Protecting against progression

Written by Laura Kolaczkowski, MS Blogger investigating recent ideas in the neurology community when it comes to treating MS

Multiple Sclerosis is a disease that raises a lot of questions. MS Blogger Laura Kolaczkowski has built a following online for asking those questions, and bringing people in the community together. We asked her to talk with Dr. Anthony Traboulsee about his experience as a physician treating MS, in the hopes that their conversation would inspire others to talk to their doctors and be active participants in their own care. Laura, who was diagnosed with relapsing remitting MS in 2008, is a writer and researcher in MS who lives in Beavercreek, Ohio.

There are a number of different types of MS, and there are even more varying approaches to treatment. However, some things are common across all types, particularly the idea that people living with MS, myself included, need to maintain a healthy lifestyle and our MS should be treated as aggressively as possible. That’s all according to Dr. Anthony Traboulsee, neurologist and Associate Professor, University of British Columbia, and Research Chair of the MS Society of Canada. I talked to Dr. Traboulsee about the approach he takes with his newly diagnosed patients and the current trends in treating and slowing the progression of MS.

According to Dr. Traboulsee, “our starting point in controlling MS is not ‘what drug should you be on,’ but ‘what can you do to improve your lifestyle.’ Throughout our entire lives, whether we have MS or not, we should try to maintain a healthy lifestyle that will put our nervous system at the best capacity to repair and endure any future injuries,” said Dr. Traboulsee.

His first way to help those of us with MS ensure better long-term outcomes is to counsel us about the choices we make for a healthy lifestyle. “You don’t have to become triathletes overnight, but just maintaining a good diet and exercise can improve brain repair or re-myelination. In the old days, we used to tell people with MS ‘don’t exercise, just go stay in bed all the time.’ That was terrible advice. Now, we try to encourage people to have a nice life balance,” said Dr. Traboulsee. He also emphasized that “diabetes, bad diet, no exercise and smoking speed up the aging process, and that is very hard on MS.”

“I understand it’s easy to say these things, but if you’re someone who smokes, someone who doesn’t exercise, and has a bad diet, it’s not easy to change that overnight,” he added. He advises people with MS not to try to make dramatic lifestyle changes at once. “We have to be sympathetic. You can’t make people with MS or any condition feel guilty about their disease and its relationship to their lifestyle. The whole idea is to talk about these things to encourage people to take control.”

Dr. Traboulsee also believes it is important not to overwhelm those of us who have MS with the unknown future of chronic disease, preferring to focus instead on short-term goals. Because MS is often diagnosed when people are in their 20s, those goals often include finishing school, getting a new job, starting a family and, of course, controlling the disease. He tells people with MS, “You should work to find the most effective approach that fits in with your lifestyle during that timeframe.” Looking at the immediate future gives us the flexibility to adjust our lifestyle and MS treatments as needed.

Dr. Traboulsee also advocates for protecting our future health through treatment with an MS disease modifying therapy as soon as possible after the initial diagnosis. “I like to be aggressive as early as possible because the young brain heals best and younger people have a greater repair capacity and more plasticity. Protecting young brains puts people with MS in a really strong position when they are in their 50s and 60s. They will have more brain tissue to help them cope with MS, as well as with natural aging.”

I asked Dr. Traboulsee how he counsels patients about the importance of taking a disease modifying therapy to protect the future health of their brain, especially people who are early in their journey with MS. He acknowledged that the response to treatment and the lifestyle choices we make are not always the same, making it hard to generalize. “Hopefully, people realize none of us has a crystal ball to see into the future, but we can control today, and part of that is by having hope. Hope is such a powerful medicine, and what saddens me terribly is when people come in with no hope,” said Dr. Traboulsee. “Yes, we have higher efficacy therapies that might not be for everyone, but 10 years ago we had such limited options and today we can slow this disease for the majority of people – it is so exciting. I’m optimistic we are now in an era of true hope for treating MS.”

The big question is if you really hit this disease hard upfront will you impact whatever is causing progression? Dr. Traboulsee is convinced that it will. “The sooner you stop that mechanism of progression you might actually change the nature of this disease as opposed to waiting until progression becomes so obvious 20 years down the road and so much [central nervous system] injury has happened. My philosophy is that while we don’t fully understand everything that is contributing to progression, if we can protect the brain as much as possible in that first decade after diagnosis, I think people will be less likely to progress,” he said.

Dr. Traboulsee is positive that whether it’s through lifestyle choices, disease-modifying treatments for MS, or a combination of the two, the future for people newly diagnosed with MS will be much different, brighter even, than it was for me not quite a decade ago.

About the interview partners

Neurologist Dr. Anthony Traboulsee has been treating MS for 15 years, and is an Associate Professor at the University of British Columbia in Vancouver and Research Chair of the MS Society of Canada. He is also the Director of the MS/NMO Clinic and Clinical Trials Research Group at UBC Hospital.

Laura Kolaczkowski is the lead patient representative for iConquerMS™, a patient-led research network of more than 4,000 people affected by MS. She contributes regularly to and, and has a personal blog at Laura worked for the University of Dayton for more than 25 years, until her MS symptoms became a challenge, and she is now on medical retirement. She and her husband of more than 40 years have two adult children and three grandchildren, and enjoy time with family and traveling.

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