Hello, friends! This is a great interview with Dr. Meghan Beier, a rehabilitation neuropsychologist based in the department of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. Megan specializes in Multiple Sclerosis (MS) and particularly focuses on mental health and thinking skills within the population of people living with MS. We talk about MS, chronic illness in general, and how this can impact your mental health and thinking abilities, as well as what you can do to help.
Introducing Dr. Meghan Beier
Dr. Meghan Beier is a rehabilitation neuropsychologist and assistant professor at the Johns Hopkins University School of Medicine who specializes in Multiple Sclerosis (MS). Meghan opens by talking a bit about her work as a rehabilitation neuropsychologist, what that involves and what a typical day might look like.
A rehabilitation psychologist is a psychologist who focuses on people living with chronic illness or an acute or longterm disability. A neuropsychologist works with people who have concerns about their thinking skills, including aspects such as attention, concentration and memory, and their emotions, including mood changes, anxiety, and depression. Combining the two, Meghan explains that she works with people with chronic illness or acute and chronic disabilities who have concerns about their thinking skills and emotions.
Meghan talks about her journey to the position she holds today and tells us how she always had an interest in health populations as well as in psychology and behavior. She completed an undergraduate degree in psychology before taking some time off to figure out what she wanted to do. During this time she got a job as a direct care worker at a residential facility for people living with traumatic brain injury. This is where she became deeply interested in neurological illness and the struggles which often accompany this. Therefore, Meghan decided to undertake a psychology doctoral program that focused on health populations. In her second year, she worked in an MS center which is when she realized that this was what she wanted to specialize in. Meghan explains a primary reason for this was because the field of MS is decades behind many other populations in terms of knowledge about mental health and thinking skills and so she wanted to make a difference and help change that. We talk about how Meghan’s career journey is a great example of how you don’t need to know an exact endpoint to your education or career – it can develop over time and sometimes you need that time and experience to find what you’re interested in.
These little opportunities pop up in our lives and we try them out and if they work, great, and if not then we move in a different direction and our path takes us somewhere.
What is Multiple Sclerosis?
Meghan explains that MS is a chronic, neurologic condition, meaning that it impacts the brain and spinal cord. It is the most common cause of disability in young people outside of traumatic injury. It’s not clear why, but with MS, your immune system activates and attacks the myelin sheath (protective covering) around the nerves which are in our brain and spinal cord. This impacts how well the brain and spinal cord are able to send information around the body. This can not only cause difficulties in walking, coordination and balance, but also in our sensations (pain, numbness, tingling), energy levels, mood and thinking skills. In reality, anything that the brain impacts can be affected by MS. Meghan explains how MS can be very difficult to diagnose and each person is very unique – symptoms are extremely variable and can range from complete loss of motor function to something as small as a tingling sensation in your fingers. We talk about how difficult this makes diagnosing MS and also how many people are wrongly told that their symptoms are caused by anxiety and depression.
We talk about the diagnostic process of MS and Meghan explains how there is no single test that can tell you whether you have MS or not. It’s a process of collecting different pieces of information and test results together, while also eliminating other possible causes. Usually, an MRI scan is required which can show the lesions in the brain, as well as blood tests and spinal tests, all of which are used to make an informed diagnosis. We talk about this more and also how it can often be mistaken for Parkinson’s disease and other rheumatoid issues, as well as Lymes disease. It can be a difficult road to navigate. Meghan shares some advice to bear in mind if you’re worried about MS. Typically, the neurological symptom that you may be experiencing (e.g. tingling in a limb) stays around for at least 48 hours and often progressively worsens over the course of several days/weeks. If you have the onset of a symptom and it sticks around for 48 hours or longer Meghan recommends that you get it checked out.
We talk more about the symptoms of MS and Meghan explains how these vary and can also come and go over time. She talks about the differences between a ‘true exacerbation’ (the onset of a new or worsening symptom that lasts for 48 hours or more, where active lesions can be seen on an MRI of the brain ) and a ‘pseudo exacerbation’. Pseudo exacerbations are no less real but don’t result from active lesions on the brain. Instead, they often occur when your body is under stress (e.g. intense heat, fighting an infection) which overly impacts the central nervous system resulting in the reoccurrence of symptoms that they have had before. Meghan gives a great example in the form of a metaphor involving electricity to help understand the complexity around MS. Meghan talks about the onset of MS and how it is most commonly diagnosed in people aged between 20 and 50. It is less common in kids and older adults but presents in a very similar way in these instances. Meghan describes how kids tend to have a worse outcome as it can interfere with the typical course of development.
Multiple Sclerosis and emotions
Moving on, we talk about the role MS may play in determining mental health. For some time it was thought that depression and anxiety occur as secondary symptoms brought about by the simple fact of dealing with the condition and how those limitations can impact your wellbeing. However, Meghan explains how it may not be so straightforward. New research is indicating that mental health issues may be directly caused by MS – studies are demonstrating that increased inflammation in the brain and spinal cord tends to result in either a new onset of anxiety or depression symptoms or changes in the symptoms when already present. Currently, a colleague of Meghan’s is undertaking a new study to examine a type of medication that blocks inflammation to see whether it has an impact on depression in people with MS. So, Meghan explains how it’s probably a two-fold factor where there is something happening physiologically which triggers these symptoms, and then concurrently you are dealing with the reality of MS impacting your life and it sucks!
Meghan explains how the presence of MS makes little difference in how she would approach mental health issues, but given the physiological causes, it does give her the opportunity to open the conversation by letting the patients know that some of this is due to the MS and not just how they’ve managed it. Meghan talks about how no matter what the illness, unfortunately, there is still a stigma attached to anxiety and other mental illnesses where many feel they are ‘weak’ or ‘not good enough’ and that if they had more will power then they could have overcome the symptoms on their own. So with MS, it can provide a solid first stepping stone to be able to stand back and say that actually there are physiologic reasons why you may be having these symptoms. It provides the opportunity to externalize the anxiety and makes it apart of the greater medical issue that you have to tackle.
Fear of isolation: Next, we talk about the fear of isolation that may be caused by having MS. We chat about this in detail and Meghan describes how this is a common worry that people with MS have, especially when one of the primary symptoms is fatigue which leaves you unable to do many of the activities or jobs you may have done in the past. Meghan talks about how she would approach this to help individuals not to become isolated. First, it’s important to take a look at the reason why somebody may be more isolated or isn’t going out as much as they used to – this could be a physical disability, fatigue, or even low mood – and then trying to work out a plan to help combat this by looking at what resources are available in the community and online to help you stay connected. There are lots of organizations and a number of online support groups to help with this. Meghan talks about the peer connections program currently run by the MS Society which pairs you with a support friend who you can call upon in moments of need. There are also in-person support groups for individuals with MS that you can attend and can help keep you connected.
Finding a mental health provider
Meghan offers her advice on what to look out for if you are searching for a mental health provider to help. She describes how it’s really helpful if you can find a provider who has some experience with health – not necessarily with MS, but with health populations and chronic illness – as this knowledge can help distinguish between the symptoms caused by a health condition and those caused by the mental health issue itself (e.g fatigue caused by MS vs. fatigue caused by depression). Meghan recommends looking for a health psychologist or a rehabilitation psychologist, both of which work with chronic medical conditions, or a neuropsychologist who provides therapy as they will often have a deeper level of knowledge and understanding when it comes to neurological conditions. Specifically for MS, you can find help and resources on the MS Society’s website, as in general you can also look for a specific therapist using resources online such as HelpPRO.
For those experiencing MS or another chronic illness who are not yet ready to seek out help from a mental health provider and may be feeling defeated, Meghan offers advice. Take some time to do an internet search for other people who have the same condition and look at how they are talking about it and dealing with it – search out complete stories of people who are living with MS that talks about what that’s like for them, how they go about their daily lives, how it impacts them and what they do to overcome some of the barriers they face. Hearing advice and knowledge from people who are in a similar position to you can be more meaningful and more helpful, even than when this information is received from a health professional. We talk about this in detail and how the variability of MS means that you’ve probably met multiple people with MS but don’t realize given the variability in symptoms and the way people overcome the barriers which they face – Meghan shares an inspirational story about an individual with MS who needs to use a motorized wheelchair and yet still runs a gym designed to help others with MS, where he is a trainer! We talk about different classes that are becoming more accessible around the country and are specifically designed for people with MS, including boxing and dance classes.
With respect to looking out for people putting out content and advice regarding MS, Meghan recommends a podcast called RealTalk MS – a podcast hosted by the husband of Jeanne, a woman who was diagnosed with secondary progressive MS in 1997. On the show, Jon breaks down the latest multiple sclerosis news and also chats with individuals who have MS and experts in the field. Also, Meghan shares the organization Can Do Multiple Sclerosis who also produce a podcast specifically for MS, as well as This Is Not What I Ordered, a more general podcast produced for people living with chronic illness, along with work by Jack Osbourne, who was diagnosed with Multiple Sclerosis when he was 26.
Brain fog and Multiple Sclerosis
Moving on, we talk about brain fog, what that means and chat about strategies to help with this. Meghan highlights how the most common cognitive symptoms experienced with MS is slowed information processing speed, also known as brain fog or cognitive fog, meaning the brain is processing information at a slower speed than it used to. This doesn’t mean it’s impaired, just that it takes longer to process the information you are taking in. Meghan explains this isn’t always due to a change in cognitive processing speed, but can also be caused by cognitive fatigue, where your brain becomes more and more tired throughout the day and so information becomes harder to process. We talk about this in detail and Meghan provides some practical examples as well as some strategies to help combat this.
In terms of dealing with fatigue, Meghan recommends taking short breaks throughout the day to allow you to recuperate and recharge. From a true cognitive perspective where lesions in the brain are directly impacting thinking skills, Meghan explains that there are a number of things that can be done. Research is demonstrating that cognitive rehabilitation (i.e. physical therapy for your brain) is something that is really helping individuals with MS improve their cognitive and thinking skills. The more you practice a skill the more connections you’re going to form and so the easier that skill is going to become. Therapists will help you work on developing these skills specific to your needs, as well as compensatory skills to help overcome barriers. We talk about this in detail and Meghan explains the differences between cognitive rehabilitation and brain training apps such as Lumosity. As well as having more objective data behind it, cognitive rehabilitation is tailored to an individual’s specific needs meaning it is a unique program created for each individual. However, research indicates that brain training applications such as BrainHQ can help improve cognitive functioning in people with MS and although you may not see the same gains as individually tailored therapy, it is a good option for those who may be unable to attend professional cognitive rehabilitation.
Final thoughts with Dr. Meghan Beier
To close, Meghan offers some advice for those who may be struggling with MS, are in the early stages or may suspect they have MS but feel like they are not being taken seriously by their doctor or primary care provider.
I always recommend second opinions…and I even say that about people who see me.
Meghan explains how she feels that if you have seen your doctor or care provide two to three times, at most, and you don’t feel it’s working or you’re not seeing any hope that it’s going to be helpful, then it’s time to see somebody else and get a second opinion. In Meghan’s experience, this will often help provide answers to the questions an individual has.
With that, I’d like to thank Dr. Meghan Beier for coming on the show and sharing her expertise with us – It’s been super interesting and I have no doubt that there will be many listeners who will find this helpful! If you’d like to find out more about Meghan’s work, as well as further resources on MS, you can head to her website meghanbeier.com. You can also connect with Meghan on Twitter @MeghanBeierPhD and find out more about her work and research at the John Hopkins School of Medicine right here.
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