Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilton , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Den .

Speaker 2: 0:18

Hey everybody, it's Dr. David Hilden , your host of the Healthy Matters podcast and welcome to the show. Today we are gonna talk about multiple sclerosis. It's an illness that many of you maybe have heard of, maybe you even know somebody or have a loved one who is living with ms. But do you really know what it is today? I invited a colleague of mine at Hennepin Healthcare in downtown Minneapolis, Dr. Ali Alman. He is a neurologist and a physician who treats and diagnoses multiple sclerosis. Ali, welcome to the show. Thank

Speaker 3: 0:49

You so much. It's

Speaker 2: 0:49

Great to have you here. I want to , if you could just start right out for us, what is multiple sclerosis?

Speaker 3: 0:55

So multiple sclerosis is a immune-mediated inflammatory disease of the central nervous system. When you say immune-mediated inflammatory, it means like the body is attacking itself and affects part of the central nervous system called the white matter predominantly. So what is the white matter of the brain? So the brain is divided into gray matter and white matter. The gray matter has these cells that are remain called neurons and then they have these cables or a axons, they're covered by something called myelin . So, which is like the kind of like the outside covering of cables. And by attacking the , the lin can cause like different manifestations and different symptoms. So it can affect your brain, your spinal cord and the covering around part of your eyes called the optic nerve.

Speaker 2: 1:45

So the myelin this, I like that description. It's like the covering of a cable.

Speaker 3: 1:49

That's what it is. Let's ,

Speaker 2: 1:51

I really like that. Yeah . Um , and that's the white matter. And apparently it's quite important for your body's neurologic function, right? What , uh, what , what , what exactly does this covering, this myelin do?

Speaker 3: 2:02

So basically the way your brain communicates and your nervous system communicates, it sends signals through these cables. And if these cables are damaged, the signals are not sent properly and can lead to problems and dysfunction because of that.

Speaker 2: 2:16

Okay. So that's the basic thing is that your body's attacking the white matter of your central nervous system. The covering on the cables, the myelin, I really do like that <laugh> . Uh uh um, so do we know what causes it?

Speaker 3: 2:28

We are not a hundred percent sure exactly what causes it. There is different theories on what's causing it. One of the theories is it's something called a common virus in the population that affects like 80 90% of people call Epstein bar virus,

Speaker 2: 2:43

Epstein Bar ,

Speaker 3: 2:44

It's a common virus that's

Speaker 2: 2:46

Everywhere. Epstein bar virus is everywhere.

Speaker 3: 2:48

Yeah, exactly. So like 18 90% of people have it. Uh, but in some people it's far to be involved in triggering this immune attack. So there was a study done at the VA and they noticed that pretty much everyone who had MS had Epstein bar and the people who weren't initially diagnosed with Epstein bar and developed MS ended up having Epstein Bar . So there is association with that,

Speaker 2: 3:11

But not everybody. 'cause like you just said, 80% of us have Epstein bar virus and we, 80% of us do not have ms. Yeah.

Speaker 3: 3:18

So there's other theories. One of the theories is, for example, like vitamin D being low is involved in like , for example the Epstein bar immunity and some of our immune signaling pathways. So that's, that's one of the other theories. But like we don't know exactly a hundred percent the cause. Like even in terms of genetics, like even if you're identical twin, the chances of you getting MS if your twin has like , like 30% percent still. So,

Speaker 2: 3:42

And you shared your DNA . So

Speaker 3: 3:44

Exactly.

Speaker 2: 3:45

That's interesting. So what literally is happening to that myelin that that sheath over the nerves? What's happening to it in ms ? So

Speaker 3: 3:53

There is inflammation. So we have these different cells involved in our immune system. So there's the things called B cells , T cells , and microglial cells. So these cells are causing inflammation. Okay. So they trigger release of inflammatory molecules and this leads to damage to these cables or my in chief .

Speaker 2: 4:14

Let me shift to how someone might know if they have it. What are the symptoms? How do , how , how does somebody know? That's

Speaker 3: 4:21

A good question but also a tricky question. The reason being is the central nervous system can lead to many different like manifestations. So

Speaker 2: 4:31

Like if the main processing computer of your body isn't working right, lots of stuff can happen.

Speaker 3: 4:35

Exactly. So it's kind of a tricky question 'cause there's a lot of different things that can present and I think it's part , part of what you need is to talk with your physician to try to clarify what's going on. 'cause for example, the most common things that people present with is like they can have what you call sensory symptoms. So you can , people can have like numbness, tingling, feeling weird sensations in their body. But there's also different common causes of those symptoms more than multiple sources .

Speaker 2: 5:03

You can get numb fingers for a lot of reasons.

Speaker 3: 5:04

Yeah. So people can have like pinch nerves or neuropathies which are maybe more common than sclerosis. So that's one of the common manifestations. Other common presentation is it sometimes can cause inflammation of the, what are called optic nerves. So people can present with some called optic neuritis. So people can have pain with the eye movements as well as visual loss and problem with seeing colors. So that's one of the, for example, classic features of multiple sclerosis. If it sometimes affects , for example your spinal cord, people can have numbness, problems with weakness, problems with controlling their bowel bladder. Another common symptom is just mean fatigue. So it's kind of a tricky thing 'cause a lot of the symptoms can be from many different things and they have a lot of different causes. But if you have to think about things in the context and in the right age and if there's many different symptoms that don't really fit or localize well that's something to think

Speaker 2: 6:01

About when you get any of these symptoms. And you literally mentioned like everything that Yeah , a nerve controls in your body, which is your whole body <laugh> . Yeah. Um , if it's in your eyes that you get visual problems, if it's in your fingers or your toes, you get numbness there, you can get weakness, you get bowel problems. So you pretty much same like everything in your body that's controlled by a nerve. Do when the symptoms come on, do they just stay, do they get worse and worse and worse? And, and and how quickly does all that happen?

Speaker 3: 6:27

That's a good question too. It also depends. Yeah. So when we classify multiple sclerosis, there are two main classifications that we use when people are diagnosed. There's some called relapsing remitting sclerosis, which is the most common type of diagnosis. So 90% of people have that. And there's some called primary progressive multiple sclerosis, which 10% of the people have just 10. Yeah, 10% people present initially as, so when people have these relapses, we define it a relapse as having a new neurotic symptom that lasts more than 24 hours and outside the setting of like fever. So some, some people can have that attack last a week for example. And then they recover. Sometimes they recover completely

Speaker 2: 7:14

And in go just go away. Yeah.

Speaker 3: 7:16

Sometimes it goes away. That's why sometimes it's kind of hard to get that diagnosis. People say, oh I just had numbness here. It just went away after a week. I didn't pay attention to it . And then they have another attack like couple of years later and then, oh there's something going on. And then they seek medical attention at that time. So sometimes it goes away. Sometimes it does leave like permanent problems. So let's say you had attack, your left arm was weak and numb. Sometimes it just stays permanently. And in the primary progressive form there isn't per se a clear cut attack. It's more just chronic worsening of symptoms. Like chronically, your left leg continues to get weaker numbered . That's more

Speaker 2: 7:57

Primary progressive. Yeah. So relapses and remitting primary progressive, they both sound like it's over a long time though. These symptoms might be going on for years before someone even knows they have it.

Speaker 3: 8:07

Yes. The primary group progressive actually the diagnosis requires you to at least have a year of

Speaker 2: 8:12

Symptoms. A year of symptoms before you can even make the diagnosis.

Speaker 3: 8:15

Yeah. In terms of the relapsing emitting like it , I can say it's variable but also the term is kind of a misnomer because people can have neurologic inflammation and changes on MRIs that they're just not noticing 'cause not in a critical area.

Speaker 2: 8:29

So those are the tumor primary kind and and it sounds like you can have MS for a while before you know that you do. When do people come to see like a specialist like you? I assume that people are going to their doctor, they're telling 'em these symptoms. What does the typical patient look like that gets to you? Have they already been trying to figure out their symptoms for a long time?

Speaker 3: 8:50

Yeah, I think most of the referrals with right time they go to get the MS specialist is usually they have an MRI that's done.

Speaker 2: 8:57

Somebody got an MR mri .

Speaker 3: 8:57

Yeah . Yeah. And the MRI looks like what MS looks like.

Speaker 2: 9:01

So you can see it on an MR mri . Uh ,

Speaker 3: 9:03

Well it's, it's kind of tricky too, but like it looks a certain way on M mri . It's like the lesions look kind of like a circularly and they're on certain areas.

Speaker 2: 9:11

Yeah. It's interesting, you know, the brain and the central nervous system is so, so amazingly complex and we know so much about it and some things we don't know so much about. But I'm always amazed that you can pinpoint exactly where the problem in someone's brain is and then maybe one day we'll figure out what actually causes this so we can get down to the root cause of it. I'm gonna talk about that a little bit later. Let's talk about how common MS is.

Speaker 3: 9:37

It's around 1 million Americans have MS and it's a lot. Yeah, it is a lot. It's actually the most common disease causing inflammation in the brain is multiple sclerosis. There are other rare conditions, but in terms of inflammatory diseases of the brain, it's the most common and it's the most common cause of neurotic disability in young adults. In terms of things like mobility separate from traumatic brain injury.

Speaker 2: 10:01

So you said young adults, is that who it hits the most? What are what? What's your typical patient or who in whom is it most common?

Speaker 3: 10:07

So in average age range of around people getting diagnosed is around 30. 30. Yeah. But it can happen when people are young and can also occur when people are older. It's slightly more common woman than men. Like many autoimmune conditions like women have it two to three times more likely than men.

Speaker 2: 10:25

I've heard that a little bit over the course of doing these podcasts for the last four seasons. We talk a lot about autoimmune illnesses. A lot of human conditions are caused by your immune system attacking itself. But it seems to be more women than men in some of them and younger women. Yeah , 30-year-old women. We did a show about lupus too. So listeners listen, listen to the show about lupus. That is a more common in young women as well. Do we know why that is? Why would it be women more than men?

Speaker 3: 10:49

I think I've read that there's some, the women have an extra ex chromosomes and the ex chromosome is involved in like the workings of the immune system. So just having that ex chromosome predisposes a lot of women to have . That's interesting . More immune conditions.

Speaker 2: 11:04

I bet there's loads of people doing research on the genetic origins of things like ms uh, what about geographically? Does that make any difference or is it just as common or worldwide or in this country? Is it, does that not matter?

Speaker 3: 11:17

So geographically the thought is it's related getting to UV light exposure and like vitamin D, it's fought that the more north for staff from the greater , more likely to get multiple sclerosis

Speaker 2: 11:28

Because of UV light. Yeah . So in Minnesota I know several people who have MS in my personal life and obviously in my clinical practice. So we're sort of in that, well we're in the northern half. Yeah . Yeah . Of things . So in Minnesota might be a place where we see more. But that's interesting then if you live in equatorial places, it's maybe not quite as common 'cause UV light is protective. Is that what you're trying to say? Yeah. Wow.

Speaker 3: 11:49

Well it's kind of tricky too. 'cause now we're studying like the epidemiology of <inaudible> . They found out it's like more common in black populations, Asian populations than we previously thought . So it's something that's also being studied. What

Speaker 2: 12:02

About your family history? Is it genetic? I mean do you, do you get it if you're folks at it? So

Speaker 3: 12:06

There is, like I said, there is that risk. So like, like if you're twins you have a 30% risk, but it's not a hundred percent guarantee. So if you have family members that have it, that increases your risk of having sclerosis. But it's a mix of environment triggers and family history. So it's not, there's no guarantee that there's no like one gene, Hey you have this gene, you're gonna have multiple sclerosis.

Speaker 2: 12:28

When we come back from the break, I'm gonna talk a lot more about the impacts on people's lives and treatments and how people are living with ms. 'cause lots of people are living with ms. But before I do that, I want to talk just briefly about diagnosis. You've, you've, you've touched on it , MRIs and, and I think it involves going to a smart neurologist like you, but how do you diagnose it definitively?

Speaker 3: 12:49

So the diagnosis is not, what we use is something called the McDonald's criteria. McDonald? Yeah. You need to have clinical symptoms that fit with multiple sclerosis. Okay. And then you need to have supportive evidence of MRIs showing that where the lesions are and they need to be what are called disseminated in time and space. So we look at where the lesions are on MRI, we look if they're picking up dire or not. And the other thing we sometimes use to help make the diagnosis is a spinal tap. So when we do a spinal tap, which is taking fluid from your back, that tells, and this fluid is what circulates around your brain. We sometimes see signs of inflammation in 90% of mul sclerosis patients. So that's something we use as a supportive of

Speaker 2: 13:37

Diagnosis. You don't do that spinal tap in everybody?

Speaker 3: 13:39

No, no. It's sometimes you can meet the diagnostic criteria without a spinal tap, but in certain cases we're not sure or you need to help confirm the diagnosis. You do the spinal tap .

Speaker 2: 13:49

Terrific. We've been talking with Dr. Ali Alman who is a neurologist in Hennepin Healthcare and we're talking about multiple sclerosis. After a short break we're gonna discuss treatment options and I do wanna ask Dr. Almon, how do people live with MS and the effect it has on people's lives. Stick around. We'll be right back

Speaker 4: 14:08

When Hennepin Healthcare says we are here for life. They mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find. But did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 14:46

And we're back talking about multiple sclerosis, otherwise known as MS. With Dr. Ali Almo from Hennepin Healthcare. He is a neurologist and an expert in this condition. So in the first half , Ali, you talked about lots of symptoms and it struck me as I've had a lot of those and I bet people listening will say, well I had a numb foot one day or I don't know, my vision was a little bit conti one day it went away. That's kind of scary. Um, because they can be due to lots of other things too.

Speaker 3: 15:13

I definitely agree and that's part of what makes it kind of tricky. So I think that the most, one of the important things is just work with your physician. If you ever have any new neurologic symptoms or physician symptoms or concerns to get evaluated. 'cause that can help identify what the problem is and to evaluate and rule out other conditions and get you on the right track in terms of a diagnosis.

Speaker 2: 15:35

Sounds good. Now I wanna talk about people living with MS treatments and, and what life is like. So I'm just gonna ask you a straight up question. Can people live a normal life if you have multiple sclerosis?

Speaker 3: 15:46

Yes, you definitely can. And that's something that's kind of freaky about us . Like I , like I mentioned there's a million people with it. So it's more common than people think. There are so many people that you'll see walking in the street and look relatively normal and they have multiple sclerosis. One of the segues in terms of this is I think the disease in terms of management has significantly changed in the past like 20 years. Like 20 years ago we only had like three drugs.

Speaker 2: 16:17

When I started practicing, there were about three things. I didn't prescribe any of them. Yeah . Because I wasn't a specialist but there wasn't a time . Yeah .

Speaker 3: 16:23

Yeah. And now there's more than 20.

Speaker 2: 16:24

More than 20. See the last 20 years have been really an amazing couple decades of I'm sure the previous 20 were as well. But I'm just, I'm , I've been practicing over 20 years and we didn't have hardly anything. So these medications, let's get into that a little bit. What kind of treatments are available?

Speaker 3: 16:40

So terms of treatments, the way we manage the disease is what we call disease modifying therapy. So there are medications that we use that work on your immune system and that helps with reducing the inflammation related to the disease. But as the way they work, they also make your body more prone to having things like infections. One of the worries we have is like , like increased risk of cancer. 'cause your body's,

Speaker 2: 17:10

It's messing with your immune

Speaker 3: 17:11

System. Yeah. Your immune system is important to survey your body. For things like cancer,

Speaker 2: 17:16

It'd be great if there were a medication that tamped down your immune system only related to where it's messing up like on the MS thing and the demyelinating of your nerves, but it doesn't affect the rest of your immune system. But I bet that's a little bit harder in medications. Yeah, just target it to the right part of your immune system. Yeah,

Speaker 3: 17:34

That that is tricky. Yeah, like there'd be nice to have a holy grail like that. But unfortunately we have, for example, the way we're approaching the meds right now is like some people, I think most MS providers right now are , are going to call like high efficacy route. So they're using more aggressive medications early on to hit the disease early on to prevent further disability in the future. But we have some of the older medications, one of them is called re acetate or Copaxone. That one doesn't tapper with the immune system as much. So it has less of those side effects, but it's slightly less of a effective medication because of that.

Speaker 2: 18:11

When you start people, you said you treat high efficacy drugs early, early in the disease. So that, that implies to me that it does matter then that you get at it as soon as possible. That

Speaker 3: 18:20

Is for sure. Yeah. So that's something we're currently also studying right now. There is some trials to see what's the right way to treat this.

Speaker 2: 18:27

So not sit around and wait 10 years until it gets bad.

Speaker 3: 18:30

Exactly. So previously what we people used to do is like put you on like the safer medications and if you start having attacks more and more activity, they switch you to more effective medications. But nowadays a lot of 'em , MS physicians tend to start people on higher efficacy, stronger, more effective medications as some of these patients have less disability, less r activity in the future. And, and we hope in the end that helps overall with the prognosis for the patients and preventing disability for them in the future.

Speaker 2: 19:02

Are there things people can do that are not the medications that you prescribe to slow down progression? Is there anything we know that in your lifestyle, here's what you ought to be doing?

Speaker 3: 19:12

Yeah, so I, the things that are important is just one of the things you can do that's very important for health in general is, for example , smoking. Smoking can worsen inflammation. Smoking can make MS progression worse. And quitting smoking is one of the best thing you can do for your health and multiple sclerosis. But also just having a healthy lifestyle in general. Healthy diet, healthy weight, controlling your risk factors for, for example, having stroke. 'cause a lot of what happens when people get older is they can have also damage the same thing that would call the white matter from having high blood pressure, diabetes, high cholesterol, those coast kind of silent strokes. And that also contributes and confounds , uh, multiple sclerosis when people are getting older.

Speaker 2: 19:53

Those are good tips and um , regular listeners to this podcast, we'll know that , uh, if you haven't learned yet that uh, you're not supposed to smoke, I encourage you to listen more carefully. You should not be smoking <laugh>. Um, I have a question about those nerves themselves. And since I got a neurologist here and I've got you captive right here in the studio, do nerves heal and in like in the MS specifically or just in generally they're demyelinated the sheath, the , the cable is damaged. The nerves are damaged here. Do they ever heal again or are you just trying to prevent future nerves from being damaged?

Speaker 3: 20:28

There is possibility of if it's just a cable that's damaged mm-hmm <affirmative> . That can heal up potentially they

Speaker 2: 20:35

Don't heal quickly. Do

Speaker 3: 20:36

They? They don't heal quickly. It doesn't heal quickly. But sometimes the inflammation is a lot and you can have like permanent damage to the cable set or we call axon loss.

Speaker 2: 20:46

So axon loss.

Speaker 3: 20:47

Okay. Yeah . So sometimes you can heal a bit, but it doesn't heal perfectly sometimes either . Sometimes the damage is permanent.

Speaker 2: 20:55

I've often wondered that about the human body and I'm not expecting you to actually have an answer to this, but you know, you cut your skin in two days later it's healed and, and many things in our body, it just, your liver can practically regrow itself, but your nerves don't. They just don't . They're so dang slow , um, in healing. And I know everybody with spinal cord injuries and brain things and Im , um, immune damage , uh, um, from things like ms. Uh , know that full well that your nerves just take forever to heal when they're able to. Let's talk a little bit about the lives people live. What, what types of support systems are important for people living with ms, particularly if it has led to some disability, either physical disability or, or mobility, things like that. So

Speaker 3: 21:40

I think it's always good to have family around you, especially if you're having, it's not just for example, like the physical toll and things . Sometimes when you have disabilities from things that can have an emotional toll as well. So having family to support you both in the physical and mental toll of things is, is very important. We also have, for example, rely on, for example, different specialists like physical therapy Okay. Occupational therapy to help people help manage their symptoms, help them adapt better, walk better, use their hands better if that's affected .

Speaker 2: 22:15

Are there resources for like support groups and others ? The MS Society is there not? Yes .

Speaker 3: 22:20

So

Speaker 2: 22:20

What I recommend , are they , uh, still out there?

Speaker 3: 22:21

Yeah. Yeah. What I recommend , uh, people to look into is the National MS Society website. Uh , that's the ME American Multiple Cirrhosis website. It's a very helpful website.

Speaker 2: 22:30

One thing we try to do on this podcast is get people to reliable accessible information. I hope, you know, I know they're getting it from this podcast, but on the internet so much of what's out there is just garbage. But the MS society is not it's reliable. Correct?

Speaker 3: 22:44

Yes . So I recommend patients look to the National MS Society website. It's very helpful. Has a lot of information, has information words in a nice way. It has FDA like labels for medication and even has like social workers available on the website that can access. They're called like MS navigators. And when people have initial MS diagnosis, it also has very useful information and also links to support groups and what whatnot .

Speaker 2: 23:07

And we can get a link to the National MS Society on the show notes for this podcast. So listeners, you can look , uh, where you access the podcast, we'll put a link right to the MS Society page there. Let's talk about the future. So there's lots of new medications , uh, that we have now and it makes it a completely different landscape than it was 20 years ago. Okay, go 20 years into the future. Now what is, what is some of the latest research looking like for ms? So one

Speaker 3: 23:33

Of the things, remember we talked about the McDonald criteria? Yeah. Uh, so the last time it was updated is , was 2017. We're actually gonna update it this year. The new updates will hopefully make it easier to make an earlier diagnosis. And there's one thing I didn't talk about. You asked like how long do you have someone have multiples without knowing it? Sometimes we get MRIs on people who have like headaches, head trauma and it looks like multiple sclerosis, but the person didn't have any clinical symptoms. Yeah. That's something called radiologically isolated syndrome and we're not , we're not sure what to do

Speaker 2: 24:06

Fully , what to make with that . You , you got an MRI for another reason you saw this thing.

Speaker 3: 24:10

Yeah. So hopefully the new guidelines will shed light on. Like how can we diagnose people with mastros and how to put these people on medications

Speaker 2: 24:18

Even before you maybe are having some symptoms. Yes.

Speaker 3: 24:22

Yeah. So it , it , the goal is to have earlier diagnosis. The other thing that's , uh, big into clinical trials right now, which is the way pharma companies test new drugs is there's a new class of drugs being tested called Bruton terin kinase inhibitors. It's used in easy

Speaker 2: 24:38

For you to say sorry.

Speaker 3: 24:40

Yeah . Yeah. It's used to

Speaker 2: 24:41

Could you say that again? What are they called? Uh,

Speaker 3: 24:43

Uh , bru . Terin kinase inhibitors. Okay . BTK inhibitors. They're used in like other, other fields like , uh, like for cancer. And these drugs are currently being studied from multiple sclerosis and we're expecting results of the newer clinical trial soon and we'll see if these drugs can get into the market.

Speaker 2: 25:01

Yeah. Um , I just, hats off to the research community. We have a big research community at , at Hennepin, but uh, for all those researchers around the globe who are working on ms , um, there's some optimism that there's some new things coming down the road and, and there's not a cure though, is there?

Speaker 3: 25:16

Unfortunately, there's no cure yet. That would be amazing. But unfortunately we don't have a cure these medications. What they do is they reduced inflammation, they reduce MRI activity, but it doesn't remove the inflammation process complete . There's no complete cure for the disease just

Speaker 2: 25:36

To stop it and be done with it. Yeah.

Speaker 3: 25:38

The medications don't reverse whatever damage that's been done prior to the medications. We don't have specific medications to do that yet. That's something that's also being looked into, but we don't have specific medications to repair those cables or myelin .

Speaker 2: 25:52

Yeah, maybe someday down the road. You know , people don't often uh , understand that. But it's something that, that took me maybe a decade or two to , to learn is that much of medicine doesn't have a cure. Much of what I do. Very little of what I do in internal medicine has a straight up cure, I guess strep throat, we can cure that with penicillin, but heart failure and high blood pressure and diabetes and all the other specialists I have in the show and in this case, multiple sclerosis. That does not mean there aren't treatments though, to make it so that you can live your life, lead a normal life and do all the things you want to do even in the absence of a cure. So sometimes people get kind of depressed when they hear, oh , there's no cure. You , maybe not, but there are effective treatments to allow you to live a fulfilling, satisfying, long life with many of these things, including ms. Thank you for being on the show today, Dr. Al Moen .

Speaker 3: 26:39

Thank you.

Speaker 2: 26:40

It's great to have you. Ali . We've been talking with Dr. Ali Al Moen . He is a neurologist at Hennepin Healthcare. We've been talking about multiple sclerosis and just know that there is help available, there are treatment options. It's getting better every day than there is hope for the future. Be sure to check us out in two weeks time for our next show. And in the meantime, be healthy and be well.

Speaker 1: 26:58

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At highball Executive producers are Jonathan , CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern . Until next time , be healthy and be well .