Ask The Expert: Suma Shah, M.D.

Suma Shah, M.D., is assistant professor of neurology at Duke University School of Medicine in Durham, North Carolina.


What’s changed for people with MS in recent years? The implications of receiving this diagnosis have changed. In the current era of treatments, there’s a new optimism about long-term prognosis.

Q: Are there patient questions that you don’t have answers to?

A: When first diagnosed, people often ask whether MS can be hereditary. I tell them it isn’t common. Or they ask whether they did something to bring on the disease. The truth is, research has yet to identify a specific cause for MS.

I also get questions about complementary or alternative treatments. Unfortunately, this is tough, as we don't have great research to help guide us with answers.

Q: It’s warming up outside. Why does this make me feel worse?

A: Some people with MS don't experience worsening symptoms at all in the heat, while others start having them after 30 minutes or an hour. In fact, some of my patients know exactly how long they can spend in hot and humid weather before they need to take a break.

Understanding your body's cues and listening to them carefully can help tremendously. MS causes Uhthoff's phenomenon, which means neurological symptoms that have affected you in the past get worse when your body temperature rises—which is what can happen in a hot environment.

For example, a common first symptom of MS is blurry or reduced vision, which occurs because of MS-related damage to the optic nerve in the eye; in warm weather, this symptom may be more pronounced because of Uhthoff's phenomenon.

Q: Why doesn’t what worked for my friend who has MS work for me?

A: MS is an incredibly individual disease. Everyone has his or her own course. Also, diet, exercise, and other lifestyle factors play a large part in a person's overall condition and quality of life. These elements can get overlooked when starting a new treatment or when first dealing with a diagnosis of this chronic illness.

I encourage patients to follow healthy lifestyle behaviors. This helps reduce the number of medical conditions that may develop over time.

Q: What do you wish your patients asked about more often?

A: One of the many reasons I chose to specialize in MS is how incredibly informed the patient population is about the condition, and how this leads to well-researched questions and excellent discussions. That said, MS can cause symptoms that are uncomfortable or embarrassing to talk about, such as loss of bladder control or sexual function. I encourage my patients to ask me about all of these issues, to see if we can find a way to help.

Sometimes, I recommend resources to help people stay up-to-date. For instance, the National Multiple Sclerosis Society is a robust source of unbiased information. The group also organizes local meet-ups and support groups. Another resource I sometimes recommend is the website, which has several MS-related programs.