Cheryl Hile is Running Around the World with Multiple Sclerosis

Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Katy Peters:
And I am Dr. Katy Peters. And this is the Brain and Life Podcast.

Dr. Daniel Correa:
Many of you may have been rushing throughout your day and maybe out of breath for a moment. Welcome back to the Brain and Life Podcast. Take a moment, sit down, relax. What about you, Katy? Are you doing activities and movements throughout your day, both for your physical activity and exercise? Or is it just the rush of back and forth to work your different events?

Dr. Katy Peters:
No, I think you have to keep on moving. Definitely. I do rush around a lot for work. But I've been trying to integrate a Pilates every day into my, I guess, my movement into learn to flow more. So, I've adopted daily Pilates. It's actually called Wall Pilates. How about you?

Dr. Daniel Correa:
That's quite an add-on daily. That's a big job. Some people, just the transition of trying to do something a few times a week or once a week can be a big transition, which I totally understand. I've been working over the last few years incorporating, doing more running as my movement activity. I also, in the past, really enjoy doing martial arts. But lately I've been enjoying being outside, getting a chance to do exercise outside, explore the city, explore the parks in New York City. And most recently, I also helped fundraise for the Epilepsy Foundation by running the New York City Half Marathon. And I got a chance to hear about someone who has been running all around the world. How many continents have you been to, Katy?

Dr. Katy Peters:
Ta-da. I'm in North America, so I've been here, I've been to Europe, I've been to Asia. I would love to travel to South America and to Africa. I'm not a big fan of the cold, so I think Antarctica would be... It's not on my bucket list. But how about you?

Dr. Daniel Correa:
Not that many. I mean, I have been to South America, but pretty much the list is otherwise pretty similar. Now, on the other hand, our guest today, Cheryl Hile, has not only ran in over 70 marathons, she did a series where she ran a marathon in every continent all the time. Also fundraising for multiple sclerosis because she herself lives with it and not just, oh, it has no challenges from it. It's a completely controlled condition. It's a regular challenge for her. She runs with an orthotic. She has mobility challenges, but it doesn't hold her back. She keeps moving forward. And we're going to be hearing from her about her own experience, some of the choices that she's had to make in her life and with her partner related to her multiple sclerosis, and why she feels so passionate to do the movement and to fundraise for others.
Saludos and welcome back to the Brain and Life podcast. I'm here now with a new guest and I'm really looking forward to talking with her. Despite her diagnosis and even some mobility issues, Cheryl Hile has completed just a pause for a moment over 70 marathons while also fundraising for research. And 62 of those were after early symptoms and diagnosis of multiple sclerosis. In fact, she's run a marathon on all seven continents. Yes, that includes Antarctica. I'm going to let her tell you more of her own story. Cheryl, thank you so much for joining us today.

Cheryl Hile:
Hi, Dr. Correa. Thank you so much for having me here today.

Dr. Daniel Correa:
So, that's just some details about your running and a momentary glimpse about the diagnosis that you've lived with. But really, who is Cheryl Hile?

Cheryl Hile:
Oh my goodness. Currently, right now I live in Washington state with my husband. And actually, I guess we can maybe blame my husband for my running habits because he was a marathon runner before I even became a runner myself. And the reason I actually started running, so this was way before MS. I started running in 2000 because my husband was a marathon runner and he would come home sore after a race. And for some weird reason, I also wanted to know that type of feeling. And so, I decided to run my first race. And my first race happened to be a marathon. And because his first race was a marathon, so of course I had to match his goals. And so, right from the beginning, the training, the actual marathon itself, and the euphoria afterwards, I was completely hooked. And so, my first marathon was in the year 2000.

Dr. Daniel Correa:
So, it sounds like it's not a competitive household at all.

Cheryl Hile:
Oh, no, not at all. Not at all.

Dr. Daniel Correa:
I think most people would see a family member coming home sore, and achy, and laying around on the couch, and they might run away. But you ran towards. And separate from the running, the marathons, the sports, the many bikes surrounding you, who are you in your own personal life?

Cheryl Hile:
That's a good question because I don't even know who I am. I'm almost 50 years old and I'm asking myself that almost every day. Who am I? And who do I want to be?

Dr. Daniel Correa:
Yeah, you're staying curious.

Cheryl Hile:
Yeah, yeah. I mean, I have a lot of other interests besides running. I love doing volunteer work. I like helping other people. Before MS and into my disease, I was managing contracts and grants for a major research university. So, I've always loved numbers and I love spreadsheets. Even to this day, all of my goals and all of my planning, they're on spreadsheets. So, yeah, I'm a numbers geek. I like doing number puzzles and also crossword puzzles. So, always trying to not just keep my body active and healthy, but also my brain as well.

Dr. Daniel Correa:
What were the symptoms that maybe started to go on your spreadsheets or things that opened the question in the puzzle about what was going on for you?

Cheryl Hile:
Yeah. Well, I started experiencing really terrible electric shocks in my right arm from my shoulder to my bicep. And the shocks were also accompanied by intense itching. So, I would just scratch and scratch my arm, and I just couldn't satiate that itch. And I was also having these weird numbness and electric shocks at the same time in my right shoulder blade. And I went to my primary care physician and he said that I probably just pinched a nerve while weightlifting. Which I was kind of a suspect because I'm only lifting like 10 pound weights. So, I don't know how much damage I could possibly do. But that was the presenting symptoms that eventually led to the diagnosis of MS.

Dr. Daniel Correa:
And probably, I imagine it jumped over a few things there. You had those symptoms and then your doctor had some suggestions at what might be the cause, but it needed more tests.

Cheryl Hile:
Exactly.

Dr. Daniel Correa:
How quickly? How many other tests did you have to get done? How many other doctors did you end up having to see?

Cheryl Hile:
Yeah, now that's a really good question because I went through a lot of those tests where they stick you with the needles, and they're prodding you, and blood tests, blood work. I saw several different, not just my primary care physician, but also neurologists. And it was a 10 to 11 month long process until I finally was given the opportunity for an MRI. And when the MRI results came back, it said that I had innumerable lesions in my brain.
But even at that time, the neurologist that I was seeing, he didn't want to diagnose me with MS at that point because of being a marathon runner. And I was only 32 years old. So, the perception back then I think was, "Well, you probably don't have MS. It's probably just something else. And if you do," the neurologist was telling me, "Just go and live your life." And so, that was counter to what I wanted to do. I wanted a definite diagnosis and I wanted to do something about it. And I went back to my primary care physician and he referred me to an MS specialist. And that's when she said, "Oh, yes, you definitely do have multiple sclerosis."

Dr. Daniel Correa:
So, at that point, you hadn't really had a flare of other new symptoms. You were still working through the definition of what was going on, but it's not like you had had discrete flares that were becoming unexplained yet.

Cheryl Hile:
Right, right. Correct. But though, when you say that, just looking back to maybe a couple of years, two, three years prior to my diagnosis or prior to those electric shocks that I was experiencing, I was thinking in the back of my head, "Oh, maybe those times that I was trippy feeling, or when my right side was a little weaker, maybe that was MS. The bout of vertigo that I weirdly experienced for about a week I think, was that the disease already rearing its head." Because I was diagnosed with relapsing remitting on MS. So, maybe those were relapses.

Dr. Daniel Correa:
And so, for listeners, you may have recall, if you've had a chance to listen to some of our past episodes about multiple sclerosis, that there's different types. And one of them is relapsing remitting MS. And in that situation, you have these attacks or flares that can happen with different symptoms. It all depends on where it's affecting you in the brain. And sometimes looking back, like Cheryl has said, there can be times in the past that symptoms were there for a few days, a few weeks, and then got better. And that's kind of a scary situation. I think we all hear that. I'm thinking, "huh? I've had something, I was a little funny for a while." But this tends to be a very different thing, like a type of function, whether it's your balance, your walking, coordination, strength that all of a sudden you lose for a short period of days. And hopefully only days and maybe at most weeks. And then it comes back to normal. And there's not really an explanation why. That was basically your experience with some of those previous events?

Cheryl Hile:
Yes, exactly. They would just come on strongly. And then I've always thought, "Oh, well, maybe I'm tired from that marathon that I just ran or whatnot." But it wasn't until those initial electric shocks that were just so persistent and lasting for months and months. And even I was given medication to help blunt the pain, but I could still sense something wrong in the background. So, I knew that I still had to keep on pursuing and trying to advocate for myself to find out what really is going on with my body.

Dr. Daniel Correa:
And for our listeners, this episode continues our discussion about multiple sclerosis. If you want more information about some of what we've already discussed, please go back and check out those past episodes that we've had throughout the seasons. In the second part of our episode, we'll be having a discussion with an MS specialist. And we're really focusing on all the different ways that our specialist suggests and Cheryl has shown us, of living better, exceeding and running forward many, many miles with her condition. And, Cheryl, over the years, how do you feel like multiple sclerosis living with the condition, the treatment, its different symptoms has impacted your family?

Cheryl Hile:
My husband, Brian, being the marathon runner and him wanting to support my endeavors, he stopped racing his marathons because he was a really fast runner. And he made all of his time goals and everything. So, he wanted to be my supporter, and he started running slow in the back of the pack with me to help my endeavors, and to just keep me active. Because when I was diagnosed, being 32 years old, I was having panic attacks, I was depressed. My neurologist gave me antidepressant pills. But it was really my husband who encouraged me to keep on running and to keep staying active.
And together we found that just being out there and running together really made me feel better than the antidepressants because it's my therapy. It really lifted my spirits. And so, that's something that we do together now side by side. And it's brought a closeness to us, to our relationship. I mean, I don't want to say that I'm grateful for MS, but it has changed my life for better or for worse. And I guess in a relationship, in a marriage, you're together for better or for worse. And we try to make the most of everything that we do.

Dr. Daniel Correa:
Well, I mean, the fact that you guys embrace that time and the connection together, even if it's related to some choices related to your medical condition, that's beautiful. So, I wanted to know, you've told us some about why you started running and how you felt about how running was positive for yourself and also for your relationship. But really why running so many marathons?

Cheryl Hile:
Well, because I like the travel. I like the excuse to go somewhere and experience a different culture by running a marathon in that country. But I really feel that while running is my therapy, it helps with the depression. But also I feel like it just keeps my body stronger for the daily battles against MS because not only do I have right side weakness, but I also have foot drop. So, I feel like being physically active by doing a sport that I really love and that I enjoy, that I can stay relatively fit, and healthy, and strong so that I can go forward and push forward throughout my day. And I also have the classic MS fatigue and also cog fog. So, I feel like exercising helps with those neural pathways. It's a feel good exercise for me, and that's why I keep at it.

Dr. Daniel Correa:
And for our listeners who maybe don't live with cognitive fatigue or brain fog, Cheryl, you described it as cog fog. For you and for some of the community members living with MS, what does that really mean for you?

Cheryl Hile:
For me, the way I experience it, I'm very slow. It feels like my brain is lethargic in terms of things like I had mentioned that I used to work for a major research institution managing contracts and grants. That's a job that I had to let go because I was just making too many mistakes and it wasn't something that I was good at anymore. I still loved it. I still love my spreadsheets. I still love numbers. It's just something that I couldn't do anymore. And so, for me having the cog fog, it's so difficult. Because even things like word finding or thought processing, I feel really lethargic and really slow. And like when you take allergy medication and you feel drowsy, that's how my brain feels. By the time the afternoon comes about. It's like, don't ask me anything. It's too hard.

Dr. Daniel Correa:
That's an interesting relation to it being somewhat similar to those stronger allergy medicines. And you mentioned that you have a foot drop. So, some people who haven't had that experience may not realize that's something very difficult to get around with, let alone to run many miles. What kind of modifications and support have you needed to battle the symptoms of foot drop and the other fatigue and cognitive symptoms that you have from the MS to be able to do all these activities?

Cheryl Hile:
Yeah. So, in terms of a foot drop, I wear a medical brace. It's called an ankle foot orthosis. And my brace is made out of a carbon composite material. And it's a brace that fits inside my shoe and there's a strut that comes up the back and it attaches to just below my knee. So, it's like an L-bracket. And what it does is it holds my foot in place with just a slight, about a six degree angle, so that when I run, I roll on my foot, and I don't trip and fall. A lot of the effort with my running is on the left side of my body because my left side is still really strong, but my right side is weaker. So, I push off strongly with my left side, and then my right side just follows along. And with the right side weakness and the foot drop, I know that I won't fall because of that ankle foot orthosis.
And in terms of the fatigue, I do a lot of my exercising during the day. A lot of my activities are during the day. And first thing I do when I wake up, I take coffee before I even go outside, walk out the door. So, coffee is a big thing. And I know that there are medications that help other people with MS to help with fatigue. I try to stay away from those just because I'm just a person who's just overly sensitive sometimes and those medications can just keep me up all night. And so, then there goes the effects of the next day, I am just tired and even dragging more. There are a lot of medications that I have to go through throughout the day, not just with my physical weaknesses, but also with energy.

Dr. Daniel Correa:
And you mentioned not only that you like to travel, but you travel and do these marathons all around the world. I think lots of people enjoy travel, but find it challenging because of the change in schedule, getting rest, figuring out just how to follow and fit into the routine. What are some things that you do for yourself to plan out those things so that way you can manage with your own condition, let alone all the challenges that everyone else encounters?

Cheryl Hile:
I know that's so true. Well, so a lot of coffee in the morning. And yeah, you know what? I've always been the person who I just get so excited on race morning that I think that energy helps get me out of bed and helps me make it to the starting line. It's just something that I'm used to doing, just traveling and running a race. In terms of preparation, I always have my lists that I print out and I go through them methodically days leading up to the race, the night of, all of the things that I need to do to prepare myself mentally in terms of hydrating and eating well. So, I feel like I have the system down pat pretty well. But marathons are so different each. Especially with MS, you never know if something... Especially now that I'm just so later in the disease, I don't know if my right leg will be tired by mile six or if I can make it all the way to mile 26. Yeah, but I think just the excitement of it pushes me forward.

Dr. Daniel Correa:
What pushes you forward through those times? Either during a race, or that morning or day that you're supposed to do an activity, whether it's a run or something, and just you feel like you have nothing? What is your why that really moves you forward and through those times?

Cheryl Hile:
Well, I guess I am a person who likes the numbers, so having another marathon under my belt is a big motivator. So, one way that my running has changed is I've created a running team or an exercising team, let's say, of other people with multiple sclerosis. And just having my teammates around me knowing that we're doing something together to help motivate and support other people with MS to exercise and to move their bodies to the best of their abilities, that's something that really pushes me forward. And just knowing that my team gives other people hope, that really makes the event more meaningful to me.

Dr. Daniel Correa:
So, hundreds of miles ago or 62 marathons ago, you decided to start running and fundraising for the MS Society and multiple sclerosis. And as you mentioned, you've started your own endurance fundraising team for these kinds of events. What made you make that commitment to run beyond just for yourself for these activities?

Cheryl Hile:
Well, the MS Society, when I was diagnosed, they were such huge supporters in terms of teaching me about the disease. Because when I was diagnosed back in 2006, there really weren't any programs or educational programs, or teams of people running with MS. But through the MS Society, I learned that I can have a great life despite the disease as long as I work hard. And so, now it's my turn to give back to the MS community by spreading awareness of the disease and also helping others to never give up and to never lower their expectations. I've always known that I wanted to do something big for the MS Society. I wanted to help other people. I thought, well, I wanted to have a global impact. And from all of my marathons, I thought, well, maybe if there isn't already another person, maybe I can be the first person with MS to run a marathon on all seven continents.
And so, I did some research, I talked to the MS Society and we found out, no, I don't think there's anybody else who has done that. So, I started that endeavor and I started fundraising for the MS Society, and I had a couple of sponsors and they promoted my adventure. And through that, I met a lot of people around the world who also have MS and that are runners or people who want to become runners. And from that point, I thought, well, I wanted to bring everybody together. And that's when I created the team. My team name is called Run A Myelin My Shoes, also known by the acronym of RAMMS. That team started in 2018. And now seven years later, we have over 300 teammates around the world and we've had representation, cumulative representation from all 50 states and also 32 countries.
So, it's a big deal. And not everybody on the team are runners. We embrace all activities so that more people can join our team. We've had people cycling, hiking, walking, doing yoga. So, just the important part is to be active and to do some sort of activity that you enjoy. Everybody on the team is so nice and so supportive. And that's what I love about the team, everybody is so giving. And we just want to be the biggest cheerleader for our teammates and really promote the idea of exercising with MS.

Dr. Daniel Correa:
Wonderful. I mean considering and thinking of that worldwide inclusive community and just that opportunity for everyone to connect. And for our listeners, we will include information in the show notes about the MS Society's movement and fundraising activities and connections, and also Cheryl's team. So, she mentioned the acronym RAMMS, Run A Myelin My Shoes. So, those of you who may not be as aware about multiple sclerosis and the parts of the brain that are affected, it includes the word myelin. And myelin is the protein around the nerves in the brain that's affected by multiple sclerosis. So, she made a nice little play on the words there for us.
And Cheryl, everybody has a challenge when they're doing activities, starting a new exercise, or training for something as extensive as a marathon and many miles of training on a bike running, rolling. But things get a little out of balance, a little sore. And you were telling us that you already have that imbalance, that your right side doesn't have that strength and your left side does more of the work. What do you do to maintain your body, and the strength, and to deal with all the aches, and niggles, and things that come up?

Cheryl Hile:
My disease has progressed from relapsing remitting to secondary progressive, and I have more weaknesses. I have not just the foot drop, but I also have hip drop. And so, I do my physical therapy exercises to try to help with that balance that you were talking about. Try to do a lot of leg weights, and squats, and things just to try to balance things out. But it's still really difficult. I told you that my left side does most of the work. So, my husband, he runs on the right side of my body to help keep me running a straight line because I tend to veer to the right since my left side is doing all of that hard work. I try to cycle during the summer to try to do another activity. And I know I should do yoga. I wish I was cool. I wish I did yoga. But it's just, oh, man, it's hard. And that's something maybe that'll be the next sport that I try to conquer, the yoga.

Dr. Daniel Correa:
Well, I think we each have to find the things that work well for us, for our motivation, for our bodies. And I think that's the challenge. But inherently, part of the beauty of our bodies and our movement is none of us are perfectly symmetric.

Cheryl Hile:
Right. There you go.

Dr. Daniel Correa:
That I'm inspired by your ability to rise to the challenge. As you look forward, you're talking about now going past 75 marathons. What's next?

Cheryl Hile:
I do really enjoy half-marathons as well. So, I feel like I'm in that point where I'm going to start transitioning out of marathons and start running more half-marathons. Because the marathon, I'm so slow now with the marathons. And I don't feel like MS is dictating that I can't run marathons anymore. I think I've just reached that tipping point where I think I'm pretty close to done with my marathons. And now I want to enjoy the half-marathon distance. And too with the half-marathons, I can still run those relatively fast. So, I'm hoping that I can gracefully transition to the next distance.

Dr. Daniel Correa:
Well, there's nothing getting Cheryl Hile or the RAMMS team down. You can't stop the miles from coming. I'm inspired and thank you so much, Cheryl, for taking the time and sharing with us and the listeners. We look forward to hearing about more of your events.

Cheryl Hile:
Thank you, Dr. Correa.

Dr. Daniel Correa:
Want to learn more about the conditions discussed in this episode and other factors that could impact your brain health? For the latest on causes, symptoms, diagnosis, treatment, and management of more than 250 of some of the most common and rare neurologic conditions, please visit Brainandlife.org/disorders
And we're back now, here with our medical expert for the episode. That was a great discussion with Cheryl and I'm really glad to continue our discussion talking about activity, exercise in different kinds of neuroimmunologic conditions like multiple sclerosis. With my friend and our medical expert for this episode, Dr. Lauren Gluck. She's the director of the Montefiore Multiple Sclerosis Center in the Bronx where I also work and an assistant professor at the Albert Einstein College of Medicine. She particularly focuses in on neuroimmunological diseases or the inflammatory diseases that can affect the brain and spinal cord in both adults and adolescents. And that includes multiple sclerosis, like what Cheryl lives with now. Within multiple sclerosis, we've had our previous several other episodes. There is the relapsing remitting and then the progressive types, primary and secondary. And then also other conditions like neuromyelitis optica. We've had a past episode on that, and neurosarcoidosis and autoimmune encephalitis. She's a great resource to me in helping the patients I see and care for. I'm glad we can talk with her here. Lauren, thank you so much for joining us on the Brain and Life Podcast.

Dr. Lauren Gluck:
Thank you for having me.

Dr. Daniel Correa:
So, Cheryl told us about this journey of not just being in love with running, and movement, and endurance activities, but after only a few marathons and her early career of just exploring these activities, she started to have problems and was diagnosed with multiple sclerosis. And yet she still was able to persist and continue to do these activities of both running, endurance activities, and biking. Let's talk about that challenge of navigating getting back to activities of before, because it's a big adjustment after this kind of diagnosis and adjusting to whatever your current mobility challenges are. How do you navigate that beyond just picking a medicine and saying, "Go home and I'll see you in a year?"

Dr. Lauren Gluck:
This is one of the big challenges of first getting diagnosed with multiple sclerosis. It often happens when people are in their early adulthood and peak fitness, starting families, having children. And to hear that your life may look different than what you expected, is a big mental and physical blow. So, a big part of what I do is teach people about multiple sclerosis and provide them resources to learn more about the disease and share it with their families. But a lot of it is also helping them start the journey in accepting and understanding their diagnosis from a more emotional way. So, talking to people not just about medication, but also about lifestyle and fitness, and how this diagnosis is going to fit into their life plan is very important. Many moons ago, in an earlier era of multiple sclerosis, people were recommended not to exercise because it would put strain on their bodies, put stress on their multiple sclerosis. And now we recognize actually, the best thing you could do is continue to move.
So, there are a lot of online resources for encouraging people to stay active at whatever their mobility at fitness level is. So, the other piece of this is, if you are no longer able to do your normal activity without assistance, I like to frame these issues as requiring mobility aids. Not something that's limiting you, but something that's aiding you. Because if you want to run, and you have foot drop, and you need to run with an external orthotic, and that can get you where you need to go, then that is aiding you. That is not limiting you.

Dr. Daniel Correa:
I like how looking at that and thinking of these things as advancements in technology and facilitators, and your capabilities, and your access to things, and not somehow a limitation or a sign of disability or decline in a way. How do you approach resetting the level each time something new or another occurrence or a change occurs to help people feel like it's not all just a decline along the way?

Dr. Lauren Gluck:
There's different kinds of progression. There's what we historically think of as progressive multiple sclerosis when your disease stops having those episodes and relapses or exacerbations. And it's just that symptoms slowly get worse over time. And unfortunately, that often refers to gait. On the other hand, there's also the progression that happened, like you said, when you have episodes or exacerbations and those symptoms don't fully recover. And that's also why it's very important to connect with your doctor, be on medication to prevent relapses, because not all relapses [inaudible 00:35:27] were influenced completely. And then you're left with symptoms, [inaudible 00:35:32] disability. So, I talk to people about both of those things. If you're able to connect with a neurologist early on, we have very powerful yet manageable and monitorable medications that can help prevent future relapses. And the effectiveness of these medicines are incredible. And especially recognizing that any medicine for MS has only been available in the last 30 years. But in any case. We can really reduce relapses. And if you start treatment early or as early as you can in your disease, we can help delay or prevent progression.
Now then there are people who have more aggressive types of multiple sclerosis and despite everyone's best efforts, don't respond as expected. Or people who've had MS for a long time who started in on progressive symptoms. Or people who had a very delayed diagnosis and now have progressive symptoms. And so, talking to people about that requires not just knowledge of medication that ultimately does not fix progression, but also these lifestyle changes of which exercise, physical activity is incredibly important.
So, one of the problems I talk about in terms of mobility is if you have weakness, or numbness, or some gait impairment, the machine that is your body will be damaged. And like any machine, if one area is damaged, it puts pressure on another part of the machine in a way it was not designed to work. And so, working with a professional, particularly one who understands and is trained in neuro-rehab, can help you learn how to compensate, how to train the right muscles to make your machine as efficient as possible. There are also a lot of adaptive exercise programs or sports programs. So, for people who are used to playing sports and being involved in teams, there are ways to get involved through local rehab facilities, through organizations directed to our patients. That can be really rewarding. And you can also meet other people who are going through similar things as you.

Dr. Daniel Correa:
So, in a way, almost even engaging with some of these fundraising or mobility activity-related events through both the MS Society or Cheryl's own team, which is not all just based out of one place, it's international, that are participating in biking and running events, can create a community to not just be able to relate to, but even ask some of these questions about how to navigate it. Now, we were talking about the medications. We've talked about different aspects about the medical condition multiple sclerosis. I'd like to remind the listeners who are joining us more recent or are newer to the podcast, this follows a series of several other episodes we've had on multiple sclerosis. Interviewing guests with different types of manifestations of the condition at different life stages and even care partners of people with multiple sclerosis. So, I would encourage you, if you want more background on the condition, please go and check out those episodes.
Each of those episodes are also complemented by a discussion with another medical expert. So, you can follow us and follow along in the scope and series of discussions that we're having. We're now really at a stage where we're talking more on the context of different ways and different examples like Cheryl's, of living with and living better with multiple sclerosis and other neurologic conditions. So, Lauren, as you're thinking about really getting a sense of what matters to a person and their family that you're helping support with this condition, and picking treatments that are going to work and fit for them, what are some considerations when you have someone like Cheryl that is, you can't slow down her international travel. Her schedule I'm sure is tight. I know there's a frequency of some of the treatments and therapies that are out there. So, what are some considerations that you discuss in terms of picking the many different options of treatments that there are now?

Dr. Lauren Gluck:
The blessing and challenge of having so many options for MS disease modifying therapy is that you get to be very selective and make a decision based on an individual's medical history and personal history. But it is certainly a challenge. So, historically, neurologists would start medications that were older and considered safer. If something bad happened, they would escalate therapy to something more efficacious, potentially with more risk. Although you should be working with your neurologist and they should know about the medicine to guide you to minimize risk. So, what the shift has been in the medical community, especially with multiple sclerosis experts, is to start people on more high effectiveness medications. These tend to be more immunosuppressive where it actually damages a part of the immune system. Sometimes it keeps it suppressed, sometimes it suppresses it initially and then allows the immune cells to regenerate or reconstitute. And these seem to have better data on reducing relapses, reducing new MRI lesions, and decreasing the risk we're delaying the onset of aggression.
So, there are a lot of things to take into account. However is if someone's multiple sclerosis is, may make me give them fewer choices because I more strongly want them to be on a more effective therapy. But we're able to take into account what their schedule is. People who can't take time off of work or don't have alternative childcare plans may not be able to come into an infusion center once a month. We do have medicines that run all sorts of ranges in terms of how you get them into your body. So, there are a few medicines where you go to an infusion center twice a year.
If you don't live near an infusion center or near your doctor, there's very powerful medicine that you could take at home as an injection once a month. There's also pills that you can take. And a lot of insurances allow people to get three-month supplies of medicine. So, if you know someone's going to be traveling for a month or more at a time, that can be very useful. There's also injectables where you have to take them multiple times a week, often eaten and refrigerated, which are not always the best for someone who's traveling a lot.

Dr. Daniel Correa:
So, Lauren, Cheryl herself is an example and an inspiration of her own resilience. I'm wondering, is there some lesson that you've learned from the community that you take care of, that you've taken into your own life, and just living and embracing each day?

Dr. Lauren Gluck:
Absolutely. The people I work with who have multiple sclerosis and other related diseases are so inspiring. They are dealing with so many different symptoms, emotional stressors, life stressors, day to day. And I try to create an open and comfortable environment for them to talk to me about everything. I think they talk to me about a lot of things. And there's still issues that people face that maybe they don't feel necessary or comfortable talking to their doctors. So, I know that there's a lot going on under the surface. And I respect and I'm inspired by all the work they put to get to work, do exercise, take care of their families, even just come into the office. That can be a big activity for the day.
And so, I always appreciate it. And I always like to hear what's really bothering people. And one thing that I've tried to integrate into what I do in the office is also ask, "What's something good that has happened recently? What are you looking forward to recently? It's not all doom and gloom because no matter what disease you have, you still have your life to live. And I suspect, or I hope you're not always consumed by the downsides of a disease. Maybe frequently, maybe sometimes. But I want you to still live your life and find joy in things, even the small things." And I love to hear about it with my patients.

Dr. Daniel Correa:
Thank you so much, Lauren. Hopefully we all can get up, move a little bit today, and find joy and enjoyment in our activities together and connect with another person that we love.
Thank you again for joining us today on the Brain and Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life magazine for free at brainandlife.org. Don't forget about Brain and Life in Espanol.

Dr. Katy Peters:
Also, for each episode, you can find out how to connect with our team and our guests, along with great resources in our show notes. We love it when we hear your ideas, our questions. You can send these in an email to Blpodcast@brainandlife.org and leave us a message at 292-928-6206.

Dr. Daniel Correa:
You can also find that information in our show notes. And you can follow Katy and me, and Brain and Life Magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @Neuro Dr. Correa.

Dr. Katy Peters:
And Dr. Katy Peters, joining you from Durham North Carolina and online @Katy Peters MD PhD.

Dr. Daniel Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Katy Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Daniel Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find a Brain and Life podcast. See you next week.

Cheryl Hile is Running Around the World with Multiple Sclerosis

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