I've been through the functional testing at your clinic, and this video gives me a better understanding of what you were trying to assess. Thank you and GOOD MORNING, Dr. B!
Amen! my neuro asks me to walk in his small office which is all of 3 steps and judges my walking based on that. That is no way indicative of how I walk outside his office. It's very frustrating because he's not getting a clear picture at all.
Kelly J some neuro’s like Dr. Boster occasionally have the patients skip, hop, or jump to see different things. While it may seem silly or pointless it helps them narrow down certain symptoms and possible causes.
Same with my ex neurologist! To get to his office, I have a 10-15 min walk from public transport. Never used to be a problem until it was. I told him. He didn't care.
Wow that's great that you spend so much time with your patients. I see my neurologist twice a year and for only 5 minutes. I'm so glad that you take the time to do these videos and give out so much useful information. Thank you
Functional test for sure! Reasons why? I can walk the walking test and walk it like bolt on the day, on my own I’m using crutches more and more because my legs feel weak. Hands, I’m struggling more and more to write. Starts well, ends up significantly different to when I first started writing. Memory, I get confused and can’t remember familiar routes when I’m driving. Also Dr Boster or anyone who knows the answer why is when I write, I can spell the word in my head but when I go to write the word I’m writing different letters? I can’t figure it out.
I'm happy to have found your educational blogs about MS on youtube. Your videos have taught me a lot about what is really happening to my body because of MS. When I tell my NP Neurologist what my symptoms are I get little to no feedback as to what is happening or what I should do about it. I feel empty when I leave my appointment. I also live 1hr 15min away. Please keep your educational videos coming. Thank you, Pamela Caudell
Hallo Aaron, I would prefer the new way of testing. It seems so much easier for the whole team: the nurses can do the exams (or a computer leads the patient through) and when the patient then sees the neurologist, they can talk about the results and get new treatmentplans or PT or whatever is needed and they are having more precious time together. I told my neurologist one appoinment: You do not see me at night with my spasms keeping me awake; you do not see me stumble out of bed,trying to reach the bathroom before I loose my urin.....; you do not see me in so much pain when it is hot. I am taking ice cold showers to not feel like burning fire on my skin! When I am in your office I am all showered, dressed up, nice hair and makeup on. You don't see how much effort it takes me to look like this every time. So, yes, the new testing would be great for all neurologists all over the world! That would be a wonderful thing! Thanks so much for your efforts and taking your precious time to explain your opinion to us! Your worldwide community is loving you! As we are having more than 100 degrees at the moment, I am stuck at home with ice towel and fan in a darkened room. Sleeping is the best, cause fatigue hits me hard. Sending you my best regards from Northern Bavaria, Britta
We lived in Aschaffenburg for some years, @britta. Loved it so much! The tulip magnolias in the park . . .oh my . . . Hope all is well for you. Gruss Gott!
You had me at "listening to the patient." Love your method of exam! I think it would pick up on issues that affect us greatly day to day but may not show up on a brief neuro exam. It definitely would be helpful in tracking progression. Thanks!
Dr. Boster, I have had so many traditional hand eye tests that I can almost do it blindfolded. Your testing at your clinic is TOP SHELF. I have done the advanced testing 2 times thus far. If anyone hasn't told you lately >> Keep up the good work !! Were all counting on you.
I'm really skeptical about the neuro exam. Every time I complain about having less strength in my hand, I'm told it's ok and I think how they can even know. Squeezing somebody's hand is not a proper method to know if somebody has less strength, how is this person suposed to remember how it was the time before, several month ago, to be able to compare. I don't even get the exam done by the same person most of the times. There are instruments that can give a proper measure, with numbers, I don't understand why they don't use them.
You are AWESOME!! Love that you are looking at us as PEOPLE vs. a number to just get in and out of your office. Not that other docs don't want us living our best lives. but you truly want to make us awesome and it shows. Thank you for that.
Dr B - I agree 100% with the functional testing. I just wish the Social Security Administration used this information for determination of SSDI benefits. I had given them over 500 pages of doctor notes from my time at OSU Medical (Wexner Medical), and yet they still sent me to see "their" psychologist and an 80 yr old general internist. They DID NOT send me to a Neurologist specializing in MS to determine if my condition constituted being disabled "enough". The exams that OSU conducted clearly states that I am disabled and have MAJOR cognitive issues related to MS, but according to the SSA, I am not disabled "enough". Any way -- I am now with Ohio Health and scheduled to see you - Dr. B on Sept. 30th. As such -- you are a VERY POPULAR MS doc! I was referred to the Neurology dept at Ohio Health back in June, and the earliest date to see you was Sept 30th! And I jumped at it! (Sorry for the long read....)
Definitely the functional testing. It’s more efficient and tells you more about the individual patient. A much better use of time having the MA do the testing prior to the actual Dr./patient visit. It tells the Dr what he/she needs to address for that particular patient. Much more individualized than a general Neuro exam since this is a snowflake disease and no 2 people have the exact same progression. Thank you for making a much more efficient use of the precious time we have with the Dr! Thank you for always thinking of the patient and ways to improve upon our game. Take care Dr. B! - Carla SC
My Neurologist did the M.S.F.C. plus test the first time I saw him. He already had my MRI results of my brain and basically told me I had lesions on my brain consistent with M.S. on the phone and sent me for an MRI of c spine and t spine before our first visit. Which also showed t spine lesions. So evidently my neurologist and you think a like. 😊 this video gave me some reassurances about my neurologist. Ty
I’ve had lots of traditional neuro exams, but not one time has any physician (neuro or otherwise) been concerned about my overall function ... which is disappearing. I can’t even vacuum a single carpet today without injuring myself to the point that I’m mostly bedridden for the next 4 days. Only a year ago, I hauled heavy camera equipment around with me. I carried vacuums all over the house with no problem. Now I can’t get laundry up and down stairs without help. I don’t go anywhere anymore or do anything outside of listening to podcasts. I shut down my business and my photography gear sits unused (I am/was a talented photographer published in Ranger Rick). Now half the day goes by before I’m even dressed because I’m tired, move slowly, can’t walk far or well, and everything I do takes so much more effort then it used to. Function is EVERYTHING!
This is very good. When I got the initial diagnosis, I had written out all that I experienced and all meds my GP had done. But my second opinion at UNC, was what really made it real. The neurologist had me lay down and he went all over my body, left and right side and I closed my eyes, he then took a device and there were noted bands all the way up my body where I could not feel. That's when I knew the severity of MS. It changed me and the way I faced the disease.
Functional testing is something you introduced me to. I truly believe that because of YOUR approach, I can call myself well for the 1st time since being diagnosed 32 years ago. I was fortunate enough to become your patient ~ 3.5 years ago. I showed up a mess. I ignored most of your great advice. (I relearned once again that the definition of insanity is to continue on with all my bad habits and expect a different result.) Understanding the severity of my brain atrophy scared me straight. I know that brain atrophy correlates to a worse prognosis. I now think I had actually had a pretty "easy course" for a long time, without doing more than taking a DMT. I realized how quickly that was about to change for the worse. My brain is (was?) truly threatened. My brain is my favorite part of myself!!! I don't want to lose it! Actually listening to you and following your treatment plan has made all the difference. Anyone who doubts it should click on my name and watch a few of my videos.
I believe that you have hit the nail on the head. I would rather have the functionality test. Sounds like a better way to track symptoms. I myself have been keeping a journal of symptoms. If I have a fall, or Charlie horse in an unusual place, walking, well you get the idea. Main reason I would get frustrated trying to remember what happened since the last visit. Thanks Dr. B I think your ideas are spot on.
Thank you Dr. B!! I would rather have the functional neuro exam because it's going to measure my individual multiple sclerosis symptoms/disabilities in more depth and help steer my treatment of symptoms in the right direction. Its overall going to be much better for the patient and physician, it's a win win! Remember to give Dr. B a HUGE thumbs up for sharing this with us!! 🧡
Awesome video Doctor B. I wish you every success in having these changes implemented. It all seems so obvious/logical. My neurology walking test was 2 and a half steps into a 4th floor window.......apparently I passed. lol All the best from Australia. Cheers.
Good morning Dr. B, Out of all the functional testing you described the clinic I go to only does the 25’ timed walk. I would definitely welcome all the other functional testing you talk about! I think it would help the patients to understand what the tests are showing the doctor rather than having to ask every time one of the traditional tests is done “what does that test tell you?” My clinician doesn’t say unless asked. Thanks Dr. B for all you do to help us learn about MS.
Preach!!! I have felt many times that despite a traditional neuro exam that I felt I could complete all tasks well, my function with my hand(s) or my legs & gait were worsening, and this was never captured unless I expressed it and gave validation to it. I really agree with Dr. Boster, it only paints part of the picture. It’s is our function level as patients that we tend to judge how well we are doing anyway, so more of a focus on thIs would make me feel better heard and that I’m collaborating with my neurologist for my best life and well-being with MS.
Absolutely Brilliant! Makes complete sense. I am sick of the typical Neuro exam. Waste of time in most parts and wastes a lot of time. Your way is the way to go. It should be taken on by all Neurologists. Well done 👏
I know the nine-hole peg test. :-) They did that during the Tecfidera study. But neurologists never did any of these tests. I told my neurologist that my walking had become worse, he didn't care. I now have a new neurologist. Oh, how I hated the low-contrast visual acuity test. They also did that during the trial.
Man I wish there were more Aaron Bosters' around. Would love to get your insight on my case but alas I am in Texas lol... Thank u for always looking out for us Ms warriors. You make a difference in our lives for the better with your support and education. Thank you!
Dr. B., you are a rebel!! I can’t believe you have 30 minutes with the patient in clinic. I think where I am it’s a 20 minute appointment, but only nine minutes of it is spent with the patient, the rest is computer time. My previous neurologist mixed in some functional testing with the traditional stuff, and I know he was learning a lot more from it. Keep up the fight! You are the MS Warrior for better treatment and better lives for MS patients! So who should we write letters to about this?
AMEN AMEN AMEN X 1 Million.....I cannot tell you how much I appreciate you. My background is as Psychotherapist and I have worked in a multitude of hospitals in the past.... I am a very easy going and patient person..... that being said...... Sometimes I feel like my new MS doctor ( my old one retired)treats me like someone who has marbles for a brain. He is young and new on the scene. He knows I have lost a child a bit over a year ago and often he acts as though my neuro issues are triggered from that even though I have had them far over 2 decades. I have brain lesions and optic neuritis. I am being treated for MS of course. I show him respect . I just do not feel as though I get the same in turn. Your way of going about things just makes so much more sense
During my professional career as a manager, there was a thinking structure that I learned that states a similar message though a little different , and it is spot on... stuff happening is measured in data and then turned into information utilizing graphs, charts and statistics...then from the information, we extract the meaning in order to take action...in summary, stuff happening, data, information, meaning and action...a doctor's time with me should be about interpretation and action...as a manager, my time was best spent helping people understand their surroundings in order to take action to effect some form of improvement. There is no other thing I can think of that is more important and having a neurologist collecting data is not a good use of time for sure...excellent video as I've become accustom to.
This. Is. AMAZING!!! Damn- why can’t all neurologists want to raise the bar!!? I 100% would want this kind of testing. My neurologist already blows off new symptoms when I relay them so this would help me feel like I’m at least being tracked more accurately! (My neuro doc also just told me that UTIs don’t involve blood in the urine, antibiotics don’t treat them and I’m imagining symptoms so maybe I’m also dealing with a unique kind of neurologist!)😬🤦🏻♀️ Amazing video Dr B!👏🏼👏🏼👏🏼
This vlog has given me more insights into how and what you are looking to identify. I think it helps that neuros would share throughout the examination. Thanks!!!!
This makes SO much sense! I just wish that more neurologists cared about doing the best for their patients the way that you do! I also wish that I could find a doctor here in Ontario, Canada like you! Thank you so much for taking your time to make these videos for all of us! ❤️
Okay Dr. Boster, I do the walking test every time I go to the Neurologist and I have asked why and the LPN always shrugs their shoulders. My results have never been explained to me. 😡 In response to your question; I would rather have this up to date testing. BUT, I feel like I need to be more proactive about it and hold my doctor accountable. Thank you for sharing this!!!
Thank you for thinking outside of the box and sharing with all of us. I hope this approach becomes widely adopted and becomes the part of the standard of care. You are a very smart cookie and a wonderful human!
What’s up Doc? Awesome video. I had to share on FB. Hope that’s ok. I’m very open about my MS life experiences on FB and publicly. Thank you for what you do!!
I just made an appointment at the Ohio health clinic, really wishing you were seeing patients right now! But I know that I’ll be in good hands with another MS specialist
Functional testing!! It's a no-brainer, pun intended. For example, I did a 9-peg test and with my more affected side, I scattered the pegs before beginning because my hand-eye coordination isn't pristine. I still did the test quickly, (awesome!), but it's hard to quantify in clinic that I occasionally hit myself in the face when answering a phone, haha... And I think this functional test probably showed that. My neuro does a combination of both functional and traditional testing. I think the functional gives us the opportunity to demonstrate what does or doesn't work for us with the MS. THANKS, as always!
TY for posting these educational videos! They have helped me alot between visits to my local MS clinic. I would LOVE the functional testing as it would help me better understand my disease course. 👍👍
I've done the functional tests during the Opera Study which do more closely correlate with daily function versus a traditional neuro exam. There have been several times I have felt weak, stiff, unbalanced, etc. but know the traditional neuro exam will show that I'm equal bilaterally within close limits of my previous exam. Doing both exams would definitely be a step in the right direction. Also, as frustrating as the math test (p-something - add the last 2 numbers you hear) is, I think that's more important for judging cognitive impairment than the matching game with the shapes/numbers. Thanks for this video & community!
I'm not a doctor and don't play one on TV but have noticed that a lot of the diagnostics seems to be far to subjective especially with tools out there that help knock out variables. Things like Neuroquant immediately come to mind. Perhaps the new findings in grey matter atrophy will help push technology more front and center for more accurate diagnosis and treatment.
Your office just performed these before I saw you on Monday, Sounds like they are great and very informative. What would be AWSOME is if the results could be given to the patients :). I have messaged a request but just a thought. Just in general I always appreciate a copy of the doctors reports, and test results it helps me to remember everything.
Maggie Mae yep, and common sense seems not to common to find these days. Iv had to quit my job as an engineer and I’m not entitled to pip. Had it for two years and now it’s been stopped yet I’m worse of now MS wise 🤔😡
I was started on the traditional exam from way back. When I was switched to the clinic a couple of years ago I was suprised. There were parts of the traditional exam but all of this new stuff. I remember it being discussed but the first visit was wonderfully overwhelming. Three years later it is just part of a clinic visit. For me, being a patient in the clinic has been nothing less than a great experince. This video has raised my appreciation of the "silly little tests". It has added tremendous context what they are adding to my clinic vists. Three months ago I was in for a follow up and not really feeling great. MS seemed to be winning more days than usual. I had a list of things to discuss during the visit. In the clinic the functional exam felt "off" compared to other visits. Dr. N must have thought the functional part of the exam was a little "off" as well. My list of things to discuss just flowed through the visit. We talked about some changes, made a plan, executed the plan and in my follow up this week the functional stuff was back on track compared to where I've been. I'm back to feeling like I'm winning more days than MS.
My neurologist here in NB, Canada, does the traditional and functional testing. I have done the peg, walk, and visual testing, but the symbol one is new to me.
On a regular neuro exam, it's really hard for the person doing it to really get a feel for what's really going on. Functional test sounds much more...functional. For example, I used to have NO deep tendon reflexes. I mean they had to have me do a hand thing to ramp up my tension, and THEN I had reflexes. Now I have a solid "1", which obviously is not normal for me. When those tests are done, I can feel the strike all the way to my spine and it makes me feel waves of severe discomfort, if it's on my left side. Docs don't feel the muscles quivering when they only test strength for a second and muscle fatigue kicks in at two seconds. I'm not completely numb anywhere, I can feel SOMETHING, but it's not right and it's not the same sensation in some areas of my body as others (bottom of my forearm and whole right arm feel normal, back of my left forearm feels very different, both more painful and more numb). EMG doesn't pick that up either.
Officially Diagnosed with PPMS 2 days ago. Having an exam like this would have saved many sleepless nights and anxiety. I agree with your thoughts on a more modern and brain function based exam. Thank you for posting videos such as this as it makes the acceptance of being diagnosed just that little bit easier.
Functional testing just makes sense. Wish my doctor offered such testing. Think it would help patient validate what is happening to them, leastwise for me. After 4 years with a diagnosis of MS, still trying to figure this out..what is real vs is that just in my head.
I think most patients will agree with you Dr B before I was daignosed, I had a traditional neurological exam, and apparently my symptoms weren’t consistent with ms. The only functional thing I did was trying to handwrite Thank goodness for some reason they decided to do an mri so they could get me off the neurology departments books. Although they were so confident in the neurological exam that They didn’t even review the mri! My primary doctor thankfully had the radiology report and chased it up. They had an oh crap moment when they eventually reviewed it. The whole process meant I was a long time without treatment 🙈
Sorry for the novel, and believe me that’s still an abridged version 😂 it was an experience that’s for sure! I’d still be in the dark about a lot of stuff if I had not stumbled across your channel when I first received that mri report (yeah even I saw the report before they did 🤦🏻♀️)
Thank you for another great video! The functional exam sounds more detailed. I know the subtle changes i am experiencing, but previous nuerologist didnt seem to listen as long as i could pass the traditional tests.
I so much like this type of examination. I have been consistently getting worse cognitively over the last five years. When sharing my concerns initially with the MA (five years ago), she ordered a neuropsych test. It came back fine. Since then my neuro has never asked me about it, nor done the modality test. At the last visit I pressed the issue and he started to send me back for another neuropsych test, but then changed his mind and wanted to send me to occupational therapy. If I search the internet for the top MS doctor in my city ( I live in one of the top ten largest US cities) his name comes up as the top doc. Maybe I'm way off and there is nothing wrong with me, but showing interest in what I'm saying and proving me wrong sure sure would be nice!
I've done all these tests during research, but I've never been given it elsewhere. My walking time dropped significantly between the first and second test, no idea why and because it's research it's unlikely my neurologist got a hold of that information. And he doesn't seem to care. Does the few steps in his office, you can clearly see my walking has worsened but nothing is said. I definitely agree those tests worked better at even showing me the difference a year has made to my body. Functional testing needs to be done. Maybe even alongside the neurological test.
Hi Dr. Bostor, I was in a drug trial at UC Davis in Sacramento and I went every 3 months. I had to do all of these tests as well as one with a tape recorder with math that I had to do in my head. The walking one was longer than what you talk about. I would have no issues with this being done before visit. Thanks for your thoughts on this!
Functional test sounds best for sure! I get tired of getting tests that don’t show anything, and yet I feel a slow functional decline. I’m currently at the infusion center with Ocrevus infusing👍! Thanks for another great video😀
I’ve worried about the accuracy of my traditional neuro exams because it changes each time! I’d love it if my clinic would use these other tests, especially the low contrast vision one. Thanks for the video, I’d love to see a future video on breathing problems in MS 🧡
I’ve worked in a related field for many years. There is 15 years of records of the traditional exam at my neuro’s office (on paper!!! 👎). Lots of data. Not a lot of information. I’ve also done the NARCOMS registry that whole time. That seems like much more useful information. Totally agree - it’s time to update what is collected. A simple self administered questionnaire would tell us both so much more. My neuro knows if I can touch my nose, but he doesn’t know since I started seeing him I can’t climb a flight of stairs, walking a city block is very hard, I’ve gotten divorced, moved, and changed careers 3 times, etc. etc. He knows he prescribed me certain meds - does he know my insurance won’t pay for some of them and I’ve bought supposedly equivalent meds from India just hoping what I’m taking is safe? Anyway - YES - please measure my ability to function and not only my reflexes. You are right on track. Teach the others!
I think it's a great idea to have more time with a neurologist to visit. Coming from the standpoint of being a tech (EEG) in a neuro department, if more responsibilities are being put on the MA's then potentially a raise should be suggested to the higher ups. Not necessarily much, but adequately enough in that their responsibilities would be increased. I only state this as overtime EEG techs responsibilities have increased (as physicians used to be able to perform the tests as well as read them in the past but no longer know how to do them and some cannot read them) but the pay has not reflected their necessity in clinic or hospital settings as a national standard. It has only increased along with costs of living and such. I only mention this because a lot of tech positions get a lot of extra responsibilities put on them and then either never see a reflection of this in pay or are under appreciated for what they do to help support their medical teams. I know this all sounds like I'm being negative, I'm really not. Just giving feedback in something to consider even if it just adds the 10-15 mins extra to their day per patient. Thank you for all you do. It's helped me get through this wait as I try to figure out what the heck is going on with my body.
Question of the day: Why would I even consider wanting old outdated and less efficient/less effective testing to help keep me healthy in an ever evolving world? Of course I'd want the functional. More effective, efficient, and allows more time for what is important, QUALITY face to face time in a clinical appointment. Addressing questions concerns and really working out the best options for me. If I'm on board, understand, and feel comfortable about my progress and treatment = better outcomes for my overall well being as your patient. I'm unlike anyone else and need different care. So let's really dissect me and my mind 😉🤣. This disease isn't cookie cutter. Its unique for every patient. So let's spend our best time on the best part of what makes me, ME.
You are TRULY REMARKABLE!!! I want you to be my NEUROLOGIST!!!! I am in FL if i ever had money could i ever see you?!?!? My neuro is great but i have never had any of those tests!!!! I need those tests!!! I have BRAIN ATROPHY!!!! I lost my career... my quality of life is almost non-existent!!!!! Please HELP!!! Your channel is so life changing! THANK YOU!
Hey there. If you decide you want to see Doc B., and thus will be coming to Columbus, I will be happy to be your concierge, if you wish. I could pick you up at the airport or help with driving instructions, advice about where to stay, good places to get a meal, etc. I could show you right to the door of the office. I think as many ppl as possible should see Doc B. I'd be happy to help. :) I'm also experiencing brain atrophy. 89% of people have more functional brain tissue than I do, hence "MS in the 11th Percentile".
The testing you described, dr Bostor, sounds better to me than traditional neuroexam. It seems more accurate, more extensive, a reliable way to keep track of progression. Plus I like how I can conduct it myself or have an MA do it instead of wasting precious time of my appointment doing the chicken dance with my neurologist. Overall: awesome sauce. (Thank you for that new addition to my dictionary)
Dude 35 years ago, post ACUTE!!! episode of MS, no Dx but already experiencing (L) problems, still climbing up to half Dome, plus driving 200 miles. Your saying, that a 25, step walking test, hand eye coordination test plus whatever would have provided sufficient information to make accurate prognoses. You know what I think.
Testing with the peg test is great, agreed. (Of course, I used to be an editor, so the name of the test in the video shown as 'teg test' just bugged me enough that I had to pipe up!)
I'd rather have both, although I know time constraints make that virtually impossible. My former neuro, who retired recently, would do a full neuro exam that would take 30-45 min every visit. The new neuro barely did any physical exam, but did a more questioning type of visit.
I like the testing on the iPad except for the contrast sensitivity part. The reason I don’t like it is such a pain to keep ones head in the range that it requires it take 15-20 minutes to do that part. I would rather have that part done by an actual person that the tablet.
I would love to have a functional test Because I do believe that it would show the progression I think the traditional testing does nothing and they rushed through it I wish I had a doctor like you supposedly I have the top doctor in Texas but I’m finding it hard to believe I wish I had you as a doctor!
Do you think an MS nurse who is responsible for coordinating care and wellbeing could also conduct some functional testing? It may assist in more regular screening, monitoring, and keeping in touch with the patient. Also, patient led functional testing with an MS nurse may indicate where additional care or support may be useful.
I would love to have a functional exam, especially the cognition seeing as of lately the brain fog has been so bad my thoughts feel like they run through gelatin. A word crossword game I frequently play has become confusing to me and I miss so many general elementary type words. I eventually get it but through a process of guessing by matching vowels to their traditional position within words. I became so unhappy when my spouse was able to finish the whole crossword within two minutes when I had been trying to solve it for a better part of a combined half hour. The other day when asking for the car keys to get the kids in the car I couldn't say it. At first I said key cars then as I struggled to correct myself it became a jumble of sounds. It was so embarrassing that it made me feel really angry. Wish even regular doctors would preform the functional test!
I have discovered something that seems that seems silly. When my bladder is full, or I have gas/constipation pains, my walking quality / speed plummets. I think I can explain why. If I am thinking "relax bladder" or "how can I move my torso to reduce this gas pain" I am not thinking "left foot - right foot". And the funny/cool thing is that it happens without me consciously realizing it. Now when I notice that my walking quality is dropping, going to the bathroom frequently improves things. Last time I was in clinic, I realized that I was walking extra slow, and asked to go to the restroom. My speed improved after emptying my bladder. (I did not think to ask how much, but it must have been significant if I noticed the difference.)
Hi Aaron I was wondering if you could perhaps do a video expIaining about lesions (apologies of this has been covered and I have missed it) in particular the healing process for them in the brain & spine ..how they change, do they heal completely, scar? Do lesions in the brain differ greatly from spine lesions? Does placement make a different in both spine and brain? How does spine lesions effect a person sign ms etc?. Are spine lesions worse than brain lesions? Also could you perhaps explain to me what ‘intrinsic cord lesions’ are. Sorry for the million questions, thank you for the great informative videos! Rebecca
The functional exam sounds entirely more meaningful than the traditional one. I’ve had three traditional exams. The only thing I’ve learned is my reflexes are more aggressive than they should be. However my walking has slowed down a lot and I know this from the app I use to walk. My recent one mile walk was 26 minutes and I used to do a mile in 14 minutes at least. I’ve done 12 minutes before which isn’t the best but far better than 26!!! My 15 year old quasi nephew was walking with me to a store and said he couldn’t walk as slow as me if he tried and I thought I was HIKING 😪 Something is not quite right and I am super concerned. I haven’t even mentioned my memory issues here!!!!😦
I think this is great, but I wonder how knowing the fine details of my functioning is any way impacts my treatment. I have PPMS and am on Ocrevus. It feels to me as there is nothing more anyone can do for me.
The only time I've ever had a thorough functional exam, was during a clinical trial. My doctor does the typical neurological exam + timed walking test. I think the functional exam would give a more accurate representation of my MS. Now, how do we get our doctors to do it?
I got one would prefer the functional testing. I think it gives the Neuro a more accurate picture of what’s going on physically with a patient. I have take the Cognitive Function test. It was a couple of years and I didn’t do to well. I may talk to my MS Specialist in a couple of weeks about repeating the test.
I've been through the functional testing at your clinic, and this video gives me a better understanding of what you were trying to assess. Thank you and GOOD MORNING, Dr. B!
that's great to hear Tracy! TY for watching and for sharing! #WeHaveMS
Amen! my neuro asks me to walk in his small office which is all of 3 steps and judges my walking based on that. That is no way indicative of how I walk outside his office. It's very frustrating because he's not getting a clear picture at all.
Kelly J some neuro’s like Dr. Boster occasionally have the patients skip, hop, or jump to see different things. While it may seem silly or pointless it helps them narrow down certain symptoms and possible causes.
Kelly J Same!!! I know I’m having trouble with stuff but walking three steps in an office means I get a 0-1 on the disability score
Same with my ex neurologist! To get to his office, I have a 10-15 min walk from public transport. Never used to be a problem until it was. I told him. He didn't care.
Wow that's great that you spend so much time with your patients. I see my neurologist twice a year and for only 5 minutes. I'm so glad that you take the time to do these videos and give out so much useful information. Thank you
Functional test for sure! Reasons why? I can walk the walking test and walk it like bolt on the day, on my own I’m using crutches more and more because my legs feel weak. Hands, I’m struggling more and more to write. Starts well, ends up significantly different to when I first started writing. Memory, I get confused and can’t remember familiar routes when I’m driving.
Also Dr Boster or anyone who knows the answer why is when I write, I can spell the word in my head but when I go to write the word I’m writing different letters? I can’t figure it out.
adele Griffiths I feel this way too
I'm happy to have found your educational blogs about MS on youtube. Your videos have taught me a lot about what is really happening to my body because of MS. When I tell my NP Neurologist what my symptoms are I get little to no feedback as to what is happening or what I should do about it. I feel empty when I leave my appointment. I also live 1hr 15min away. Please keep your educational videos coming. Thank you, Pamela Caudell
Hallo Aaron, I would prefer the new way of testing.
It seems so much easier for the whole team: the nurses can do the exams (or a computer leads the patient through) and when the patient then sees the neurologist, they can talk about the results and get new treatmentplans or PT or whatever is needed and they are having more precious time together.
I told my neurologist one appoinment: You do not see me at night with my spasms keeping me awake; you do not see me stumble out of bed,trying to reach the bathroom before I loose my urin.....; you do not see me in so much pain when it is hot. I am taking ice cold showers to not feel like burning fire on my skin!
When I am in your office I am all showered, dressed up, nice hair and makeup on. You don't see how much effort it takes me to look like this every time.
So, yes, the new testing would be great for all neurologists all over the world! That would be a wonderful thing!
Thanks so much for your efforts and taking your precious time to explain your opinion to us! Your worldwide community is loving you!
As we are having more than 100 degrees at the moment, I am stuck at home with ice towel and fan in a darkened room. Sleeping is the best, cause fatigue hits me hard.
Sending you my best regards from Northern Bavaria, Britta
We lived in Aschaffenburg for some years, @britta. Loved it so much! The tulip magnolias in the park . . .oh my . . . Hope all is well for you. Gruss Gott!
You had me at "listening to the patient." Love your method of exam! I think it would pick up on issues that affect us greatly day to day but may not show up on a brief neuro exam. It definitely would be helpful in tracking progression. Thanks!
I'm so glad my neurologist does these tests! Thanks for a deeper explanation of why these are done
Dr. Boster,
I have had so many traditional hand eye tests that I can almost do it blindfolded.
Your testing at your clinic is TOP SHELF.
I have done the advanced testing 2 times thus far.
If anyone hasn't told you lately >>
Keep up the good work !! Were all counting on you.
TY John!! #WeHaveMS
I'm really skeptical about the neuro exam. Every time I complain about having less strength in my hand, I'm told it's ok and I think how they can even know. Squeezing somebody's hand is not a proper method to know if somebody has less strength, how is this person suposed to remember how it was the time before, several month ago, to be able to compare. I don't even get the exam done by the same person most of the times. There are instruments that can give a proper measure, with numbers, I don't understand why they don't use them.
Really wanted to see this. Glad it came back up. I would rather do this testing over traditional .
Thanks Dr B
Hooray!! I am so happy to see this. I would love to see my doctor’s office do this. What is you opinion of the EDSS scale?
You are AWESOME!! Love that you are looking at us as PEOPLE vs. a number to just get in and out of your office. Not that other docs don't want us living our best lives. but you truly want to make us awesome and it shows. Thank you for that.
Dr B - I agree 100% with the functional testing. I just wish the Social Security Administration used this information for determination of SSDI benefits. I had given them over 500 pages of doctor notes from my time at OSU Medical (Wexner Medical), and yet they still sent me to see "their" psychologist and an 80 yr old general internist. They DID NOT send me to a Neurologist specializing in MS to determine if my condition constituted being disabled "enough". The exams that OSU conducted clearly states that I am disabled and have MAJOR cognitive issues related to MS, but according to the SSA, I am not disabled "enough". Any way -- I am now with Ohio Health and scheduled to see you - Dr. B on Sept. 30th. As such -- you are a VERY POPULAR MS doc! I was referred to the Neurology dept at Ohio Health back in June, and the earliest date to see you was Sept 30th! And I jumped at it! (Sorry for the long read....)
I hate that you're having to jump through all those hoops. You will really like Dr. B. He's a rockstar.
Definitely the functional testing. It’s more efficient and tells you more about the individual patient. A much better use of time having the MA do the testing prior to the actual Dr./patient visit. It tells the Dr what he/she needs to address for that particular patient. Much more individualized than a general Neuro exam since this is a snowflake disease and no 2 people have the exact same progression. Thank you for making a much more efficient use of the precious time we have with the Dr! Thank you for always thinking of the patient and ways to improve upon our game. Take care Dr. B! - Carla SC
My Neurologist did the M.S.F.C. plus test the first time I saw him. He already had my MRI results of my brain and basically told me I had lesions on my brain consistent with M.S. on the phone and sent me for an MRI of c spine and t spine before our first visit. Which also showed t spine lesions. So evidently my neurologist and you think a like. 😊 this video gave me some reassurances about my neurologist. Ty
I’ve had lots of traditional neuro exams, but not one time has any physician (neuro or otherwise) been concerned about my overall function ... which is disappearing.
I can’t even vacuum a single carpet today without injuring myself to the point that I’m mostly bedridden for the next 4 days.
Only a year ago, I hauled heavy camera equipment around with me. I carried vacuums all over the house with no problem.
Now I can’t get laundry up and down stairs without help. I don’t go anywhere anymore or do anything outside of listening to podcasts. I shut down my business and my photography gear sits unused (I am/was a talented photographer published in Ranger Rick).
Now half the day goes by before I’m even dressed because I’m tired, move slowly, can’t walk far or well, and everything I do takes so much more effort then it used to.
Function is EVERYTHING!
Functional Testing sounds like it offers much better insight.
This is very good. When I got the initial diagnosis, I had written out all that I experienced and all meds my GP had done. But my second opinion at UNC, was what really made it real. The neurologist had me lay down and he went all over my body, left and right side and I closed my eyes, he then took a device and there were noted bands all the way up my body where I could not feel. That's when I knew the severity of MS. It changed me and the way I faced the disease.
Functional testing is something you introduced me to. I truly believe that because of YOUR approach, I can call myself well for the 1st time since being diagnosed 32 years ago. I was fortunate enough to become your patient ~ 3.5 years ago. I showed up a mess. I ignored most of your great advice. (I relearned once again that the definition of insanity is to continue on with all my bad habits and expect a different result.) Understanding the severity of my brain atrophy scared me straight. I know that brain atrophy correlates to a worse prognosis. I now think I had actually had a pretty "easy course" for a long time, without doing more than taking a DMT. I realized how quickly that was about to change for the worse. My brain is (was?) truly threatened. My brain is my favorite part of myself!!! I don't want to lose it! Actually listening to you and following your treatment plan has made all the difference. Anyone who doubts it should click on my name and watch a few of my videos.
I believe that you have hit the nail on the head. I would rather have the functionality test. Sounds like a better way to track symptoms. I myself have been keeping a journal of symptoms. If I have a fall, or Charlie horse in an unusual place, walking, well you get the idea. Main reason I would get frustrated trying to remember what happened since the last visit. Thanks Dr. B I think your ideas are spot on.
Thank you Dr. B!! I would rather have the functional neuro exam because it's going to measure my individual multiple sclerosis symptoms/disabilities in more depth and help steer my treatment of symptoms in the right direction. Its overall going to be much better for the patient and physician, it's a win win! Remember to give Dr. B a HUGE thumbs up for sharing this with us!! 🧡
I’m so glad you have been posting these videos.
What a novel idea. What you describe and implement for your patients makes you an amazing human on many levels. Thank you so much!
Awesome video Doctor B. I wish you every success in having these changes implemented. It all seems so obvious/logical. My neurology walking test was 2 and a half steps into a 4th floor window.......apparently I passed. lol All the best from Australia. Cheers.
Good morning Dr. B,
Out of all the functional testing you described the clinic I go to only does the 25’ timed walk. I would definitely welcome all the other functional testing you talk about! I think it would help the patients to understand what the tests are showing the doctor rather than having to ask every time one of the traditional tests is done “what does that test tell you?” My clinician doesn’t say unless asked.
Thanks Dr. B for all you do to help us learn about MS.
Preach!!! I have felt many times that despite a traditional neuro exam that I felt I could complete all tasks well, my function with my hand(s) or my legs & gait were worsening, and this was never captured unless I expressed it and gave validation to it. I really agree with Dr. Boster, it only paints part of the picture. It’s is our function level as patients that we tend to judge how well we are doing anyway, so more of a focus on thIs would make me feel better heard and that I’m collaborating with my neurologist for my best life and well-being with MS.
Absolutely Brilliant! Makes complete sense. I am sick of the typical Neuro exam. Waste of time in most parts and wastes a lot of time. Your way is the way to go. It should be taken on by all Neurologists. Well done 👏
I know the nine-hole peg test. :-) They did that during the Tecfidera study. But neurologists never did any of these tests. I told my neurologist that my walking had become worse, he didn't care. I now have a new neurologist.
Oh, how I hated the low-contrast visual acuity test. They also did that during the trial.
Man I wish there were more Aaron Bosters' around. Would love to get your insight on my case but alas I am in Texas lol... Thank u for always looking out for us Ms warriors. You make a difference in our lives for the better with your support and education. Thank you!
Thanks Doc! I quickly sent this video directly to my neurologist hoping it doesn’t piss him off rather it’s taken to heart and moves him to action !
Dr. B., you are a rebel!! I can’t believe you have 30 minutes with the patient in clinic. I think where I am it’s a 20 minute appointment, but only nine minutes of it is spent with the patient, the rest is computer time. My previous neurologist mixed in some functional testing with the traditional stuff, and I know he was learning a lot more from it. Keep up the fight! You are the MS Warrior for better treatment and better lives for MS patients! So who should we write letters to about this?
Also I’m super happy my Doctor does this. Dr. Kinkle is awesome.
Thanks a million Doc!
AMEN AMEN AMEN X 1 Million.....I cannot tell you how much I appreciate you. My background is as Psychotherapist and I have worked in a multitude of hospitals in the past.... I am a very easy going and patient person..... that being said...... Sometimes I feel like my new MS doctor ( my old one retired)treats me like someone who has marbles for a brain. He is young and new on the scene. He knows I have lost a child a bit over a year ago and often he acts as though my neuro issues are triggered from that even though I have had them far over 2 decades. I have brain lesions and optic neuritis. I am being treated for MS of course. I show him respect . I just do not feel as though I get the same in turn. Your way of going about things just makes so much more sense
During my professional career as a manager, there was a thinking structure that I learned that states a similar message though a little different , and it is spot on... stuff happening is measured in data and then turned into information utilizing graphs, charts and statistics...then from the information, we extract the meaning in order to take action...in summary, stuff happening, data, information, meaning and action...a doctor's time with me should be about interpretation and action...as a manager, my time was best spent helping people understand their surroundings in order to take action to effect some form of improvement. There is no other thing I can think of that is more important and having a neurologist collecting data is not a good use of time for sure...excellent video as I've become accustom to.
This. Is. AMAZING!!! Damn- why can’t all neurologists want to raise the bar!!? I 100% would want this kind of testing. My neurologist already blows off new symptoms when I relay them so this would help me feel like I’m at least being tracked more accurately! (My neuro doc also just told me that UTIs don’t involve blood in the urine, antibiotics don’t treat them and I’m imagining symptoms so maybe I’m also dealing with a unique kind of neurologist!)😬🤦🏻♀️ Amazing video Dr B!👏🏼👏🏼👏🏼
This vlog has given me more insights into how and what you are looking to identify. I think it helps that neuros would share throughout the examination. Thanks!!!!
This makes SO much sense! I just wish that more neurologists cared about doing the best for their patients the way that you do! I also wish that I could find a doctor here in Ontario, Canada like you! Thank you so much for taking your time to make these videos for all of us! ❤️
Okay Dr. Boster, I do the walking test every time I go to the Neurologist and I have asked why and the LPN always shrugs their shoulders. My results have never been explained to me. 😡
In response to your question; I would rather have this up to date testing. BUT, I feel like I need to be more proactive about it and hold my doctor accountable. Thank you for sharing this!!!
Thank you for thinking outside of the box and sharing with all of us. I hope this approach becomes widely adopted and becomes the part of the standard of care. You are a very smart cookie and a wonderful human!
Another awesome video, Dr. B! Thanks for the information.
What’s up Doc? Awesome video. I had to share on FB. Hope that’s ok. I’m very open about my MS life experiences on FB and publicly. Thank you for what you do!!
I just made an appointment at the Ohio health clinic, really wishing you were seeing patients right now! But I know that I’ll be in good hands with another MS specialist
This is amazing. Thank you for working hard to change neurology for the better! How can this be spread so that other neurologists do it?
Dr. Boster this makes so much sense! I'm going to share this with my neurologist on my next visit. Thank you.
Functional testing!! It's a no-brainer, pun intended. For example, I did a 9-peg test and with my more affected side, I scattered the pegs before beginning because my hand-eye coordination isn't pristine. I still did the test quickly, (awesome!), but it's hard to quantify in clinic that I occasionally hit myself in the face when answering a phone, haha... And I think this functional test probably showed that. My neuro does a combination of both functional and traditional testing. I think the functional gives us the opportunity to demonstrate what does or doesn't work for us with the MS. THANKS, as always!
TY for posting these educational videos! They have helped me alot between visits to my local MS clinic. I would LOVE the functional testing as it would help me better understand my disease course. 👍👍
I've done the functional tests during the Opera Study which do more closely correlate with daily function versus a traditional neuro exam. There have been several times I have felt weak, stiff, unbalanced, etc. but know the traditional neuro exam will show that I'm equal bilaterally within close limits of my previous exam. Doing both exams would definitely be a step in the right direction. Also, as frustrating as the math test (p-something - add the last 2 numbers you hear) is, I think that's more important for judging cognitive impairment than the matching game with the shapes/numbers. Thanks for this video & community!
I'm not a doctor and don't play one on TV but have noticed that a lot of the diagnostics seems to be far to subjective especially with tools out there that help knock out variables. Things like Neuroquant immediately come to mind. Perhaps the new findings in grey matter atrophy will help push technology more front and center for more accurate diagnosis and treatment.
Thanks a lot for explaining Dr.
This just makes good sense!
Your office just performed these before I saw you on Monday, Sounds like they are great and very informative. What would be AWSOME is if the results could be given to the patients :). I have messaged a request but just a thought. Just in general I always appreciate a copy of the doctors reports, and test results it helps me to remember everything.
Love it! Sounds like common sense to me. ❤
Maggie Mae yep, and common sense seems not to common to find these days. Iv had to quit my job as an engineer and I’m not entitled to pip. Had it for two years and now it’s been stopped yet I’m worse of now MS wise 🤔😡
Awesome!!!! Thank you, Dr. B!!! Christine in N.C. Diagnosed in 1992... Would love to find a great new Nero in N.C.🤓😃🙏🏻
I was started on the traditional exam from way back. When I was switched to the clinic a couple of years ago I was suprised. There were parts of the traditional exam but all of this new stuff. I remember it being discussed but the first visit was wonderfully overwhelming. Three years later it is just part of a clinic visit. For me, being a patient in the clinic has been nothing less than a great experince. This video has raised my appreciation of the "silly little tests". It has added tremendous context what they are adding to my clinic vists.
Three months ago I was in for a follow up and not really feeling great. MS seemed to be winning more days than usual. I had a list of things to discuss during the visit. In the clinic the functional exam felt "off" compared to other visits. Dr. N must have thought the functional part of the exam was a little "off" as well. My list of things to discuss just flowed through the visit. We talked about some changes, made a plan, executed the plan and in my follow up this week the functional stuff was back on track compared to where I've been. I'm back to feeling like I'm winning more days than MS.
My neurologist here in NB, Canada, does the traditional and functional testing. I have done the peg, walk, and visual testing, but the symbol one is new to me.
I hate that freaking symbol test, lol. Of course, I do it, but I hate it!
On a regular neuro exam, it's really hard for the person doing it to really get a feel for what's really going on. Functional test sounds much more...functional. For example, I used to have NO deep tendon reflexes. I mean they had to have me do a hand thing to ramp up my tension, and THEN I had reflexes. Now I have a solid "1", which obviously is not normal for me. When those tests are done, I can feel the strike all the way to my spine and it makes me feel waves of severe discomfort, if it's on my left side. Docs don't feel the muscles quivering when they only test strength for a second and muscle fatigue kicks in at two seconds. I'm not completely numb anywhere, I can feel SOMETHING, but it's not right and it's not the same sensation in some areas of my body as others (bottom of my forearm and whole right arm feel normal, back of my left forearm feels very different, both more painful and more numb). EMG doesn't pick that up either.
Your way of testing seems to make a whole lot of sense. Comparatively.
TY
Officially Diagnosed with PPMS 2 days ago. Having an exam like this would have saved many sleepless nights and anxiety. I agree with your thoughts on a more modern and brain function based exam. Thank you for posting videos such as this as it makes the acceptance of being diagnosed just that little bit easier.
Functional testing just makes sense. Wish my doctor offered such testing. Think it would help patient validate what is happening to them, leastwise for me. After 4 years with a diagnosis of MS, still trying to figure this out..what is real vs is that just in my head.
I would prefer the functional exam because it sounds like it would be more helpful in determining what needs addressing in a plan of care.
Functional testing!! Neuro exams don't pick up how my performance drops over time
I think most patients will agree with you Dr B before I was daignosed, I had a traditional neurological exam, and apparently my symptoms weren’t consistent with ms. The only functional thing I did was trying to handwrite
Thank goodness for some reason they decided to do an mri so they could get me off the neurology departments books. Although they were so confident in the neurological exam that They didn’t even review the mri!
My primary doctor thankfully had the radiology report and chased it up. They had an oh crap moment when they eventually reviewed it. The whole process meant I was a long time without treatment 🙈
Sorry for the novel, and believe me that’s still an abridged version 😂 it was an experience that’s for sure! I’d still be in the dark about a lot of stuff if I had not stumbled across your channel when I first received that mri report (yeah even I saw the report before they did 🤦🏻♀️)
Thank you for another great video! The functional exam sounds more detailed. I know the subtle changes i am experiencing, but previous nuerologist didnt seem to listen as long as i could pass the traditional tests.
I so much like this type of examination. I have been consistently getting worse cognitively over the last five years. When sharing my concerns initially with the MA (five years ago), she ordered a neuropsych test. It came back fine. Since then my neuro has never asked me about it, nor done the modality test. At the last visit I pressed the issue and he started to send me back for another neuropsych test, but then changed his mind and wanted to send me to occupational therapy. If I search the internet for the top MS doctor in my city ( I live in one of the top ten largest US cities) his name comes up as the top doc. Maybe I'm way off and there is nothing wrong with me, but showing interest in what I'm saying and proving me wrong sure sure would be nice!
I think this is a more in depth testing and should be done at every appointment! Thank you for everything you do
I've done all these tests during research, but I've never been given it elsewhere.
My walking time dropped significantly between the first and second test, no idea why and because it's research it's unlikely my neurologist got a hold of that information. And he doesn't seem to care. Does the few steps in his office, you can clearly see my walking has worsened but nothing is said.
I definitely agree those tests worked better at even showing me the difference a year has made to my body.
Functional testing needs to be done. Maybe even alongside the neurological test.
Great 👍💕
Hi Dr. Bostor, I was in a drug trial at UC Davis in Sacramento and I went every 3 months. I had to do all of these tests as well as one with a tape recorder with math that I had to do in my head. The walking one was longer than what you talk about. I would have no issues with this being done before visit. Thanks for your thoughts on this!
I would like to have the new Neuro exam. Just because I have had MS for 26 years and I think having new testing is always a good thing.
Functional test sounds best for sure! I get tired of getting tests that don’t show anything, and yet I feel a slow functional decline. I’m currently at the infusion center with Ocrevus infusing👍! Thanks for another great video😀
Thank you for sharing this information! I would opt for functional testing as it seems to convey much more details about disease progression.
I’ve worried about the accuracy of my traditional neuro exams because it changes each time! I’d love it if my clinic would use these other tests, especially the low contrast vision one. Thanks for the video, I’d love to see a future video on breathing problems in MS 🧡
I’ve worked in a related field for many years. There is 15 years of records of the traditional exam at my neuro’s office (on paper!!! 👎). Lots of data. Not a lot of information. I’ve also done the NARCOMS registry that whole time. That seems like much more useful information. Totally agree - it’s time to update what is collected. A simple self administered questionnaire would tell us both so much more. My neuro knows if I can touch my nose, but he doesn’t know since I started seeing him I can’t climb a flight of stairs, walking a city block is very hard, I’ve gotten divorced, moved, and changed careers 3 times, etc. etc. He knows he prescribed me certain meds - does he know my insurance won’t pay for some of them and I’ve bought supposedly equivalent meds from India just hoping what I’m taking is safe? Anyway - YES - please measure my ability to function and not only my reflexes. You are right on track. Teach the others!
I think it's a great idea to have more time with a neurologist to visit. Coming from the standpoint of being a tech (EEG) in a neuro department, if more responsibilities are being put on the MA's then potentially a raise should be suggested to the higher ups. Not necessarily much, but adequately enough in that their responsibilities would be increased.
I only state this as overtime EEG techs responsibilities have increased (as physicians used to be able to perform the tests as well as read them in the past but no longer know how to do them and some cannot read them) but the pay has not reflected their necessity in clinic or hospital settings as a national standard. It has only increased along with costs of living and such.
I only mention this because a lot of tech positions get a lot of extra responsibilities put on them and then either never see a reflection of this in pay or are under appreciated for what they do to help support their medical teams.
I know this all sounds like I'm being negative, I'm really not. Just giving feedback in something to consider even if it just adds the 10-15 mins extra to their day per patient.
Thank you for all you do. It's helped me get through this wait as I try to figure out what the heck is going on with my body.
Functional testing makes more sense to me for all the reasons stated.
Question of the day: Why would I even consider wanting old outdated and less efficient/less effective testing to help keep me healthy in an ever evolving world? Of course I'd want the functional. More effective, efficient, and allows more time for what is important, QUALITY face to face time in a clinical appointment. Addressing questions concerns and really working out the best options for me. If I'm on board, understand, and feel comfortable about my progress and treatment = better outcomes for my overall well being as your patient. I'm unlike anyone else and need different care. So let's really dissect me and my mind 😉🤣. This disease isn't cookie cutter. Its unique for every patient. So let's spend our best time on the best part of what makes me, ME.
Go Doc! Sharing
You are TRULY REMARKABLE!!! I want you to be my NEUROLOGIST!!!! I am in FL if i ever had money could i ever see you?!?!? My neuro is great but i have never had any of those tests!!!! I need those tests!!! I have BRAIN ATROPHY!!!! I lost my career... my quality of life is almost non-existent!!!!! Please HELP!!! Your channel is so life changing! THANK YOU!
Hey there. If you decide you want to see Doc B., and thus will be coming to Columbus, I will be happy to be your concierge, if you wish. I could pick you up at the airport or help with driving instructions, advice about where to stay, good places to get a meal, etc. I could show you right to the door of the office. I think as many ppl as possible should see Doc B. I'd be happy to help. :) I'm also experiencing brain atrophy. 89% of people have more functional brain tissue than I do, hence "MS in the 11th Percentile".
Functional Testing please ❣️😊👍
The testing you described, dr Bostor, sounds better to me than traditional neuroexam. It seems more accurate, more extensive, a reliable way to keep track of progression. Plus I like how I can conduct it myself or have an MA do it instead of wasting precious time of my appointment doing the chicken dance with my neurologist.
Overall: awesome sauce. (Thank you for that new addition to my dictionary)
Please can you provide some details of perhaps online consulting? Happy to pay
Yeah! I would like to do that first test, the one that couldn't be shown for copyright reasons.
Dude 35 years ago, post ACUTE!!! episode of MS, no Dx but already experiencing (L) problems, still climbing up to half Dome, plus driving 200 miles. Your saying, that a 25, step walking test, hand eye coordination test plus whatever would have provided sufficient information to make accurate prognoses. You know what I think.
Testing with the peg test is great, agreed. (Of course, I used to be an editor, so the name of the test in the video shown as 'teg test' just bugged me enough that I had to pipe up!)
I'd rather have both, although I know time constraints make that virtually impossible. My former neuro, who retired recently, would do a full neuro exam that would take 30-45 min every visit. The new neuro barely did any physical exam, but did a more questioning type of visit.
I like the testing on the iPad except for the contrast sensitivity part. The reason I don’t like it is such a pain to keep ones head in the range that it requires it take 15-20 minutes to do that part. I would rather have that part done by an actual person that the tablet.
I would love to have a functional test Because I do believe that it would show the progression I think the traditional testing does nothing and they rushed through it I wish I had a doctor like you supposedly I have the top doctor in Texas but I’m finding it hard to believe I wish I had you as a doctor!
Do you think an MS nurse who is responsible for coordinating care and wellbeing could also conduct some functional testing? It may assist in more regular screening, monitoring, and keeping in touch with the patient. Also, patient led functional testing with an MS nurse may indicate where additional care or support may be useful.
Functional test for sure!!! I am in south Africa and I feel that they are still in the dark ages here!!!
I hope other Neurologists listen!!
I would love to have a functional exam, especially the cognition seeing as of lately the brain fog has been so bad my thoughts feel like they run through gelatin. A word crossword game I frequently play has become confusing to me and I miss so many general elementary type words. I eventually get it but through a process of guessing by matching vowels to their traditional position within words.
I became so unhappy when my spouse was able to finish the whole crossword within two minutes when I had been trying to solve it for a better part of a combined half hour.
The other day when asking for the car keys to get the kids in the car I couldn't say it. At first I said key cars then as I struggled to correct myself it became a jumble of sounds. It was so embarrassing that it made me feel really angry. Wish even regular doctors would preform the functional test!
I have discovered something that seems that seems silly. When my bladder is full, or I have gas/constipation pains, my walking quality / speed plummets. I think I can explain why. If I am thinking "relax bladder" or "how can I move my torso to reduce this gas pain" I am not thinking "left foot - right foot". And the funny/cool thing is that it happens without me consciously realizing it. Now when I notice that my walking quality is dropping, going to the bathroom frequently improves things. Last time I was in clinic, I realized that I was walking extra slow, and asked to go to the restroom. My speed improved after emptying my bladder. (I did not think to ask how much, but it must have been significant if I noticed the difference.)
I hadn’t thought of it before, but now that you mention it ... you’re exactly right.
👍capturing the illusive neuro symptoms that are mostly missed 👍😇😇
Hi Aaron I was wondering if you could perhaps do a video expIaining about lesions (apologies of this has been covered and I have missed it) in particular the healing process for them in the brain & spine ..how they change, do they heal completely, scar? Do lesions in the brain differ greatly from spine lesions? Does placement make a different in both spine and brain? How does spine lesions effect a person sign ms etc?.
Are spine lesions worse than brain lesions?
Also could you perhaps explain to me what ‘intrinsic cord lesions’ are.
Sorry for the million questions, thank you for the great informative videos!
Rebecca
Great topic for a video! I'll add this to my list. TY Rebekah.
The functional exam sounds entirely more meaningful than the traditional one. I’ve had three traditional exams. The only thing I’ve learned is my reflexes are more aggressive than they should be. However my walking has slowed down a lot and I know this from the app I use to walk. My recent one mile walk was 26 minutes and I used to do a mile in 14 minutes at least. I’ve done 12 minutes before which isn’t the best but far better than 26!!! My 15 year old quasi nephew was walking with me to a store and said he couldn’t walk as slow as me if he tried and I thought I was HIKING 😪 Something is not quite right and I am super concerned. I haven’t even mentioned my memory issues here!!!!😦
Be our Moses, Aaron!
I think this is great, but I wonder how knowing the fine details of my functioning is any way impacts my treatment. I have PPMS and am on Ocrevus. It feels to me as there is nothing more anyone can do for me.
The only time I've ever had a thorough functional exam, was during a clinical trial. My doctor does the typical neurological exam + timed walking test. I think the functional exam would give a more accurate representation of my MS. Now, how do we get our doctors to do it?
I got one would prefer the functional testing. I think it gives the Neuro a more accurate picture of what’s going on physically with a patient.
I have take the Cognitive Function test. It was a couple of years and I didn’t do to well. I may talk to my MS Specialist in a couple of weeks about repeating the test.