00:00:00:00 - 00:00:38:17
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 that provide support and advice for each other. If you haven't checked it out already, please do so at MyMSTeam.com.

00:00:38:19 - 00:01:01:22
Mary Ray
We are very excited to have a full house today. Over 550 people pre-registered for tonight's event, and I'm even more excited to welcome back one of my favorite guests who has a great sense of humor, as you can see in the chat already, his own YouTube channel with over 350 videos, covering a range of MS topics, and an insightful video and article series on MyMSTeam,

00:01:01:24 - 00:01:24:12
Mary Ray
Dr. Aaron Boster is here with us today. He's a neurology specialist focused on MS, and he's the president and founder of the Boston Center for Multiple Sclerosis. And of course, a great friend to us here at MyMSTeam. Welcome back, Dr. Boster.

Dr. Boster
Mary, it's awesome to be back. Thank you for having me. I've been looking forward to this all week.

00:01:24:14 - 00:01:54:10
Mary Ray
So have I, and actually all of us have. Something you said in our last two live events that continues to resonate with our audience is the importance of sharing with your doctor whatever you can relate, whatever can be related to your MS, but what you call the up theres and the down theres is that some people don't necessarily connect to MS. Some of the more embarrassing topics are also some things that are very important.

00:01:54:10 - 00:02:15:11
Mary Ray
And today we're going to dig into these topics. And as usual, due to high demand, we're going to provide a recording of this live event for those who are missing it. And by the way, we're doing another live event. So stay tuned at the end of this session to get more details about that. So before we begin, by now, some of you already know my personal connection to MS is through my mother-in-law, who lived with MS

00:02:15:11 - 00:02:35:14
Mary Ray
for over 30 years, but before we start, Dr. Boster, for those who don't know you, could you remind our audience of your personal connection?

Dr. Boster
With pleasure. I was a family member of someone impacted by MS, decades before I learned about the pathophysiology or immunology of the disease. I actually don't remember a time when my uncle didn't have MS.

00:02:35:16 - 00:02:56:06
Dr. Boster
I was 12 when I decided to become an MS doctor when I promised my mother and my grandmother that I would learn to do it better. And I've had a rather directed course. I was that weirdo in high school that said, “I'm going to be an MS doc,” and it's become my mission to help people impacted by MS, and to help families impacted by MS, live their best lives, despite this disease.

00:02:56:08 - 00:03:13:17
Mary Ray
Thank you for sharing that. You know, ever since you mentioned that concept, again I'll come back to this, the up theres and and down theres, and how important it is to talk about it with your doctor. I can't help, but think this is a reference for anyone to talk to their doctor about whether they have MS or not.

00:03:13:19 - 00:03:45:03
Mary Ray
Can you give a brief overview for our audience of what I'm talking about? What are the three up theres and the three down theres?

Dr. Boster
With pleasure. So much of multiple sclerosis is invisible. Everyone listening to this call has experienced the, “Honey. You look so good.” “Oh, you don't look sick.” The majority of the pathology of MS is invisible to the casual observer, and a lot of it can be encapsulated in what I oftentimes refer to as the up theres and the down theres.

00:03:45:05 - 00:04:08:23
Dr. Boster
So for me, when I reference the up theres, I'm talking about the triad of cognition, which is thinking and memory, mood and energy levels. And these are some of the most commonly expressed symptoms by people impacted by MS.. They're one of the leading causes of loss of work in multiple sclerosis, and yet they're completely invisible. And honey, you look fantastic.

00:04:09:00 - 00:04:36:05
Dr. Boster
And so I think checking in with a human that's surviving and thriving, despite having MS, and asking how they're doing with their mood, how they're doing with thinking of memory, what their energy is like, is a requirement to make sure that we're doing our very best job caring for them. Likewise, the down theres are terribly important. And to your point earlier, sometimes they're a little bit culturally sensitive or a little bit taboo in some cultures,

00:04:36:07 - 00:05:00:12
Dr. Boster
but really, what I'm talking about are massive proponents of quality of life amongst adult humans, bowel, bladder and sexual function. And all too often, when I bring up how's your bladder, there's a pause because for the first time somebody is asking them what's going on with their pee pee, and they're a bit taken aback. They're a bit scared and surprised.

00:05:00:13 - 00:05:21:13
Dr. Boster
Oftentimes, they're profoundly relieved that they can finally talk about the fact that they have to wear a dependent undergarment, or they have to wear a pad all the time because they're wet. And when I dig into it, sometimes nobody has ever brought that up to them, and they didn't even know that it was related to their disease or that we could do something to fix it.

00:05:21:15 - 00:05:44:00
Dr. Boster
And so I think it's very important that we address the up theres and the down theres with every single visit, every single interaction. It's a quick check, but it's so important.

Mary Ray
Fantastic. So just in summary, what I heard, or when we think about the up theres cognition, energy and mood, and we're thinking about the down theres. We're talking bowel, bladder, and sexual function.

00:05:44:04 - 00:06:05:04
Mary Ray
So to start. So that's just for those who are just joining us now, we are here with Dr. Boster. Dr. Boster, in a survey that MyMSTeam did back in 2018, over 443 members had participated in the survey and said that they began to experience cognitive impairment symptoms well before being officially diagnosed with MS.

00:06:05:06 - 00:06:28:12
Mary Ray
Does that surprise you?

Dr. Boster
Nope, not even a little bit. When we look at someone who has clinically isolated syndrome, so the very first event that may go on to develop MS, and we study these folks, what we find is they already have evidence of accelerated brain volume loss. So their brains are already shrinking at a faster clip than what we would want.

00:06:28:14 - 00:06:54:19
Dr. Boster
And when you do sensitive neuropsychometric testing, they manifest cognitive impairments, cognitive impairments that are subtle at that point, but they're present. And so I'm not surprised by that. Not at all.

Mary Ray
So one of our members had asked, “Why can't I keep a coherent thought? I can't remember doing things. What kind of cognitive issues affect people with MS?”

00:06:54:24 - 00:07:16:05
Mary Ray
And if you can answer this, why?

Dr. Boster
Sure. So the first thing I'd like to say, Mary, is that MS. is not Alzheimer's dementia. So often my patient is petrified that their MS is going to lead to a place where they saw their grandfather, who had an Alzheimer's dementia and didn't remember his loved ones or who he was, and things like that.

00:07:16:05 - 00:07:50:02
Dr. Boster
And that is simply not the situation with multiple sclerosis, the cognitive impairments, which unfortunately are very common, maybe 50 to 70% of people impacted by MS may experience cognitive impairments in some capacity are not like Alzheimer's dementia. It's typically what I refer to as prefrontal. So the kind of problems that we see in cognition as it relates to MS are things such as difficulty with multitasking, difficulty with keeping lists in their head, difficulty with remembering a series of patterns,

00:07:50:04 - 00:08:14:08
Dr. Boster
very commonly someone will tell me, Aaron, I didn't used to have to keep phone numbers written down because I knew everyone's phone number by heart, and now I can't find the list with all the phone numbers on it. And this deals with executive functioning and prefrontal functioning, and that's the most common thing that we see. If you were to talk about one cognitive deficit in MS, the most common is what we call attention.

00:08:14:10 - 00:08:31:09
Dr. Boster
So attention is our ability to lock onto a task. And I'll give you an example, so we're going to take a stereotypical husband and wife, and the husband likes the foosball, and so it's Saturday and he's watching the foosball, and she's in the other room trying to take care of the house, and she says, “Hey, bring me your dishes.”

00:08:31:09 - 00:08:50:08
Dr. Boster
And he says, “Ooh,” and then about five minutes later, the wife comes in the room and says, “Why didn't you bring me the dishes?” He didn't really attend. Right? So he was so focused on the foosball that he heard noises, but he didn't really attend to what she had to say, and he couldn't remember it. And then he gets in trouble because he didn't bring her the plate.

00:08:50:10 - 00:09:17:00
Dr. Boster
Someone with MS may be looking at you, may be listening to you. They may be desperately trying to take in what you're saying, but they can't attend to the problem, and therefore they can't remember. And that is the single most common thing that we see in the setting of multiple sclerosis.

Mary Ray
Got it. So I just want to remind our audience we have some great questions coming through here that if you have a question, please do use the Q&A feature,

00:09:17:00 - 00:09:48:13
Mary Ray
and we have a team who's fielding some of our questions through here, and also a reminder that Dr. Boster will not be giving out specific medical advice. However, we are going to stick to the general topics of cognition, energy, and mood, as well as bowel, bladder, and sexual function. You know, one’s social ties to friends, family, work, work colleagues, and even teachers can be an important support system for people with MS who have experience with these sort of cognitive difficulties that you've pointed out, not to mention MyMSTeam as a social tie, right,

00:09:48:13 - 00:10:16:00
Mary Ray
but that assumes you feel comfortable about being able to be open with your feelings, and what you're going through, and some people don't even do this with their doctor. So what guidance do you have to make people more comfortable with broaching the topic about sharing, perhaps issues around cognition, their memory health that might feel a little embarrassing to face head on?

00:10:16:02 - 00:10:34:17
Dr. Boster
There's a couple things that I would like folks to keep in mind. Number one, it's treatable. There's a bunch of things that we can do to treat problems with thinking and memory in MS. And so the first thing I want folks to remember is the reason I want you to tell me about it is because I can make it better by helping you.

00:10:34:18 - 00:10:53:03
Dr. Boster
All right, and that's a really big deal. The second thing that I want to comment on is there's no shame in that game. There's no shame in saying, hey, I'm having more trouble remembering stuff, I'm having more trouble at my job, and I want people to hear me. If you don't tell me that it's a problem, I can't help you make it better.

00:10:53:05 - 00:11:19:01
Dr. Boster
So I need you to be an active member of your care, just like I want to be an active member of your care. And it's important that I create a safe space, that I create an environment where I honor what you're saying. I'm respectful of what you're saying. I listen to what you're saying, and I treat it in a very delicate manner because it's a delicate, important topic.

00:11:19:03 - 00:11:37:20
Dr. Boster
The onus is on me to create that environment, and it's my sincere hope that we all do that. And I want to convey to you that I can help you make it better, and that together by working through it, we can really navigate. And where we end up is oftentimes pretty fantastic.

00:11:37:22 - 00:11:58:18
Mary Ray
Can we role play for a second? I just want to kind of like, I’m the doctor, and you are going to talk to me about some cognitive issues, some lapses that you've experienced. we're talking, we’re saying how's it been going, the general, how are you doing?

Dr. Boster
I'm pretty good. I can't really complain. Thanks.

00:11:58:20 - 00:12:18:23
Mary Ray
That's a typical answer, isn't it? That's what you hear often in your own practice, I'm sure.

Dr. Boster
So what I always say is, iis that a socially polite good or are you actually really good? And nine times out of ten they say, actually I'm doing really [bleep].. And I'll say, okay, let's start there, because it's oftentimes when you say, how are you doing?

00:12:19:00 - 00:12:43:19
Dr. Boster
the person asking the question doesn't actually care how you're doing, they're just saying hello in a polite manner, but when I, as a physician in my clinic room, say how are you doing? I'm not asking casually. I really want to know how you're doing.

Mary Ray
So how should our audience here answer that question and understand that's not a polite, social, polite, what should, if cognition is,

00:12:43:21 - 00:13:04:04
Mary RAy
bear with me here, top of mind as an issue, what should I say? What would you say?

Dr. Boster
Step one is I want you to write down your concerns on a piece of paper, because you can get flabbergasted and you can get befuddled in front of the doctor, and you may have a momentary lapse and not remember.

00:13:04:06 - 00:13:21:22
Dr. Boster
So I want you to write it down. That's your security that if you happen not to remember, you can just refer to it. That's the first thing. The second thing is when the doctor says, how are you doing? I want you to say, honestly, doc, I'm not doing very well, and then just pause and let the doctor say, tell me more,

00:13:21:24 - 00:13:44:04
Dr. Boster
but I want you to start off recognizing that the clinic environment, although it feels like it should sometimes feel like a casual conversation, it's not. And that is a holy time for me. When I'm trying to help you be the most awesome version of you possible, despite having MS, then I need you to be honest with me. I mean, sometimes I only have a half an hour to talk to you.

00:13:44:04 - 00:14:04:24
Dr. Boster
That's not a lot of time. So we have to dig in quickly and get to the bottom of what's really bothering you. And when I say, how are you doing? I really want you to want to say, I'm not doing very well today.

Mary Ray
Got it. We have one member who wrote in saying that her cognition health had been declining for about five years, and now she's not able to work.

00:14:05:01 - 00:14:36:00
Mary Ray
What could she do to slow down that decline?

Dr. Boster
Pick a number between two through ten.

Mary Ray
Three.

Dr. Boster
All right, let's do three things that she could do to decrease the decline, right? One of them is to exercise as part of her lifestyle. Exercise has been demonstrated to improve energy levels and improve mood, which indirectly help cognition, and exercise has been demonstrated to literally improve thinking and memory in multiple sclerosis.

00:14:36:02 - 00:14:58:24
Dr. Boster
And so you can actually up your thinking and memory game by exercising this part of your lifestyle. So that's a really important pro tip that I sometimes think people ignore or overlook. So that's the first thing. The second thing is they can look at their list of medications and streamline polypharmacy. So polypharmacy is a doctor term for “man,

00:14:58:24 - 00:15:20:08
Dr. Boster
I have you on way too many medicines. What am I doing?” And doctors, particularly allopathic doctors like myself, are awesome at giving medicines. We're not very awesome at taking away medicines, and sometimes you can end up on a laundry list of meds which have the risk of clouding the sensorium, and it's happened so slowly over so long that you don't even realize it.

00:15:20:10 - 00:15:44:21
Mary Ray
Okay, so just rewind for a second. We'll put a little footnote, clouding the sensorium. Can you just?

Dr. Boster
Yes. So clouding the sensorium is my way of saying medicines that make it so that you have trouble taking in your surroundings. You kind of feel fuzzy headed. You know, you're kind of out of it, there's a host of medicines that help with pain, spasticity, bladder.

00:15:44:21 - 00:16:00:23
Dr. Boster
There's a host of medicines that are super awesome for various symptoms, but they can make you have foggy thinking. So that's what I mean when I say the second thing that we can do after exercise is we can look at our medication list with our doctor and say, “Hey, doc, which of these meds can I cut in half?”

00:16:01:00 - 00:16:20:10
Dr. Boster
“Which of these meds do I not need? Which of these meds are a requirement? And I want to have a smaller medication list.” Moreover, I would challenge everyone listening. If the doctor asks you to start a new med, say, “No problem. Which one are you going to take away?”

Mary Ray
Hmm. I want to pause there for a second.

00:16:20:10 - 00:16:45:23
Mary Ray
If everyone if you didn't hear this, because I know there are a lot of questions about medication and treatment, and what to do and what not. That is such an important insight right there. If this polypharma concept and this idea that if someone's adding yet another to also ask what to take away. Have you had many patients have the confidence to say something like that?

00:16:46:00 - 00:17:09:01
Dr. Boster
Yes, I have had patients, who say, “Hey, that's a lot. Can we get rid of one?” But I ask my patients to challenge me, I ask them and say, “Well, each time I talk to you, if I ever add a med, challenge me to remove one. I'm asking them to be an active participant. And sometimes at the end of a visit, I'll say, “Okay, let's attack your medication list,” and we'll look through the medicines.

00:17:09:02 - 00:17:29:18
Dr. Boster
And sometimes we conclude that you need every single one of them, but sometimes we find one that we can cut in half or take off. That is a really powerful way of improving thinking and memory I think.

Mary Ray
Got it. This is great because you answered like yet another question. Someone asked the next question about additional treatments and what have you,

00:17:29:18 - 00:17:58:09
Mary Ray
but there's this important question that's been a theme recently in just this live chat right now too, is what connections are there between the up theres and down theres or particularly up there, excuse me, with things like anxiety, depression, OCD?

Dr. Boster
So when again when I think of the up theres, I'm thinking about the triad of energy, thinking and memory, and mood, and they are tied together with a ribbon really tightly.

00:17:58:11 - 00:18:21:03
Dr. Boster
If you impact one, it will have an effect on the others. There's actually a paper in the medical literature that came out a couple weeks ago that stated that, and I was reading and said, yeah, and if you have anxiety, it will make it harder to think clearly. If you are profoundly exhausted, it will make it harder to think clearly.

00:18:21:05 - 00:18:42:06
Dr. Boster
If we can work on your anxiety, it will improve your cognition. The flip is also true. If I can help your cognition, it will improve your mood. And I state this, having done MS neurology for 15 years now, and I see it time and time again. Those three symptoms are a triad. They're linked together very tightly.

00:18:42:08 - 00:19:07:02
Dr. Boster
And you can't impact one without impacting another.

Mary Ray
We're about to go to a poll question here because we're going to slowly shift to the down theres, but before we do that, is it common for you to confer? This is just a question of coming from a patient perspective, of course, but to confer with other folks, other providers that your patients see related to mental health.

00:19:07:02 - 00:19:29:11
Mary Ray
So I'm just thinking if somebody is on medication to treat the depression or anxiety and what have you, and they're also I'm talking about polypharma,. They're also dealing with a lot of meds on MS. What is that process like? Or how can a patient bridge those conversations together? Because you know what they’re on, you have your EHR, you have your system.

00:19:29:11 - 00:19:55:19
Mary Ray
Right, but could you shed some light on that for the audience?

Dr. Boster
So nobody gets to have MS by themselves. Here we are, talking together with MyMSTeam. What an awesome name for an awesome organization, which creates an opportunity to help you find your village. And every person thriving, despite having MS, needs to have a village,

00:19:55:19 - 00:20:31:18
Dr. Boster
and doctors want to be village members. I want to be your village member. I want to help and participate. And I'm not the only doctor that you see probably. And so, we have to treat ourselves as a village, and one of the things that is obligated, in my opinion, is that when I write a note, I send a copy to my patient. The medical note that I write, I mail it to the patient, or I make it available electronically to the patient because they need to see what I said, and they need to have a copy to take to their primary care doctor, to take their gastroenterologist, to take it to their urologist, whomever.

00:20:31:20 - 00:20:50:21
Dr. Boster
I also feel like I am obligated to send letters to all of those people. So I call it the circle of care. And when I write a letter, I want to craft it in a way and share it with your entire village. Now, if the urologist or the orthopedic surgeon doesn't want to read the neurologist letter, okay, but I think it's important to share.

00:20:51:02 - 00:21:11:06
Unknown
And likewise, it is my request that my patient have all of their clinicians send me copies of their correspondence. The other thing that I do is, is I make my cell phone and my email available to my patient with instructions to give it to all of their providers. So I want their primary care doctor to have my cell phone on speed dial.

00:21:11:06 - 00:21:37:03
Dr. Boster
So if they need me, they can call me. This is nothing more than bringing people together with a common goal of making you the most awesome you possible, and I don't think we can do it in silos. Now, the patient can be their own advocate and they can say, “I need you to call my GI guy because he's telling me something different than what you're telling me, and I need the two of you to talk,”

00:21:37:05 - 00:22:01:07
Dr. Boster
and the doctor should say, “Okay,” and it's not uncommon that when I finish my clinic day, I have a couple phone calls to make to various team members of my patients, so that we can confer and get on the same page. I'll give you a very quick example, a patient of mine with pretty bad MS, who has Crohn's disease and lupus, and she's on a medicine that treats her MS

00:22:01:07 - 00:22:19:15
Dr. Boster
and her lupus, but now her Crohn's disease is acting up. So I have a medicine I want to switch her to, which will treat MS and Crohn's disease, but it'll leave the lupus out. So I've got to have a three-way combo with the GI guy, the rheumatologist, and me, so we can sort out what we're going to do.

00:22:19:17 - 00:22:35:07
Mary Ray
Got it. That's great. I mean, that's wonderful to hear that how lucky a patient she is to have you. I want to go to our poll question. Those of you who are familiar with this, you know, it's super easy. We're going to have this poll question show up, and all we have to do is answer it, and we'll share the results.

00:22:35:07 - 00:23:07:09
Mary Ray
So what down there issue frustrates you the most? And as people are answering this, just thinking about cognition, and other challenges relate to up theres and down theres. What about dealing with MS symptoms in cold weather?

Dr. Boster
Yeah. so you know, I live in sunny Columbus, Ohio. and I've been enjoying shoveling and scraping ice off my car in the morning.

00:23:07:11 - 00:23:24:10
Dr. Boster
And so, the folks that live in the Midwest, we're experiencing that cold weather that you just referenced. And there's a lot of changes that we can see in the setting of cold weather. Now, the obvious one, which is outside the scope of today's chitchat is spasticity, which gets worse. You get tighter, stiffer, you have more cramps in the cold,

00:23:24:13 - 00:23:51:04
Dr. Boster
but when there's cold weather in Ohio, there's also gray darkness because it's now getting dark really early, like 5 p.m. at night, 6 p.m. at night, and it's dark when you go into work in the morning. And so, as it relates to the up theres to energy levels to thinking and memory, and to some extent, cognition. The winter doldrums are upon us, and we have to do things to fight back.

00:23:51:06 - 00:24:11:17
Dr. Boster
I commonly ask my patients to buy those S.A.D. lights, the seasonal affective disorder lights, and soak in some equivalent of sun. during these rough months.

Mary Ray
Got it. That's great. Well, we have our poll results. Thank you for talking about the weather impact on our up theres, but let's talk about the down theres. What is everyone saying?

00:24:11:17 - 00:24:40:05
Mary Ray
Right now, it's incontinence has topped the list followed by a low libido, sexual dysfunction, or pain, lack of sensation, and constipation. So this is out of our audience watching here. Does this sort of resonate with what you're seeing among your clients, your patients in your practice?

Dr. Boster
Yes. I think that bladder is something, you know, we pee multiple times a day.

00:24:40:07 - 00:25:01:07
Dr. Boster
So if you have a bladder problem, you're going to be reminded of it each time you go to try to empty. We don't have sex several times a day, or at least, not in my neck of the world, and so we don't have occasion to recognize that we have erectile dysfunction, or no sensation, or dryness, or inability to achieve orgasm as frequently.

00:25:01:07 - 00:25:21:14
Dr. Boster
If you're having trouble with peeing, you're going to notice it very, very often and very frequently. We saw that there's constipation on that list, and constipation is a very, very common symptom in MS, but no, I'm not surprised by that list at all. Now, just real quick, I know that we're shifting gears, but Fire Tablet brought up a really important point.

00:25:21:16 - 00:25:41:11
Dr. Boster
Fire Tablet said, “Whoa, what's the third thing for the up theres?” Remember, you picked three and we only did two. So just very quickly so that I can feel complete. Otherwise I would be trying to find Fire Tablet online, so I can do that.

Mary Ray
Yes, let’s do that.

Dr. Boster
The third thing that I'll talk about is having structure to your life.

00:25:41:13 - 00:26:10:14
Dr. Boster
The more structure that you create for your life, the more routines that you have, the better you'll be. And I'll use an example of my medicine and my keys. So every morning my family used to laugh because I leave to go to work and I go to my car and I don't have any keys, and I run back in the house, and then I'd run around the house like a crazy man trying to find my keys, because I was going to be late to clinic, until finally I decided that I only put my keys in one location, so there's one spot in my house, and that's where my keys go.

00:26:10:16 - 00:26:28:20
Dr. Boster
And if my family sees they're not there, they put them there. And ever since I've done that, I've never been late to clinic for lack of finding keys, because I always go to that same spot. Another example is taking medicine, so it's hard to remember to take medicine, or at least for me, it is. And so I link taking medicine to something that I always do.

00:26:29:01 - 00:26:46:07
Dr. Boster
I always drink coffee when I wake up in the morning, my home could be burning down, and I would make a cup of coffee and drink it, and then I would try to put the fire out. And so what I like to do is I put my medicine on my coffee maker. So every morning when I go to get coffee, I say, “Oh, there's medicine there,”

00:26:46:07 - 00:27:05:09
Dr. Boster
and then I take it. By creating structure and linking things together, you can't forget them, and it helps a tremendous amount and you can extend it far reaching into your life.

Mary Ray
I'm a big fan of that. Create a system around yourself. When you, as a person, can't really do it, have the system and scaffolding around you to do it.

00:27:05:10 - 00:27:32:05
Mary Ray
Great idea. Well, you mentioned, sex was on there as well, just sexual dysfunction. So let's just get right into it. Does having MS affect sex drive? We're talking libido and why?

Dr. Boster
So it can. When I think about sexual function for a gentleman, I think about arousal, libido, I think about obtaining, maintaining an erection, and ejaculating.

00:27:32:07 - 00:27:59:14
Dr. Boster
So those are the things that I'm interested in exploring. For a lady, if we're talking about sexual, function, I'm thinking about arousal, libido, lubrication, which is the biological equivalent of erection and orgasm, so those are the topics at hand, and there's multiple different reasons why someone would have a low libido. Now to frame this discussion, Mary, I want to talk about primary, secondary, and tertiary sexual dysfunction.

00:27:59:16 - 00:28:26:16
Dr. Boster
And I find these concepts extremely helpful in talking about getting it on. So primary sexual dysfunction is where the circuitry of sex is damaged, so the brain and spinal cord have taken a hit from the MS, and the circuitry of sex, the electrical systems that create erection create arousal have been damaged. Secondary sexual dysfunction is when symptoms of MS make it hard to be sexy.

00:28:26:16 - 00:28:48:13
Dr. Boster
For example, we saw that 37% of the respondents commented on incontinence. If you're having sex and you wet yourself, that's not very sexy, and that will stop the activity, or if you're nervous that you might be incontinent of urine, you may not engage in intercourse just for fear that that may happen, and that's an example of secondary sexual dysfunction.

00:28:48:15 - 00:29:12:00
Dr. Boster
Another example would be spasticity. If you're having sex and your leg goes into an extensor spasm, you're not having sex anymore. You're grabbing your leg and rocking and trying to get the pain to stop. Now, tertiary sexual dysfunction is a psychological phenomenon where we just don't feel like a sexy beast. We feel like we're ill, and we just don't feel like a sexy entity.

00:29:12:02 - 00:29:35:04
Dr. Boster
And all three of them can contribute to a lack of libido for different reasons, obviously. And so, when I'm trying to tackle libido, I'm looking into those things.

Mary Ray
Yeah. There are two things I want to drill home here. So going back to the primary, and then also there's going to be managing interpersonal relationships around it.

00:29:35:04 - 00:29:57:11
Mary Ray
So let me just go for the first part, okay. It's common to get numb down there, lose sensation. I think that's related to the primary that we're talking about where it affects having an orgasm. We have a participant in this event right now who says they're also postmenopausal, and have dryness, and they want to be able to address that.

00:29:57:13 - 00:30:22:00
Mary Ray
Is there any guidance you can provide there? I mean, obviously we're talking about this, but what would you say about that?

Dr. Boster
Absolutely. So I'm going to teach you a very powerful tool. I call it the vibrator trick. So step one is to purchase a water-based lubricant. Right. Why? A water-based lubricant increases skin sensitivity.

00:30:22:02 - 00:30:47:14
Dr. Boster
And so it helps increase your skin's ability to receive stimulus. Now, step two is a very important step, and it involves a plug in the wall vibrator. And allow me to explain. Right now, as I talk to you, Mary, I'm using my indoor voice. I'm not screaming and yelling. I'm just speaking normally. And you can hear me fine because there's very little interference between my mouth and my mic,

00:30:47:16 - 00:31:14:03
Dr. Boster
and your speaker in your ear. But if we had all 550 people that signed up for this in one room, the ambient noise would be so loud that me talking with my indoor voice wouldn't cut it because you wouldn't be able to hear me because there's too much interference between my mouth and your ear. So I would have to increase the intensity of my voice, and I'd have to talk really loud so that you could hear me.

00:31:14:05 - 00:31:38:12
Dr. Boster
We can have the exact same problem with intercourse because of primary sexual dysfunction. When you stimulate the down theres, the message has to go all the way up the spinal cord to the brain, where the brain's like, oh, oh, that's what we're doing. Okay, okay. And then it has to send a message all the way back down to create adequate lubrication or erection or what have you,

00:31:38:14 - 00:31:57:08
Dr. Boster
and not uncommonly in the setting of MS with spinal cord damage or brain damage, the message dies along the way. So we use a water-based lubricant and then we use a plug in the wall vibrator. Now, I am a big proponent of the Hitachi Magic Wand. I don't have a kickback. I don't work for them.

00:31:57:10 - 00:32:15:12
Dr. Boster
It's not a Stark violation. I just really like the product, and I think they're amazing. A Hitachi Magic Wand is a plug in the wall vibrator, like I'm talking like hardcore DC power, right? And my recommendation is bring this into the bedroom. You can use the water-based lubricant and the plug in the wall vibrator by yourself.

00:32:15:14 - 00:32:36:17
Dr. Boster
You can use it during intercourse. You can put it between you and your partner. You can use it on your own. You can use it afterwards. There's a host of things you can do. So a gentleman can put it on the head of the penis, the shaft of the penis under the testicles, a woman can put it on the clitoris or somewhere else in the vulva. And oftentimes it can provide what I refer to as overdrive stimulation.

00:32:36:19 - 00:32:59:03
Dr. Boster
It's about 50 bucks. And I will tell you that 80, 90% of the time, the patient comes back with a big thumbs up, and the spouse comes back with a big thumbs up because it was able to overcome the interference.

Mary Ray
That's a great analogy actually, with regard to volume and what we're talking about here. And I appreciate you disclosing the fact that you have no kickback there.

00:32:59:05 - 00:33:22:06
Mary Ray
Now we're going to go-

Dr. Boster
Before we move on, just another thing about vaginal dryness. We have someone that responded that they're postmenopausal. And as a result, there can be less local estrogen. Talking to your doctor, whether they be your neurologist or your OB/GYN, we can prescribe estrogen cream. Estrogen cream is awesome sauce because rubbing it on the vulva,

00:33:22:08 - 00:33:46:14
Dr. Boster
you can increase the vascularity of the tissue. You can increase the ability to become lubricated, but you're not exposing the whole body to high levels of estrogen, which can be associated with some bad things. So it's a really important thing to bring up. And if you just tell your OB/GYN or your primary care doctor, or your very well attuned neurologist, hey, I've got vaginal dryness and postmenopausal, we can prescribe some estrogen cream.

00:33:46:15 - 00:34:06:21
Mary Ray
It's localized treatment, basically. That's great and I appreciate it. Thank you for that. And so those are sort of the mechanics of things. This next question, you're not a marriage therapist. You're not a relationship therapist. I'm still going to lob this over anyway, and see if you have any insight and we can move on from there.

00:34:06:21 - 00:34:31:18
Mary Ray
But there are a couple questions that are coming in around managing a spouse with a high libido. When you have low libido, do you have guidance for relationships when the MS patient has that situation? And how can they, I mean, again, we went over the mechanics of things that they might be able to address, but maybe in having the conversations.

Dr. Boster
This is extremely common,

00:34:31:20 - 00:34:53:13
Dr. Boster
very, very common. And I do think that it's very important to address it. So the number one thing is we need to have open dialogue about sex. So you and your partner need to have a dialogue where they say, I'm not getting late enough. And you say, yeah, but I hurt and I'm tired, and you have a discussion.

00:34:53:15 - 00:35:28:06
Dr. Boster
Now, if we clarify that one partner has a sex drive much higher than the other partner, there's ways of addressing that. For example, maybe once a week they have vaginal intercourse. Maybe once a week, they participate in manual stimulation. Maybe once a week, they mutually masturbate next to each other. But my point is we're having an adult conversation about two consenting adults trying to game out how they can enjoy the bedroom. And it doesn't mean that you always have to have sex.

00:35:28:08 - 00:35:55:23
Dr. Boster
You might be able to make sure that your partner is satisfied and that your needs are met without having to engage in classic missionary intercourse. And so that's not a conversation that you can have if you don't talk about it. And so I think getting to the bottom of what's driving, you know, what's going on? Why do you keep asking me this? Very often, I'll have a situation where, and I'll use an example where the patient is the wife and the husband is in the room.

00:35:55:23 - 00:36:26:22
Dr. Boster
Just as an example, very often the wife will disclose I have spasms of my vagina and it hurts like the dickens or I have, I have pain. It feels like I'm on fire. And the husband doesn't know that, he's unaware. And he says, oh my God, honey, why didn't you tell me? Oh, I was uncomfortable. And so in the clinic room, they're starting to discover that by talking, they didn't understand, the patient didn't understand, and the spouse didn't understand.

00:36:27:00 - 00:37:07:09
Dr. Boster
And so having those conversations is the starting point to making it better.

Mary Ray
That's great. And we did have a question that somebody had asked about pain in the clitoris and even numbness. And I will say that a key point, I think all of our audience should take note of here is reinforcing this point, how important it is to talk to your doctor, because then they can have the language and be informed, better informed in how to talk to their partner at home, who may not understand. And that partner may be even more open-minded to what is going on physically and mechanically, as it's related to the condition,

00:37:07:09 - 00:37:26:15
Mary Ray
so thank you for sharing that. Now to that specific question someone had, one member told us that numbness around the clitoris actually made sex painful, where some of the mechanics that you had talked about with estrogen cream, water-based lubricants, are those the sorts of things that can help that? Or is that something else going on related to MS?

00:37:26:18 - 00:37:45:15
Dr. Boster
It's not clear based on the question, but it could be something. For example, people impacted by MS can develop, it's called paresthesia and dysesthesia. Those are doctor words for numbness and tingling and painful sensations. And you can have them in your hand. You can have them in your face. You can have them in your penis.

00:37:45:15 - 00:38:08:19
Dr. Boster
You can have them in your vulva. I mean, it can be in the down theres and the same medicines that help neuropathic pain in your face will help neuropathic pain in your groin. And so identifying, hey, this hurts. It's a painful sensation, allows us then to explore opportunities to treat it. And there's a lot that we can do.

00:38:08:21 - 00:38:31:04
Dr. Boster
There's numbing creams. There's neuropathic pain medicines. There's a host of things that we can do to help. One tip that we haven't talked about yet, but it's so very important. And so if you guys weren't listening to what I was saying, I'd ask you to start listening right now. Pelvic floor physical therapy is a best kept secret in the MS clinic,

00:38:31:06 - 00:38:49:23
Dr. Boster
and a pelvic floor physical therapist can change your world in a way that you didn't think was possible. They oftentimes, it's kind of like physical therapy for bowel, bladder and sexual function. And the pelvic floor physical therapist that I use the most likes to tell people, hey, listen, I'm going to get up in your business.

00:38:49:23 - 00:39:17:11
Dr. Boster
She puts you up in stirrups. She gets up in your business, and she helps retrain the pelvic floor. Oftentimes, people have a disuse phenomenon where the pelvic muscles have atrophied and they can no longer activate them adequately, or they're having horrible pain and spasms. And it's contributing to a lot of pain, and time and time again, when you visit the pelvic floor physical therapist, it's like the sky opens up and the birds sing and there's rainbows.

00:39:17:11 - 00:39:47:01
Dr. Boster
I mean, it's a really, really big deal. And so if you are struggling with bowel, bladder or sexual dysfunction and you have yet to see a pelvic floor physical therapist, I strongly encourage that you do so it'll change your life.

Mary Ray
Thank you for sharing that. I know that a lot of women who have had, cheers, I know a lot of women who have had babies, who've had gone through vaginal delivery, have challenges with that.

00:39:47:01 - 00:40:04:01
Mary Ray
And so this isn't going to be a foreign concept to them around pelvic floor kind of rehabilitation and incontinence actually, you might hear that. And I think probably our audience might, that might resonate with them when you first had a baby and you're laughing. You're like, wait a minute. Something else has happened for a second there.

00:40:04:05 - 00:40:23:13
Mary Ray
So pelvic floor exercises, when we think about Kegels, those are some of the exercises that a professional might help you with.

Dr. Boster
A pelvic floor physical therapist will make Kegels seem like child's play. I mean, it's kicking it up like six levels and it's really, really cool.

Mary Ray
That's great. Well, we're going to go to, so that's really cool.

00:40:23:13 - 00:40:41:16
Mary Ray
I love the positive note on that front. We're going to go to our next poll question. And it's more along the lines of, what is bringing you joy right now during this pandemic, during COVID? Here’s some options here. So if you can go ahead and answer that. What about you, Dr. Boster?

00:40:41:16 - 00:41:04:15
Mary Ray
What are you doing to kind of I would say, relax, recharge, bring joy?

Dr. Boster
So anytime that I'm able to spend with my family is a really important time to me. I also need some downtime where I decompress and I spend a lot of time on YouTube, educating myself on things that I don't do on a daily basis.

00:41:04:17 - 00:41:26:07
Dr. Boster
That's a real fun thing for me. So I spent a lot of time there and it's a nice relaxation. The biggest thing that I do almost on a nightly basis almost all year round is I sit out by my outdoor fireplace. And until it's below zero, I'll be out there every night burning logs, and just sitting with my dog and relaxing, watching the fire.

00:41:26:09 - 00:41:51:10
Dr. Boster
To me, that's really one of the most important mental health things that I do.

Mary Ray
Wonderful. That's great. I will say I had some delightful satisfaction in using a snake to unclog a sink. And I just was so gratified by that. So just a little something about me. All right. So going back, here are the poll results.

00:41:51:12 - 00:42:15:02
Mary Ray
I think they're up here. There we go. Ah, a lot of media, consuming content basically, listening to some music, reading books, watching movies. Got it. And getting outside. You have some folks who are joining you in that camp there too. Fantastic. Great. Well, we're going to go on to the next question here. A member wrote in, we’ll say on incontinence,

00:42:15:02 - 00:42:41:14
Mary Ray
my incontinence has been so severe that I now have no control. How common is incontinence with MS? What causes it? And besides, what can people do about it? We had talked about the pelvic floor therapist. What else can they do?

Dr. Boster
The bladder is a really interesting animal. And really I divide the bladder function neurologically into two categories.

00:42:41:16 - 00:42:58:20
Dr. Boster
The bladder is a bag that holds urine. And so it has to be able to fill up with urine. And one of the common problems in MS is that that bladder spasms down into a tight little racquetball, and you drink a can of Coca-Cola and it's full. And now you're having frequency where you're running to the bathroom, you're having urgency,

00:42:58:20 - 00:43:15:19
Dr. Boster
where move out of the way, mom’s going to pee right now, then you're having episodes of incontinence. You can also have nocturia where you wake up at night to go potty. The other problem is not the bladder, but the outflow. So you have the urethra, which goes from the bladder to the outside world. That's where you pee.

00:43:15:21 - 00:43:35:20
Dr. Boster
The urethra is a smooth muscle and it can contract. And so you can have a normal bladder that's full of urine, but you're trying to push it out through the equivalent of like a swizzle straw, and you can't get the urine out. And in that case, you'll have urinary retention. You'll have double voiding where you pee, stand up, you sit back down and pee again, you'll dribble.

00:43:35:22 - 00:44:01:17
Dr. Boster
And what can happen over time is it fills up so big, the bladder does, that it's finally overcomes the bladder neck, and then you completely empty your bladder in a surprise. Now, MS can be very complicated because you can actually have both problems at the same time, and that's called this dyssynergy. And so when we're trying to treat MS bladder, we have to try to parse out those elements based on a history,

00:44:01:19 - 00:44:24:04
Dr. Boster
and oftentimes we'll use a bladder ultrasound machine to help figure out how they're voiding, and then based on that information, there's one set of drugs for a tight little racquetball bladder. There's another set of drugs for the bladder neck. And sometimes we need to use both. Now, the person shares that they're completely incontinent of urine, and that's an unfortunate situation that we can find ourselves in.

00:44:24:06 - 00:44:45:05
Dr. Boster
There's a lot of options for what to do about that. We're going to need the help of an expert urologist, but there are options such as bladder stimulators, and make sure they're MRI compatible please. There are options such as suprapubic catheters. There's even options where they connect the bladder and the bowel, so that it drains directly into the bowel.

00:44:45:05 - 00:45:11:13
Dr. Boster
So there's a lot of different things that can be done to help keep people not wet.

Mary Ray
Yeah, that's great. And sort of related to this topic, it's crossing a little bit over well, urinary tract infections. Are they more common among those with MS?

Dr. Boster
It certainly feels like it. You know, when you, it's not uncommon that people impacted by MS can have bladder problems.

00:45:11:13 - 00:45:31:19
Dr. Boster
And if the bladder neck is tight and you can't get the urine out, you're keeping bladder full of urine. Now, as an experiment, if you peed into a cup and left it at your table, it would grow bacteria. It would smell and stink, and it would fester. And if you can't empty your bladder, the same darn thing happens.

00:45:31:21 - 00:45:54:04
Dr. Boster
And so urinary tract infections are all too common and oftentimes they can trigger what we call a pseudo exacerbation or a pseudo attack, where in the setting of a minor UTI, your old optic neuritis comes back out, or your clumsiness gets more intensified. Some patients, they don't even know they're having a UTI. They just know their neuro symptoms are worse,

00:45:54:06 - 00:46:18:02
Dr. Boster
and we do a urine dipstick. And we say, look, you've got a UTI. I probably treated five UTIs in clinic today. Five, that's a lot.

Mary Ray
Yeah. I'm not surprised just from some anecdotal conversations I've had with people I know with MS. So constipation, it is a real issue. We saw the survey responses here.

00:46:18:02 - 00:46:41:22
Mary Ray
Obviously incontinence was huge, it was at the top of the list, but why is that such an issue? And what can folks do about it?

Dr. Boster
Unfortunately, one of the uncommonly discussed symptoms of MS is slowed gut transit. So literally you're moving stool through your gut slower, and constipation can become a really big problem.

00:46:41:22 - 00:47:06:04
Dr. Boster
Now, we can worsen constipation by giving you a bunch of medicines that can make you more constipated. Medicines for your bladder, medicines for thinking, medicines for depression. There's a host of medicines that will contribute to constipation. You know, I have a YouTube video where I think I listed like 66 contributors to constipation or some really high number, because I just kept thinking of more and more things that could contribute to constipation.

00:47:06:06 - 00:47:28:18
Dr. Boster
If we talk about a couple really, really key ones, the number one thing that I see that people can do to improve their ability to poop is up their water game. So I always talk about the MS water challenge, when I drink, you drink, so let's all try that right now. If you’ve got a beverage at home,

Mary Ray
Let's drink some water.

00:47:28:20 - 00:47:47:19
Dr. Boster
Because very commonly someone will shy away from water because of their lifestyle or because they don't want to be wet, and they're really, really dehydrated, and that makes their stool really, really dehydrated. So step one is to up your water game. I challenge people listening right now, drink one glass of water with each of your three meals.

00:47:47:21 - 00:48:12:04
Dr. Boster
So glass of water with breakfast, glass of water with lunch, glass of water with dinner, then drink one glass of water between breakfast and lunch, not a big deal. You got like four hours, just drink one glass of water, then drink one glass of water between lunch and dinner. Also not hard to do. If you do that, you've upped your water game substantially, and you're going to notice a difference in your ability to poop.

00:48:12:06 - 00:48:36:16
Dr. Boster
Now, step two is to add fiber. So fiber are indigestible solids like sawdust, and so you can eat sawdust. Now, if you ate sawdust and didn't add water, it would turn your stool into like cement, which is a bad idea. But if you add water to sawdust, it expands like a sponge, and it helps make the stool bulky and soft and easy to hold onto and easy to pass.

00:48:36:18 - 00:48:58:03
Dr. Boster
Now, the best way to do fiber, in my opinion, is through foods. And so apples, pears, and prunes are the jam because they're super high in fiber content and they're super high in water content, and they're super high in sorbitol, which is a sugar that also helps with moving your bowels.

Mary Ray
Can I test a recipe with you really quick?

00:48:58:05 - 00:49:23:09
Mary Ray
All right. Tablespoon of applesauce, a tablespoon of prune juice and a tablespoon of a fiber cereal.

Dr. Boster
So I like it, but I would rather you actually eat the apple because the applesauce-

Mary Ray
Oh, okay.

Dr. Boster
The applesauce has a tremendous amount of the fiber removed from it. The prune juice has a tremendous amount of the fiber removed from it. So I would much prefer that you eat a prune than I would you drink prune juice.

00:49:23:14 - 00:49:43:09
Dr. Boster
I would much, much prefer that you eat an apple than you have applesauce or apple juice, because what they take out when you make apple juice, they take the fiber out.

Mary Ray
Got it.

Dr. Boster
Now some of us, we can't eat enough broccoli or apples to help. And so you can buy Metamucil FiberCon, any of these over the counter products,

00:49:43:11 - 00:50:03:18
Dr. Boster
there's an entire aisle in the supermarket called I can’t poop. And it's got a host of fiber products there.

Mary Ray
Is that what they call it in Ohio? What else can it be found?

Dr. Boster
it actually isn't labeled as such, but that's what it is. The whole aisle is to help you go potty. And if you simply up your water game and add fiber, that's going to make a big difference.

00:50:03:18 - 00:50:25:19
Dr. Boster
Now in the spirit of coming up with three suggestions for no particular reason.

Mary Ray
Sure, let's do it.

Dr. Boster
The third option, if you're ambulatory, is to walk more, the more exercise you do, the more you get your gut moving and the easier it's going to be to move your bowels. Now, I lied because I want to add a fourth one in, and I want to talk about something very important called the gastrocolic reflex.

00:50:25:21 - 00:50:50:21
Dr. Boster
When you put a hot beverage, not this water, but a hot beverage in your stomach, or and when you put food in your stomach, about 20 to 30 minutes later, your bowels try to poop, the stimulation to your gut, gastric triggers the colon, gastrocolic reflex. Now in the setting of MS, you may lose that feedback and you may not feel like you need to go, but your body is trying to go.

00:50:50:23 - 00:51:17:10
Dr. Boster
So the best time to have a successful bowel movement is about a half an hour after your morning coffee or half an hour after your lunch, or a half an hour after your dinner, that's the prime time to move your bowels.

Mary Ray
Got it. We have some questions coming in right now. How do you determine when it's an MS thing versus something like a neurogenic bladder or IBS thing?

00:51:17:12 - 00:51:38:00
Dr. Boster
So you bring up a really good point that human beings are not books, they're humans. And the human being doesn't have a MS problem. They experienced a symptom. So you experience a symptom of I'm really having trouble pooping. You don't know why you're having trouble pooping. It could be because of MS. It could be because of a multitude of other things.

00:51:38:02 - 00:51:59:19
Dr. Boster
This is where your team member, your village member, or your doc can really help out. See, you know more about you than anyone. You're a you expert. I read books you didn't read, which does not make me smarter or better than you. It just means I read things you didn't read. And so if you can share with me your you experience, I can share with you stuff I read that may help.

00:51:59:19 - 00:52:22:02
Dr. Boster
And then together as a team, we can make you poop. And so it's all predicated not on doctor googling it and trying to figure it out on your own, but just telling your doc, hey, by the way, I poop once a week and it hurts.

Mary Ray
Got it. There was one question about going back to incontinence from Botox injections that actually had crossed my mind as well.

00:52:22:05 - 00:52:40:23
Mary Ray
I'm not sure if that's better answered by an urologist or what have you, but do you want to address it?

Dr. Boster
Sure, absolutely. So remember how I said you can have a tight little racquetball bladder?

Mary Ray
Yes.

Dr. Boster
So you can Botox that bladder and get it to relax. And so, it can fill up with normal capacity. It is a powerful tool that I adore.

00:52:41:00 - 00:52:57:09
Dr. Boster
One of the nice things is you only need to have it done every three months. So you go in every 3 or 4 months, and they do a bladder Botox, and then you're good in the hood. Now, one very common side effect of bladder Botox is that you can't get the urine out on your own, and you may need to use a catheter.

00:52:57:13 - 00:53:20:23
Dr. Boster
And everybody on the call just said, whoa, but let me share with you from years of experience helping people impacted by MS. When you learn how to self catheterize, it's empowering. And I have a wonderful patient of mine who I absolutely adore that was kind enough to write an essay on this topic. And what she shared was she used to live in fear of leaving her home.

00:53:21:00 - 00:53:38:05
Dr. Boster
She wouldn't go very far because she would wet herself, and she needed to know where every bathroom was. And she would try to avoid fluids all day long. And all she was ever thinking about was, I'm going to pee, I'm going to pee, and it really degraded the quality of her life. We tried medicines that didn't work. We tried various things.

00:53:38:05 - 00:53:56:19
Dr. Boster
Finally, she got some bladder Botox and she has to self catheterize. And she says in exchange for putting a catheter in her hoo-ha, she is able with impunity to do anything she wants, go anywhere she wants. Never worry. She can go swimming. She can go to the mall. She can go to dinner. It's empowering to her.

00:53:56:22 - 00:54:17:18
Dr. Boster
And she shares, it turns out to be very, very simple to self catheterize. She also shared a pro tip that the very best place when you're out and about is the bathroom at Starbucks because they’re private, they’re individual in the door locks, and they're super clean. And so, when she's out and about, that's her pro tip. That's where she likes to go.

00:54:17:20 - 00:54:34:19
Mary Ray
Yeah, and I guess we would, I would probably have to get that pro tip updated because in places where we're sheltering in place, right, like a lot of these places are not open for that. So this might even be an interesting option to think about. So, I'm going to shift gears a little bit here.

00:54:34:19 - 00:54:59:04
Mary Ray
We're going to go to our final poll question, and it's about our audience's thoughts on COVID. Given what you know now, what approach are you taking to the COVID vaccine? I don't know for those who joined a little bit later, Dr. Boster, you had mentioned that the FDA had recommended approval of their vaccine, of the COVID vaccine.

00:54:59:09 - 00:55:21:10
Mary Ray
So this is quite timely, isn't it?

Dr. Boster
While we were prepping this call, I just got the notice that the FDA Advisory Committee, so not the full FDA, but the advisory committee reviewed the data for one of the vaccines, the Pfizer vaccine, which is up first for review. And by 77%, they accepted it saying that the benefits outweighed the risk,

00:55:21:12 - 00:55:49:14
Dr. Boster
and so I am beyond overjoyed at that result. That's a really, really big deal, and it's going to herald in a new post-COVID era. I'm super thrilled.

Mary Ray
That's fantastic. All right, so what are the results, folks? Let's see what we have answered as a group. Oh okay. Get vaccine, 33%, but most people had said wait and see.

00:55:49:16 - 00:56:12:11
Dr. Boster
That’s really sad.

Mary Ray
Yeah, interesting. So well, Doctor Boster, you've already helped inform some of the MS specific COVID content on MyMSTeam. Can you give us what's known so far about the vaccine and MS? And seeing the answers here from the audience, I think it's appropriate that we really get right to it.

Dr. Boster
Thank you. Now, first of all, I'm not an epidemiologist.

00:56:12:11 - 00:56:29:19
Dr. Boster
I'm not a virologist. I don't make vaccines for a living, but I care a whole bunch about this, and I've done a lot of reading on it, and I am actively working towards trying to keep my patients safe, so please take all those caveats into consideration. And by the way, the guy that likes my tie. Thank you.

00:56:29:21 - 00:56:56:16
Dr. Boster
So the first thing that we have to think about is what does a vaccine do? Or what is a vaccine? Because a lot of people aren't exactly familiar with the vaccine. What you're doing with the vaccine is you're showing your body little pieces of a foreign invader, Kike you take a virus and you mash it up in a blender, and then you inject it into your skin and you show your immune system portions or parts of that virus.

00:56:56:16 - 00:57:20:13
Dr. Boster
It's dead. And then your immune system builds an arsenal against those pieces and parts, and so then you have developed an immunity. We have cultivated an immunity against that viral or that bacterial invader before you actually see it. So then later when you come in contact with it, your immune system is already primed to jump on it, kill it and clear it.

00:57:20:15 - 00:57:44:05
Dr. Boster
That's the concept of a vaccine. Now, up until like a month ago, no one in the world had ever been successful creating a coronavirus vaccine. Keep in mind that COVID-19 is not the first coronavirus. So there's hundreds upon hundreds of coronaviruses. Coronaviruses are older than humans, but this novel coronavirus, with a high mortality, is really something horrible.

00:57:44:05 - 00:58:10:06
Dr. Boster
And we've never been able to make a coronavirus vaccine, and we were not successful in making a protein vaccine the way that I described. There are some amazing scientists. There's a gal, and I think she's in Turkey, who really heralded in this new concept of an mRNA vaccine. Now, just to go back to college for a quick second, you have DNA, which is like the blueprint for making people.

00:58:10:06 - 00:58:33:22
Dr. Boster
Right. And then from DNA, you make a sub blueprint called RNA, and then from RNA, you make protein. And what we figured out was really, really cool because we couldn't make the protein for our immune system to see. We could make RNA. And when you inject RNA into the human, their body makes the protein of the M spike of the virus.

00:58:33:24 - 00:58:55:22
Dr. Boster
Now, you're not making the virus, you're just making a small piece of protein from the virus. Then your immune system can see that and it can build an arsenal against it, which is freaking brilliant. You know, I am a pro-vaxxer because science, because medicine, and we have cured horrible diseases that have ravaged the world.

00:58:55:22 - 00:59:27:06
Dr. Boster
You know, we forget that there were conditions that wiped out a third of the Earth, and we've now eradicated them off the face of the Earth because of vaccines. And the reason that I said I was feeling really sad when I saw the very, the numbers being quite low, is that if you take a vaccine, it's going to help you. It's going to protect you against getting the virus, but it's also going to protect your grandma, and it's going to protect your great auntie, and it's going to protect people that are at high risk, if enough people are vaccinated.

00:59:27:08 - 00:59:47:18
Dr. Boster
And so 50% in the country won't cut it. We really need something more like 90%, if we're going to make this go away. And so I hope that through education, we can help people become confident and comfortable.

Mary Ray
Yeah. I'm with you. I had my flu shot, and I will say that when that vaccine’s ready, I'm in line for it.

00:59:47:20 - 01:00:07:02
Mary Ray
I want to say thank you for joining us today, Dr. Boster, I-

Dr. Boster
It was my pleasure and appreciate our conversations, I really do. And we all appreciate the confidence building guidance around how to think and talk about the up theres and down theres. Again, cognition, energy and mood, as well as bowel, bladder and sexual function with our own doctors.

01:00:07:06 - 01:00:31:09
Mary Ray
Let's get confidence to be able to do that, and I really appreciate you spending some time on even how to address these issues with our loved ones who may not fully understand. I’m Mary Ray, Co-founder of MyMSTeam. Thank you all for being here with us today. The information and support doesn't stop here. If you already are a member of MyMSTeam, please share the helpful advice you got today with other members in the activity feed.

01:00:31:11 - 01:00:55:12
Mary Ray
If you'd like to become a member, just go to MyMSTeam.com, and sign up for free. Remember, you're not alone. I hope to see you at our next event with Dr. Boster on January 21st. It's a Thursday when we discuss the many questions surrounding COVID-19, and MS. We’ll extend this conversation and discuss new information about how the vaccines may affect people with MS.

01:00:55:14 - 01:01:33:06
Mary Ray
The link to register for the event is right here in the chat. Thank you again. And Dr. Boster, we'll see you next time.

Dr. Boster
Thank you guys. Have a great night.