00:00:00:00 - 00:00:57:21
Mary Ray
Welcome, welcome everyone. I'm Mary Ray, co-founder of MyMSTeam, the largest and fastest growing social network for people living with MS. Personally, I first learned about MS through my mother-in-law who passed away the year we launched MyMSTeam in 2013. Her strength of character continues to inspire me, as MyMSTeam continues to grow. Today, one in seven people diagnosed with MS in the United States is a member.

00:00:57:22 - 00:01:23:27
Mary Ray
Worldwide MyMSTeam has more than 160,000 members, who provide support and advice to each other. If you haven't checked it out yet, please do at MyMSTeam.com.. We are excited to have a full house today. Nearly 700 people have pre-registered for tonight's live Q&A event, and it's great to see so many returning members coming back for our talk with one of my favorite guests, Dr. Boster.

00:01:24:00 - 00:01:43:00
Mary Ray
Before we jump in, we have a bonus event right after this, I want to mention, MyMSTeam Zoom Online Social, which is immediately following this event. Anyone living with or caring for someone who has MS, should join using the registration link that's in the chat. It'll be fun, I am looking forward to it.

00:01:43:03 - 00:02:04:01
Mary Ray
I'm thrilled to welcome back one of my favorite guests, as I mentioned, who has a great sense of humor and his own YouTube channel with nearly 30,000 subscribers who love his videos. He covers a range of MS topics and an insightful video and article series on MyMSTeam, Dr. Aaron Boster.

00:02:04:01- 00:02:04:03
Dr. Boster
Howdy, howdy. Thank you so much for having me back, Mary.

00:02:04:03 - 00:02:26:04
Mary Ray
Absolutely, and you can see by all the comments in chat how many people are excited to have you back here, regulars in fact, people were looking forward to this. And I think anything that you're going to talk about regarding MS. For those who don't know, Dr. Boster is a neurology specialist focusing on MS. And is the president and founder of the Boston Center for Multiple Sclerosis and a great friend to us obviously, here at MyMSTeam.

00:02:26:04 - 00:02:33:06
Mary Ray
Again, welcome back, it's May already, we've been doing this (chuckles) for six months. It's hard to believe.

00:02:33:06 - 00:02:36:07
Dr. Boster
Crazy. Where did 2021 go?

00:02:36:07 - 00:02:57:06
Mary Ray
Right exactly, well, May is Mental Health Awareness month. And in the spirit of that, we collected a lot of questions about how to live with MS and deal with some of the mental health changes that can happen with MS. And as usual, due to high demand, we're going to provide a recording of this live event for those who are missing tonight.

00:02:57:08 - 00:03:16:25
Mary Ray
By the way, we're doing another live event in July, July 15th. So stay tuned for more details on that at the end. Tonight, the questions are, there are so many of them that we collected before this event. And don't worry if you didn't get a chance to send in your own question, do so in the Q and A Zoom link below.

00:03:16:27 - 00:03:45:13
Mary Ray
Please note that Dr. Boster isn't able to answer specific medical questions in this form, and those should be addressed to your doctor. Dr. Boster, I wanted to share a statistic from the Yale School of Public Health that every year 1 in 4 people, basically 57 million people in the US, are experiencing a mental health disorder. So it's more common than people realize. Does that surprise you?

00:03:45:13 - 00:04:06:29
Dr. Boster
No. And so it's a very commonly tossed around statistic that a quarter of adults experience a mental health issue. I think it's actually much higher than that. I think that's massively underreported because of stigma and bias. What I think is terribly relevant as we think about people impacted by MS is that in the setting of having MS, you're twice as likely.

00:04:07:02 - 00:04:24:50
Dr. Boster
So it's literally double that number. People experiencing depression, doubly likely to experience anxiety. It's a very, very real part of living your best life managing MS, is managing mood, big, big, important point.

00:04:24:50 - 00:04:31:29
Mary Ray
Great and according to WHO, you talked about a quarter, 1 in 4 people aren't getting the treatment they need for a variety of reasons.

00:04:31:29 - 00:04:49:14
Mary Ray
And there was a lot to unpack in what you had said earlier. Studies show that access, knowing where to go, stigma, as you mentioned, are the most common reasons. And if folks are getting care, it may not be the most effective thing for them. I want to go right into a couple of questions from our members.

00:04:49:14 - 00:05:19:53
Mary Ray
Carolyn wants to know, I'm gonna put these together. Carolyn wants to know from an anatomical standpoint, is the MS brain more susceptible to depression, anxiety than a healthy brain would be? And along the same lines, Maria asks, if MS leads to depression and anxiety, or is it? Does MS lead to depression, anxiety or is it triggered by MS medication? Or is it something else altogether? People are really wanting to understand, how does this get coupled with MS?

00:05:20:27 - 00:05:38:18
Dr. Boster
Psychiatry is neurology, we're just not there yet. We don't understand the intricacies of the neurochemical abnormalities. We're moving very, very quickly in the field of psychiatry. Unfortunately in the popular culture, psychiatry is still a black box for many people.

00:05:38:20 - 00:06:03:25
Dr. Boster
The underpinnings of why people with MS have an increased risk of depression are multifactorial. That's a Scrabble word, for there's lots of different reasons. So one of the reasons is certain structures in the brain, structures that are upfront in the frontal cortices, which codes for issues related to mood, can be impacted by MS. So brain damage to those areas can actually increase the risk of depression.

00:06:03:28 - 00:06:26:23
Dr. Boster
It's my strong belief that having an overly abundant inflammatory milieu in the brain is also a set up for depression. And if you add insult to injury, the nature of MS, the uncertainty of knowing when I wake up tomorrow, will my eyes work, will my hands work, will I swallow? Will my penis work, will I be able to move my bowels?

00:06:26:25 - 00:06:51:05
Dr. Boster
Not knowing that, creates a tremendous amount of anxiety and stress. And so when you start to unpack why someone with MS might be depressed, it's shocking that more people aren't, to be blunt.

00:06:41:06 - 00:07:07:26
Mary Ray
For someone newly diagnosed with MS, it can be overwhelming. As you mentioned, a lot of things are going on and to have this diagnosis and not have a clear picture of what the future will look like as you mentioned, could create anxiety. And Tammy wants to know what resources can help with that? That feeling of anxiety, because she's actually still in the early diagnosis process. What would you advise her to do in terms of going for resources, questions for her doctor?

00:07:07:26 - 00:07:29:12
Dr. Boster
So it's kind of like drinking from a fire hose, isn't it? You almost don't know where to start. And so I like to start with very, very objective, very, very concrete things that we need to do as a team. So you and I have talked, Mary, about my desire for you to be four for four in your fight against MS. There's only four things because there's four things I'm aware of that slow down MS.

00:07:29:12 - 00:07:54:29
Dr. Boster
But it's also your marching orders. Exercise as part of your lifestyle, eat clean, supplement vitamin D, stop smoking stuff and taking MS medicine. And if that's quote, all that you do, you're on "The Road to Wellville." And once we get on that road, we can start to deal with chronic symptoms. Typically, the very first symptom I tackle with the family is fatigue and depression.

00:07:55:01 - 00:08:19:08
Dr. Boster
Those are the first two things, because if you're pathologically fatigued or if you're clinically depressed, it colors everything ugly. It colors everything gray. And so as we start down this road of living your best life, despite having MS, very early on, we get into managing mood symptoms. Just to make one more comment, every single visit, we screen our patients for depression.

00:08:19:10 - 00:08:40:20
Dr. Boster
Every single visit we have them fill out questionnaires. There's a special questionnaire called the PHQ-9, it's nine questions, and I ask all patients to fill that out prior to meeting with me. And it is a guaranteed topic of discussion with every single visit. How are the up theres, what's going on with mood, what's going on with energy, what's going on with thinking because it's so, so relevant.

00:08:40:20 - 00:09:11:25
Mary Ray
You know, on the other end of the spectrum, it's great to hear that you do ask with every visit, because that doesn't change just because you're more familiar with your condition. In fact, people who have been living with MS for a while need to find hope or get lost in sort of being that, feeling overwhelmed, the feeling of anxiety that will this get worse? How much worse can it get? Elaine wants to know if you have tips for how to find hope when MS symptoms do get worse.

00:09:11:30 - 00:09:36:17
Dr. Boster
Yes, I hope Elaine that I can convey several elements that are very, very hopeful. For starters, I like to set realistic expectations for understanding your disease process. So, Mary, we've talked about a couple people that have shared kind of early in the disease process, they're struggling, and I think it's fair to set a realistic expectation that it's going to take two years before you're comfortable.

00:09:36:17 - 00:09:50:04
Dr. Boster
So I've been doing this job now for about a decade and a half, and I can say with a lot of experience working with families who are newly diagnosed, that it takes about two years before you become comfortable in your own skin.

00:09:50:06 - 00:10:05:06
Dr. Boster
And the reason that's so important is I want to set up a realistic expectation that for the next two years, you're not going to feel comfortable, that you're going to feel yucky and people are going to say weird things to you, and it's going to create a tremendous amount of emotional turmoil, and there's going to be a lot of processing.

00:10:05:09 - 00:10:26:04
Dr. Boster
And the first thing I want to tell them is during those first two years, I'm your translator. So if you hear something weird or read something or have a dream about something and you're concerned and not sure, I want you to call me so I can translate for that family what is and isn't real. And after around two years, people start to come into their own.

00:10:26:06 - 00:10:36:05
Dr. Boster
But setting that realistic expectation is very important. Otherwise, you'd say it's been two weeks, it's been four weeks, why am I not comfortable? Well, unfortunately, it takes a little bit longer.

00:10:36:05 - 00:11:02:01
Mary Ray
So going to the question of a veteran, who's been living with it, say for 10 years and might be on the decline a little bit. So again, for that person who might be a veteran and experiencing this feeling of anxiety that their symptoms are getting worse. What about that person? They've been through that first two years, but it's something else. They know how to manage the external factors. They're kind of, there's too much dealing with the symptoms right now.

00:11:02:01 - 00:11:24:24
Dr. Boster
So I think we have to do a couple things at the same time. We have to look at if there's anything contributing to the depression that's modifiable. So for example, if you have MS and you're taking an interferon beta product, those can worsen depression. Now they don't normally, but they can. So I have to look critically at am I giving you a medicine that might be worsening your depression. Is that possible?

00:11:24:26 - 00:11:52:11
Dr. Boster
We have to look into behaviors. Sometimes people self-treat when they're depressed with drugs and alcohol. And unfortunately that actually makes the problem worse downstream. So we need to kind of have a conversation about that. I want people impacted by MS to exercise as part of their lifestyle. But exercise is an antidepressant. That's a fact. That's one of the ways that I manage my depression is through exercise. And so we need to have a candid conversation about what are you doing to move your butt around? What are you doing there?

00:11:52:13 - 00:12:17:12
Dr. Boster
We need look at resources, do they identify a team? Do they have a village? Do they have someone they can talk to? And then we get into the real nitty gritty. For example, if you Mary, tell your husband, you're sad, he feels an emotion, he's not objective, he experiences an emotion and that's both beautiful, but it's also a barrier to finding solutions.

00:12:17:12 - 00:12:40:07
Dr. Boster
You and your husband are less likely to have an aha moments. If you say, "I'm sad," and he says, "Oh my God, I'm sad too." That kind of shuts down the creative juices, so to speak. And so having a therapist, having a trained listener, whether that be a rabbi or a priest, whether that be a social worker, a psychologist, whatever flavor of counselor, is objective.

00:12:40:09 - 00:13:03:18
Dr. Boster
They don't have any stake in your life. So when you say, "I'm sad," they say, "Tell me about that." And that is a space that we must create. And unfortunately, in Western culture you're not allowed to talk about how you feel. Absolutely not. You can talk about your kids. You can talk about work. You can talk about medicine like your medical ailments, but you're not allowed to talk about how you feel, which is a travesty.

00:13:03:23 - 00:13:29:06
Dr. Boster
And really creating that space with a counselor is sacred. It's very, very important. (talking over each other) One more thing. I'm so sorry, I fail at brief answers. But there's one more really important element that we must bring up and that's medicines. So it's not a sign of weakness to take a medicine for depression.

00:13:29:13 - 00:13:46:12
Dr. Boster
I take two. And antidepressants adjust the chemical imbalances that MS has created to cause depression. And so really we wanna look at a rather holistic, multi-pronged approach for how to help that veteran live their best life and overcome depression.

00:13:46:12 - 00:14:12:03
Mary Ray
Right so that is what I'm hearing too, so you multi-prong, the three things I'm hearing here are, one, there's some basic lifestyle things to address off the bat, that'll put you on the right track,
whether that's drinking, smoking, certain kinds of eating, exercise, that's one area, just lifestyle in itself. The other is making sure there is some sort of therapist or counselor on your team. You got to the heart of Diane's question.

00:14:12:03 - 00:14:40:27
Mary Ray
There's a live question that just came in here. So I just want to acknowledge that. Diane, thank you for that question. And then there's the third, which is medication, but there is no one silver bullet. It is looking at the whole big picture. So again, the three things to consider are the lifestyle aspect, a therapist, an objective ear, and finally medication as needed, and not worry about the stigma.

00:14:40:27 - 00:14:56:00
Mary Ray
Amanda wrote in and you had mentioned an assessment you give your patients, Amanda wrote in with a question about self-assessment, how can she determine whether she's depressed? She feels like a generally happy person, but she has breakdowns now and then, when her MS symptoms give her trouble.

00:14:56:00 - 00:15:21:15
Dr. Boster
I think she's answered the question for herself. I think she already told us the answer. She's experiencing sometimes where her mood is not what it wants to be. Now, that is enough to my ears to engage in a conversation about what can we do to make things better. That stated, there's a lot of different ways of doing self-assessments. I made that comment earlier about the PHQ-9.

00:15:21:17 - 00:15:46:24
Dr. Boster
All right so this is a standardized battery which is used in most primary care clinics around the universe to screen people for depression. It's quick nine questions, you score it, and it gives you a really, a very very solid indicator of depression. And that's one of enumerate batteries that are available online, or in a doctor's office to monitor you.

00:15:46:27 - 00:16:02:11
Mary Ray
Is it easier to have a professional assessment rather than the person always kind of checking in with themselves? It sounds like you feel like it can be fairly balanced.

00:16:02:11 - 00:16:45:29
Dr. Boster
I think it depends. Right. So some people have great insight into their mood, so some people don't. So I'm an example of someone who didn't. I was clinically depressed for years as a doctor caring for people, prescribing antidepressants. I was depressed and people would say, you're really depressed and I would say, "No, you're stupid, you're wrong." And they weren't wrong. I was wrong. And I'm trained to understand depression. So I don't think that everyone always has adequate insight into the way that they feel, hence the value of some objective measure, whether that be a spouse or a therapist’s impression or a battery of tests like we're talking about. I think sometimes those are very helpful.

00:16:46:02 - 00:17:18:21
Mary Ray
COVID's still with us. We know that a lot of people are getting vaccinated. And again, I wanna give a great shout out to Dr. Boster, you've done a couple of events already on the topic, and it's moved the needle, we believe, within our community here with MyMSTeam. And Jerry would like to know actually, if you have any tips on coping with depression in MS, while adding in the fear and anguish of COVID or other unexpected events that really throw a wrench in the works. Unexpected events, perhaps even when a loved one has been lost in the pandemic or has been sick with COVID.

00:17:18:24 - 00:17:59:22
Dr. Boster
Yeah, there is a global viral pandemic and there is a global mental health crisis right now. I have treated more depression and more anxiety and more medically refractory depression and anxiety in the last year than I have in the last 10 years combined. So this is very, very real. So what what can we do to address depression in a group of people that are at high risk of depression during a global viral pandemic, when we've taken away most of the tools that we gave them, like support groups, and gyms, and community seminars, and classes, and all those things are removed.

00:17:59:22 - 00:18:20:02
Dr. Boster
So what do we do? Well, one thing we can do is we can get a pet, right? So get a dog, so pets are ridonculously helpful in managing depression and mood. I will never be without a dog the rest of my adult life. I will never ever be without a dog. My dog sleeps in bed with me.

00:18:20:04 - 00:18:31:25
Dr. Boster
My dog goes in the car to work with me. My dog is right here, come here. My dog sits in the office with me. My dog sits at my table when I eat dinner, I mean she is-

00:18:31:27 - 00:18:36:40
Mary Ray
And your dog is huge, your dog is huge. Are you gonna have her make a debut here?

00:18:36:25 - 00:18:48:14
Dr. Boster
I dunno if I can pull it off with my, let me see if I can be super Zoom fancy, one moment. I don't know how to make my camera work so you can see, she's, I'll have to-.

00:18:48:50 - 00:19:00:24
Mary Ray
That's okay. (Laughing) Dr. Boster, that'll be the bonus in the social hour. We'll get a picture of your dog and we'll share that with the group in the social hour.

00:19:00:24 - 00:19:12:24
Dr. Boster
She's a 180 pound American Mastiff, the love of my life. Second, only to my wife and children. And she's a constant companion, and getting a dog is a game changer and so I'm not joking.

00:19:12:24 - 00:19:33:26
Dr. Boster
Getting a pet has been shown to help depression a lot. I mean, it helps with a bunch of other things. I have several YouTube videos I made about why you need a dog. So that's something that you can do during a global viral pandemic. And because a lot of people are working from home, it's a stellar time to onboard a dog to your family, because they're not going to pee and poop on the floor.

00:19:33:26 - 00:20:08:11
Dr. Boster
When you're there, you're going to be able to take them out and kind of help the puppy get used to things. So that's actually a powerful tool. What else can we do? Well, there's this organization called MyMSTeam, one of the largest repositories of humans with MS in the world, all on one social media platform. Ta-da, and what you're offering this evening is a brilliant way of combating social isolation and depression and fear by bringing a giant group of humans with a common interest together virtually.

00:20:08:13 - 00:20:32:00
Dr. Boster
And you guys do it arguably better than most. There are other organizations that are doing the same kind of thing. And I would encourage people listening, seek out an online community. I mean, one of the things I think is so cool about your organization, if it's three o'clock in the morning and you can't sleep, you can jump on MyMSTeam and there's a bunch of other people at three in the morning that can't sleep, that are excited to talk to you.

00:20:32:03 - 00:20:53:13
Dr. Boster
And it's a readymade community of people that are caring, and that's brilliant, so leveraging social media, or leveraging virtual experiences is the new norm. I mean when I say I have a meeting, it's assumed it's a Zoom meeting, right? I mean, I don't remember the last time I had a meeting that wasn't a Zoom meeting.

00:20:53:15 - 00:21:01:00
Dr. Boster
And so those are two things that you can do. One is reaching out virtually to other human beings, and one is getting a dog.

00:21:01:00 - 00:21:09:20
Mary Ray
That's great, very specific. And I appreciate that tee up for MyMSTeam. We're gonna go on a poll question now.

00:21:09:20 - 00:21:10:06
Dr. Boster
Let's do it.

00:21:10:06 - 00:21:48:21
Mary Ray
Yeah, so here's the poll question today. What has been the biggest impact of COVID-19 on your mental health? Not seeing friends and family. Not getting to go to exercise or physical therapy. Being afraid to go to the doctor's office. Fear of getting sick or something else. Dr. Boster, you and I were talking a little bit earlier about this ourselves and some sort of feelings we had about going out, even after getting vaccinated, being out of our two week window and sort of still having a little bit of, sense of reluctance.

00:21:48:27 - 00:22:19:08
Dr. Boster
Yeah, there's a term, a medical term called agoraphobia, which means a fear of being in an open public place for fear that you'll have a panic attack. And we kind of use the word agoraphobia colloquially, to mean, I don't want to be outside. And I've remarked that in my own myself and in my family, and in the families that I interact with in my job, many, many people are experiencing a very mild agoraphobia where when they're outside, it feels weird, because for the last year we were told, "Don't go outside, don't be around others."

00:22:19:11 - 00:22:38:07
Dr. Boster
And suddenly it's okay, but it doesn't feel okay. It's a very interesting re-entry. A long time ago, Mary, I was an exchange student, I lived overseas for a year. And when I came back, I had this reverse culture shock where Americans really bothered me and it was really, it took me a couple of months to get back into the American groove.

00:22:38:09 - 00:22:50:23
Dr. Boster
And I sort of feel like all of us have been sequestered at home and quarantined, and now we're all going through this reverse culture shock as we're getting used to being back in groups. It's fascinating.

00:22:50:23 - 00:22:55:26
Mary Ray
It is. this is all new, we're all doing it together too. So it'll be interesting to see how we get on the other side of this.

00:22:55:26 - 00:23:22:18
Mary Ray
We have our poll results here. Yeah, just what I expected. Yeah, the impacts of not seeing our loved ones, our friends and family as is topping the charts here. In terms of response, half of folks really felt that. And then the fear, the actual fear of getting sick. Sure. So there was one note here about being afraid to go to the doctor's office.

00:23:22:18 - 00:23:36:00
Mary Ray
Only 6% felt that. My question for you Dr. Boster is, did you notice a dip in patients coming in to see you, at all during the pandemic? And if so, is it starting to change?

00:23:36:00 - 00:24:14:06
Dr. Boster
So, we converted over to a virtual platform very early. So I opened the Boster Center for MS on March 19th, and on March 21st, the governor saw fit to close the state of Ohio. And so within a couple of days, we converted over to telemedicine, and at the risk of being paternalistic, we didn't give people an option because we were trying to keep people safe. And so I think that what I saw the most was people frustrated, not about going to see the doctor or fear, but about not being treated.

00:24:14:08 - 00:24:37:01
Dr. Boster
So they would attend a doctor's visit, and the doctor was the one who reportedly was reluctant to offer a therapy or offer a treatment and wanted to kind of watch and wait. So I don't think that I had a lot of families that were shying away, but also they weren't coming in, and sort of in a weird turn of events, Mary, everyone was at home, so everyone attended their visits because there weren't allowed to go anywhere.

00:24:37:03 - 00:24:46:26
Dr. Boster
So nobody was late, I mean, for months and months and months, everyone was on time and everyone showed up because where else were they going to be? And it was really weird.

00:24:46:26 - 00:25:00:26
Mary Ray
Interesting turn there with telehealth. We do have a question from Cole and he wants to know about antidepressants, if they have a stronger or more damaging impact on the brain for people with MS compared to the general population.

00:25:00:28 - 00:25:21:29
Dr. Boster
So, I think the efficacy of an antidepressant is agnostic to whether or not you have MS. So I don't think that someone with multiple sclerosis fares better or worse compared to the general population. Now, I can say with great authority, having done this for a while, that antidepressants work very, very well in the setting of MS.

00:25:22:01 - 00:25:49:21
Dr. Boster
And one of the things that doctors try to do is, we try to be little alchemists where we wanna get twofers and threefers. So I'll give you an example. If someone I'm taking care of has depression and neuropathic pain, I'll pick an antidepressant that has neuropathic pain properties. So I get a twofer. If someone has depression and horrible insomnia, I'll give them an antidepressant that makes them sleep.

00:25:49:23 - 00:26:08:24
Dr. Boster
So we try to get a twofer and threefer. My favorite antidepressant has a side effect of energy. It's energizing, and it can kind of wake you up. And it doesn't impair sexual function, which to me is very important. And it doesn't cause weight gain, it actually causes weight loss. And so those are side effects.

00:26:08:24 - 00:26:22:30
Dr. Boster
But most people that I work with are really, really happy about them. And so we can kind of custom tailor the best fit for that human being and their particular situation.

00:26:22:30 - 00:26:36:13
Mary Ray
That's great. Teresa asks, "What types of lifestyle changes have you seen work in people to improve depression without adding more medications to their lives?" In the past you've talked about, what can we take away, can you go ahead and address this one?

00:26:36:16 - 00:26:57:28
Dr. Boster
Yeah. So a couple high yield things. High yield thing number one, remove sugar from your diet. Now a lot of people on this call just went, (groans loudly) or they made some negative comment in their head, "No." But the reality Mary, is that if you remove sugar from your diet, your mood skyrockets.

00:26:58:04 - 00:27:17:04
Dr. Boster
And if you don't believe me, try it for a month. The other thing that you'll find when you remove sugar, is that your energy skyrockets, it's really, really weird, but it's true. A second thing is increase your water intake. And again, now you're like, "Aaron's crazy and he's making stuff up," but I'm not. If you're dehydrated, you'll have a depressed mood for real.

00:27:17:05 - 00:27:36:16
Dr. Boster
So try it, up your water game and you'd be shocked at like how better you feel and how you have more energy. Here's another pro tip, steal an extra hour of sleep. So most red-blooded American adults put our family to bed, our kids go to bed around 9:00 or 10:00, and it's finally quiet for the very first time.

00:27:36:19 - 00:27:57:04
Dr. Boster
And so what do we do? We claim the adult time, we sit and stare at the television blindly for hours until we stumbled to bed a couple hours later. So here's the challenge. Steal back an hour, so instead of watching "The Boob Tube" from 10:00 PM to midnight, turn the TV off at 11:00 and get an extra hour of sleep.

00:27:57:11 - 00:28:25:13
Dr. Boster
You will be shocked at what it does to your mood. Here's another pro tip, go for a walk once a day. If you can ambulate, walk around the block. Throw a mask on if you need to and exercise. Just walk around the block, that does something neurochemically which is remarkable and is a lot like an antidepressant. So those are things that your mom might tell you to do, except she was right. And they make a gigantic impact in the quality of your life.

00:28:25:13 - 00:28:35:29
Mary Ray
Thanks for sharing that. Andrea has a question. She wants to know if you can discuss whether there's a connection between MS and bipolar disorder.

00:28:35:29 - 00:28:54:22
Dr. Boster
That's a great question. It has been studied, and there is an increased risk of bipolar disorder amongst people with MS. Maybe not to the same degree as you see, with increased risk of depression and anxiety, but it is an increased risk. That's absolutely true.

00:28:54:25 - 00:29:04:14
Mary Ray
Great. So in general, is there a common mental health condition among people with MS? Is depression common?

00:29:04:14 - 00:29:18:20
Dr. Boster
Depression. Depression is the most common mental health illness. I don't even like that term. But like the most common mood disorder that we see in MS is depression, hands down, across all age groups, it's depression.

00:29:21:17 - 00:29:41:22
Mary Ray
I want to go directly to some live questions now that have been coming in. Sarah asks, "I have MS and I've been told that I have borderline personality disorder. I want to know how to control my mood. I'm not sure if there's something here. Maybe there's a particular type of doctor?"

00:29:41:22 - 00:30:22:13
Dr. Boster
So, sometimes nature is too generous. And sometimes you get to have MS and you get diagnosed with personality disorder in this example, and that's not fair, but that's real life. And so it benefits us to extend our team. So in this example, with a personality disorder, there isn't a pill for that ill, but there is therapy, which is extremely valuable. And so I envision this person living their best life working with an MS neurologist and working with a psychotherapist, whether that be a cognitive behavioral therapist or some other form of therapist. And they're gonna need multiple team members, and they're going to fare really, really well, absolutely.

00:30:22:13 - 00:30:33:13
Mary Ray
Peggy asks a question. I'm not sure if this is going to get the same response as the sugar answer you gave, but what about caffeine intake? Does that impact anxiety or depression?

00:30:33:13 - 00:31:02:19
Dr. Boster
I'm not aware of data that caffeine intake worsens depression. So if there is data to that, then I'm not familiar with it. I do think that we have to be cautious. Caffeine is a stimulant and sometimes stimulants can worsen anxiety. Most people don't have a significant problem with caffeine, but I do have some patients where caffeine sends them over the edge. And so I would flip the question around and ask that human being, when you drink caffeine, what happens?

00:31:02:22 - 00:31:23:14
Dr. Boster
And if they tell me that the rest of their day they're really anxious and kind of on edge, then I would do an experiment with them where I would ask them to avoid caffeine for a week or two, just to kind of see what their experience is like. They may find it doesn't matter. They may find that it makes a difference. And so the cool thing is we can figure that out for that individual, through that experiment.

00:31:23:14 - 00:31:34:16
Mary Ray
So Peggy, if you wanted to try that for yourself, you could do that and take your own notes and see if you're noticing anything different of course, and talk to your doctor.

00:31:34:16 - 00:31:58:24
Dr. Boster
Yeah and you could kick it up a notch, and Peggy, you could ask your friends and family, "Hey, listen I'm gonna do an experiment, where I'm gonna change my diet for two weeks. Tell me if I act any different, have you noticed anything?" And then they might come back and say, "You know what, you seem more calm," or, "Oh my gosh, honey you seem like X or Y." And sometimes that external input is so valuable because they're seeing you from the outside in, as opposed from the inside out.

00:32:00:04 - 00:32:15:08
Mary Ray
Jane asks a question, and this is really about access. We've touched on this before around assessment. "I can't access the neuro psychologist, the neuro testing that I think I need, what can I do locally?" Is there someplace you can go?

00:32:15:08 - 00:32:37:15
Dr. Boster
So, there's different kinds, so neuropsychometric testing is a very special kind of testing. It involves a very, very special kind of psychologist in about five hours of paper and pencil testing. And as you can imagine, during a global viral pandemic, coupled with the shortage nationally of neuropsychologists, that's hard to do.

00:32:37:17 - 00:33:10:28
Dr. Boster
And so if the person who asked the question is seeking neuropsychometric testing, which has more to do with thinking of memory than mood, and we can't find someone that can provide that locally, then the next best thing is to have a mini assessment by a speech pathologist. So speech pathologists are easily found, in large physical therapy groups where there's a physical therapist, an occupational therapist and there’s a speech therapist, and those speech pathologists or speech therapists have special training in cognition.

00:33:11:00 - 00:33:25:11
Dr. Boster
And oftentimes even without formal neuropsychometric testing, which is like the real deal Holyfield, they can do a short battery when they meet someone, and that is a second best option.

00:33:25:13 - 00:33:53:11
Mary Ray
I want to come back to the concerns of those who are newly diagnosed. On the one hand, we know that folks with MS might be more prone to depression anxiety. Is there something that you've seen, or is there data that suggests that when someone's in the newly diagnosed phase, compared to when they're in veteran phase, the rates of depression or anxiety go up or down,or is there a connection to where they are in stage of MS?

00:33:53:11 - 00:34:19:14
Dr. Boster
So, there is data that people with advanced multiple sclerosis, have an increased risk of depression. So as disability increases, depression risks increasing. It's not a guarantee or a foregone conclusion, but it also makes some degree of logical sense. And so we do see that. I don't think that it's as clear cut as, at this many years you're going to have this rate of depression.

00:34:19:14 - 00:34:27:23
Dr. Boster
But we do see a trend that is significant, that with advanced disease state, we see increased risk of depression. Yes.

00:34:27:23 - 00:34:43:23
Mary Ray
In MyMSTeam, we had done some research that found that when someone lost their mobility, they lost their sense of independence, which then created this spiral into depression. So that seems to align as well.

00:34:43:23 - 00:35:05:04
Mary Ray
Charlene is who I was thinking of when I asked you that question, "What would you tell a newly diagnosed patient, a person like myself who's grappling with understanding the diagnosis?” She just got this in December. "What it means now, and in the future, I'm scared. I can ignore it most days, some days I just want to cry. I ask why me."

00:35:05:06 - 00:35:31:16
Dr. Boster
So, let's tackle that in a couple of different ways, maybe three different ways, because I think it's super important. There's a guy who's an Osmond, he's Donny Osmond's nephew. And he's an amazing singer and guitar player. And he speaks nationally sometimes about his own experiences with MS.

00:35:31:18 - 00:35:48:10
Dr. Boster
And I had the privilege of sharing a stage with him many years ago, and when we got on stage, if I'm honest with you, I kind of thought, he's going to do a spiel and I'm going to sit here and listen to him and whatever. I cried on stage, I bawled like a little baby. What he shared was so impactful to me.

00:35:48:10 - 00:36:11:26
Dr. Boster
And I want to share it with you now because I think it's relevant. He, after his recent, when he was first diagnosed, he had transverse myelitis and he couldn't move his legs or his arm, which is a big deal because he plays the guitar, and he's at the Osmond house with Donny Osmond and a giant family and he's in a wheelchair and he's watching his brother wrestle with his son on the floor.

00:36:11:29 - 00:36:30:04
Dr. Boster
And he got angry, he got mad, and he said, "Gosh, darn it, why me? Why can't I use my legs, why can't I use my arm, why me?"Then he paused and he had an epiphany. And he said, "If I am going to challenge that bad experience, I have to also take back every good thing that's ever happened to me.

00:36:30:06 - 00:36:48:02
Dr. Boster
I have to take back that I'm surrounded by loved ones. I have to take back that my son is healthy." And he went through this whole thing, and then I started bawling, but it's such an important point that, yes it sucks to have MS, and yes that's not cool, and I wish to God that you didn't, but you do.

00:36:48:05 - 00:37:06:09
Dr. Boster
And you're still alive. And now we have to move forward despite the fact that this is real. I'm not saying that so you're like, "Oh, okay I'm fine now." But my point here is that there is a degree of acceptance that we have to take. You've heard the old saying, "God doesn't give things to people they can't handle."

00:37:06:10 - 00:37:24:07
Dr. Boster
And sometimes I feel like the people that are saddled with this, they're special in many ways and they can handle it. I'll share with you something that happened today that really was impactful. A lady that I've taken care of for a very long time, she's very dear to my heart.

00:37:24:09 - 00:37:45:06
Dr. Boster
And she is a teacher in a school and a music teacher. And she's a pianist, and she has been so excited to be teaching at the school, and there's a series of concerts next week. And last Friday, she had an attack that took out her right hand. Her dominant hand. She can't play.

00:37:45:09 - 00:38:01:23
Dr. Boster
She can't feel her hand. She doesn't know where her hand is on the keys. And she can't play the concerts. And she's in my office and we're giving her steroids, and there's tears and I have tears and. And it's very, very sad. And I don't have like a punchline where I'm like, "And then it's okay."

00:38:01:23 - 00:38:21:08
Dr. Boster
I mean, it's a very sad thing, but this is the real world and it's what we have to deal with. So my first comment here is that we have to accept, okay, I didn't want this. I don't want this. But it happened and I'm not dead yet. And I need to figure out within the confines of this new situation, how I'm going to win.

00:38:21:10 - 00:38:39:15
Dr. Boster
And I immediately raise my hand and say,"I wanna help you win. I wanna help you through that process." And then we start to leverage all of the things that I've been talking about, and we start to leverage, "Are we doing enough with support systems? What are your support systems, and do we need to grow them?”

00:38:39:17 - 00:38:56:26
Dr. Boster
I'm not above connecting two people that don't know each other who have a common interest and are both awesome. Do we need to augment the medicines that we're using? Do we need to add something to something? Do we need to tweak it? What are we doing to manage our daily expectations?

00:38:56:26 - 00:39:09:12
Dr. Boster
And are we exercising as part of our lifestyle? And are we eating clean? I mean, sometimes we have to roll up our sleeves and dig in Mary, and it's what we have to do. And it happens way more often than I wished it did.

00:39:09:12 - 00:39:24:14
Mary Ray
So, Charlene, you're not alone, MyMSTeam is here. Many of us, many of the members have gone through the stages of grief, so to speak, from diagnosis to getting to that world of acceptance.

00:39:24:14 - 00:39:46:01
Mary Ray
And in fact, I think we have, I'm going to ask the team to put this in the chat, if they can find the resource in MyMSTeam about the stages of grief, so you can see that it really is about processing what you're going through. It is a lot. It is life changing. And your feelings are validated here, we hear you, and we understand.

00:39:46:01 - 00:40:09:15
Mary Ray
And also taking a holistic approach to this and understanding that others have been there. Peggy had just put into chat that she's 13 years in and still has those moments and those days. But hopefully these will subside. And Dr. Boster, you had mentioned that it takes about two years that you've seen when someone's first diagnosed to actually get to that world.

00:40:09:20 - 00:40:25:12
Mary Ray
There's a lot that happens in the first year of figuring out which treatment works best. What additional support systems they need. In the short term perhaps Charlene, you might even add a counselor to her team, even in the early stages. Do you want to shed any more light about what tends to happen in the two years?

00:40:25:15 - 00:40:48:13
Dr. Boster
I would, but I also want to double back to another tool that I don't think is utilized enough. Particularly when you're, Peggy's comment about feeling kind of despondent and really struggling. I think it's very, very important that we celebrate small wins and grieve losses. And I'm not talking about, like, wins.

00:40:48:13 - 00:41:06:16
Dr. Boster
Like, I got a new job, or I bought a house or I won the lottery. Yeah, I mean those are great things to celebrate. I'm talking about, I wore high heels and I didn't fall. I went to the concert and I didn't pee my pants. I went on a date, and I didn't bite it on the cement outside of the restaurant.

00:41:06:20 - 00:41:32:20
Dr. Boster
I mean, small wins. We have to identify that they're wins and we have to celebrate, like literally like, yay, we have to celebrate those wins. And we have to grieve small losses. So if you are a lover of stiletto heels and MS has made it so that you can't walk with stiletto heels anymore, it is wholly appropriate to grieve the loss of high heeled shoes.

00:41:32:22 - 00:41:53:03
Dr. Boster
And I think that it's only appropriate to take a moment and say, that sucks, and to talk about it a little bit. And I think to not do that is not to live your life, and it's not to appreciate the rollercoaster that we're on. It's not just about big exciting things. It's about day to day life.

00:41:53:06 - 00:42:13:09
Dr. Boster
I think we all too often, maybe because of media and other things, we only think about big things that happen outside of our lives. But if you stand at your high school son's graduation the whole time, and you don't have to sit down the way you were scared you would, we celebrate that. That's a celebration.

00:42:13:12 - 00:42:34:06
Mary Ray
Absolutely, absolutely. Ingrid has a question, I wanna ask this question before we go into our poll question, "What about problems trying to get back to work? We touched on this a little bit, it's been two weeks and I have brain fog, depression and anxiety. I don't feel like I'm able to help my team."

00:42:34:09 - 00:42:57:21
Dr. Boster
So, I think that's a gigantic question, which definitely deserves some unpacking and getting into the whole discussion of employment is such a big, important thing. And fortunately or unfortunately in our culture, we put excessive value on what you do. So like, how are you and what do you do? Are very common questions when we meet a human.

00:42:57:23 - 00:43:19:27
Dr. Boster
And so we don't wanna know like, oh you're a dad and a very caring member of your church. We mean like, what do you do for a living, right? Right. And there's so much tied up in that. So I hope that you have a supportive work environment. And I hope that, I would love it if you had people at work that understood your disease, it's really hard to have MS and for no one at work to know.

00:43:20:00 - 00:43:42:25
Dr. Boster
I have many, many families that that's what they do, and I support them in their decisions, but it's so much better if people know, because oftentimes a simple accommodation wins the day. Right, it doesn't have to be a, "You lose your job or we have to do something completely different."

00:43:42:28 - 00:44:06:24
Dr. Boster
Maybe it's something as simple as you can wear tennis shoes. Or you're allowed to sit down. I mean, simple things can really, really help win the day. The other thing that I think we have to think about is when you are having not one, not two, not three, four, or more things going on. We can't put band-aids on four things.

00:44:06:24 - 00:44:24:23
Dr. Boster
As an MS neurologist, I'm starting to ask the question, Are we having an attack? Do we need to address this at a higher level? Is there a role of coming in with steroids? Is there a role of coming in with a break from work? What do we need to do? We need to dig in. And it all goes back to something that we started to talk about Mary, it's about being open and communicating.

00:44:24:23 - 00:44:48:28
Dr. Boster
So when I first started in MS I had hair and I forgot to look up when I was assessing a patient with a relapse, so someone would have a numb foot and I'm like hyper-focused looking at their foot going, "Oh my God, the foot, the foot." Where I forgot to look up and if I look up, the human is depressed and they're confused.

00:44:49:00 - 00:45:10:05
Dr. Boster
They have cog fog. And what I learned was when someone has an attack, almost always mood takes a hit and energy takes a hit. And so I have to be sensitized to that, because a lot of times what I'll realize is, this is MS rearing its ugly head. And that's when Aaron gets out a big stick and beats it like a redheaded stepchild back into submission.

00:45:11:05 - 00:45:34:14
Mary Ray
Got it. Let's go to the poll question. For everyone at this live event, how often do you talk to your neurologist about mental health issues? Dr. Boster, I think your patients are incredibly lucky to have someone like you checking in on the up theres and down theres, but particularly the up theres.

00:45:35:18 - 00:45:52:11
Mary Ray
You would think it's somewhat of a given for a neurologist, but then in a way you wouldn't, can you kind of just, as we wait for the results, touch on why you think all MS providers should do what you do.

00:45:52:13 - 00:46:15:04
Dr. Boster
Thank you for the kind words. I do what I do because it's the only thing that makes sense to me. And I really think if you pay attention to people trying to live their best life despite having MS, it becomes very clear that the up theres, a thinking, a memory, energy, mood are really, really big factors in the disease process.

00:46:15:04 - 00:46:41:18
Dr. Boster
And so at the same time, they're big factors, they're also completely invisible. And there is so much stigma in our culture about talking about mood, talking about energy, talking about cognition, that people are predisposed to hide it. I start most clinic visits, whether that be telemedicine or in the office, saying, "How are you doing?" To which the person will say, "Good, how are you?"

00:46:41:24 - 00:47:02:11
Dr. Boster
And then I will say, "No, no, no, no, I don't mean the socially polite, how are you doing? I mean like, how are you actually doing?" And Mary, nine times out of 10, they say, "Actually I'm doing really shitty." That's immediately their response, and I say, "Okay, let's start with shitty, tell me about that." And then we get into a real conversation, and I think invisible symptoms aren't less real.

00:47:02:12 - 00:47:15:27
Dr. Boster
They're just not evident to the outside observer. And so I'm not going to miss those symptoms. And so I trained myself to ask every single time because it's the best way to figure it out, is to ask.
00:47:15:27 - 00:47:19:02
Mary Ray
Let's see how our audience responded to this question.

00:47:26:27 - 00:47:50:02
Dr. Boster
And so this question read, how often do you talk to your neurologist about mental health issues? And the majority said fewer than half of my doctor's visits, and only 20% said every doctor's visit. Now, for the people that said, I never have, or said, fewer than half my doctor visits. I have a challenge for you.

00:47:50:04 - 00:48:22:16
Dr. Boster
I challenge you to tell your doctor how you're feeling. Like volunteer and say, "Hey, doc, I'm depressed." Or, "Hey doc, I have a really bad anxiety problem." I want you to volunteer that. Every human with MS needs an advocate. And one of the best advocates to bring with you is yourself. And so if you have some anxiety about that, write it down on a piece of paper. Take a piece of paper and write, "I am depressed, I am anxious, I want you to help me." And then bring it in the doctor's office and just say, "Hey, I have some notes, I wanna read you what I wrote."

00:48:22:16 - 00:48:45:26
Dr. Boster
I wrote, "I am depressed," and force your doctor to address it. It's your body, it's your brain and it's your life. And honestly, we should ask you, but if we don't, I want you to volunteer and say, "Hey, guess what's going on in my life? I'm really struggling and I want you to help me today."

00:48:45:29 - 00:49:05:07
Mary Ray
That's great. Susan wants to know, the next two questions here, I'm still gonna ask, I know a lot of people have this on their minds, okay. They're on different levels, but there's still, the question is, is the answer similar? Susan wants to know if mood changes are related to MS and what can be done about them.

00:49:05:10 - 00:49:15:08
Mary Ray
And then there's another question from someone who feels like their personality is changing due to MS, and is there anything to be done about that?

00:49:15:10 - 00:49:36:08
Dr. Boster
So, yes, both of those people have identified real things that happen in MS. When you break your arm, it's really easy to tell your arm is broken and people will carry your book bag and stuff. But when MS affects your personality, that's a big deal and it's harder to see at first.

00:49:36:10 - 00:50:06:20
Dr. Boster
And MS is a disease that affects the entire brain and spinal cord, so the supercomputer that runs your body and your mind and controls mood. And so sometimes you can see difficulties and changes. The most common change in personality that we see, which is typically not appreciated except for in the setting of sort of more advanced multiple sclerosis, is problems with social cognition, which can be misunderstood for mood.

00:50:06:23 - 00:50:30:12
Dr. Boster
So social cognition is what you're doing right now. You're making eye contact with me. You raised your eyebrows, which is a cultural signal that you're interested in what I'm saying. You're making direct eye contact. I mean, you're doing things to let me know that you're engaged, that's social cognition. And sometimes some people with MS lose that. So I experienced that for the first time when I was a child with my uncle who had MS.

00:50:30:12 - 00:50:45:22
Dr. Boster
My uncle Mark, I now understand, had a problem with social cognition. And I would come into his bedroom where he was watching TV in his wheelchair, and say, "Hi, Uncle Mark," and he would stare at the TV and he wouldn't look at me. And then I would think, well, maybe he didn't hear me, so I'd say it louder.

00:50:45:26 - 00:51:02:14
Dr. Boster
"Hi, Uncle Mark, it's Aaron." And he wouldn't look at me.And then I would stand in front of the television so he could see me, 'cause I thought maybe he didn't see me.I said, "Hey, Uncle Mark, how are you doing?" And he would just stare at me. And then I would leave the room. And I wouldn't tell my grandparents because I thought maybe I had done something wrong.

00:51:02:16 - 00:51:18:27
Dr. Boster
I didn't do anything wrong, my uncle didn't understand the social cues and he had some, and towards the end of his life had some really significant problems with social cognition. So that is real and we don't need to be ashamed about it, and we don't need to hide it and we should talk about it.

00:51:19:00 - 00:51:38:03
Dr. Boster
And what I find is oftentimes if I bring these topics up, people are relieved because they know it's happening, but they think maybe they're making it up or it's invented or that I'll be judgy. And so if you're listening to the call and you're experiencing issues, I want you to feel comfortable saying, "Hey, this is my only life I get to live, and I want you to help me sort it out 'cause I'm having this issue."

00:51:38:03 - 00:52:03:22
Mary Ray
Really important takeaway there, which is, do speak up, don't second guess yourself and bring it up with your doctor. Heir on the side of mentioning it, than not. There is a really interesting question from Giovanna. "How can I know if what I have is grief or depression?"

00:52:03:24 - 00:52:27:03
Dr. Boster
It's confusing, isn't it? And I think that they're so muddled. I think sometimes grieving a loss, and experiencing depression overlaps so much that I, as a neurologist, I'm not sure I can sort them out. Now, maybe my friends who are psychologists and psychiatrists could. But for me, I want to dig in. I want to give you a really big hug, and I want to support you, and I want to be there for you.

00:52:27:05 - 00:52:48:02
Dr. Boster
And I think so much of depression in MS is related to grief. It's loss of function. I used to be able to dance and I can't do that. I used to be able to run and I can't do that, and I miss that. And I grieve the loss of my ability to run. I think I actually can't answer her question because I think that it's so interlaced that I struggle to pull it apart.

00:52:48:02 - 00:53:16:25
Dr. Boster
But what I would rather do is be supportive in both situations and that I think we can do. And that's something that this village, this village that we're talking on right now, MyMSTeam, that's something that we can all do because we've all experienced grief. We've all experienced loss. Every single one of us have experienced depression and I don't think it takes much to be a good listener and to help out.

00:53:16:27 - 00:53:35:10
Mary Ray
Dr. Boster for friends and family of loved ones with MS, who are struggling with a mental health condition of some kind, what guidance would you give them to be supportive? To be able to carry that bag for the person with the broken arm, so to speak.

00:53:35:13 - 00:54:10:28
Dr. Boster
So. So, there's a very scary statistic that two thirds of care partners of people with MS are terrified that their loved one is progressing and they never say anything. Now think about that for a second. So here we have a situation where the wife of someone with MS is terrified that in this case, her husband is progressing and she's scared to say anything. And that's a really scary, bothersome statistic. I can only fathom how she must feel at home, next to her husband, scared like that.

00:54:11:00 - 00:54:32:03
Dr. Boster
And I guess what I want her to do, is I want her to say, "Honey, I'm scared." I want her just to lay it out there and say, "I'm worried about you." I spend a lot of time in clinic asking the spouse to weigh in, because let's be honest, Mary, they have MS too. My hashtag, #WeHaveMS, that's not a misunderstanding.

00:54:32:03 - 00:54:50:13
Dr. Boster
I did it on purpose because you don't get to have the disease by yourself. And if you think that your spouse doesn't experience this with you, I hate to tell you you're wrong. And so the first and important comment that I want to make is, I challenge you to be open with your loved one.

00:54:50:18 - 00:55:17:05
Dr. Boster
Share with them how you feel, what will ensue is two things, some tears and some understanding, because you'll have the most meaningful adult conversation with your spouse that you've had in the last eight years. Where they will share with you their fears, what they're scared of. Because in that same poll where they said that care partners were scared, they also asked the people with MS, and guess what?

00:55:17:05 - 00:55:39:02
Dr. Boster
No surprise, over half of them hid things from their spouse because they didn't want to scare their spouse. Here are two loved ones hoping to support each other and not talking, doesn't work very well, Mary. I think instead we have to flip it on its head and say, "You know what? I'm scared to death and I need your support."

00:55:39:04 - 00:55:59:27
Dr. Boster
That's what I want to have happen. When you stood up in front of everyone you knew and said, for better or worse, I remind families of that. I really do. And sometimes I'll say this. I'll say, if the roles were reversed and you were the one, you weren't sick, your husband was sick and you were taking care of him.

00:55:59:27 - 00:56:26:06
Dr. Boster
And he pushed back. You would tell him to shut up. You would say, "I'm doing this." So you have to allow them to do that for you. It works both ways, and oftentimes the person living their best life with MS, the person with multiple sclerosis offers their spouse a beautiful gift by sharing how they feel and allowing their spouse to care for them.

00:56:26:08 - 00:56:54:14
Dr. Boster
I mean, let's face it, if I get to bring my wife a blanket, I feel good as a husband because she was cold and now she's not. And so she gives me a gift by letting me give her a blanket. That happened last night. The same thing happens as it relates to this topic of depression and anxiety. And so it takes a place, a special place of vulnerability to allow a loved one to share how they feel and to receive that.

00:56:54:14 - 00:57:17:24
Dr. Boster
But that's what love is about. And if you're scared, I bet you a dollar, so is your spouse. And I bet you $2 and you can mail them to me later, that if you engage in that conversation, it will open up a very, very special moment in your life. I challenge you, just like I challenge you to avoid sugar. Try it out and see what happens. I think you'll be really excited by the result.

00:57:19:24 - 00:57:37:16
Mary Ray
Well, thank you so much for joining us today, Dr. Boster. Your insights, your heart, your passion. It's all very clear and laid out for everyone here. And we really appreciate all of the best ways to deal with mental health challenges you've laid out for us today. And your genuine interest in helping the community.

00:57:37:18 - 00:57:59:28
Mary Ray
As you said, we have MS. I'm Mary Ray, co-founder of MyMSTeam. We hope to see you at our next event on July 15th, when Dr. Boster will be returning for another lively Q&A event. The link to register for the event is in the chat. In addition, we'd love for you to join us at the MyMSTeam Online Social, which will begin immediately following this event.

00:58:00:02 - 00:58:14:24
Mary Ray
Go to the link right now in the chat window and you'll be routed directly to the Online Social, where Dr. Boster will have passed over his photo of his dog, his 180 pound American Mastiff. Will you do that Dr. Boster?

00:58:14:27 - 00:58:20:25
Dr. Boster
I'm gonna try to figure it out, I am. Her name is River, and if I can figure out how to get a picture, you're gonna see it.

00:58:20:28 - 00:58:44:25
Mary Ray
Or just text it to one of us, and then we'll do a share of that. And when you do get to the Online Social, you'll be able to connect with others and chat with others living with MS, or caring for someone with MS. Thank you all for being with us today, for all of your questions. The information support doesn't end here.If you are already a member of MyMSTeam, please share the helpful advice you got today with other members in the activity feed.

00:58:44:27 - 00:59:01:26
Mary Ray
If you'd like to become a member, go to MyMSTeam.com and sign up for free. Remember, you're not alone. Thank you everyone!