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The-MS-guide Riding across Canada For MS. Follow at . Support, join and donate to the cause. Follow at www.strava.com/atheletes/rc4ms

16/10/2026

What have you learned this week that will help your patients? I'm taking that question to MS doctors in Toronto.
ECTRIMS 2026 runs from 21 to 23 October. Thousands of doctors and researchers, three days, all talking about us. Most of us won't be in the room. I will be.

Just over a year ago I cycled across Canada. This time I'm being wheeled through the airport. Same country. Different transport.

Coming up on the channel: short videos on what's new, in plain English, and chats with doctors built around that one question.

I'm also there helping with some trials, as a co-author on a poster, and as comms officer for iAIMS. Very glamorous.
What would you ask an MS doctor if they weren't rushing you out the door? Tell me in the comments. I'll take some with me.

06/10/2026

I told you I'd be off getting my eyes fixed. Here I am. Same glasses.
Three years of planning with my ophthalmologist and neurologist. Thirteen clinics, one letter, full health disclosure, MS and all. NeoVize said yes.
Then the day came. Four hours of tests, then a doctor who hadn't been told a thing about me. The reasons came next. Plural. Some were things the clinic had already said were fine.
£150 for tests. Well over a grand on flights and hotel. They could have said no before I left home.
I'm crushed. I've also had worse. Much worse. The disappointment is going in the ever-expanding box marked "MS really pi**es me off".
Thinking about surgery abroad? Watch this first.
Illegitimi non carborundum. Look it up ;)

02/10/2026

Told a treatment isn't an option for you "yet"? Price may be part of that.
Your neurologist picks from a list. Somebody else writes the list.

In the UK, NICE decides what the NHS funds and roughly where each drug sits in the running order. Two drugs can work in almost the same way and land in different places, because of licensing and price.
In the US, the insurer writes it. Step therapy means trying a cheaper drug and having it fail before a stronger one opens up.

Different machinery. Same result. Your options were narrowed before you sat down.
Cost shouldn't be the only factor, and it isn't. Safety, monitoring, pregnancy plans and your scans come first. But time on a drug that isn't working is not neutral time.

One question in the video. Two routes, depending on the answer.

18/09/2026

Ever wondered why the right side of my head looks cut away in my videos? It's my glasses.

MS has given me double vision. When I was first diagnosed, it came and went. Over 35 years it stopped passing and slowly got stronger. I never used to need prisms. Now a big one in my glasses pulls the two pictures together. It's strong enough to change how you see my face.

The plan is squint surgery. First, the gap between my eyes has to go: my right eye is far more short-sighted than my left, and that part isn't MS. So next week both lenses inside my eyes are being replaced. Then the squint gets measured, more than once.

Please don't read this as a reason to rush. Surgery is where I've ended up after 35 years. For many people, double vision comes and goes. An orthoptist is worth asking about.

I'll be back from ECTRIMS2026 at the end of October.

13/09/2026

Your B-cell count comes back up, and you spend the next three weeks waiting for something to go wrong.
I want to take some of the weight off that.

Ocrelizumab is 600 mg every six months whether you weigh sixty kilos or a hundred and twenty. That interval is a calendar, not your biology. When clinics stretched it during COVID, stable patients didn't see disease come flooding back.

New work shows your own repopulation rhythm is remarkably consistent, cycle after cycle. And Klaus Schmierer's commentary makes the distinction that matters most: a rising B-cell count tells you the drug is wearing off. It does not tell you your MS is returning. Memory B cells, the ones that seem to count in MS, stay down far longer.
Your pharmacology is not your prognosis.

04/09/2026

More than twenty years before the first symptom, something was already showing up in people's blood.
A study published in Brain this month has put the sequence in order. Swedish researchers went back to blood frozen in national biobanks years before anyone knew who would go on to develop MS. Nine hundred and eighty one people who did, matched against twelve hundred and seventy eight who didn't.

Antibodies against the Epstein Barr virus in its active phase, more than twenty years out. The latent marker at fifteen. Antibodies against one of the body's own proteins at nine. A marker of nerve damage at seven.

Two things the headlines will drop. These are group averages, not a clock you can put yourself on, and there's no test here to ask for. And the study can't prove the virus caused any of it.

01/09/2026

Your scan is stable. You are not.

That contradiction is one of the most common things people with MS tell me, and it usually gets treated as a misunderstanding on the patient's part.

A new study looked at donated brain tissue from 291 people with MS and compared it against genetic groups already linked to disease severity. The group with the worst clinical outcomes did not have the most inflammation. The group with the heaviest immune-related genetic load hard more smouldering lesions and less disability.
Two processes running at once, and we only routinely count one of them.

This is post-mortem tissue, so
me numbers are small, and the same paper still found smouldering lesions to be a strong marker of severity. It's not an argument against treating inflammation. It is a reason to stop treating a clean MRI as the end of the discussion.

Check out dominishadbolt.substack.com
24/08/2026

Check out dominishadbolt.substack.com

22/08/2026

If EBV causes MS, where's the vaccine? Here's the honest position this week.

A big melanoma trial has just reported. A personalised mRNA vaccine plus an immunotherapy drug beat the drug on its own. First result of its kind at phase three. Topline only, no paper yet.

Why that matters to us: the T cells that should keep EBV quiet in MS look worn out. Vaccinate someone and you may be giving orders to a workforce that's stopped listening. The melanoma result suggests pairing a vaccine with a drug that wakes those cells up can work.

The catch is that waking them up is also one of the ways autoimmune disease starts.

Moderna is running a phase two EBV vaccine study in MS, recruiting people diagnosed within two years. It's mainly a safety study.

Real step forward. Slow one.

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