S2E11 In conversation with Caroline Clarke

Geoff Allix  00:00 

Hi everyone, Geoff Allix here, your host of the Living Well with MS podcast. To all our listeners, I hope you and your families are staying safe and healthy during this COVID-19 crisis. While social distancing and other restrictions may seem like a drag in the long run, it will prove critical to stemming the tide of this epidemic and returning to a sense of normality. I have faith we will come out of this stronger, smarter and a bit more enlightened as a result. In the meantime, we at Overcoming MS and the whole team behind this podcast are here for you to keep you informed and help you keep on track with your personal journey to a healthier you. Now on with the show. Today’s episode is a personal and professional perspective on OMS. For this episode, I’d like to welcome Caroline Clarke, the Chief Executive of the Royal Free London NHS Foundation Trust. Caroline has been the Royal Free London NHS Foundation Trust Chief Finance Officer since 2011 and in 2012, she was named Finance Director of the Year by the Healthcare Financial Management Association. She was appointed the trust Deputy Chief Executive in 2012, and Chief Executive in 2019. Caroline is a trustee of Overcoming MS. So welcome Caroline to the podcast and I’d like to start out by asking you why as someone who’s heavily involved in the NHS, you chose to follow OMS and really just about your MS journey. 

 
 

Caroline Clarke  01:33 

Okay, so I was diagnosed with something called Transverse Myelitis I think probably 1997 when I was working at a hospital in the East End, and I can remember I fell off my motorbike and I remember thinking something’s wrong with my leg and I went to A&E and of course, it was my mates who were doctors and they said, well, we probably need to just run a few tests on you and nobody was really explicit about what was going on and it was kind of when I was given an MRI and they wanted to look at my head when I thought I’d slipped a disc in my back. But I realised something was a bit strange and then they sent a senior neurologist, and the neurologist explained that I had a lesion, one lesion and if it was only one it was called Transverse Myelitis. And then I sort of read loads about it and you know that thing, when you read what you want to see. So I sort of read that there was a kind of conversion rate into MS, but that it was tiny, tiny, tiny, and I think I probably transpose the numbers, unfortunate, because I’m an accountant. So anyway, so that was 2007 and then and I was quite poorly and I couldn’t walk for a while and it took me about a year to recover properly, but I got better and carried on working. And then I think in about 2015 I remember the same creeping, people call it the MS hug thing you get around your stomach. And that happened and remember, it was Wednesday morning and I was working in my current organisation at the Royal Free in North London, and I just thought, “Oh God, I know what that feeling is” and I suddenly thought I think I got a horrible feeling, I think this might be MS. So I hadn’t thought about it, I’d had to kind of you know, six or seven pretty good years and I just always thought I had this weird neurological thing, and it was called weird neurological thing. And then I went into work, I saw my medical director who referred me to a neurologist and really, really quickly, unlike lots of people, I had a diagnosis and I had a bunch of lesions on my sort of neck, quite high up and it’s really, really knocked my arms and hands out and I had the stuff, so it was all upper body. And so I was able to walk and then quite quickly, one of my colleagues said, you need to go and see Gavin Giovannoni, who’s at Barts. So quite quickly, I got kind of medicated, but at the same time, one of my colleagues and I was quite open at work, I just thought I’ve got to make a decision about whether I’m going to tell people and it’s a bit like coming out so I’m gay I came out, well every day I have to come out to people, because you sort of have to do the explanation about where your husband isn’t and all that stuff. And so I sort of took a decision is a bit like that. So I kind of just, I’m gonna come out to everybody and one of my colleagues gave me the OMS book and just said you need to read this and she’s a woman that has an underlying health condition herself, but knows Linda Bloom brilliantly. And so this connection happened. And I read it and I’ve been I like most people I’ve done the thing I trolled the internet, I’d gone through a period of eating organ meats, you know, what’s that diet? Is it the Wahls diet? Oh, this feels really peculiar and not quite right. Although there’s some of the science, you know, I work in the health service, and I’m quite interested in science. So I sort of quite like that. But then I read, I read George’s stuff, and it blew me away and I was like, this just makes perfect sense. And it made perfect sense, partly because I kind of, you know, my partner’s an acupuncturist, I live a relatively healthy diet, I’m 51 years old, so I’m coming middle age, and there’s a middle aged wake up call isn’t. And, then the science behind it and the fact that there are these different facets of the OMS program really appealed to me, I’m not the most disciplined person in the world. So, you know, that’s something I’ve always struggled with the most is this compliance aspect. But no one’s telling you to do it, you’re doing it for you, that’s the point. And so I started doing that. And then I really lucky to be introduced to Linda and Tony and the sort of OMS gang, and just thought they were the most amazing people. I’m conscious of it and I think I’m flattering them and I’m not, they’re amazing, you know, I think what they’ve done is brilliant. I think Linda’s journey is inspirational and something about that really, really got me but I kind of I would I was, you know, I’d made the decision to follow it, because I felt like it would make me stay strong and well, and thus far it has. 

 
 

Geoff Allix  06:36 

And what do your colleagues in the NHS think about it? Do they think, “Oh, this is like, complete alternative, sort of new world stuff?” Or is it sort of generally respected? And you think, Oh, actually, you’re doing the best you can?  

 
 

Caroline Clarke  06:56 

You know, so it’s really interesting, isn’t it? The NHS is made up of really different people and doctors are, there’s a broad church of people who are doctors and most doctors, all doctors want you to follow a healthy lifestyle, right. So there are aspects of the OMS program, which are just so uncontentious, and you know, I don’t see how anybody can really you know I don’t really see how anybody can say anything negative, about OMS, beecause I just think it’s so good and so sensible. But where people hold back a bit more, are a bit more reticent is I think they just don’t see that there’s more science that’s needed. And I suppose what I’d urge the MS community and a scientific MS community to do more is just do some more research on it, do some more research on the different facets, do some more research on the diet, because that would really help. And I think, but I think, you know, generally sort of most of my colleagues just, this is what I do. It’s not, you know, and I don’t always get it, right. But I’m, you know, they know that I practice mindfulness, I’m very open about that. And in fact, it’s opened up some brilliant opportunities for me, so during the COVID crisis, which we’re in now, we’ve put together a very big health and wellbeing program for our staff, because they’re having to do things in their daily lives that they don’t normally do, it’s much, much more stressful, and they’re working really hard. So we put in a bunch of psychological support programs, and mindfulness programs and yoga and all this stuff. And being able to talk about it from a position of knowledge and practice actually really helped. So I think there is, you know, it’s opened up loads of avenues for me, and I sort of really, I’m really glad that I’m doing it. 

 
 

Geoff Allix  08:55 

And so you’ve obviously got very high pressure and high profile job. Now a lot of people with MS end up taking early retirement, they physically might not be able to and mentally sometimes. So most people will find that stressful situations probably exacerbate their symptoms. So how does having a high profile job or high pressure job affect your MS and how do you deal with that and how is there a tip for people to deal with pressures at work? 

 
 

Caroline Clarke  09:28 

Yeah, so good question. So the first thing I should say is that my symptoms at the moment; touch wood, are relatively gentle so I can’t write, my hands are really affected and my kind of arms, it’s in my upper body, but I can walk and run to a certain extent, not much, but a bit so I feel pretty physically able so therefore you’re constantly have to come out to people it’s that kind of hidden thing, isn’t it? In which lots of people will experience all the time. My symptoms get worse with stress for sure and my team all notice. So I have a feeling when I fiddling with my hands because I can’t feel the and I want to make sure they’re still there and my team know that and it’s like one of those signals. And they’re kind of, if there’s a big conversation, and Caroline’s fiddling with the hands, I’m trying to learn to sit on my hands and of course, during the COVID epidemic, pandemic, there’s all this stuff about touching your face, so I’m really trying not to be so moving around with my hands. So I am not a particularly high stress individual, that’s the first thing to say as well, like I just have have always been to a relatively, I found it relatively easy to pull myself back from a situation, take a deep breath and now having practiced mindfulness for a number of years, that’s helped. And, I’m quite disciplined about taking holidays, and having weekends and having timeout, that’s really important. I have a 10 year old daughter, who, who makes it all worthwhile, and you know that, stuff and have a lovely partner who’s very supportive. And so you know, all those things make it easier to take time out and as soon as you walk in the door, you have to stop worrying about work. I have to say, I’ve been rubbish at that recently, the last few weeks, I think it’s kind of, I would say that I’m not living my usual life, but I will get back to it. And so I think that, you know, managing stress in MS is probably the most important thing that I can do. And the way I got into mindfulness was really helpful actually, some people kind of get in through apps or whatever, I did an eight week course and that was probably the single biggest intervention I’ve made over the last 10 years, it’s really made a difference. Because it means that I have a practice, and that it’s not, you know, I don’t spend an hour every morning doing it, I practice throughout the day at different periods and it just really helps. And you know, in a really stressful meeting where I don’t know, we were discussing oxygen levels in the hospital, and then we got an oxygen, actually, breathing and taking a step back and observing what’s going on is really, really helpful technique. So out of everything I’ve done, actually, you know, along with a diet and exercise, mindfulness is really, really helpful practice. 

 
 

Geoff Allix  12:38 

So actually, if you so if you’re feeling at all stressed, you do a sort of like, micro… 

 
 

Caroline Clarke  12:43 

Micro session. Yeah. In fact, sometimes I just go to the toilet, and do it, I just do you know, there’s something about just getting away. I’ve even, you know, so little things in life, so someone bought me an Apple Watch for my 50th and that’s got a little breathe, it tells you to breathe and even that’s quite helpful. You know,  I think the thing you learn when you practice mindfulness is to be kind to yourself and give yourself a break, you need some discipline and some practice, and you’ve got to keep doing it. It’s like anything, isn’t it? 10,000 hours of practice makes you better. But um, but you know, you can do it at weird times of the day, and all that stuff. And the other thing that really helps, of course, is sleep. So I have really noticed my sleep patterns, ebb and flows, so they really changed after I had Lemtrada. So that, I don’t know what happened there, but they kind of just did for them slightly and then they came back and then recently I’ve been a bit agitated in sleep, which I think that’s a decent response to the COVID pandemic, you know, kind of I’m not anxious then who am I, but I am so much better when I sleep. So really sleeping properly, not eating big meals at night, not drinking too much and all that stuff, really sensible advice, the things we learn in middle age, and all that stuff. Annoyingly true. 

 
 

Geoff Allix  14:07 

Yeah, there was something Craig Hassed said, who does a lot of the mindfulness stuff for OMS. He said about that, it’s good to do a mindfulness session every day, is great. But actually to throw in sort of mini mindfulness sessions as well and just say, you can do a minute here and just to sort of reset yourself, it’s a useful technique and if you just want wandering somewhere, then you can do that mindfully. You can make a cup of coffee mindfully. 

 
 

Caroline Clarke  14:35 

Yeah, live your life mindfully. I think that’s absolutely right. If I mean, I would say I probably have 10 at least such mindful incidents in a day, but I mean, it just is how I am and the escaping to the loo thing doesn’t happen quite so often, but I do you know, I do take time and I do kind of go for a little strolls around. And so I work in across three hospital sites in North London, and it’s perfectly easy to walk out of hospital and walk around it or in Hampstead to walk on to Hampstead Heath or, you know, find some space where there aren’t other people and just breathe. And that’s quite that’s, you know, that’s a thing everybody can do. They can get out, they can get out, I think, well, actually, that’s not true, so it’s quite interesting, isn’t it in these COVID times you realise not everybody has a balcony or an outside space, not everybody has a garden, so some people do have to work harder than that. 

 
 

Geoff Allix  15:35 

Yeah, no, I’ve I’ve realised we moved 16 years ago, from Central London, to North Devon, which, and this goes out around the world. So that’s a very rural area to go from very, very built up area. And we had a shared front door so no outside space, shared front door, it is very easy, very different and now I have a garden and I can actually stay on my property and do some exercise and yet it is it is difficult, isn’t it? We’ll come back to COVID-19 in a minute, but I realise you’re not a medical doctor, but do you have any advice for people with MS? Because obviously, you are very, very connected with the health service and obviously, your neurologist is Gavin Giovannoni, who’s top specialist so you do have a lot of exposure to this information and know Linda and Tony Bloom as well. So do you have any advice for people who have MS in general terms to start off with? 

 
 

Caroline Clarke  16:50 

Generally? Well, I mean, I suppose you know, you can only talk about the things that have helped you and the stuff you’ve read. And I think re-reading George’s book actually helps me I’ve probably read it about four or five times now. So there’s something familiar, and it’s because there’s nuggets in there and so that’s always, you know, if you can be bothered to read a book, but you know, or just, you know, having a look at the website. I’m not a particular disciplined person, so I’m constantly needing kind of sources of kind of re-inspiration and things, so, you know, if we’re thinking about diet, I’m always after kind of new things to cook and make and all that stuff. And, you know, like I hate oily fish like that, It’s really disappointing, but I hate sardines. So that’s, you know, where do you eat protein from and I tell you what, in the last few weeks, I’ve eaten more lentils than you can shake a stick at. But you know, so there’s something for me around sort of re-inspiring oneself. I think there’s a real thing at the moment about I know, it’s been really sunny, but if people are in lockdown, they haven’t been out as well think about Vitamin D isn’t there? So making sure you keep all that up and keeping exercising if you’re locked down that’s quite hard. I’ve personally found it really difficult to exercise recently because I’ve been so time pressured. I cycle everywhere and that’s kind of how I get my base exercise. But I’ve sort of been promising myself to return to normal exercise. I have say I think I’ve had COVID-19, I had it quite early on and I was quite poorly for a couple of weeks and I haven’t been for a run since because I haven’t wanted to test my lungs and it’s a nasty illness. And so I kind of, but I think you just you need to you know the exercise we know that our muscles waste if we don’t exercise right so you know people who are listening to this who are in completely different situation to me will know that more than I do. But you know, there’s something about where you can take your moments to exercise in any way you can, I guess.  

 
 

Geoff Allix  19:14 

I mean, on a personal basis I do I found because I used to do lots of exercise. So I went from I ran a marathon, thats probably getting 10 years ago now, rock climb, surf, mountain bike, snowboard everything and I never really, doing a mountain out to train for but the other things, I didn’t really train specifically I just went out and did stuff and it was always fit and active. And now if I don’t do anything for a few weeks, my fitness levels drastically drop really quickly, and I don’t know if that I mean, it’s certainly a sign that sort of an MS specific thing that you think? 

 
 

Caroline Clarke  20:01 

It’s general Geoff, I think it’s if we don’t, so we see this in hospitals, right. So you know, people say that kind of, if someone comes into a hospital bed, we just want to get them up and about as quickly as possible. In fact, the worst thing you can do if you’re ill is just, lie down in some senses. But you know, particularly older people and frailer people, once, you start lying down, you lose muscle mass, and it’s much, much harder to get up. So I think that’s for all, it’s going to be particularly for people who’ve got less ability and have more impact of MS.  

 
 

Geoff Allix  20:41 

It does seem that actually a lot of the things that we’re doing in OMS are becoming more mainstream anyway, not for people with MS, they are now. So exercise; yes. Eat healthy; Yes. They are now saying, in the UK, they’ve just recently said you need to take Vitamin D, because that might help you with COVID-19 and about a year ago, they are saying everyone’s probably deficient of Vitamin D, and particularly with COVID-19 we think that might help. So a lot of the things that we’re doing are starting to become mainstream, not even for people with MS, they are just saying everyone needs to do this stuffcar. 

 
 

Caroline Clarke  21:22 

Well, I hope so. That’s what I meant. When I said before, I really hope the, the research MS community does more into particularly aspects of our program that haven’t been so researched. So more on diet and low fat diet, I think will be really helpful. 

 
 

Geoff Allix  21:40 

And so the other thing I wanted to ask about, so this recording is being done at the height of the COVID 19 pandemic, certainly in the UK. And if you’re managing a healthcare trust, I just wanted to ask specifically, is there any advice for people with MS at this time, with with COVID-19? 

 
 

Caroline Clarke  22:02 

Yeah, so I caveat, everything by saying that I’m an economist and an accountants, I’m not medically qualified. So I can only talk about what I know, and what I’ve read and what people have told me. So I think I’ve had, I’ve had the disease, and I have antibodies to it, because I’ve had a test and although people tell me the tests aren’t as accurate as they could be, but I’d like to think it’s my immune system, giving me some payback. So it’s so good, it’s attacking my myelin sheath, and it’s making antibodies. So and it’s nasty, and it made my symptoms worse so it made the neurological damage that I have in my ability to use my hands, always gets worse when I have a cold or a fever. And it was exactly the same with with COVID, so that’s, that’s one thing. I had it relatively mildly, and it was unpleasant, so that’s another thing to say and of course, my hospitals are treating hundreds, possibly 1000s of people now who are very, very ill, and quite quickly get into very severe breathing difficulties. That didn’t happen to me. So the things that I know are, of course, if you’re immunosuppressed, it’s a really horrible thing to get. And we’re seeing more patients in our hospitals who have a compromised immune system. So for us, that will be lots of people on medication, I guess, were the medication works in a way that suppresses your immune system. I’ve had Lemtrada and I know that I would not, I didn’t want to go near anybody with a cold after taking Lemtrada and so the same rules apply. As you just said, Geoff, we’re all being encouraged to take Vitamin D and I don’t know the science behind that but I do understand science behind the sunlight, Vitamin D connection. So people who are in lock down and not outside as much, then it seems quite obvious that they should take Vitamin D and I’ve upped my dose. And in fact, here in London, we’ve got our first rainy day for about three weeks, It’s quite weird. I think the same the same issues around making sure you take exercise and making sure you keep fit and healthy. I mean, it’s kind of you know, it’s the the same rules. The difficulty with COVID-19 is we don’t really understand the disease, it seems to progress in a way that we’re not familiar with and can attack. People go into multi organ failure more quickly and in an unexpected way. So because it’s quite a new disease, my medical colleagues are still trying to work out you know, the best way of treating people. There are loads of clinical trials going on in the UK now, we’ve got a vaccine trial that’s just started trials in humans. So you know, one would hope within a year to 18 months there will be a vaccine, but that’s a year to 18 months away and that’s an optimistic view. One would hope that the clinical trials of actually treating the disease will result in a treatment relatively quickly. But again, clinical trials can take a long time, because the results need to come through and you need enough patients to have tested them in, you know, testing new drugs in to be sure that they’re going to do the right thing. And, of course, testing people in the UK, we’ve been quite slow to test people. Whereas in other countries, actually, you know, testing out in the community is prevalent. And we see, we see that making a real difference to keeping the COVID numbers down. So I think for our MS community and the OMS community I’d stick to the program. If your immune system is compromised, just take extra care and in the UK, in the next two weeks,  we know the government’s thinking about the policy of physical social distancing and we know that there’ll be some more guidance coming out and I think I think for our community, we just need to be super careful, take extra care and there’ll be people listening to this, who are probably on the list of what they call shielded people in the UK, where people are having to take special care. 

  

Geoff Allix  26:27 

I got my letter, just last week, and but we’d already decided to, essentially shield anyway. So you know, I do live in a rural area. So I do walk my dog, but I don’t see anyone when I walk my dog just go directly to fields and literally, I don’t have physical contact with anyone at all.  So it does seem to be inconsistent. I mean, I got my letter, somewhat unexpectedly, because my MS nurse didn’t think I would and I’ve had it and I’ve had Lemtrada as well and I thought it might be because of that, but it just says the reason on it is because I have Multiple Sclerosis. So some people are getting the letters to say and I mean, this in the UK, some people will be familiar in the UK with the shielding term. But essentially, what they’re saying is people who are sent these letters should stay in their own property and to the extent that they will actually even send you food deliveries, and you should stay in your own property for 12 weeks. So do you think does it make sense for people with, you know, with MS whether they’ve had a letter or not to say they should, does it make sense to to isolate themselves as much as they practically can? 

 
 Caroline Clarke  27:48 

Oh, I don’t know. I think it’s really difficult, because I think the shielding guidance has been really inconsistent and it’s followed different local authorities are doing it differently. The advice that I’ve had personally from clinicians has been I’m okay and I’ve asked a neurologist, an immunologist, and I asked about four different people because I was concerned. Remember, I took Lemtrada, the last dose was four years ago, and my immune system and I get tested, you probably have the same thing Geoff, do you have monthly blood and urine tests to check everything’s okay? So I’m pretty confident about my immune system. And I feel okay, I’m not taking any undue risks in my job. So I’m,trying to provide visible leadership to my teams, over the phone and over the iPad and then I do go and visit the hospitals and see people, but I’m appropriately you know, two meters away and where it’s appropriate, I’ll wear a mask if I’m in a patient area, so the shielded things very difficult, isn’t it?  I don’t really, you know, I think if someone had sent me that letter, I would feel quite uncomfortable, but I’m at a different cycle to my treatment to you and I’ve had some different clinical advice. And this is the nature of all these illnesses, isn’t it? We don’t know 100% what’s going on. But if you feel your immune system is compromised in any way, then that’s, you know, then I guess you follow the advice.  

  

Geoff Allix  29:28 

So maybe so be careful, but no, not be overly concerned.  

 
 Caroline Clarke  29:35 

If you’re in my position where I know I’m not immunocompromised, I know my immune system is okay. Then I think I’m just like everybody else. So I think and I think I’ve had COVID and my partner’s had COVID I think I had it slightly, I was slightly more effected/she was braver than I was. But I’m OK, you know, so, It’s very difficult to give advice in these situations, isn’t it? It’s a new disease, so it’s really difficult and when you have new diseases, people are super cautious, you know, I think I would feel very differently if this if this was 2017 and I was, I was like, you know, kind of months after my second lot of Lemtrada and possibly thinking I might have to have a third, then I’d be thinking really differently to how I do now.  

 
 

Geoff Allix  30:25 

So best to speak to your new neurologist about that. 

 
 

Caroline Clarke  30:32 

Yeah, that’s quite interesting, isn’t it, I wonder if people listening to this, there may be people listening, thinking I’ve had my treatment delayed because of the pandemic, I think in my organisation, if you were, if you were do some treatment, you would still have it. But I don’t know that and of course, if you, one of the things we’re thinking about in English NHS is how you restart services, in a way that protects people who haven’t got COVID, and how you test them and stuff. So it is likely that if you’re waiting for treatment, you’re going to have to have a COVID test to make sure that you’re good. And, you know, there’s a whole there’s a whole bunch of things that we probably haven’t done in the past, but we will do in the future as a response to the disease. And that will impact people waiting for treatments or in treatment. And I also expect that we’ll be doing it slightly differently around the country, because it’s all so new and it’s you know, things aren’t so heavily protocolised yet, but I think they will. 

 
 

Geoff Allix  31:31 

Gavin Giovannoni did actually say that the the year between Lemtrada treatments or, you know, if you’re having Ocrelizumab then you have the sort of treatment sort of schedules, they’re not set in stone that you don’t have to worry too much and delaying it by several months, six months even it’s not an issue really, it almost fits easily just to say, oh, it’s yearly. That’s sort of really that’s kind of random to how the Earth spins around the sun, It’s not actually medically a thing. So he was very much saying, you know, don’t worry about it. And actually personally, so my second round of Lemtrada, completely not in a serious way, we were going on holiday to Thailand, so they said oh, yeah, just delay it, we’ll just let delay it two months. So I don’t think people need to be, from the advice from Gavin Giovannoni, certainly don’t be overly concerned by delaying around a treatment, because it’s fairly random in almost that it’s exactly a year it doesn’t have to be. 

 
 

Caroline Clarke  32:41 

I think I have 16 months between my two treatments for exactly that reason that summer got in the way. I remember my second treatment and it must of been in June because it was I was waiting for the European Union referendum results and stuck at home post Lemtrada being forced to listen to the radio, strange days indeed. Although that seems like a terribly long time ago, doesn’t it? 

  

Geoff Allix  33:07 

Yes. Right. Well, thank you very much for a very informative chat. And just really, you know, insight to as much as anything, having a very high pressure, high profile job and managing really well with OMS. So yeah, I’d just like to thank you very much for being our guest on this podcast. 

 
 

Caroline Clarke  33:29 

Thank you for having me, and thanks to OMS for making a real difference to my life. 

 
 

Geoff Allix  33:36 

With that, I’d like to thank you all for listening to this episode of Living Well with MS. Remember that there is a wealth of information at overcomingms.org including show notes, and an archive of all Living Well with MS episodes. Once again, that’s overcomingms.org. There you can also find OMS friendly recipes and exercise tips, connect with other OMSers in your local area through our OMS circles program, and learn about the latest research going on in the MS world generally and related to OMS specifically. I encourage you to register on the site, and stay informed about the latest news and updates. I also encourage you to subscribe to this podcast, so you never miss an episode and please feel free to share it with others who might find it of value. Let us know what you think about the podcast by leaving a review, and if you have ideas for future episodes, we’d love to hear from you. So please contact us via our website overcomingms.org. Thanks again for listening, and for joining me on this journey to Overcoming MS and Living Well with Multiple Sclerosis. I’m Geoff Allix and I’ll see you next time.