Aaron Boster

And you think about the most common symptoms in MS.

I think about the up there's, so energy, mood, thinking, and memory, they're all invisible.

The leading cause of loss of work in MS is not loss of leg function, it's loss of ability to concentrate and stay awake.

Or you think about the down there's, bowel, bladder, bedroom, those are invisible symptoms to the outside observer, and they're devastating in many respects.

And so you're spot on.

I try sometimes to give an example to a well-intended spouse who might say something like, well, I'm tired too.

So two nights of no sleep.

Then the next morning, we're going to go for a walk and talk about fatigue.

It's that kind of fatigue where the human being is desperately trying to keep their eyes open.

They're trying to make eye contact and they're desperately trying to take the information in.

You know, I'm going to date myself, but when I was in medical training, we didn't have duty hours.

So you stayed until the work was done.

And I remember 36, 40 hours into working thinking,

You know, there'd be a long hallway in the hospital and I would close my eyes while I was walking just to take a break, you know, and just hope I didn't smack into a wall.

And it's that kind of, I call it pathologic fatigue that many people with MS struggle with, you know, and then their spouse or their loved ones say, well, you don't look tired.

So you don't look ill informed.

Yeah.

You touched on so many really important things.

There is a prodrome before MS, a prodrome defined as vague symptoms prior to a diagnosis.

And when you look at claims data where people who later on get MS and you go backwards three to five years, you'll see a massive uptick in prescriptions, a massive uptick in ER visits, hospitalizations, and doctor visits.