00:00:00:00 - 00:00:45:07
Mary Ray
Welcome, everyone. I'm Mary Ray, co-founder of MyMSTeam, the largest and fastest growing social network for people with MS. Already 1 in 9 people diagnosed with MS in the United States is a member. Worldwide, MyMSTeam has more than 150,000 members who provide support and advice for each other. If you haven't checked it out already, please do so at MyMSTeam.com.

00:00:45:09 - 00:01:11:07
Mary Ray
As always, we are very excited to have a full house today. Nearly 700 people have pre-registered for tonight's event, and I'm even more excited to welcome back one of my favorite guests who has continued to have a great sense of humor. His own YouTube channel with over 350 videos covering a range of MS topics, and insightful video and article series on my team, Dr. Aaron Boster.

00:01:11:09 - 00:01:14:06
Dr. Boster
Howdy everyone. Thanks for having me back.

00:01:14:06 - 00:01:34:06
Mary Ray
Definitely. Dr. Boster is a neurology specialist focused on MS, and is the president and founder of the Boster Center for Multiple Sclerosis, and a great friend to us here at MyMSTeam. Well, Dr. Boster, it's a new year, and there are now officially two new COVID vaccines that have started to be distributed.

00:01:34:08 - 00:01:56:02
Mary Ray
Yet, there are so many, so many questions about the vaccine. And today we're going to dig into that topic. And as usual, due to high demand, we are also going to record this event. This live event. So those who are missing it won't be able to, we'll be able to catch up. By the way, we are going to do another event in March, and so just stay tuned and we'll have details at the end of this event.

00:01:56:04 - 00:02:17:08
Mary Ray
By now, many of you do know my personal connection to MS is through my mother-in-law, who lived with MS for over 30 years. Before we really start, I'd also like Dr. Boster, if you can share your connection to MS as well.

Dr. Boster
I learned about MS, one of my earliest memories. I don't remember a time when my uncle didn't have MS.

00:02:17:10 - 00:02:39:01
Dr. Boster
I decided to be an MS doc when I was 12. I came into my grandma's house, and my mother and my grandmother were crying because they couldn't get ahold of his doctor, and I promised my mom that I would learn to do it better. I've had a very directed course, and my goal, it's almost become a mission of mine to help people impacted by MS lead their best lives.

00:02:39:03 - 00:03:01:03
Mary Ray
Thank you for sharing that. Tonight we have a lineup of really interesting questions that we collected before this event. And for those of you watching right now, don't worry if you didn't send one in, you can post a question in the Q&A through the Zoom feature. So throughout you'll just be able to post and we have some folks who can help call those questions and bring them to my attention, which I can field.

00:03:01:05 - 00:03:22:24
Mary Ray
Please note again that Dr. Boster isn't able to answer specific medical questions in this forum. Those should be addressed to your own doctor. All right. To get started, back to these vaccines, can you give us an overview of the two vaccines available for COVID in the US?

00:03:23:01 - 00:03:48:15
Dr. Boster
Yes. I want to take one step back and talk about what is a vaccine because sometimes it's confusing for folks. When your human body comes in contact with a virus, your immune system tries to make antibodies and cells against the virus, and you have a sort of a cold war, where your immune system is trying to develop itself and the virus is trying to attack you. And hopefully the immune system wins and clears the virus.

00:03:48:17 - 00:04:15:12
Dr. Boster
What we do with the vaccine is we try to give you a head start. We try to prime your immune system, and in normal virus vaccines, we shred the virus in a blender, so we have like little shredded pieces of virus. It's dead, and then we load that in a syringe. You inject it into your arm, and then these particles, these virus particles, are floating around the bloodstream, and the immune system identifies them as foreign proteins,

00:04:15:12 - 00:04:40:14
Dr. Boster
foreign structures. And it says that's not supposed to be there. And then your immune system builds an arsenal, builds antibodies and cells against those viral pieces, and then it's amplified. So what you've done is you've created a sort of an army, like a bunch of stormtroopers that specifically identify parts of that virus, even though you've never seen the actual infection and that is maintained in the human body.

00:04:40:14 - 00:05:00:00
Dr. Boster
Then later, if you come in contact with that virus and you already have a giant arsenal and you jump on top of it and clear it quickly. And so if you've been vaccinated for something, it doesn't mean that you can't catch that illness, but as soon as the illness hits your body, your body clears it very easily. That's the goal of a virus vaccine,

00:05:00:00 - 00:05:27:10
Dr. Boster
and we've used vaccines to successfully eradicate things like smallpox, and in this attempt at creating a vaccine created a lot of problems for us because we weren't able to create a viral protein. It didn't work, and so what the folks that ultimately created these vaccines did was absolutely brilliant. It's scientifically eloquent and most certainly is going to win the Nobel Prize.

00:05:27:12 - 00:05:54:21
Dr. Boster
They took one step back, and instead of making the protein, they made the blueprint for the protein. So in humans and in viruses, there's a blueprint that tells you how to make protein structures like skin, or your eye, or your nose. And the blueprint is in humans DNA, then RNA, then protein. In this particular coronavirus, COVID-19, it's an RNA situation,

00:05:54:21 - 00:06:20:24
Dr. Boster
and so the RNA encodes for protein. Now there are 26 proteins in the COVID-19 virus, and we isolated the blueprint for one, the spike protein. So if you've seen a cartoon of COVID-19, it's like a cooch ball with a bunch of spikes sticking out, and all those spiky things is kind of how the virus attaches and enters the human cell.

00:06:21:01 - 00:06:46:14
Dr. Boster
And almost all coronaviruses have the same spike protein, and so what we did was really cool. We took the blueprint for the protein and the RNA, and we inject it into you and it's absorbed into your cell, and your cell looks at the blueprint, says, I can make that. And it uses your own amino acids, and it builds the protein based on the blueprint

00:06:46:16 - 00:07:05:17
Dr. Boster
except the protein is a viral spike. It's not making the virus, it's just making the spike. It's like we're not making the unicorn. We're just making the horn, and then that unicorn horn, or that viral spike starts floating around the human body, and then your immune system says, whoa, whoa, whoa, whoa. That's not a human sequence. That's a viral sequence.

00:07:05:19 - 00:07:30:01
Dr. Boster
And your immune system can then mount a response against the spike protein, and so, you develop antibodies and you develop T-cells against the spike protein. And then in the meantime, messenger RNA is very unstable, and as soon as it's inside your cell, your cellular enzymes start to degrade it, so pretty soon the blueprint’s gone and your immune system is now primed.

00:07:30:03 - 00:07:58:03
Dr. Boster
If you come in contact with COVID-19, your immune system has a massive head start, and what we've seen with both the Pfizer and Moderna vaccines is that we have 99 and 95%, respectively, immunity, which is absolutely amazing. It's actually way better than what we see with, say, like a flu vaccine. Now, before we talk about specifics, I want to give an analogy that I think helps kind of understand the way these vaccines work.

00:07:58:05 - 00:08:22:00
Dr. Boster
Imagine, Mary, that you wanted to build an IKEA bookshelf, right? And you didn't have an IKEA bookshelf, and I mailed you the manual, the instruction booklet for the IKEA bookshelf, not the parts, just the booklet. And because you're creative, you run around your house and you look for parts and pieces and you amass all the materials from your own home, and then you follow the blueprint for the IKEA bookshelf, and you make an IKEA bookshelf,

00:08:22:02 - 00:08:45:22
Dr. Boster
except you made it with your own parts, and then you throw the manual out, and then your family walks in the living room and says, hey, you got an IKEA bookshelf because that's what it looks like. That is exactly how we are beating this, this virus with the vaccine, and I think that's really, really cool,

00:08:46:00 - 00:09:04:20
Mary Ray
but definitely this idea of a blueprint and using our own bodies to fight using that blueprint is pretty remarkable. So, just to be clear, and I do want to get down to the differences, you've already pointed out. One, in terms of effectiveness, but again anything over 90% is remarkable. So between the two vaccines, one’s 94% effective, one’s 99% effective I think I heard you say, but are they, and they are not live. There is not a live virus in it. It's a blueprint. So, I just want to reiterate that point.

00:09:04:21 - 00:09:29:10
Dr. Boster
It's an extremely important point, particularly with this community. People impacted by MS are asked to avoid live vaccines, and these are not live vaccines at all. It's not even a part of the virus itself. It's actually just a blueprint for one protein.

00:09:29:10 - 00:09:57:20
Dr. Boster
So there's no concern in my mind that we would trigger an infection, or trigger a relapse because of it.

Mary Ray
So what are the side effects?

Dr. Boster
So based on the clinical trials, these vaccines behaved like vaccines normally behave. Generally you see just soreness where you got injected. I got my vaccine the first shot, last Saturday and Sunday, I felt like somebody had socked me in the arm.

00:09:57:22 - 00:10:21:18
Dr. Boster
You know, and I was happily achy all day, and that's the largest side effect that we see. Some people feel flu-like, they feel punky, particularly, I'm told, after the second shot. Largely, people are tolerating this remarkably well. Now, when you look at the nitty gritty, there's been extremely rare cases of Bell's palsy where one side of the face may droop.

00:10:21:20 - 00:10:44:04
Dr. Boster
In extremely rare cases of Guillain-Barré, which is a peripheral demyelinating condition. That's quite serious, but we're talking about exceedingly rare events. You're more likely to be struck by lightning than to have one of those side effects, and you're certainly more likely to be in a car accident than have those side effects.

Mary Ray
So what I'm hearing, loud and clear, is people with MS should get one of these two vaccines.

00:10:44:06 - 00:11:05:11
Dr. Boster
Yes, now, we can't make a blanket statement for 700 people listening in right now, but in my estimation, unless there's a massive reason, and the only reason that I can think of is you have a history of anaphylaxis to vaccines. I'm recommending that my patients get vaccinated as soon as it's offered.

Mary Ray
Do you have a preference? One over the other?

00:11:05:13 - 00:11:26:20
Dr. Boster
Yes. I prefer the first one that you can get a hold of, and so I have no preference between the two. If somebody offers you Pfizer, say thank you. If somebody offers you Moderna, say thank you.

00:11:26:20 - 00:11:50:11
Mary Ray
Right. And those are the two right now that have been approved by the FDA. There are some more that will be coming that actually are different, don’t come with a blueprint. So, we don't need to talk about that now. We can have updates later, but just to be clear, it's the Pfizer and Moderna vaccines that you're talking about, and you're saying if you can, either one.

Dr. Boster
Correct.

Mary Ray
Great. Fantastic. Thank you. You know, many people asked if the vaccines were tested on people with MS in the clinical trials.

00:11:50:13 - 00:12:25:24
Dr. Boster
So there were a few people with MS included in the trials, but I mean a few, and it's too small for us to pull them out as a sample and learn from them, so we don't have a dedicated trial in that space.

Mary Ray
Okay. Thank you. If we don't know how many people with MS, but we know there are a few people we don't really know if that's going to be enough of a sample. How do we know that it's actually safe for people with MS? Could it cause a flare or possibly speed progression? That's a big fear.

00:12:25:24 - 00:12:44:00
Dr. Boster
Well, let's think through that. If the vaccine could trigger a relapse, and I don't think that it could. Imagine what happens when you get COVID. So I'm an MS doctor, and unfortunately I've had several patients that got COVID, and it triggered an attack, not a serial attack, but an attack.

00:12:44:02 - 00:13:04:15
Dr. Boster
So I don't want to lose sight of the real concern. The real concern should not be the intricacies of the vaccine. It should be the risk of death of the virus, and when people say, well, I'm healthy, I think that I can, you know, I could handle it. Okay, maybe that's true, but how about your parents? How about your grandparents who are elderly?

00:13:04:15 - 00:13:27:04
Dr. Boster
How about your neighbor who has brittle diabetes? And so there's more to think about than just the individual themselves, I think. To go back to what you're saying, I don't want to skirt around it. I don't think that triggering the immune response to respond to COVID-19 is a set up for a relapse.

00:13:27:09 - 00:13:52:24
Dr. Boster
We haven't seen that with dead vaccines in other realms, and I haven't seen any inkling of that in any of the forums that I spent time in or any of the articles that I read or my colleagues around the country that are infusing.

Mary Ray
Another question has come up. And again, I think I know the answer to this, but it is very specific for people who are on DMTs, disease-modifying treatments, can they get the vaccine?

00:13:52:24 - 00:14:14:06
Dr. Boster
So again, you're going to need to talk to your doctor. I can share my opinion which doesn't make me right. It just makes me really opinionated, but you're stuck listening to me, so I'll share. I can't think of a situation where I'm not going to vaccinate someone. Certain DMTs, we have to think about the timing of the vaccine.

00:14:14:08 - 00:14:35:16
Dr. Boster
And in a perfect world, where I had ample access to vaccine, I might pick and choose when I vaccinate someone. The reality is the way that the American government has rolled out the vaccine. We're not really getting a choice when we pick, and hence the conclusion of the National MS Society and the MS International Federation, and Aaron, is that if you're offered the vaccine, you should take it.

00:14:35:19 - 00:15:00:13
Dr. Boster
Let me give you an example. A lot of people are concerned that if they receive a DMT, that is a B-cell killer, and so there are several B-cell killers, rituximab, ocrelizumab, ofatumumab. These are MS medicines that are highly effective, and they work by depleting adult B-cells.

00:15:00:15 - 00:15:21:15
Dr. Boster
And so there's a lot of concern on the table that maybe that would attenuate or it would make the response less robust. And there's a theory based on other vaccines that if you were to wait a month prior to taking your next infusion or shot, that that's like the primo time, which is great, but that's only going to work for a handful of people,

00:15:21:17 - 00:15:42:09
Dr. Boster
and because we don't know when their lot will be pulled, I don't want to not treat their MS. I mean, I'm an MS doctor. I want to treat the thing I know they have, and slow down the disease progression, and if it works out perfectly that we can, we can vaccinate a month beforehand, glory be, but even if not, it's still going to work.

00:15:42:09 - 00:16:06:23
Dr. Boster
And I want to explain that for a second. The Moderna vaccine and the Pfizer vaccine mount a massive humoral response, so that's doctor talk for antibodies. They also mount a massive T-cell response, a cellular response. They do both, and if you're on a B-cell killer and your B-cells are suppressed, you're going to mount a 100% T-cell response,

00:16:07:00 - 00:16:30:04
Dr. Boster
and you're going to mount a B-cell response. It'll just be attenuated. So hypothetically, Mary, let's say that I have MS, and you don't, and we both get vaccinated. You're going to have 100% T-cell response. I'm going to have 100% T-cell response. You're going to have 100% B-cell response. Maybe I have a 50 to 70% B-cell response. Okay, that's still fantastic, and the more people in your bubble in your village that get vaccinated, the safer and safer it is for you.

00:16:30:06 - 00:17:00:03
Mary Ray
I want to go to some questions from our audience right now, and these are pretty good questions. I mean, these are excellent questions, actually. Is multiple sclerosis considered an underlying condition to receive the COVID vaccine? Basically, does that put them in the 1B group as they say?

00:17:00:03 - 00:17:23:13
Dr. Boster
No, it doesn't appear to. MS is not an immunosuppressed condition. It's the opposite. People impacted by MS are not immunosuppressed. Their immune system is overly active. Now we can place people on medicines that suppress the immune response on purpose, but MS in and of itself is not an immunosuppressed state, and it was not deemed by the powers that be, to be in that second tier category. Thank you.

00:17:23:15 - 00:17:47:16
Mary Ray
Thank you. This comes from Linda. I just had COVID. Does this mean I cannot get it again? And thus vaccinations will not be needed? I do have MS.
Dr. Boster
So unfortunately, that's not necessarily true. We would like that to be true because it seems to be true with certain other vaccines, but I want you to think about this virus and this vaccine, kind of like the flu.

00:17:47:18 - 00:18:09:07
Dr. Boster
And right now there's some weirdness going on where some people have had COVID, they clear COVID, and then they don't have an antibody response a couple of months later, which is really disheartening and confusing. What I have chosen to do with my patients with MS who have had COVID and cleared it, is I'm checking their antibody response to COVID-19.

00:18:09:09 - 00:18:27:23
Dr. Boster
So SARS-CoV-2 antibodies, and if they mount an antibody response then they probably may not need to be immunized, but if they don't mount an antibody response then I'm encouraging them to get the vaccine.

Mary Ray
So what does that call that you administered to be able to test that?

00:18:27:23 - 00:18:59:04
Dr. Boster
So it’s a blood test, it's a, it's commercially available. It's not a special blood test. It's commercially available and it tests for COVID antibodies. So SARS-CoV-2 is the actual name of the causative agent. So it's SARS-CoV-2 IgG, it's a COVID antibody.

Mary Ray
Great. There are lots of questions related to being on Ocrevus and getting the vaccine. I'm not sure if this is going to change your answer again from what we've already said before, but, could you speak to that specifically?

00:18:59:08 - 00:19:22:03
Dr. Boster
I would be happy to. So if you have multiple sclerosis, then your immune system is constantly and unrelentingly chewing on your brain, which is bad for you. And we want to do things to slow that or stop that. And we want to do that during a global viral pandemic. And we want to do that when there isn't a global viral pandemic.

00:19:22:05 - 00:19:50:24
Dr. Boster
And if the way that you're treating your MS is with a B-cell killer, that's a really effective way to treat MS. It works super well. And if you are on Ocrevus or any of the other B-cell killers, Kesimpta or Rituxan, then we've suppressed your B-cells to limit your MS. If you need vaccinated, it might result in an attenuated or a smaller B-cell response.

00:19:51:01 - 00:20:11:19
Dr. Boster
It's not a zero B-cell response. We don't think, it's a smaller response, and the T-cell response will be robust. Now I need to make a comment. I share that with you based on data from a clinical trial called the VELOCE trial, and that was a trial where we gave, and I was involved in the trial where we gave people with MS Ocrevus,

00:20:11:19 - 00:20:35:14
Dr. Boster
and then a couple months later we immunized them, not against COVID because that didn't exist, but we immunized them against DTaP, MMR, the flu, stuff like that. And what we saw was extremely reassuring. They mounted immune responses. It was just a partial response like 50%, and so I'm borrowing the data to try to envision what I think's going on with COVID-19.

00:20:35:16 - 00:20:56:24
Dr. Boster
It's not dangerous to get the COVID vaccine. If you've received a B-cell killer and it will work, the T-cell response will be 100%. We don't measure T-cell responses because it's really hard to do that outside of fancy pants laboratories, and you will mount a B-cell response. It'll just be attenuated, we believe, attenuated being a doctor term for smaller.

00:20:57:01 - 00:21:18:13
Mary Ray
There's this again real concerns about side effects from the vaccine. Are they more intense, Based on any anecdotal evidence that you've seen, I know there were only a few people in the trial, so it may not be clear. Are the side effects more intense if you have MS?

00:21:18:15 - 00:21:44:08
Dr. Boster
I don't have that answer. I'll tell you anecdotally, I have a lot of patients who are, who have been vaccinated because they're doctors and nurses and they're teachers, or they're in nursing homes. So I've had probably a couple hundred people that I take care of with MS who have been vaccinated. I've heard no problems. Now, that doesn't mean that there couldn't be a problem, but that's the best anecdotal data that I have, and it's very reassuring.

00:21:44:10 - 00:22:07:20
Mary Ray
That's great to hear. As you had mentioned before, unless you have had a life threatening reaction to vaccines, cannot breathe. Several members have asked, you know, if they've had a bad reaction to a previous vaccine, should they skip it, or could they possibly be too old to get the vaccine?

00:22:07:22 - 00:22:32:04
Dr. Boster
I don't think it's appropriate to be ageist. On the contrary, governments around the world have agreed that older people, who are at higher risk of a more severe COVID, deserve to be immunized first, and I think that makes a tremendous amount of sense. Why are we vaccinating nursing home residents first? Mary, because 25% of the deaths in the United States have occurred in nursing homes, and we're talking about 400,000 Americans.

00:22:32:04 - 00:22:53:00
Dr. Boster
This is a plague, and so I don't think it's a good idea to be ageist. On the contrary, I think people who are older need the vaccine more and they can mount a response. I think that's really, really important.

Mary Ray
And again, that's also supported by the CDC anyway. They're in the first group.

Dr. Boster
Correct. Those are some really smart scientists and doctors that have gamed that out.

00:22:53:02 - 00:23:20:16
Mary Ray
Right. And then to this, this question of, I've had a reaction, I've had a bad reaction to vaccines before. You suggested like it's weighing that against not being will even survive COVID. What's your response? What do you consider a bad reaction?

00:23:20:16 - 00:23:39:22
Dr. Boster
Anaphylaxis is a situation where your throat swells shut, you can't breathe, you lose your blood pressure, like you'll die. So anaphylaxis is not a bad reaction. Anaphylaxis is a life threatening reaction, and if there was a concern, what I would probably want to do, is I would get the vaccine, and I would carry an EpiPen, and I would try to get the vaccine in a medical environment. So where I got my vaccine was really weird.

00:23:39:24 - 00:23:56:23
Dr. Boster
I live in Columbus, Ohio, and at the state fairgrounds, they opened up one of the big buildings, and I drove into it and I stopped and gave a guy my ID and all my credentials. And then he had me pull forward, and then I rolled up my sleeve and the guy jabbed me while I was in my car.

00:23:57:00 - 00:24:19:09
Dr. Boster
And then he said, go out and wait for 15 minutes in the parking lot and honk your horn if something bad happens. Now, before you think that's irresponsible. The reason they were able to do that is we're not seeing scary events. That stated, if you had a significant fear, I would try to opt to have the vaccine in front of medical personnel, and I would probably have an EpiPen with me. And my point here is, I think it's so important that I would try to figure out a way to receive the vaccine anyways.

00:24:19:14 - 00:24:40:11
Mary Ray
Yeah. Got it. That makes sense. And, and you've made this other point which is I do know as they've been doing this rollout, they are wanting to observe everyone's reaction. So that's, it's not like they give it to you and off you go.

00:24:40:13 - 00:25:00:07
Dr. Boster
Something else that's really cool is when you get your vaccine, they give you a link to an app and the app is set up so that you can record your symptoms. And so hundreds of thousands of people throughout the United States are constantly, daily recording our symptoms after the vaccine. And guys were not seeing something scary.

00:25:00:09 - 00:25:24:12
Dr. Boster
Now somebody just asked a question. And at the risk of jumping ahead of things, they asked whether or not there's ever been a vaccine with mRNA technology before. And I want to remind the person that asked that question that mRNA technology is not new. mRNA technology has been around for over ten years. Now, this is the first time that we've made a vaccine like this out of it, but it's not a brand new invention. Not at all,

00:25:24:12 - 00:25:54:07
Mary Ray
but because of the ten years of work and research that has gone into it, that's the amazing progress that we made in a year to get this together right. That's what we should all be grateful for. Right. I want to go into our poll questions for tonight. And the question is, how likely are you to get a COVID vaccination?

00:25:54:09 - 00:26:10:14
Mary Ray
Well, Dr. Boster, I know your answer. My answer is, I will definitely get it. You're already halfway there. You still need your follow-up shot, I believe.

Dr. Boster
Correct. Yeah. And I'm really grateful that we're doing two shots here in the United States.

00:26:10:16 - 00:26:38:02
Mary Ray
Oh. You're suggesting what? What’s happening abroad?

Dr. Boster
That's suggesting that in England, because of a shortage of supplies, they're just doing the first shot because they don't have enough shots. And unfortunately, it doesn't work as well, but it works better than nothing. And so I think that's one of those, like, tough situations. I'm really, really fortunate that we can get the two step vaccine because it takes you from, you know, 50% way up in the high 90s.

00:26:38:04 - 00:26:57:21
Mary Ray
Wow. You know, it's interesting, we had asked the same question in December, at the last event we did with you in December. And I'm, I am very curious to see how the responses have changed since then with more information.

Dr. Boster
It's my hope that the responses that there's a higher response of folks that are willing to take the vaccine.

00:26:57:23 - 00:27:33:10
Mary Ray
Yeah. So let's find out. We can pull up the results now, and I can let you know what happened last time. We'll see today's results. 64% will definitely get it. 3% already got it. 6% won't get it. And there's 27% waiting and seeing. So, you all saw the results from last time. This is significantly, a great, you know, sign that the information that's out there, including this session, is motivating people to protect themselves against COVID and the risk of it.

00:27:33:12 - 00:28:03:14
Dr. Boster
And I would like to make another really, really important point in why that number 64 is so fantastic. You want to get vaccinated so that you don't die from COVID, and you want to get vaccinated so that you don't pass it on to somebody else. But there's a population health reason to get vaccinated, because if enough people in the United States, and we're predicting between 60 and 70% of the population is vaccinated, we will literally eradicate the virus.

00:28:03:16 - 00:28:30:20
Dr. Boster
So I want to talk about that just for a second, if I may. When we talk about viral replication rates. All right. And it's called the R value. It's basically saying if I get infected, how many people will I infect before I either die or clear the infection. And the R value for COVID is like three. Meaning if I contract COVID-19, I'm going to statistically give it to three humans before I die or before I clear the virus.

00:28:30:22 - 00:28:51:02
Dr. Boster
And that's why you're seeing an exponential growth, you know, of cases in a really scary fashion. If we can drop the R value below one, the virus goes away. And that's what they did in Taiwan by successfully social distancing. So in Taiwan, the military helped a little bit. And if you had COVID, they locked you in your house.

00:28:51:04 - 00:29:11:12
Dr. Boster
And if you're in your house and you're not around anybody, you're either going to die or clear it, but you're not going to pass it on. And so the virus dies. And in the United States, we failed miserably in our attempts at social distancing. And so that didn't work. And as a result, you've seen this massive uptick of infections, which is really sad.

00:29:11:14 - 00:29:39:17
Dr. Boster
But we have a second chance because if enough people get vaccinated, here's what happens. So let's say that you walk into a room and you have COVID and you cough on 25 people and you give 25 people COVID, but they've all been vaccinated. Their bodies kill the COVID and it doesn't go anywhere. And so if you're in the center of a bubble and everyone around you has been vaccinated, the virus can't get to you, because when it hits the people, it clears it.

00:29:39:19 - 00:30:10:04
Dr. Boster
And so we can eradicate this virus. If all of us are willing to help by getting vaccinated. And again, you might say, well, I'm tough and rugged and I can clear it. Good for you. But what about your grandma? And so you may pass that on to somebody else. There was a terrible situation during the Christmas holiday when a guy dressed as Santa Claus went and brought presents to a nursing home, and 75 people died because he didn't know that he had COVID and he spread it throughout the entire nursing home. Hence the desire to vaccinate folks in nursing homes. Be wary of Santa Claus. No, I'm just teasing.

00:30:10:06 - 00:30:33:21
Mary Ray
I wanted to branch out a little bit from COVID for a moment here. Aside from getting the vaccine right, which can contribute to better managing your health anyway, there are plenty of ways people with MS can take care of themselves this year. And one member has asked, how does your well-being affect MS symptoms?

00:30:33:21 - 00:31:00:22
Dr. Boster
So that's a fantastic question. It's very naive, in my opinion, to think that your stress level and your mental health does not have an influence because it does. It very much does. And when I think about living your best life, despite having MS I talk a lot about being four for four and your fight against MS.

00:31:00:24 - 00:31:19:17
Dr. Boster
Meaning I want you to exercise is part of your lifestyle. I want you not to smoke things. I want you to supplement vitamin D, and I want you to take a disease modifying therapy. Make sure it's working. I have a really good friend, who is an amazing PhD psychologist specializing in MS. One of the best in the country, in my opinion.

00:31:19:17 - 00:31:46:08
Dr. Boster
Her name is Amy Sullivan. And Amy said, Aaron, you're off. It should be five for five. And I said, well, what's the fifth one? And she said, mental health. Because if you have untreated depression, your disease gets worse, faster, actually, you get worse neurologically faster. Same thing with anxiety. And by learning mindfulness and by learning how to take care of yourself and your health and manage stress, you actually live a better life. It's a really, really important point that she makes.

00:31:46:08 - 00:32:08:14
Mary Ray
I definitely agree with you and her on that. And there is a body of evidence supporting that, of course. There is a question around well-being, things that we have control over. Sometimes we don't have control over stress, but diet, we certainly do. Is there a definitive diet for people with MS?

00:32:08:16 - 00:32:30:11
Dr. Boster
No. So there is no diet that's been proven to slow the disease. Okay. I want to repeat that. There's no diet that's been proven to slow the disease. However, diet 100% impacts symptoms, 100%. I've seen it again and again and again. There's a lot of diets out there. And there's a lot of, there's a lot of different diets.

00:32:30:11 - 00:32:49:09
Dr. Boster
And if I was to pick one MS diet that I like, the most, it would probably be overcoming MS, and I don't have an affiliation with them. I just think that's a very nice diet. But I don't know that somebody has to abide by something like that. I would challenge people, if you want to clean up your diet, just do the following.

00:32:49:11 - 00:33:21:13
Dr. Boster
Eat real food. So don't eat overly processed foods. Don't eat fast food. Don't drink soda. Don't eat foods that have chemicals and ingredients that you can't pronounce. Eat foods that have ingredients like apple, chicken, broccoli. Eat real food and whole food. When people ascribe to that and they cut sugar out and they cut out fatty foods and they cut out fried foods and fast foods, invariably their energy levels skyrocket and their depression plummets.

00:33:21:15 - 00:33:39:07
Dr. Boster
And I've seen it time and time again, over 15 years in clinical practice. And if you don't believe me, I double dog dare you to try it for a month and see what happens.

Mary Ray
Great. Thank you for that. I want to go back to some live questions coming in right now. And these, kind of, branch out even further.

00:33:39:07 - 00:34:06:01
Mary Ray
So what is the best way to advocate for an individual that suffers from MS? And I, I would suggest that we think about this from a, you know, self-advocacy standpoint, either to protect well-being or to speak up with specialists.

00:34:06:03 - 00:34:28:01
Dr. Boster
So every person needs an advocate. And in the medical space, you need an advocate.
And I always want you to cultivate the very best advocate, self-advocacy, you as an advocate. And so I think we have to start with the fact that it's okay to be selfish. So many of us are selfless and we want to do stuff for others, and we just poo poo our own needs, and to live with MS and not let it pick for you, you have to be a little bit selfish.

00:34:28:01 - 00:34:45:17
Dr. Boster
And what I mean by that is if, for example, you know, you bring something up to your provider, something that's concerning to you, and they sort of blow it off. Don't let that pass. Hey, no no, no, stop! It's my body. It's my brain. I'm telling you, that's important. And I want you to help me do it.

00:34:45:19 - 00:35:13:11
Dr. Boster
And that's fair. You know, they're going to see 13 other patients that day, you know? And if you don't get your needs met, you don't get your needs met. And so it's very, very important to cultivate self-advocacy. Let me give you a pro tip on how you might do that. When I get ready to see you in clinic, I prepare for each patient, I review MRIs, I look through the old clinic notes, and I prepare what I want to do during that visit.

00:35:13:16 - 00:35:45:14
Dr. Boster
And I want you to do the exact same thing. You should prepare for your doctor's visit, right? All of your current medicines and supplements down with all the proper doses. Take pictures if you need to. Write all your questions on a piece of paper so that you have them at the ready, bring any of the records or labs or things that you know they're going to ask, make sure that you're wearing clothes that's easy to move around in, and bring an extra set of ears and eyes so that they can help you remember and listen and help participate in the conversation.

00:35:45:16 - 00:36:04:24
Dr. Boster
Walk into that office ready to talk and be an advocate and say, no, no, I have five more questions Doc. They are really important. I want you to answer them.

Mary Ray
That's great. I wanted to, I know there are a couple of people who are like, what was that diet again? Overcoming MS was the diet. I'm sure you can google that. Overcoming MS.

00:36:04:24 - 00:36:29:05
Mary Ray
And the other question that had come through is a little bit of confusion about the sequence of events around infusions and vaccines, but I think the net of it is, just get the vaccine.

Dr. Boster
Yeah. So the take home message is if somebody offers you the vaccine, say yes. And after you say yes, if you need to, call your provider, call your MS neurologist and say, hey, I've been offered the vaccine.

00:36:29:05 - 00:36:52:23
Dr. Boster
Are you cool with that? If I'm your provider, I'm going to say, yeah, get it. Because even if the timing is not perfect, it's way better than not taking the vaccine by a long shot.

Mary Ray
Thank you for reinforcing that. This question is about specialists. What specialists, other than a neurologist, should MS patients visit on routine for overall treatment?

00:36:53:00 - 00:37:21:19
Dr. Boster
I think that every person with MS needs to have a primary care doctor. And I view primary care as a subspecialty. Being the primary care doctor is actually super hard. So I read every night about one topic, multiple sclerosis. A primary care doctor has to be competent in enumerate different aspects of you as an adult. And so honestly, the most important provider, maybe aside from your MS neurologist, is your primary care clinician.

00:37:21:21 - 00:37:44:01
Dr. Boster
It's imperative. A long time ago, when I was a naive med student, I said, I'm going to be the everything doctor for MS And I'm going to do all of the care for my MS patients, the cardiology and the endocrinology. And I was completely naive. That's impossible. I have to have partners and so the most important one, honestly, in my opinion, is your primary care doctor.

00:37:44:03 - 00:38:18:08
Dr. Boster
If I was to pick another subspecialist, it would be a therapist, a psychologist, someone that you like talking to that can help you manage your stress. And, advocate for yourself and help you overcome psychological and emotional hurdles. That would be my next fav.

Mary Ray
What about a physical therapist? Occupational therapist?

Dr. Boster
So whereas every person with MS is going to benefit from a therapist, a talk therapist. I think that many may or may not need physical or occupational therapy.

00:38:18:12 - 00:38:40:24
Dr. Boster
I find that to be something I do selectively when needed. So, for example, most insurance carriers in the United States will not allow more than 12 weeks of physical therapy. And so given that we can only do it for 12 weeks, I'm very targeted when we use it with specific questions. So having an excellent physical therapist that you can use when needed is a really good idea.

00:38:41:01 - 00:38:59:16
Dr. Boster
I guess I was kind of thinking of who's going to be a constant member of your team.

Mary Ray
Of your team, right. Right. So I guess you could say you have, so some specialists in there, right? A very, very unique specialist. But that's great to hear that the primary care physician should play such a big role.

00:38:59:18 - 00:39:27:17
Mary Ray
Is telemedicine an option for people living with MS? That came from Cesar. And again, thank you. Thank you, Luther and Ellen, for the previous questions. This is from Cesar. Is telemedicine an option?

Dr. Boster
I've been doing 90% telemedicine for months. So, you know, I opened the Boster Center for MS, which is a standalone MS facility, March 19th of 2020, and the governor of Ohio closed the state on March 21st.

00:39:27:19 - 00:39:55:09
Dr. Boster
And so, two days after I opened my doors, we closed our doors and switched everything to telemedicine. Now, I see patients in the office for procedures, and I see them for infusions and for clinical trials, because those are things you have to be on site, but everything else I'm doing remotely. So today I saw a handful of patients in the infusion suite, and I did a couple of procedures, and the rest of the time, all the other patients I saw on camera.

00:39:55:11 - 00:40:14:08
Mary Ray
Can you, let's talk about this a little bit more. What are some best practices? We had talked about, you know, how to advocate for oneself, with doctors and just in general. But what about with telemedicine? What's the best way for both, you know, you as a physician, but also as a patient? To get out of telemedicine? What should they do and consider?

00:40:14:08 - 00:40:37:13
Dr. Boster
So I made a couple of YouTube videos on this exact topic because it's so important, Mary, and I want to go over a couple tips with the folks today. First of all, when you're going to do telemedicine and make sure that you have a quiet place. So I've done telemedicine visits where there's a dog and a cat and five kids and two people arguing, and there's mass chaos surrounding us, and I can't hear the person.

00:40:37:13 - 00:40:55:22
Dr. Boster
And it's really challenging. So if you have to go in your car and close the door. Make sure that you have your device, whether that be a tablet or a computer or a smartphone, fully charged and plugged into the wall, because there's nothing worse than when you're in the middle of a telemedicine visit and your phone dies.

00:40:55:24 - 00:41:17:10
Dr. Boster
Make sure that you've downloaded the software. So, for example, we use Zoom, a medical version of Zoom. That's how we do our telemedicine visits, and that necessitates the person downloading the Zoom app onto their device, and so you got to do that ahead of time. Make sure that the lighting is adequate so we can see you because I'm not just talking to you, I'm examining you on camera,

00:41:17:10 - 00:41:36:13
Dr. Boster
and make sure that you're not holding your phone because I need you to have both hands free. So make sure that your device is stable. Make sure that you have your questions ready, just like you would in any other situation. And I would encourage you because you're probably in your house to bring your medicines to the spot where you're talking.

00:41:36:15 - 00:42:00:19
Dr. Boster
Now, one of the really cool things about telemedicine is it's actually easier to bring somebody with you because they can Zoom in also, and so if you don't have someone at the house with you, we've done a lot of, discussions that look like Brady Bunch, you know, with all the different boxes where I'm on camera and the patient's on camera and their spouse called in from work or from another city, and it really is, is is very successful,

00:42:00:21 - 00:42:18:02
Dr. Boster
but I think gaming out and planning out ahead of time is really the important piece to having success with telemedicine.

Mary Ray
That's great.

Dr. Boster
One last thing is, I'm sorry, I just forgot one other. Make sure that you have enough space that you can stand up and sit down and move around. I'm going to ask you to stand. I'm going to ask you to walk, and so if you're crammed into a closet or if you're in your car, I can't do that.

00:42:18:02 - 00:42:37:12
Mary Ray
Okay. Right. Yeah. Trying to somewhat replicate what it's like to be in person, but taking advantage of that. This question comes from Dana, and this is going back to one's well-being and mental health.

00:42:37:12 - 00:43:04:20
Mary Ray
What do you recommend for people who are feeling isolated and lonely during this pandemic? Any coping skills to share? I will say MyMSTeam is something. MyMSTeam.com is a great place if you haven't been there already to meet other people, to connect, socially, connect. If for some reason the social ties in person you do not have or aren't able to make like you would normally, you would normally be able to make not during this pandemic, but Dr. Boster, what would you add to that?

00:43:04:20 - 00:43:25:02
Dr. Boster
That's an excellent point. And when I recently made a YouTube video on the topic of social isolation, and I actually said join MyMSTeam because I think it's a perfect organization to bring people together, so really the crux of the concern is something called social isolation,

00:43:25:04 - 00:43:55:02
Dr. Boster
and people impacted by MS are at high risk of that. If you're not in the workforce or you're not out in society for various reasons, you risk being isolated from other humans. And social isolation, we need to identify and fight against because it makes depression worse. It can make MS worse over time, and the problem is that many of the strategies that we've developed and cultivated to combat social isolation have been removed from our options because they're not safe.

00:43:55:04 - 00:44:13:13
Dr. Boster
So you can't go to an exercise class at the gym when the gym is closed, and you can't go to the library and read to children when the library is closed, and you can't get involved in your church when church is closed, and so it's really kind of unfair that we're forcing people to be so isolated.

00:44:13:14 - 00:44:36:11
Dr. Boster
So let's talk about a couple options. Number one, we need to avoid contact with people that we don't live with, but that doesn't mean we need to stay inside. Sometimes psychologically you think, okay, well, I just have to shelter in my house and that's not true. Going outside is really, really healthy, and so stand on your stoop for five minutes and breathe fresh air, or go sit in your backyard, or take your dog for a walk.

00:44:36:11 - 00:45:02:12
Dr. Boster
It's okay to be outside. We just need to make sure that we're wearing a mask and that we're away from other people. Going outside is really important. Using social media needs to be done with caution, and so sometimes because we're not around humans, we think, okay, well, I'm going to get my fix to be involved in the world and to learn about stuff by spending hours upon hours upon hours staring at the Tikity Toks,

00:45:02:12 - 00:45:26:07
Dr. Boster
and that's actually been shown to make you depressed. There's actually some research that suggests that spending an inordinate amount of time trolling social media can actually make you feel more sad and disconnected, and so I actually recommend the exact opposite. I recommend a one week vacation from social media, and it's cathartic, and what you'll find is after a while, you actually physically feel better.

00:45:26:07 - 00:45:49:16
Dr. Boster
And it's my hope when you go back to your, your Twitters, and your so and so forth that you maybe do it in moderation. Now, that doesn't mean that we don't want to use technology. I'm just recommending a pause in social media. Technology is our friend, and one of the things that I think is the most helpful is to have at least a weekly video chat with a loved one, and I want it to be a video chat.

00:45:49:16 - 00:46:09:15
Dr. Boster
I mean, it's great to talk to your mom on the phone, but it's way better to see your mom. Human beings crave contact, and so this is a great time to call your old college roommate and say, hey, why don't we chit chat for five minutes on, on, you know, FaceTime? Or to reach out to your cousin in Texas, or your grandma, or whomever.

00:46:09:17 - 00:46:30:02
Dr. Boster
And, I would actually recommend that you have a standing meeting, a standing chit chat, where you can see someone that you care about and you can feel connected to them and talk to them and laugh and share something. Along the same lines, you can plan events, and so I challenge everyone to plan a Zoom event. So this coming Saturday, there's a really big UFC fight,

00:46:30:04 - 00:46:50:16
Dr. Boster
and I had a thought about asking a couple of my friends that I know are going to be at home watching the fight. We could all get on Zoom, and we could literally watch the fight together, and cheer and scream, and drink an adult beverage. Throw popcorn or whatever, but we could do it together.

00:46:50:16 - 00:47:21:09
Mary Ray
And so, yeah, there's a way to revisit and have versioning of what we used to do in person.
I myself am taking part in a dark chocolate tasting with some friends who are across the country, which is awesome. We just purchased our own little candy bars, but, anyway, that's not that healthy. We're thinking now, coming back to physical well-being, do you have guidelines and tips for other pillars of physical well-being? You've touched a little bit on getting outside and here and there you touched a little bit about, you know, moving, exercise, sleep. What are some basic pillars of physical well-being that we should all keep in mind for managing MS?

00:47:21:11 - 00:47:42:06
Dr. Boster
So really, these are things that your mom told you, but she was dead on right. So making sure that you get restorative sleep is the start. So that means making sure you get a solid eight, not six hours a night, and many of you on the call are going like this, thinking it doesn't add up to eight because we're literally not budgeting enough time to get proper sleep.

00:47:42:08 - 00:48:06:22
Dr. Boster
Now, sleep hygiene is a very large topic, but suffice to say that you need to prioritize your rest and recharging your battery, and if you're getting less than eight solid hours, you're starting your day massively disadvantaged, whether you have MS or not. Now, in the setting of MS, the problem is compounded because your functional reserve is smaller so you don't wake up with as many spoons as somebody else does.

00:48:06:24 - 00:48:25:14
Dr. Boster
And if you only got five hours of sleep, you're cutting your spoons in half, spoons being a unit of energy. And so, starting with sleep is really important. The next thing that I would think about is water and hydration, and many of us spend the day dehydrated, and at night, we try to pound water,

00:48:25:14 - 00:48:41:24
Dr. Boster
and then we wonder why we wake up to pee all night long, but being adequately hydrated is really important, and if you don't believe me, I dare you to try the following. Drink a glass of water with each of three meals, and a glass of water between each meal. Try that out for a week and see what happens to you.

00:48:42:01 - 00:48:59:14
Dr. Boster
And I know what's going to happen to you. You're going to lose weight. You're going to have more energy. Your mood will improve. You'll actually sleep better and you won't be as hungry. It's really cool. So try that out. We talked about diet. Diet is very important. If you're living off of fast food and diet soda, you're not actually eating real food at all.

00:48:59:14 - 00:49:22:08
Dr. Boster
You're eating chemicals, and that concerns me, and so I would encourage you to put down the McDonald's cheeseburger, and to pick up an apple or make yourself some real food. I think that's super important. And you touched on exercise, but we need to highlight that because so many of us have just completely stopped exercising as part of this pandemic because we couldn't go to our biking class,

00:49:22:08 - 00:49:43:24
Dr. Boster
so we just stopped. And it's incumbent upon us, particularly given that this is not ending anytime soon, that we creatively come up with other options. For example, every single person right now that's participating in this event has an internet connection. All of us do, and if you have an internet connection, then you can go on to YouTube.

00:49:43:24 - 00:50:06:23
Dr. Boster
And there's many, many, many YouTube yoga videos for MS. I mean like hundreds, and so you could do a yoga video in your pajamas, you know, with your iPhone sitting on the counter, and that is a great form of exercise, focusing on balance, core strengthening, flexibility. That's good stuff, and it's free. Going outside and going for a brisk walk is a really good idea.

00:50:07:03 - 00:50:27:13
Dr. Boster
And as a pro tip, walk fast enough that you can't carry on a conversation like I'm talking right now. You want to walk quick enough that you're taking a deep breath, and so think about it this way, could you walk once on the weekends? Is that possible? Could you walk once during the workweek? That's a good place to start.

00:50:27:15 - 00:50:45:02
Mary Ray
Great. Well, I want to take this to the audience. Let's go ahead and put this poll question up. What physical well-being practice makes the most difference for you? Healthy diet, regular exercise, or good sleep?

00:50:45:04 - 00:51:05:01
Mary Ray
It's interesting. Water, you saying hydration is really important. There is a question that came floating through. Is it possible to over hydrate? I'm sure there's a rule of thumb about how much to consume, but do you have advice about how much water?

00:51:05:01 - 00:51:22:22
Dr. Boster
So you can over hydrate. Now, you're not going to over hydrate by drinking a couple Nalgenes. All right, but yeah, you actually can hurt yourself. It's called water toxicity believe it or not. As a general rule, if you drink a glass of water meaning 16 to 20oz of water with each meal. So breakfast, lunch, dinner, and then you drink a glass of water between breakfast and lunch and a glass of water between lunch and dinner.

00:51:22:22 - 00:51:44:19
Dr. Boster
You're doing great. Now, I could tell you to shoot for 48oz or something like that, but I'm not going to. I'm just going to ask you to drink a glass of water with each meal and a glass of water between each meal, and you've got it covered.

Mary Ray
So, while we get ready to have the results, what well-being practice do you feel works best for you right now that you're prioritizing Dr. Boster?

Dr. Boster
Me?

Mary Ray
Yeah.

00:51:44:21 - 00:52:05:02
Dr. Boster
My fireplace outside. So I sit by my outdoor fireplace almost year round, at night with my dog, and I have a fire. And I sit there and I stare at the fire, and I relax. And to me, that is a really important aspect to my day. I look forward to it. I sometimes video it or take or I, you know, take pictures and I look at it later.

00:52:05:04 - 00:52:22:11
Dr. Boster
And so, that's something for me that's very special, and that approaches mindfulness that almost approaches like a meditative practice for me. I spend a lot of time with my dog. My dog's one of my best friends. She's underneath the table right now snoring like a freight train. And I bring my dog to work with me actually.

00:52:22:11 - 00:52:39:09
Dr. Boster
My dog comes to clinic with me every day. She sleeps in bed with us at night. She's a constant companion and she is a fantastic source of stress relief for me. It’s very, very important. The other thing is like some personal hygiene stuff, like for. And you're going to think this is silly, but showering every day, right.

00:52:39:09 - 00:52:54:23
Dr. Boster
Making sure that I always brush my teeth and take my medicine. Making sure that I eat lunch. These are things that sound silly, but in a busy lifestyle where you're running around like a chicken with your head cut off, sometimes you can let things go by the wayside, and I think it's important that we ground ourselves in those things.

00:52:55:00 - 00:53:14:15
Mary Ray
Yeah, especially the keystone habits for sure. I myself, do appreciate, meditating a bit. I use things like headspace. There are things on YouTube, too, with guided meditation, absolutely free that one can use that I've used as well. Also, exercise is very important to me. Every morning I get up for my little 6 a.m. workout and, off of a video as well.

00:53:14:17 - 00:53:22:16
Mary Ray
So what are the results? So let's see how everyone answered. What works for your well-being.

00:53:22:18 - 00:53:47:22
Mary Ray
Interesting, okay. So regular exercise and good sleep, just about tied, with healthy diet taking third.

Dr. Boster
Nice.

Mary Ray
Are you surprised by this Dr. Boster? What are your thoughts?

00:53:48:03 - 00:54:11:00
Dr. Boster
I'm not, I mean, I think, the American lifestyle, forces us into some really bad eating habits. And, combating those eating habits is really challenging. Other cultures do it better. So, I used to live in France. And they have a culture of eating, which is, it's, it makes it easier to eat healthy because of the way they approach food. So, you know, that doesn't surprise me. I think Americans have a difficult time in eating healthy.

00:54:11:00 - 00:54:40:21
Mary Ray
Yeah. I’d like to move on to questions around new diagnosis. So the MS Discovery Forum estimates that there are 200 new cases of MS reported every week in the US. That means more than 10,000 people are diagnosed with MS, were diagnosed with MS in 2020. What advice would you give someone who might be on this event who's been newly diagnosed?

00:54:40:23 - 00:55:13:00
Dr. Boster
So when you're first diagnosed, it's really scary and you don't know the language and you don't know if what you're hearing is true. And if you tell someone you have MS, they'll tell you a story. Oh, back when I used to live in Iowa, I went to church with this guy, and he had a dog, and the dog was friends with a cow, and the cow had MS and died. And it creates a tremendous amount of fear and anxiety. And so my first recommendation is to recognize that it's going to take you about 1 to 2 years to become comfortable in your own skin and to know the answers and to know, to have a filter when something doesn't smell right.

00:55:13:02 - 00:55:30:16
Dr. Boster
And until you develop that filter, I, I want to be your filter. I want you to lean on your provider. And I tell my patients, if you hear something, see something, read something, bring it to my attention, and I'll tell you if it's real or not, and we can talk through it. And so that's one of the things that I think are really, really important.

00:55:30:18 - 00:55:52:12
Dr. Boster
If you're not sure what to do when you get MS, starting off by not smoking stuff, exercising as part of your lifestyle, eating a clean diet, and taking an MS medicine is the four tenets of winning and living your best life despite having MS.

Mary Ray
Can you say that one more time? Four things, one more time.

00:55:52:14 - 00:56:13:24
Dr. Boster
I want you to be four for four in your fight against MS. Right. The four things I want you to do. Number one, I don't want you to smoke things because smoking speeds up MS by about 50%. Number two, I want you to eat a clean diet and supplement vitamin D. Number three, I want you to exercise as part of your lifestyle. And number four, I want you to take a disease modifying therapy and make sure it's working.

00:56:14:01 - 00:56:34:16
Dr. Boster
If you do those four things, you're going to be in a very strong position to live your best life and not let MS make decisions for you.

00:56:34:18 - 00:56:58:08
Mary Ray
Fantastic. I know we're at the 5:00 hour. We're at the top of the hour, but, there is this question I want to get to, and it can be our final one. Looking back on 2020, were there any advances in MS research that you could share with all of us?

Dr. Boster
Yes. There have been, and there's some of them are really exciting. So probably the area that I'm most excited about, has to do with a new molecule that's being studied in MS, and it's called a Bruton tyrosine kinase inhibitor, or BTKI,

00:56:58:08 - 00:57:21:06
Dr. Boster
and this is heralding in a new, a new way of approaching MS therapy. Very, very exciting! These molecules do two things that we've never been able to do before. Number one, they can mute B-cell communication without killing B-cells. So instead of murdering the B-cell, we just la la la I can't hear you.

00:57:21:06 - 00:57:42:15
Dr. Boster
And it accomplishes a similar goal without killing the cell, and that's a cool trick, but even better. Number two, they work in the brain on these cells called microglia. Now, microglia are very involved in MS pathology, except we've never been able to reach them, you know, because our therapies don't get inside the brain and work on them,

00:57:42:20 - 00:58:04:04
Dr. Boster
and this BTK inhibition does, and it turns off these naughty autoreactive microglia, and so I am thrilled, we're actually enrolling for two clinical trials studying BTKI. There's several that are going on globally right now, and I'm very, very excited about this new type of therapy. I think it's heralding in a new era of therapeutics, so that's an area that I'm particularly sassy about.

00:58:04:08 - 00:58:34:21
Mary Ray
That's great. We are going to ask one final poll question. You know, March is MS Awareness Month, so what we're going to do is ask the audience, what are you planning for MS Awareness Month? I can tell you what we're planning with Dr. Boster is a webinar where we'll discuss questions about cognition, mental health, mobility, and that'll be exciting.

00:58:34:21 - 00:58:51:03
Mary Ray
That’ll be on March 18th. So mark your calendars and keep an eye out. We'll be promoting that quite often, and there's a link right there where you can register for the next live event. Great. Okay. So can we see the results of what are you all planning for MS Awareness Month? Obviously, everyone will be going to this webinar we've just talked about on March 18th.

00:58:51:03 - 00:59:15:01
Mary Ray
Nothing planned yet. Well, here's some ideas. Promote on social media. Engage in activities like a walk and donate money and encourage others to donate. Okay. Well, thank you so much for joining us today, Dr. Boster. We appreciate the confidence, building up guidance around how to think and talk about the vaccine.

00:59:15:03 - 00:59:39:13
Mary Ray
It was great to see those results. Honestly, since December. Yeah, I feel a lot better too. There's a lot of good information, including this webinar. If you participated in this event, please share the recorded event, which we'll have out shortly in about a week's time, and make sure you share with others who may not be as familiar with the vaccines that are out there and the impact that it has with life with MS.

00:59:39:15 - 00:59:55:21
Mary Ray
Thank you all for being here today. The information and support, of course, doesn't stop here. If you are already a member of MyMSTeam, please share the helpful advice you got today with other members in the activity feed. If you'd like to become a member, go to MyMSTeam.com and sign up for free. Remember, you're not alone.

00:59:55:23 - 01:00:13:11
Mary Ray
I hope to see you at our next event again during MS Awareness Month in March with Dr. Boster on March 18th, where we are going to discuss cognition, mental health and mobility, and you can register for the link, right there in the chat. Thank you again.

01:00:13:13 - 01:00:17:12
Dr. Boster
Take care of everyone. Have a great night and thank you. Be safe. Get vaccinated.