From White Coat to Hospital Bed: A Doctor's Journey Through Multiple Sclerosis!
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Kara Wada, MD: Welcome back everyone to this episode of the Becoming Immune Confident podcast. My name is Dr. Kara Wada. I'm a pediatric and adult allergy immunology lifestyle medicine physician and autoimmune patient. And goodness, do we have a treat for you today. I love bringing guests on the podcast, colleagues, and other folks that I know will really resonate with our community and Dr. Lisa Doggett is right in step with all the things we were talking about. She is a family physician and writer. She is based out of Austin, Texas, and she was diagnosed with multiple sclerosis, an autoimmune condition, in 2009. She is passionate about improving care for vulnerable populations. and helping people with MS and other chronic conditions live their best lives.
She recently joined the MS and Neuroimmunology Center at the University of Texas, Austin, Dell Medical School as a primary care and lifestyle medicine physician. Dr. Doggett is the author of a new memoir, Up the Down Escalator: medicine, motherhood, and multiple sclerosis. Thank you so much for taking time out of your busy schedule and having a conversation with us today.
Lisa Doggett, MD: Thank you so much, Kara. It's really a thrill to be on your program.
Dr. Lisa Doggett's Journey with Multiple Sclerosis
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Kara Wada, MD: I would love for you, if you wouldn't mind, to just share a little bit of your story. How did you end up where you are now?
Lisa Doggett, MD: Yeah, so thank you again. I am a family doctor, as you said was practicing medicine in Austin for A few years, had two young daughters who were two and four and was working a really busy schedule. I was actually running a clinic for people with without private insurance. I'm married to a pediatric hospital doctor and so he was working evenings and weekends.
I was really stressed out all the time and one morning I woke up dizzy, and thought, "Oh, I'm just getting a cold. No big deal." Kept going on throughout my week. It wasn't like incapacitating dizziness, but it was certainly very annoying and harder. It made everything just more difficult. But I started getting new symptoms towards the end of the week.
Got double vision, had some taste changes, was like, "What is going on?" I started getting kind of freaked out. I think as a physician, we're taught to think of all the things that could go wrong or what's the worst case scenario? And so I started thinking, "Oh my gosh, I must have a brain tumor. This is just not making any sense."
Fortunately for me as a physician, I was able to connect really quickly with a couple other doctors. I saw a neurologist and then an ear, nose and throat doctor and got an MRI. And I had a diagnosis nine days after my the dizziness had started of multiple sclerosis. That really was a transformation for me from doctor to patient and it's really impacted my career in some major ways, including now being back at at being at Dell Medical School and MS Clinic.
Kara Wada, MD: Going back to kind of when you had that initial diagnosis, What sorts of things were going through your mind, kind of in that initial few days, weeks, months, even?
Lisa Doggett, MD: Oh my gosh, it was a total shock. Of course I was glad I didn't have a brain tumor, but MS is a big deal and I knew kind of embarrassingly little about MS. I had never diagnosed anybody with it. I'd only seen a couple of patients that had it and they were being cared for by a neurologist.
So I really was not It didn't even occur to me that I could have MS even when I was thinking all these other things, but I didn't think of MS at the time of my diagnosis. And so I started to, I had to learn a lot about it. And at first, I turned on the computer and started reading MS as a leading cause of disability and young adults, see all these pictures of people with creative mobility devices and start reading about all the symptoms. And that was terrifying.
Understanding Multiple Sclerosis Care & Treatment
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Lisa Doggett, MD: So just like a quick aside, MS, you know this, but for listeners, is a disease of the central nervous system and it is an autoimmune process. So the body attacks itself and specifically it's attacks myelin, which is the coating around nerve cells.
And it causes all kinds of weird symptoms kind of most common commonly and noticeably, it causes mobility problems, but it also can cause things like sensory changes, cognitive problems, depression, anxiety bowel and bladder problems, vision problems, you name it and right. It's head to toe and certainly it's a weird condition because it's often relapsing, remitting, which means you have periods where you get better and periods where you get worse. And so if I had actually had not been able to get in and get care pretty quickly, I certainly could have had the diagnosis missed because I got better as the natural course is for about 85 percent of people with MS.
So I mean, all that to say, this was a huge shock. I didn't know about MS, I didn't know what treatments were out there. I knew it was kind of a big deal but it took a lot of time for me to come to terms with the fact that I had gotten this chronic condition at a young age when I was really too busy with other things to even have time to handle it.
Yeah, and then to live with the uncertainty of this condition as you also know.
Kara Wada, MD: What sorts of approaches are there that are out there in regards to treatment?
Lisa Doggett, MD: About 30 years ago there was nothing and one of the kind of terms or expressions that was used with MS was "Diagnose and adios". That's what the neurologist said because they would diagnose you and then there was nothing else to be done. Fortunately I got MS at a time when there were a lot more treatments and today 14 years, 14 and a half years since my diagnosis, there are even more treatments actually more than two dozen disease modifying therapies that significantly reduce the progression of MS.
I now get an infusion twice a year. It's not a big deal anymore. It was certainly scary at first, but I, and I've been through several other treatments. The treatment that I'm on now didn't exist at the time of my diagnosis. There just continue to be new developments. But now lots and lots of good therapies and we still don't have enough for people that have progressive MS, which is a smaller percentage of people who have, don't have that, those remitting periods, but actually continue to get worse.
And a lot of those people do end up with significant disability.
Kara Wada, MD: It's amazing to even think because the last time I did a more than a surface level dive into MS probably would have been primarily in medical school. And at that time, it really was just maybe a handful of treatments. This was losing track of time, but almost 15 years ago now. And that, I mean, it sounds similar to this robust increase in treatments that we've also seen for and for rheumatoid arthritis and inflammatory bowel and now hopefully seeing for Sjogren's too, knock on wood. In this family, a lot of them are biologic medications. So kind of really working a little bit more targeted to o to that immune system that is not behaving as it should.
Lisa Doggett, MD: Exactly. Yes. We're so fortunate to have seen these advances and I hope they continue.
Kara Wada, MD: Agreed. I was interacting with someone in the last few weeks that was just given a really scary diagnosis. Something that is a life shortening diagnosis that's in the autoimmune family, quite rare, but it's hearing stories like this where we've seen such an increase in treatments and treatment availability that I think at least, and I'm hopeful that they will be able to have some hope that there may be, even though they're given maybe by their care team a specific amount of time, that some of these treatments really do blow those estimates that folks were initially given out of the water.
Lisa Doggett, MD: Right. No, we definitely are seeing advances in, in many different areas, but we still have a long way to go. And there are some diagnoses that can be still devastating. Fortunately, MS is not one of them most of the time, although for people with progressive, sometimes rapidly progressive MS, it can be a major life event.
Lifestyle changes that combat MS
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Kara Wada, MD: You also have a focus of using lifestyle to kind of help with your patients. And I'd love to hear, how that comes into play and maybe things that you found helpful.
Lisa Doggett, MD: Oh my goodness, I tried so many things because the disease modifying therapies for MS, they do slow progression, but they actually don't really address most of your symptoms. And so I was still struggling with dizziness even after I started therapy and even after I stopped having progression or my relapses improved I still had a lot of symptoms.
And I still have symptoms from time to time. Dizziness is still my main one. But I learned a lot of things to cope. I already was really healthy. In fact, I was so angry that I got diagnosed because I was like, "I'm already a health nut. I'm already doing everything I need to." And I still got sick.
And that's a frustration is that you can do everything right. And still there's bad luck. But that doesn't mean that you should stop trying. And for me, I decided one chronic disease is more than enough. And I don't want to get any more.
Kara Wada, MD: High five for that.
Lisa Doggett, MD: Totally, right, so I doubled down on my healthy diet, made sure I exercise every day.
I really made self care a priority, getting enough sleep, stress management, which is a huge struggle still, but I do my best and in connection with others, a lot of those tenants of lifestyle medicine that we know are really important I made those serious priorities. I also tried some weird things like visual therapy and balance therapy.
I went in, tried acupuncture a few times, which did help some. Did yoga and I think the thing that really helped me the most in the end was meditation. Mindfulness meditation. I took a class learned how to do it because I thought I can't sit still. I can't stop my thoughts and learned how to deal with a lot of the kind of challenges that people face commonly with meditation.
And that's become a regular practice for me and has helped my symptoms a lot.
Kara Wada, MD: I, similar, for me I've used some of the free apps that are out there to kind of, to learn and and keep me accountable. And I think, it's a lot of that how you manage your mind that really builds so much of the resiliency that is really helpful when you're dealing with the uncertainty of a condition that has the potential to flare up.
Lisa Doggett, MD: Right. Yeah, one of the sayings that my meditation teacher taught me is just, this is the way it is right now. And I just love that because when I'm having dizziness, or I'm feeling fearful about my future, or just kind of coping with that uncertainty that saying, "This is the way it is right now", brings me back to the present moment, and also reminds me that, " Yes, this is how things are now, but things will change".
There's that, the one constant is change, and it just kind of helps me to refocus, reframe, and just, yeah, to reset my mindset.
The Power of Support in Managing Health
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Kara Wada, MD: It's so important. and I don't know about for you, but for me, like I have to keep reminding like time and time, it's like this lesson that like, I know, but it just, it requires this constant like coming back to especially when you're just caught up in the busyness of seeing your patients in clinic or doing bedtime with the kids or traveling, any of those sorts of things.
It's, " Oh, no, wait. We're here. Things will change. It is what it is."
Lisa Doggett, MD: Things will change.
Kara Wada, MD: When you are talking with patients about using lifestyle in conjunction with medications, what are some of the roadblocks or things that they maybe find difficult in making some of those changes?
Lisa Doggett, MD: I think our culture is not set up to embrace a lot of the tenets of lifestyle medicine. We don't have walkable neighborhoods in a lot of parts of the country. Restaurants don't offer healthy plant based options in many cases. We have a culture that also kind of values toughing it out.
And if you don't sleep for a long time, you're tough, that's good for you. You're lazy if you're sleeping too much. There's just a lot of messages that our culture kind of sends and surrounds us with. And I think that really combating those and calling them out for being unhealthy.
And then also trying to be creative to find solutions it's important, but it's part of the challenge that I face as well as certainly my patients do.
Kara Wada, MD: I'm just thinking about medical training and how those are magnified especially when it comes to the toughing it out and sleep is for the weak and all these things that I mean, I believed as a med student in resident and now I'm like, "Oh gosh, how much did this set me up for these problems?"
Lisa Doggett, MD: Our training is not healthy at all. I know. We're just trying to eat whenever you can, whatever it is that's in front of you. And it's pizza and
Kara Wada, MD: Exactly what came to mind, like
Lisa Doggett, MD: the easiest thing to bring into meetings. Yeah, absolutely. And I think that's part of the problem is that we doctors also are not taught to take care of ourselves.
We're not taught even basic nutrition a lot of times in medical school and residency. We aren't there to support our patients. And so that's why I sought out extra lifestyle medicine training so that I really am able to support my patients to make healthy choices and to change their lifestyles.
Kara Wada, MD: And one thing that I have been trying with my patients is just trying my best to meet them where they are in, what they're ready.
If we're having a conversation about their asthma or like how is your sleep? How is your, how is your air quality and then in kind of just getting the sense of " Okay, are we going to be able to tackle taking the candles out of the house?"
Or are we going to talk about exercise? What are you ready for? And then how can you help formulate that plan of thinking being there to support and stimulate some ideas and thinking, but also helping that person come up with the idea.
Lisa Doggett, MD: Yeah, exactly. I think, we're taught, often we're really pressed for time, right? So we go into the room and say, "okay, you need to do this, and this." But that's not actually very helpful.
Challenges in Healthcare for Chronic Conditions
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Lisa Doggett, MD: Totally. Yeah. I think Fortunately, I now have longer visit times than I used to and I'm able to really dive in with patients to understand what their interests are, you know what they are willing to change, what are some areas where they're not and to try to come up with goals that they formulate, but that I can support and can validate as good options. And that I can help kind of provide some ideas be creative with them, problem solve around some barriers, and maybe ask some questions to help them think about ways that they might get tripped up in meeting their goals, but how to overcome those barriers.
Kara Wada, MD: Yeah. Have there
Diet & Mindfulness: Tools Against MS
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Kara Wada, MD: been any particular changes in your own lifestyle that were really tough, but now you're like, "Oh yes." I'm curious.
Lisa Doggett, MD: I did get a little more strict with my diet. I was already vegetarian, but I became a vegan about four years ago and I wouldn't, I'm not super I'm super strict about it I am flexible especially when I travel because there aren't a lot of options sometimes and I just don't want to be difficult, especially if I'm traveling with other people but that was a pretty significant change that I now have embraced and feel like it's not nearly as difficult as I once thought it would be, so yeah, just a healthier plant based diet and then the meditation, like I thought, "Oh my gosh, I can never meditate. I don't know how to stop my thoughts." And then learning that when you're meditating, you're focusing on the present moment, but it's normal to have those thoughts and they are intrusive and they're constantly coming at you, but that's okay.
And you can just accept, recognize them and just let them go again. When you recognize that you're sidetracked with a thought, that's a mindful moment. And so you can kind of pat yourself on the back and say, "Okay, that's a mindful moment. I'm being mindful" and continue with your practice. Really making sure that I incorporate some of those principles of meditation, being mindful throughout the day, not just when I'm doing a practice, but also I have made meditation a part of every morning and every evening, just a short, few minutes of meditating and connecting with that present moment.
Kara Wada, MD: That's awesome. I have recommitted to moving every day and that, I mean, that's another place where I think I've had to have that flexibility that you kind of mentioned with diet, of " okay, it's going to look different based on the schedule or for or if I have a cold or the kids aren't sleeping or what have you", but what I've realized is for me that it has made a significant difference in my energy and my pain levels and it's then seeing that benefit, I feel like is helpful in its own right, but then bringing recognition of " Oh yes, yes, this is part of what has helped me, like has been helpful in keeping it because that was we had a conversation recently with another guest, Dr. Ken, just talking about how maintenance but also relapse are both parts of what we call the states of change. So realizing that this is a journey, we're going to have ups and downs, and sometimes we're going to bumps in the road. But learning that bounce back. Yeah.
Lisa Doggett, MD: No, and I love what you said about exercise. I exercise every day and I do it in part to prevent other chronic diseases as we said, but I exercise each day to feel better that day because I do feel so much better. I mean, it just helps my energy and my mood and my sleep.
There's so many reasons just for that particular day to get out and move. So that's what I do first thing every morning, seven days a week. And then I thought of one more thing that you were talking about, kind of new changes that I've made. And the most recent one has actually been adding strength training.
I really wasn't doing that much before, but yeah, I learned from my lifestyle medicine training how important it is and how strength training is connected with prevention of lots of chronic conditions as well as reduction of disability and it's especially important for people with MS. So now I've added strength training twice a week and I feel definitely stronger and feel great about it.
Kara Wada, MD: That's part of my like routine too. I have actually my little goals for 2024 and it's get strong. And I was never, I mean, I'm still not doing real heavy weights or anything, but just incorporating some of that strength. It's and one of the things that I thought this would just happen last night, that just tickled me. My eight year old picked up the two pound weights and she joined me for like half of my like arms workout. And this morning at the bus stop we're chatting and she's " Yeah, that was fun. But my arms kind of fell asleep about halfway through." You'll get to it. It's okay. Five minutes is it's five. It's more than none. And it's cool seeing how our habits, like they to some degree, they're a little bit contagious for others to see too.
Lisa Doggett, MD: Absolutely. I love it that your eight year old saw you. That's just like exactly what you want with role modeling. You may not even be intentionally like demonstrating this for your kids, but they are catching on and noticing that this is important and obviously, wanting to try it out.
That's awesome. I love that.
Kara Wada, MD: They weren't so excited about the more it wasn't totally plant based, because we had a little goat cheese, but I made like a more plant based dinner option this week. And they weren't as enthusiastic about that one, but we'll keep working at it.
Lisa Doggett, MD: Yeah, you just have to kind of, you have to make some little adjustments every now and then and maybe they'll get, maybe, they'll find new things that they like.
Kara Wada, MD: Yeah, it was squash and lentils. It was quite tasty. It was, I think just a little bit off of the not the typical kiddo type food, right?
Lisa Doggett, MD: Right. Yeah.
Advice for those Seeking Diagnosis and Support
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Kara Wada, MD: As you think about these lessons that you've learned as both a patient and as a physician do you have advice you would give to maybe someone who's still on that diagnostic odyssey of they know something isn't right?
And they may have some thoughts on what it is, but they're really struggling with getting someone to listen.
Lisa Doggett, MD: That is so difficult and I've talked to a lot of people, especially people who are struggling with a diagnosis that's not obvious to get a doctor to listen, to get an answer that's a very scary time. I think it's important not to give up, so make sure that if you really feel like something's wrong and you see a doctor and they're not getting it, they're not giving you time of day, you have to go seek care from another physician and just keep pushing for answers. That self advocacy part is really important, even after you have a diagnosis, whether it's fighting to get a bill that was unfairly sent to you written off or to get your medication delivered on time.
I have a whole chapter about my medication delivery issues in my book but yeah, I mean I think that self advocacy piece is really important when you're seeking a diagnosis. I also think it's important to get help. Find people, make sure you've got a support circle. That's a really important bit of advice.
It's just, if you don't have a support circle, seek others: new relationships, new friends in your community. There's I just learned about meetup.com, which is a really great way to meet new people and connect around different activities with others in your community. There's lots of ways to meet people, take a class, do a volunteer activity, but establish your support circle.
And then if you're struggling you have to turn to that support circle and don't be afraid to ask for help. So I think, advocacy, getting support, making sure that you find a doctor who's curious and really will go the distance to give you answers those are really important.
It can be very tough though.
Kara Wada, MD: It's interesting. I'm listening to this audio book. It's called The Well-Lived Life. It's by Dr. Gladys McGarey. She's like 102. She's, I think, still practicing as a physician. It's an interesting listen but one of the little bit that I listened to on the drive home last night was talking about just how our culture has very much shifted away from, it was commonplace back when she was raising her kids that you'd ask the neighbor to watch your kids for a few minutes or borrow a cup of sugar or what have you and we've gotten away from that and then of course throw a pandemic on there where there was legitimate like concern about germs and but that community and that ability to lean on one another is so vitally important.
Certainly in chronic illness, in motherhood and in all of these struggles that we're bound to have at some point along the way.
Lisa Doggett, MD: No, absolutely. Social isolation is, it's a risk factor itself for a number of chronic conditions including like heart disease, stroke, it increases cancer, deaths, dementia, mental illness. We know that being connected with others is so important and I think that's another piece that I've learned from lifestyle medicine is often missed in traditional medicine.
We doctors often don't ask people about their Connection with others and how their relationships are going. But it's actually a really important part of life and an important part of health.
Kara Wada, MD: I'm just thinking back to even some of those instances and training, especially of you didn't want to go there because goodness, that was a whole can of worms that might open up, right? And that might make that visit longer. But it's so short sighted.
Addressing Time Pressure in Medical Practice
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Lisa Doggett, MD: Absolutely. Yeah the time pressures in medicine are really a problem and that's another thing. I wrote a lot bout it in my book is just, we're constantly under productivity expectations to see lots of patients as fast as possible. And you just don't have the time to be medically curious or to ask questions about relationships or to help patients understand what their motivations and goals are really to get at that rather than just kind of telling them what to do.
And we do have some issues where we ideally would shift our culture and our the way that we conduct our visits so that we have more time and really can get to know people.
Kara Wada, MD: One of these days we'll convince the powers that be in all parts of the system, how important that is.
Lisa Doggett, MD: Yeah, I hope so.
Up the Down Escalator: Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis
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Kara Wada, MD: Where can people find you? Where can they pick Up the Down Escalator? Tell us all the places people can connect.
Lisa Doggett, MD: Yeah, so Up the Down: Escalator Medicine, Motherhood, and Multiple Sclerosis is my memoir. It is available at kind of all the usual places. You can order it through your bookstore if they don't carry it. You can also get it on Amazon, of course. There's an audiobook and I am very proud of the audiobook.
It was super fun to narrate and I was able to narrate it myself and I'm a big fan of audiobooks because I do like to multitask and you can do that while you're driving or emptying the dishwasher. That's one way to learn more about my story. I also have a website which is www. lisadogget.com and Lisadogget is L I S A D O G E T T. There's a newsletter that I send out every two, one to two months with health tips about MS but also in general for other people and lots of fun photos. I do a lot of photography. Those are fun ways to kind of stay in touch. And then I'm also on all the kind of usual social media channels Lisa Doggett MD and Facebook is author Lisa doggett.
Kara Wada, MD: We will make sure to have links to all of those in the show notes, so you can just click over and get signed up for the newsletter, order the book, all of those things. It is on my list, my short list of the books to read while I'm out of town this coming week, so I'm super excited.
And I can't wait. I know we are gonna, I am so glad we were able to connect and our universes overlapped and I'm sure this is just the first of many conversations to come. So thank you so much.
Lisa Doggett, MD: Thank you so much. This was great.
Kara Wada, MD: If you are loving this mix of self discovery and science found here on the Becoming Immune Confident Podcast, I'd love to invite you to sign up for my email list. Hop over to drkarawada.com and hit subscribe to ensure you don't miss out on any insights into new immune system science or how we can harness healing through our daily habits.
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