Terry Streetman (Host): Hello, listeners. Thanks for tuning into the Well Within Reach Podcast, brought to you by Riverside Healthcare. I'm your host, Terry Streetman. And joining me today is Dr. Israr Ul Haq, neurologist and clinical neurophysiologist with the Riverside Brain and Spine Institute. And we're here today to talk about multiple sclerosis. Thanks for joining us, Dr. Ul Haq.

Dr. Israr Ul Hoq: Yeah. Thanks for having me. It's a pleasure to be here for the podcast and be able to talk to our listeners about multiple sclerosis.

Host: All right. Well, we appreciate you sharing your expertise. And we'll jump right in. Actually, can you tell our listeners about your background and your role here at Riverside?

Dr. Israr Ul Hoq: So, I'm a neurologist with the subspecialty training in clinical neurophysiology, like you mentioned. As for the neurologist side, I specialize in everything to do with the central nervous system and the peripheral nervous system with the diseases ranging from epilepsy, multiple sclerosis, stroke, Parkinson's, migraines, and so on. I also have a background in functional neuroimaging research and cognitive neuroscience research. And all of that led me to develop special interest in the field of clinical neurology as well as neurophysiology and functional neurology.

Host: Awesome. We're grateful to have all of that experience here with us at Riverside. So, our subject today is multiple sclerosis or MS. In simple terms, how would you explain MS and how prevalent is it?

Dr. Israr Ul Hoq: So, multiple sclerosis is an autoimmune inflammatory disease of the central nervous system where the body's immune system crossfires and ends up attacking its own nervous system while misidentifying the brain tissue or the spinal cord tissue as foreign, and the extra inflammation is what ends up causing damage in the central nervous system. And this is generally in what we call the white matter or the large fibers that connect different parts of the central nervous system and ends up leading to slowness in processing of information across the nervous system and leads to whole range of symptoms including weakness, imbalance, vision changes, dizziness, and numbness and tingling. It's a whole slew of symptoms from that.

Host: Okay. And so, you mentioned some of those symptoms. Are there any other warning signs and symptoms or are those kind of the main ones people should look out for?

Dr. Israr Ul Hoq: So, definitely, those are the common ones. People can have sudden onset of weakness or paresthesias or numbness and tingling, feeling heavy on one side of the body or the other, losing their balance, dizzy spells. But there's also some more subtle signs. Preceding some of these symptoms, people can have extra fatigue leading up to these or headaches or brain fog. And then, followed by some of these more discreet or focal symptoms that could be suggestive of an autoinflammatory disease affecting the nervous system.

Host: So when we see these signs and symptoms, people are experiencing these effects, how is MS diagnosed then, and why is early diagnosis important?

Dr. Israr Ul Hoq: So, multiple sclerosis is oftentimes seen or first comes to presentation in otherwise young, healthy individuals with no other comorbidities. And this could be their first interaction with the disease process as well. So, it's important to recognize when they're having symptoms like that, like we talked about, like having these focal changes like weakness, numbness, tingling, sudden changes or balance, vision changes. They evaluate that properly and seriously and get in touch with their PCPs about necessary diagnostic testing, which will generally include imaging, brain imaging, spinal cord imaging, and then also biomarkers, blood testing.

And oftentimes, it may also necessitate lumbar puncture or spinal fluid testing to confirm or further evaluate these symptoms and also kind of rule out other CNS inflammatory conditions, which are not autoimmune per se, but infectious and other things, other progressive conditions that could present in similar ways.

So, the diagnostic testing in conjunction with medical team is absolutely necessary. Early diagnosis is very important, because the earlier you diagnose, the more chance of minimizing damage from the inflammation that is ensuing and lower the risk of accumulating disability with these symptoms and with these inflammation episodes that are happening.

Host: Okay. And that's why we like to have folks like you on the podcast to give people that information so they can recognize those symptoms and get that early diagnosis. So before we continue to our next question, we're going to take a minute to pause and discuss the importance of primary care.

At Riverside, our primary care providers are right here in your community, offering personalized care for you and your family, close to home and connected to the specialists and services you may need. Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up. Because remarkable care should never be out of reach. Remarkable care right where you live. To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew.

Okay, we'll jump back into it. How can folks like you, neurologists and neurophysiologists, help people who are living with MS?

Dr. Israr Ul Hoq: So, the role of a neurologist in MS is obviously from first diagnosing to then appropriately treating MS from what we have, using disease-modifying therapies. And what these are, are basically targeted therapies that try to tamper down the autoimmune process that are happening, the hyperactive immune cells that are attacking the central nervous system.

So, choosing the appropriate medication based on patient's history, other medical problems, and the nature of the disease, the stage that they're at. And also, medication because we have any different options from orals to injectables to infusions, picking something that's appropriate for their lifestyle as well as their needs. So, the neurologists work with the patient in quite close proximity and depth to kind of make those decision choices for what's best for the patient. And also, counseling them on potential risks that are associated with the medications, monitoring for any changes that could happen as a side effect of the medications that they're on. Monitoring MS for any potential relapses while they're on the treatment, and doing appropriate diagnostic testing to keep monitoring those things. Monitoring for relapses. And at the same time also, managing patients' symptoms from the MS with its associated therapies. For example, patients with MS can have a lot of increased spasticity. They can have problems with urinary control. And they can also have problems with headaches and memory issues, walking difficulties. So, involving other specialties that can also coordinate care with us and other supportive treatments, medications that can help with some of those symptoms.

So, working with the patients very closely to manage all those things that are a great part of the job for a neurologist, with the goal not only to prevent progression and disability, but also allow the patient's symptom relief while at whatever stage they're at and allowing them to be as functional as possible and continue to go on with their normal lives and enjoy things that they like to enjoy doing.

Host: Okay. Well, and we love that personalized care and that coordination of care, that collaboration between departments. And that's something I think we brag about a lot at Riverside, is having this unified system and having everything through myChart to make that easier. So, we appreciate the way that you all work together.

So for people who are living with MS, are there things that they can do to help manage their symptoms?

Dr. Israr Ul Hoq: Some of this we already kind of touched upon, like working with their medical team to be on their right treatment that helps with some of the symptoms we talked about. In general, from a holistic or general point of view, obviously, within neurology for brain health, we advocate neuroprotective diet, avoiding toxin exposure. So, just common things, like, for example, Mediterranean diet has a lot of benefit for neuroprotective abilities. So, making sure there's no deficiency in micronutrients and vitamins. Vitamin D, for example, is very heavily implicated with multiple sclerosis. So, deficiency of vitamin D has been associated with more progression. So, we make sure our patients are avail of balanced diet and have all their micronutrients and vitamins, and are following up with all the associated specialties as well to take care of their symptoms.

And in general, we obviously advocate for a healthy lifestyle, including a good amount of physical activity that can prevent patients from accumulating more disability and have more problems.

Host: Okay. Yeah. I'd say unsurprisingly, that's probably one of the things we hear most is just, you know, live a healthier lifestyle, eat a healthier diet, you know, get more physical activity, that kind of thing. So, that's good advice—kind of evergreen advice, I'd say. So when it comes to the treatments and detection and all of that, have there been any major advancements in the recent years?

Dr. Israr Ul Hoq: There's actually been quite a lot of advancements in MS treatment in the way that we are targeting the immune system. We've come a long way from where we were doing very broad spectrum treatments to prevent the autoimmunity from targeting our CNS, our central nervous system. Whereas now, we've, over time, learned about the specific paths within the immune system that are more activated and more damaging to the nervous system. So instead of having to stop the whole immune system broadly, we're able to pick out individual cells that might be more implicated and target them with medications so that we can affect the disease process, but still leave individuals' immunity intact to fight other viruses, infections, and so on, relatively intact.

So, those have been really good. And then, at the same time, we've also had a lot of advancement in the method of delivery of medications. So, we have a range of medication options from orals to self-administrable injectables at home to infusions. And within that also, there's a wide range of treatment, ways. So, for example, there's medications that are taken daily versus monthly versus every three-monthly versus every six-monthly. But also, there's some you can take once a year and they can have a lasting effect.

There's also a lot of advancement, understanding how different medications are suitable or not suitable as far as for women of childbearing age or planning to get pregnant. So, we've become more targeted, we've become more insightful. And we're also having more targeted therapies for the progressive forms of multiple sclerosis. And we're coming up with more research on that as well. So hopefully, in the near future, we'll have some more information on that too.

Host: Well, if someone has noticed signs or symptoms, if they have concerns about MS, what should they do?

Dr. Israr Ul Hoq: Some of the signs and symptoms we talked about earlier, we recommend taking them seriously and consulting with your PCP so that they can talk to you more about the details of your symptoms as well as any other associated symptoms you may have had or haven't realized or were worried about and kind of put them together for deciding whether you need to see a neurologist soon or even before they need to have more urgent testing, be seen in the hospital right away. So, having a listening provider that you can reach out to and explain your symptoms to is crucial, and who can guide you then right away on the next steps. So, those would be very important things.

Host: And as a reminder to folks, if you don't currently have a primary care provider, you can find a primary care provider who's accepting new patient's by visiting myrhc.net/acceptingnew. And as you heard, that's very important. So, make sure you check that out.

We are here at the end of the podcast. One thing I always like to ask is, what would you say is the biggest thing that listeners should take away from this episode?

Dr. Israr Ul Hoq: So, the biggest thing would be more awareness about multiple sclerosis as a disease that affects as an inflammatory disease of oftentimes young and middle-aged people who might otherwise be very healthy. And that can happen with certain symptoms—focal symptoms in the neurological system—that should be taken seriously as well as evaluated to timely rule out any autoimmune central nervous system disease, such as multiple sclerosis, by appropriate diagnostic testing in conjunction with your primary care provider and a neurologist right away. The sooner, the better because, while in the past, multiple sclerosis accounted for a good percentage of disability within a population of neurology patients. We've come a long way where we've had very good disease-modifying therapies where we've been able to, with early diagnosis and appropriate treatment, keep patients symptom-free and disability-free for a very long time. And the most important thing with that is early diagnosis and working with a provider to get you on the right treatment so that we can nip it in the bud.

Host: Okay. All right. Well, thank you so much for sharing your knowledge with us. And if people would like to learn more about neurology and the Riverside Brain and Spine Institute, you can visit myrhc.net/brainandspine. Thanks again for joining us today.

Dr. Israr Ul Hoq: Thank you for having me.

Host: And thank you to our audience for tuning into the Well Within Reach podcast with Dr. Israr Ul Haq and your host, Terry Streetman. Be sure to like and subscribe to well within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about the services at Riverside Healthcare, visit riversidehealthcare.org.