When he began his career as a neurologist specializing in multiple sclerosis, Robert Shin, MD, remembers seeing waiting rooms full of patients with wheelchairs and walkers.
Now the view is vastly different. MS treatment has advanced by leaps and bounds in the past three decades. Three classes of daily modifying therapies (DMTs) came on the scene. Patients are benefitting from these medicines and a better understanding of MS — and more are delaying or avoiding disability completely.
Shin, director of UVA Health’s MS and Clinical Neuroimmunology Division, focuses his practice specifically on MS and neuro-ophthalmology. That allows him to stay abreast of the latest research and treatment guidelines for MS, which continue to change rapidly.
In this Q&A, Shin shares the key points every provider needs to know to identify and help their patients with MS.
How has MS treatment changed in your time as a specialist?
It has been exciting to see and be a part of dramatic advances in early detection and increasingly effective treatment of MS and other related disorders. When I was in medical school, MS was an untreatable, often devastating, diagnosis. Today, when diagnosed correctly and effectively treated, MS can be a very manageable condition.
What do you wish more healthcare providers knew about MS?
We no longer believe in the “wait and see” approach to MS in mild cases. The earlier someone living with MS gets an effective MS treatment, the better they will do in the long run, even when they seem to have mild to no symptoms at first.
Which patients are more likely to have MS?
For a long time, we used to describe MS as primarily affecting women of Northern European ancestry — it turns out that this isn’t true!
We now realize that MS can affect almost anyone: men or women, older or younger, of any race or ethnicity. We have some work to do to undo the bias that can lead to a delay in MS diagnosis.
How can providers help their patients with early detection and diagnosis?
"Think MS" — meaning consider the possibility of MS early on for anyone who complains of visual issues, dizziness, weakness or numbness of the arms or legs — regardless of gender, age, or race. Those individuals might benefit from referral to a neurologist or MRI of the brain or spinal cord.
When should providers refer their patient to your program?
Any time there is a question about whether or not someone has MS or if there are any questions about how to best treat someone’s MS, we would be happy to help!
We have an entire team focused on our patients, including our adult and pediatric neurology physicians, nurse practitioners, nurse coordinators, pharmacologists, physical and occupational therapists, and social workers. We work together every day to try to optimize care for anyone living with MS or other related disorders.
What’s your approach to working with referring providers?
It is greatly appreciated when referring providers share their medical records or previous imaging and laboratory test results. In return, we will do our best to communicate back to the referring provider and to set up a partnership to help care for our mutual patients.