Episode 1
Moving With MS
In this episode, we sit down with GP Dr James Carvell to explore what it really means to live and move with multiple sclerosis. Drawing on both clinical insight and personal experience, James shares how physical activity can support not just physical function, but also mental resilience in the face of a fluctuating condition.
Resources Mentioned in this Episode
- Monkey Sox at https://monkeysox.org/
- Charities: James recommends the MS Society, MS Trust, and MS UK as fantastic starting points for reliable information and support for newly diagnosed patients.
- British Society of Lifestyle Medicine (BSLM): bslm.org.uk
Produced with support from the British Society of Lifestyle Medicine.
Find us at https://themovementprescription.co.uk/ and join the conversation!
Transcript
Welcome back to the Movement Prescription Podcast. After quite a long hiatus,
Speaker:Hussein, Susie and I have decided to come back for another series.
Speaker:Thanks for all the messages we've received in our absence.
Speaker:We really appreciate the positive
Speaker:feedback and it's definitely inspired us to keep giving some more.
Speaker:To kick us off with this new series, I have interviewed Dr. James Carville.
Speaker:James is a GP and a lifestyle medic in the southeast of England and a huge movement enthusiast.
Speaker:James also suffers from multiple sclerosis and since his diagnosis has become
Speaker:an advocate for people living with the disease.
Speaker:He set up a community interest company called Monkey Socks which raises money
Speaker:for MS charities and he also has a podcast called Never Matched which covers
Speaker:things like running a business, living with MS and tips for healthier living.
Speaker:It was really interesting to dive into some of the details around physical activity
Speaker:and multiple sclerosis.
Speaker:It's not something I knew much about and James offered a really enlightening
Speaker:conversation highlighting both the physical and the mental benefits from continuing
Speaker:to be active with a diagnosis like MS.
Speaker:So I hope you enjoy and please provide some feedback. We love to hear from you.
Speaker:Hi, James. Thanks for joining us today. How are you?
Speaker:Hi, Callum. I'm really excited to be on the podcast. Yeah, I'm well. Thank you.
Speaker:Oh, cool. Look, we're really looking forward to hearing a bit about you and your journey.
Speaker:I wonder if a good place to start is by telling us, telling me a little bit about you.
Speaker:Gosh, I'm trying to think about where I start. From an activity point of view,
Speaker:um i've always enjoyed my sport yeah and
Speaker:i think that's kind of played into kind of
Speaker:every part of my journey so far um even
Speaker:from kind of graduating from
Speaker:med school and um seeing seeing all these anesthetists in their in their lycra
Speaker:and i'm wanting to be like them and active cycling to work and things like that
Speaker:so i um i went did my anesthetics um and then and then shifted to to general practice um and a.
Speaker:Good move i'd say james.
Speaker:Yeah i'm loving it i'm loving it i'm a gp in twickenham um really love talking
Speaker:to patients we've set up a lifestyle clinic there and loving loving the patients oh.
Speaker:Cool so you grew up quite active did you sounds like you played lots of sports as a kid growing up.
Speaker:Yeah exactly yeah but um i tried to do a bit a bit of everything kind I've enjoyed
Speaker:my football my rugby I was quite good at those two and then enjoyed cricket
Speaker:but deep down I think I knew I wasn't really that good,
Speaker:but still enjoyed playing it and,
Speaker:yeah I've tried to carry that forward kind of going through yeah.
Speaker:That sounds a lot like me James I think I'm exceptionally competitive but kind
Speaker:of deep down know that the competitive edge will only get me so far hiding a lack of talent.
Speaker:Yeah we got found out towards the end yeah yeah.
Speaker:There's only so far you can go. Yeah.
Speaker:Oh, bro. So GP into econom, it's really amazing that you kind of managed to
Speaker:try to integrate some of that physical activity into your work.
Speaker:One of the reasons I wanted to talk to you today was kind of really about your
Speaker:personal journey and how that kind of interacts with your professional one in many ways.
Speaker:And so in 2016, you were diagnosed with multiple sclerosis.
Speaker:I was, yes.
Speaker:That, yeah, it would be really interesting if you'd be willing to,
Speaker:you know, I know it's sometimes hard because these things can be really emotive.
Speaker:But would you be willing to share that process?
Speaker:You know, what happened and how has that impacted you, but also your ability
Speaker:to be active in your day to day life?
Speaker:Yeah, of course. I'm very happy to share. It was obviously a huge thing to go
Speaker:through and try to try to understand and work through my mind.
Speaker:I think, really, the first thing was that there was a lot of unexplained things for me.
Speaker:We talked about me enjoying rugby. I was playing rugby sevens,
Speaker:and I was struggling with my vision to actually even see the ball to catch,
Speaker:and I was dropping things a lot more than I used to do.
Speaker:When I was running, I was tripping on curbs, or just really on flat roads.
Speaker:Um and even even walking up kind of
Speaker:stairs at work I remember being at Charing Cross Hospital and walking
Speaker:up the stairs and my balance was just so off
Speaker:um and I think really
Speaker:I didn't know what was going on and I knew there was something but
Speaker:I didn't know what was going on and it's quite frustrating as a
Speaker:as a doctor you know we're supposed to know what's going
Speaker:on we're supposed to know the answers to these things and it took a really
Speaker:long time for me to to be diagnosed with ms we went
Speaker:through you know um kind of
Speaker:i went to the opticians i was checked for diabetes um
Speaker:i i had ecgs echoes i um you know i had i had it all to try to find out what
Speaker:was going on and then eventually when i did see a neurologist um everything
Speaker:just clicked and and like that within days i was diagnosed with ms it was yeah
Speaker:honestly it took me it took me a bit of time to,
Speaker:get used to the diagnosis but
Speaker:actually throughout all of that the thing that did help me was exercise.
Speaker:Looking back on it now,
Speaker:The thing that got me through it was staying active. And that's something that
Speaker:I'd always done, always throughout.
Speaker:And even now, I could talk to you about this morning. I woke up,
Speaker:my right leg was so heavy and noticeably different to my left,
Speaker:which I've always talked about.
Speaker:But I've been for a swim, and I wouldn't be able to notice the difference right now.
Speaker:And that's why I try to get across to patients, is that it does make a difference.
Speaker:That's amazing. I suppose, or maybe put your brains on that difference.
Speaker:In that process of diagnosis, that long process, it's really interesting your
Speaker:example was kind of a physical one.
Speaker:Did you find that being active during that process was a real psychological help as well?
Speaker:Yeah, completely. I'm sure that everyone can kind of agree with this as well,
Speaker:that when they exercise, they feel better afterwards mentally.
Speaker:For me, being physically active certainly helps me manage the day better.
Speaker:I'm sure if you spoke to my wife, she'd sound less grumpy once I've exercised.
Speaker:Yeah, I think that kind of component to it is key to me.
Speaker:During that process of being diagnosed, you mentioned the impact that a lot
Speaker:of the symptoms were having on your ability to be active,
Speaker:whether it was tripping on curbs or not able to have the vision you once had
Speaker:during sport, rugby was the example you gave.
Speaker:But how did you navigate the symptoms with being active and being safe?
Speaker:Do you know what? I brought it back a bit. I think, you know,
Speaker:we talked about how right at the beginning, our keenness, you know,
Speaker:eventually was found out that we couldn't quite make it to the top.
Speaker:And I think I just needed to accept that, that, you know, you don't always have
Speaker:to, you don't have to do everything to the max.
Speaker:You can still exercise and not have to pass out after exercising.
Speaker:So I brought it back a bit that brought back my symptoms a bit I think I've worked out that,
Speaker:when I get very hot during exercise my symptoms are actually worse so I suppose
Speaker:having that knowledge that maybe when I push it too hard I get too hot,
Speaker:my symptoms are brought out in me,
Speaker:but that's really a personal thing, I think really psychologically I just, I know that,
Speaker:I need to not push as hard for certain things or push for shorter periods of time.
Speaker:Yeah, no, it's really interesting. Two things you mentioned I want to pick up on.
Speaker:The first is about the way that we view physical activity.
Speaker:I think, you know, I was actually talking to someone earlier about how binary we are in how we view it.
Speaker:It's either something that we do or we don't do or we cycle to work or we don't
Speaker:cycle to work as opposed to driving halfway and cycling a bit or having gradients of what's possible.
Speaker:And your example there of just kind of pulling in the boundaries a bit is a
Speaker:really kind of pertinent one for me from the back of conversations today,
Speaker:but also a really interesting example of how we can do that.
Speaker:Presumably you see that in your clinical work, but are you able to kind of coach
Speaker:people through those gradients of physical activity and use your personal example in that?
Speaker:Yeah, that's one thing, isn't it? I think we need to, it's not all or nothing, is it?
Speaker:There's a spectrum and it's graded and it's very personal to each patient and
Speaker:very specific to them as to what they can do.
Speaker:And certainly, I think that's where us as GPs, we're really privileged and able
Speaker:to just speak to individual patients, do something, suggest something personal
Speaker:to them that they are able to do.
Speaker:And that's the whole motivational interviewing thing isn't it,
Speaker:getting them to come up with the ideas that's the most personal way of doing things.
Speaker:Yeah, no, for sure. The other thing I wanted to pick up on, and Joe,
Speaker:I really know very much about MS and physical activity, which is why it's so
Speaker:interesting to have this conversation.
Speaker:But one of the things I did have, a question I did have for you was about heat
Speaker:and MS, because one of the things that can make MS symptoms worse is heat.
Speaker:And you kind of alluded to that with physical activity.
Speaker:I think it's maybe a really interesting segue.
Speaker:Could you kind of possibly tell me a bit more about the role of physical activity in MS generally?
Speaker:I imagine it's really kind of complex given that some is good,
Speaker:but too much or too much heat might make it since it's worse.
Speaker:So yes, the heat does affect things. But I think just knowing that for people
Speaker:with MS, then fine, there are things you can do.
Speaker:People can still exercise with MS and just have an awareness that they need
Speaker:to not get too hot doing it.
Speaker:There are cooling vests. There is swimming.
Speaker:There's lots of things that can keep your body cool whilst exercising.
Speaker:Um and i think people with ms there are kind of barriers to to to exercise but i think,
Speaker:i think you can get around them there there are lots of things we can do i i
Speaker:just say to people that kind of any movement is is good movement um anything
Speaker:any activity is good um it doesn't matter how you do it, what you do, just do it.
Speaker:So for those with MS, I suppose I've touched on it with heat.
Speaker:So I have an infusion once a month, and it's a really good way of meeting other
Speaker:people with MS and talking to them about it.
Speaker:Some people experience the same symptoms as me in the freezing cold.
Speaker:I think the first thing is that every person with MS is different,
Speaker:and that's why it's important to talk about them, talk to them about their symptoms
Speaker:and how they're affected day to day.
Speaker:But I suppose we always talk about how there are very few contraindications
Speaker:to exercising, and I think it's just about finding what's right for you.
Speaker:People with MS, I think fatigue is a really big thing that people with MS will
Speaker:talk about, And that's not just that, oh, I'm tired.
Speaker:That's like how you feel after doing really intense exercise.
Speaker:Or people talk about, oh, I feel like I've run a marathon. Your legs are heavy,
Speaker:arms are heavy. You just want to lie down.
Speaker:People with MS, that kind of fatigue symptoms, they're dealing with that quite
Speaker:a lot more than others would experience.
Speaker:Yeah. I was going to ask about barriers and fatigue is a really interesting one.
Speaker:How would you advise someone with MS that's struggling with fatigue to be more
Speaker:active and what kind of advice might you give there?
Speaker:I'm hoping that I can, I don't know, that's where using my own kind of personal
Speaker:experience is quite helpful.
Speaker:And the science backs it up as well. And I know that people feel fatigued,
Speaker:but I honestly know that if you exercise, you will feel less fatigued.
Speaker:It sounds contradictory, but honestly, people will feel their symptoms get better if they exercise.
Speaker:And looking at it from a science point of view we know that exercise reduces
Speaker:inflammation, MS is an inflammatory condition,
Speaker:I've even gone down a rabbit hole of looking I have no neuroscience background
Speaker:or anything like that but I've gone into,
Speaker:neurotrophins and cellular repair mechanisms and exercise benefits all these areas is.
Speaker:Chronic inflammatory conditions like MS will reduce your ability to repair neurologically.
Speaker:So exercise is key for my side of things.
Speaker:Yeah, it's kind of counteracting the process in some ways.
Speaker:I think things like fatigue and pain I find really interesting because often,
Speaker:for example, in chronic pain, we know that being more active will help the pain,
Speaker:but actually the pain itself is the barrier to being active and it kind of can create a vicious cycle.
Speaker:So finding ways to kind of break that cycle and actually your stories are a
Speaker:really pertinent one that I and hopefully people listening can use to advocate
Speaker:for the power of physical activity to people that might come in with MS.
Speaker:Yeah, I think from my side of things, I think just anything that you can do
Speaker:is better than doing nothing.
Speaker:And it doesn't have to be running marathons. It doesn't have to be doing ultras or, you know,
Speaker:you can, like you mentioned, you can drive for a bit and then cycle for a bit
Speaker:or get the bus and cycle a bit.
Speaker:I'm quite a big advocate for kind of your active commute, I think,
Speaker:or fitting physical activity into your daily routine.
Speaker:I think that's a really important point about it doesn't have to be extreme,
Speaker:but also having role models is important and showing what's possible.
Speaker:And I know that you do triathlons, so I think you stand as a really amazing
Speaker:role model of what can be achieved with MS and the symptoms that you suffer with.
Speaker:I want to be that role model. I want people to,
Speaker:firstly, when they're first diagnosed with MS, I want them to see someone that's
Speaker:managing their symptoms and showing that it's not the end of the world.
Speaker:It's not something that will mean that you can't do what you want to do.
Speaker:There's just some adaptations that you have to make.
Speaker:And if we as doctors can inspire that to people, then I think we're doing a good job.
Speaker:Yeah. Talking of those adaptations, you mentioned some earlier.
Speaker:I just to pull them out. One is, you talked about cooling vests can be quite
Speaker:helpful if heat's an issue. Are they easy to get hold of, James?
Speaker:You can get them on Amazon. They cover the torso.
Speaker:You can just get a vest that has ice packs that you put into them.
Speaker:And some people say they don't work, some people say they do,
Speaker:but it's something worthwhile.
Speaker:Or, you know, even like swimming to help dissipate that heat.
Speaker:I think things like swimming are really good.
Speaker:Interesting. So, yeah, there's kind of, yeah, the activity and then the intensive
Speaker:activity you mentioned as well as an adaptation.
Speaker:Any other kind of specific adaptations that you're aware of for people suffering MS?
Speaker:The most common things, fatigue, physical disability, bladder and bowel symptoms, and balance problems.
Speaker:I think that kind of encompasses your problems that people with MS will feel day to day.
Speaker:And if you can find a physical activity
Speaker:that is a bit more open to these disabilities, then that's helpful.
Speaker:Which is why I think swimming is quite good it's more of a weightless activity,
Speaker:it allows you to kind of adjust that intensity and you,
Speaker:kind of do as much or little as you want.
Speaker:Yeah, yeah. And balance is possibly, once you're in the water,
Speaker:then balance is less relevant.
Speaker:Correct me if I'm wrong. I'm just, yeah.
Speaker:Exactly, I think so. And the kind of repercussions of losing your balance are lesser in the water.
Speaker:Yeah, yeah, yeah. Interesting. And what about, is that kind of,
Speaker:presumably that's open water swimming as well as in pools, James?
Speaker:Oh gosh, I love open water swimming. Yeah.
Speaker:Yeah, if I don't, if we if we can get patients open water swimming that's great
Speaker:i've managed to get my mom open water swimming she's getting close getting close
Speaker:to 80 i shouldn't say she she might not want me want me to say that but she's
Speaker:she's open water swimming in clacton um and she absolutely loves it.
Speaker:Yeah oh well i'm sure she'll listen you'll get you'll be told off james.
Speaker:James's mom please please go light.
Speaker:On him yeah one of the things that that you've done which is amazing is is set
Speaker:up this company called Monkey Socks.
Speaker:Yeah, and completely related to what we've been talking about.
Speaker:So Monkey Socks is kind of a social enterprise that my wife and I have set up
Speaker:where we sell sports socks.
Speaker:They mismatch sports socks to represent the imbalance in symptoms that people
Speaker:with multiple sclerosis feel day to day with the intention of getting people active.
Speaker:We donate 50% of our profits to multiple sclerosis charities from the sale of
Speaker:our sports socks and hopefully the fact that they are sports socks,
Speaker:we're trying to show and get people talking about being active,
Speaker:talking about the reason they're wearing odd socks and,
Speaker:doing what we can.
Speaker:Yeah, it's a really cool concept and credit to you.
Speaker:I'm going to go buy myself have a pair of monkey socks, just jump on Google,
Speaker:put monkey socks with an X.
Speaker:Yes, monkey socks with an X. Yeah, do it.
Speaker:James, if, you know, one of the challenges in primary care and in all health
Speaker:professionals is time. I'm...
Speaker:Having long conversations about physical activity is realistically few and far between.
Speaker:Are there any, you mentioned MS charities, it just made me think,
Speaker:could you recommend any resources or signposts that we can be aware of if we
Speaker:want to send patients to get more information, where could we send them?
Speaker:Yeah, really good point. I think, so we support three charities in the UK.
Speaker:So the MS Society, which is probably the one that people know about.
Speaker:There's the MS Trust and MS UK. They're probably the three biggest.
Speaker:All their websites, if you just type into Google MS Society,
Speaker:MS Trust, MS UK, their websites are great.
Speaker:They're honestly really easy to use and loads of really good information,
Speaker:especially for if we have someone
Speaker:that's newly diagnosed that's probably struggling with the diagnosis.
Speaker:I think sending them to the charity's website is a really good place to start.
Speaker:Or sending them the Monkey Socks website.
Speaker:And I'd be very happy to talk to them.
Speaker:Cool. Oh, that's kind of you. We'll do that.
Speaker:Is there information on the charity websites or even on Monkey Socks about being active in MS?
Speaker:Yeah, there really is. And I think it's pretty global that everyone is on the
Speaker:same page talking about how physical activity helps those with MS.
Speaker:And before this podcast, I was looking up from BSLM, I think it was Dr.
Speaker:Sykes, he's got an activity kind of module on there.
Speaker:And he talks about so much good stuff and about how physical inactivity is linked
Speaker:to one in six deaths in the UK. Yeah.
Speaker:Talking about how balance and strength are so important in older life,
Speaker:which we know, this is what people with MS really struggle with.
Speaker:They struggle with their balance. They struggle with their strength, their mobility.
Speaker:As they get older, exercise is just as, if not more important to them.
Speaker:So if there's anything that they can be doing, we need to enable them to do it.
Speaker:Yeah, I think that's a really interesting point is stressing the balance,
Speaker:the strength, as well as the activity,
Speaker:helping with symptoms, there's kind of a whole round effect and then obviously
Speaker:there's the psychological impact of being active and the improvement in mental
Speaker:wellbeing that can have, particularly with someone that's facing the challenges
Speaker:of a long-term condition like MS.
Speaker:Yeah, you summed it up really well. Yeah, exactly.
Speaker:Amazing. yeah a credit to you you're an amazing
Speaker:advocate and uh you're in a unique position as a health professional and and
Speaker:and someone suffering with ms and you know if there was one message that you
Speaker:could give to to others with ms uh about physical activity what would that be gosh.
Speaker:I think i've mentioned it all the all the way along i think any movement is
Speaker:is good movement and as long as you can keep it consistent.
Speaker:So I think the best way is if you can factor it into your daily routine,
Speaker:Just, again, it doesn't have to be to the extremes, but just factor in some
Speaker:movement into your daily routine. Keep it consistent.
Speaker:And I think you benefit from it.
Speaker:Yeah, amazing. And yeah, this is me ad-libbing. I'm not giving you any time to prep this one.
Speaker:Let's go. Let's try it.
Speaker:Yeah, yeah. If you're giving advice to a health professional,
Speaker:if there was one message you wanted the health professional to get across to
Speaker:that person that's just been newly diagnosed with MS,
Speaker:what would that message be?
Speaker:And it doesn't necessarily have to be physical activity pertinent initially,
Speaker:but maybe the second message could be a particular physical activity one.
Speaker:I think, so from my side, all I had to go on was our medical textbooks where you read about MS.
Speaker:And that got me quite down, seeing about it.
Speaker:One thing I would say is that treatments for multiple sclerosis are new and developing every year.
Speaker:And there are some very good treatments at the moment.
Speaker:I think if I was told that, the best thing that my neurologist said to me,
Speaker:she said to me that the aim of what we want to do is to keep you as you are now.
Speaker:And the uncertainty with being diagnosed with MS is probably the hardest thing
Speaker:because there's such a range of symptoms that people can experience.
Speaker:You don't know. You don't know if you're going to be the worst end of the spectrum.
Speaker:You don't know how you're going to be affected.
Speaker:If someone could tell me that the aim of treatment, the aim of,
Speaker:The aim of managing your symptoms is to keep you as you are today.
Speaker:I think that would be helpful.
Speaker:Or if not, even reverse some of the symptoms that you've got.
Speaker:And some are reversible.
Speaker:I know that it's kind of a stepwise reduction in ability, but there are some reversible features.
Speaker:I don't know if that really covered your question, Callum.
Speaker:Yeah, no, it doesn't. And the second part is about physical activity,
Speaker:specifically a kind of a physical activity specific message for the same person?
Speaker:If they weren't already active, I would very much advise them to. It helps.
Speaker:So from a case study of one, me, and from lots of other research that's gone
Speaker:around, I know that physical activity will help the patient's symptoms.
Speaker:So the person with MS will benefit from being physically active.
Speaker:That's a really good note to end on, I think. Yeah, really kind of powerful.
Speaker:And Luke, thanks so much for joining us.
Speaker:You've been really honest and open and candid, and we really appreciate that.
Speaker:And we hope that your journey can have a real impact and inspire others to move.
Speaker:So yeah, thanks for joining us, James. and yeah, hopefully some people get some monkey socks.
Speaker:Thanks so much for having me on. I really appreciate the time to talk.
Speaker:I hope everyone got something from it. Thank you.
Speaker:Pleasure. Cheers.
Speaker:Hi, it's Callum. I really hope you enjoyed the episode.
Speaker:We are so grateful to the British Society of Lifestyle Medicine for their support
Speaker:in producing these podcasts.
Speaker:And we wholeheartedly share their vision of transforming healthcare and levelling
Speaker:health inequalities through lifestyle medicine.
Speaker:If you want to find out more, please head to bslm.org.uk.
Speaker:Although catering for healthcare professionals, this podcast is for everyone.
Speaker:If you enjoyed it, please share it and we love hearing from you so do reach
Speaker:out thanks for listening.
