School in our Ms. Center where I can really have the time necessary to really dive into patients concerns and understand where they may be having problems around lifestyle.
- [21:44]
A
So let's turn now to brain health. So how do you explain, in a way that makes sense for someone living with ms, what brain health is?
- [21:52]
C
Ms. Is a condition where the immune system mistakenly attacks parts of the brain and the spinal cord. And of course, this affects how the brain can send signals to the rest of the body. But the brain is also resilient and it kind of has a backup system which we call neuroplasticity. And it means it can adapt and reroute signals and even build new connections and taking care of your brain through the right treatments, of course. And all of the tenets of lifestyle medicine can help protect that ability. So you can't control everything that Ms. Does, but there's a lot you can do to support your brain and give it its best chance to stay strong. Studies have shown that at least 60% of strokes, 40% of dementia, even late life depression. They're attributable to modifiable risk factors, including things like alcohol intake, blood sugar, cholesterol, depression, diet, hearing loss, feeling, a sense of purpose, many other things. So it's really critical to adopt and maintain a healthy lifestyle in order to help preserve brain function function, especially when you've got another problem like Ms. That's creating more difficulties for your brain.
- [23:00]
A
Lisa, you mentioned diet just then. How do you talk to your patients about diet and supplements? Are there certain things you recommend or steer people away from?
- [23:10]
C
Yeah, diet is confusing and Ms. I mean, I think it is for everybody because there's so much conflicting information out there, but especially with Ms. And so I've really tried to learn a lot about this and I've told my patients there is no Ms. Diet yet that has been clearly proven to slow or stop Ms. Progression. There is ongoing research. What we do know is that the best diet for MS, or really for anyone, is not the traditional western diet. And by the way, both the MSAA and the National Ms. Society have great resources on their websites to help people who want to learn more about the best diets for people with Ms. But the American College of Lifestyle Medicine offers a lot of help and they recommend a whole food plant predominant diet, which I mentioned earlier, to help prevent other chronic conditions. So again, people with Ms. Are at higher risk for many other chronic conditions. So really honing in on a healthy diet is critical. So in particular I steer my patients away from sugar sweetened beverages which can cause rapid blood sugar spikes and promote insulin resistance, can also increase inflammation, can contribute to weight gain. I also tell people to limit or eliminate red meat, especially ultra processed meats like hot dogs and sausage which are high in sodium and saturated fat and preservatives. Ultra processed meats are those that are often in like that deli section and plastic in the grocery store. And these can increase the risk of certain cancers, heart disease and other chronic diseases. But you know, instead of talking about like what you have to take out of your diet, I really like to focus on what we can add to someone's diet. Focus on adding more fruits and vegetables, whole grains, legumes, nuts and seeds. These are really the core of a healthy diet diet. And then in terms of supplements, this is another really challenging topic that is very confusing and I don't take a one size fits all approach to that. I really want to make sure that if you are supplementing, you understand why you're supplementing and it really choosing the right supplement Depends on what underlying condition you're trying to treat. So, for example, vitamin D is something that we don't get enough of in our diet. Usually low levels have been linked to developing Ms. And may increase the risk of relapses. So a lot of us should probably supplement vitamin D and talk with your doctor, of course, about the best dose and how necessary that is, depending on your level of vitamin D, which is a blood test. Vitamin B12 is another supplement that I recommend if you're on a strictly vegan diet where you don't have any animal products, or if you take certain medications or have a deficiency that's found through blood testing. But not everybody needs to take vitamin B12 or even needs to take. Take a multivitamin. In fact, I don't take a multivitamin. Prenatal vitamins, though, are necessary, especially prenatal vitamins with folic acid. For people who are pregnant, or if they could become pregnant. Magnesium supplements may be useful for a variety of conditions like migraines or constipation or sleep. But the best form and dose really depends on what you're trying to treat. So I really want to understand what someone specifically is needing, what symptoms they're having, before we really dive into supplements, and in many, many cases is people are over supplementing. I think the other thing to keep in mind is that supplements are not regulated by the Food and Drug Administration the way medications are. So frequently the contents inside don't match what the pill container says, and that is a huge concern and it's hard to get around.
- [26:42]
A
Yeah, that's all really useful information, and I think it's important to have that conversation with your healthcare provider when you come into the office and really be open with it. We're pretty receptive to hearing about what supplements you're taking and kind of give you some advice and make sure not interacting with anything you're taking on a regular basis.
- [26:59]
C
Yeah, absolutely. Great point.
- [27:00]
A
What about social connection? How important is that when trying to protect brain health?
- [27:05]
C
Yeah, social connection, that's my favorite of all the six tenets of lifestyle medicine, is really staying connected and prioritizing those important relationships. So we know that isolation and loneliness raises the risk of chronic conditions, including things like dementia, as well as mental health problems and even early death. Ms. Can make it more difficult to get out of the house, to get out and see friends, to make new friends. But it is really important to find ways to keep those connections. Don't let that slide in your life. Positive social relationships can improve physical, mental and Emotional health. So my recommendations are to really prioritize those important relationships that bring you energy and joy. Reconnect with old friends and family, look for ways to meet new people. So that may be volunteering. You can even volunteer from home and that's a great way to connect with others. In many cases you can join a book club or an Ms. Support group, take a class, get involved in a church or a place of worship, get to know your neighbors, be part of someone else's support circle. Because if you're part of someone else's support circle, they're probably going to be part of yours. And you can really help each other when needed.
- [28:17]
A
Excellent. So what about mental health? So we know about half of people with Ms. Struggle with depression. And one study was 43% of people with Ms. Have anxiety.
- [28:29]
C
Yeah.
- [28:30]
A
How do you manage this aspect of living with ms?
- [28:33]
C
Depression and anxiety are definitely a concern in people with Ms. And as you mentioned, are much more common than in the general population. I get it. I've struggled with both at different times in my life. I think that that years of therapy and actually writing have helped me, even at the time of my diagnosis, to kind of be prepared with how to move forward. So over the last 15 years, I also think that daily exercise, prioritizing my sleep and meditation have helped a whole lot. And then nourishing my support circle has been important. So I stayed in contact with friends and family. I'm in regular contact with a wonderful group of close friends. I'm involved in a number of different organizations. I have great colleagues and I connect with my extended family, usually on a weekly basis.
- [29:20]
A
Too many of my patients and many people living out there with Ms. Have really struggle with stress management. And you mentioned meditation was helpful for you. Are there any other tools or techniques that work really well for your Ms. Patients?
- [29:34]
C
Absolutely. So we really have to examine on ourselves to understand what our triggers are. So for me I've learned that a big one is being rushed. If we know our triggers, it's helpful. We can take steps to avoid or reduce those situations in some cases. And then while we can't avoid it, we can control our response to stress. So have some go to strategies. So things like finding ways to self soothe or relax through music, exercise, dance, maybe yoga, Take time for fun and hobbies. Don't be a workaholic. That's been something I struggle with a bit as well, I would imagine. I think a lot of us do. In medicine, practicing gratitude is great and so important just to remember all the things that you do have that are going well in your life or certainly that have in the past. Writing is a great outlet for many people. We talked about meditation counseling, especially if you are really having a lot of trouble and can't seem to find a way to manage your stress. Stress if it's getting out of control. And then I think of course you want to incorporate all the other pillars of lifestyle medicine into your life, great.
- [30:42]
A
So if someone's just been diagnosed with Ms. And they're scared about what it means for their brain, what do you say to them?
- [30:50]
C
I get it. You know, an Ms. Diagnosis is scary. I know it's overwhelming. It's okay to feel all the things. I felt a lot of grief for really probably years. I was jealous of my former healthy self and I, I just couldn't believe that I had gotten stuck with this chronic disease. I call it my life sentence. But you know, while Ms. Is a serious condition, it's not hopeless. There are new treatments. Disease modifying therapies or DMTs are available that can significantly slow Ms. Progression, can help many people with Ms. Live long fulfilling lives. I am a big proponent of disease modifying therapy. And so while lifestyle changes are important, they should be done with medication, not instead of dmt. And then there's a lot you can do with lifestyle choices to help with your symptoms and prevent other chronic conditions. Keep your brain as healthy as possible. You want to make sure you've got a good doctor, usually an Ms. Specialist that you can trust and then again reach out to your support circle. I do think it's important to share your news if it's possible with others you can trust and who can provide support, especially as you're processing the news and figuring out your next step.
- [31:59]
A
So, Dr. Daggett, any final thoughts or lessons you've learned about protecting brain health while living with ms?
- [32:05]
C
Sure. Thank you for the question. I think exploring and defining your sense of purpose is really important. It can be a challenge with Ms. If you're losing your abilities. And I have patients that come in and are just feeling so frustrated that they can't do what they used to do anymore. And feeling kind of that their life is. Doesn't have the value that it used to. But I really believe that everyone has something to offer and so figuring out what that looks like can really help. It can change over time. You may have to adjust your expectations. A lot of times you do, and that can be hard if you're really not sure. It's important to reflect on your past. So when have you been happy and most fulfilled? What activities have you enjoyed in the past? Who do you like spending time with? Are there aspects of those experiences that you could incorporate into your life now and then keeping your purpose in mind, you can also think about setting some goals. And I often set health goals, lifestyle goals with my patients, but then having something to work towards a goal like that is really important to give you a sense of accomplishment and a reason to get up in the morning.
- [33:07]
A
Ah, that's really great insight. In fact, I've seen people who've navigated Ms. Despite disability very, very well because of that sense of purpose. And it was a change too. A lot of people had to shift that paradigm of expectation that are living very meaningful and fulfilling lives.
- [33:24]
C
Absolutely.
- [33:25]
A
Well, thank you so much Dr. Daga for being on the Ms. Living well podcast and providing all your insight into preserving brain health. You know, we talk about disease modifying medications, changing how the Ms. Disease course goes, but there's so much more that we can all do as both people living with Ms. And healthcare providers trying to help people with this journey with this disease.
- [33:49]
C
Great. Thank you so much.
- [33:50]
A
Pleasure. Thanks to our listeners for downloading this episode of the Ms. Living well podcast. Boosting Brain Health Blueprint for Ms. Maintaining brain health is important for everyone, but for people diagnosed with Ms. MS, it's essential for long term well being. Fortunately, as Dr. Dagad and Dr. Miravalli emphasized, there are many practical ways to support brain health such as regular exercise, quality sleep and staying socially connected. When these healthy habits are combined with effective treatments prescribed by your doctor, living well with Ms. Becomes more achievable than ever. Thanks again to TG Therapy for sponsoring this episode. Keep in mind the topics we discuss on the show are strictly informational and not medical advice. Any change in your treatment should be discussed directly with your healthcare providers first. Our show is hosted by me, Dr. Barry Singer and Dr. Jamie Holloman and produced by Carriott Harmon. Our theme music is the Gold Lining by Broke for Free. If you like the show, please share it with others living with us and I really appreciate a positive review on Apple Podcasts. It helps more people find out about the show. You can follow me on X at Dr. Barry Singer and Dr. Jamie Holloman at BrainBoyNeuro. More information about our guests and websites can be found in the show Notes for this episode in the blog section on mslivingwell.org thanks so much for listening. This has been an Ms. Livingwell podcast cast.