IN THE NEWS: Battling MS on multiple frontsSaint Thomas Comprehensive Multiple Sclerosis Care Center, in their March edition. Learn more abuot the care and treatment of MS,and the Saint Thomas MS Care Center in their original article. Find it online at www.nashvillemedicalnews.com.
PHYSICIAN SPOTLIGHT: Battling MS on Multiple Fronts
Fallis Leads Saint Thomas Health’s Integrated Efforts
It’s a good thing Robert J. Fallis, MD, likes puzzles.
The board-certified neurologist has spent most of his professional career trying to piece together clues on behalf of patients suffering from a range of bewildering symptoms. Recognized for his expertise in identifying and treating multiple sclerosis, Fallis said MS is a confounding disease to diagnose because there is no single test to definitively confirm the condition.
“It’s like assembling a jigsaw puzzle, and when you put it together, you get your diagnosis of MS,” explained Fallis, a member of Tennessee Neurology Specialists. Of course, he added, the first step is to “make sure you’re assembling the right puzzle.” Easier said than done since MS shares symptoms with a host of other diseases and conditions including Sjögren’s syndrome, lupus, Lyme disease, fibromyalgia, sarcoidosis, and others. Even a B12 deficiency can cause demyelination, which might be mistaken for MS.
Adding to the confusion is that the disease is highly individualized. “If you have a room full of people with MS, each will be affected differently,” Fallis noted. A number of comorbid conditions — ranging from depression and fatigue to cognitive issues and urinary tract infections — adds to the difficulty of managing MS.
The need for integrated care is one of the reasons Fallis helped found the center he continues to direct in 2007. Now called the Saint Thomas Comprehensive Multiple Sclerosis Care Center, following a 2010 designation by the National MS Society, Fallis noted, “We became the first comprehensive multiple sclerosis care center in the state. To get that (certification) required offering specialized patient care spanning multiple disciplines, ongoing research efforts, and integrated ancillary health services all focused and directed to the needs of the MS patient.”
While Saint Thomas had most of the components at hand, the various disciplines were scattered throughout the system. “We were able to pull it into a cohesive unit and grow it into the position it is now,” Fallis said.
Coming up with a correct diagnosis is much easier than it was even a generation ago with the advent of MRI, newer laboratory tests and exclusion criteria to eliminate some of the mimicking disorders. “Traditionally, you waited until a patient had multiple attacks,” Fallis said. “A lot of times, people were disabled before they were even diagnosed.”
Today, patients have multiple options to help them manage their symptoms and disease. “There have been a lot of changes in medical treatment for MS,” Fallis noted. He said the first MS therapy received Food and Drug Administration approval in the 1960s ... followed by three fairly dormant decades. In the 1990s and early 2000s, several new treatments came online. “But in the last two years, the floodgates have opened,” Fallis said with clear excitement.
With two new oral agents and two more in trial or awaiting FDA approval, physicians and patients have a much larger armament with which to fight the disease. “That’s very exciting. It’s going to make treatment of these patients more complicated, but they’ll have more options,” he said.
“All of the available treatments,” Fallis continued, “work better when given earlier in the course of the disease.” It’s one of the reasons neurologists work against the clock to get an accurate diagnosis. A number of pathology breakthroughs and enhanced MRI testing have leveled the playing field. “MRI is critical. With MRI, the hope now is to diagnose after the first event.”
What first drew Fallis into the field and has kept him excited throughout his career are the patients he serves. “My fellowship training was in MS, which was very unusual at that time,” he recalled, but both the disease and those who had it intrigued him. “MS patients, as a group, are just wonderful to work with,” he continued. “They are very well informed and very pro-active.”
After graduating from the University of Kentucky College of Medicine, Fallis completed his internship in internal medicine at Georgetown and the VA Medical Center in Washington, D.C. Following that, he returned to Los Angeles, where he grew up, for his neurology residency at the University of Southern California. Fallis then embarked on the first of his three research fellowships in Boston before being named a senior staff fellow in the neuroimmunology branch of the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health.
Ultimately, he returned to Kentucky to practice, and it was during this second stint in the Bluegrass State that he met his wife Karen, who was an RN at Saint Joseph Hospital. Fallis, who has a son and daughter, said the family enjoys outdoor activities and music.
“We play different instruments. My wife plays flute,” he said of the family’s musical inclinations. When his daughter, now a freshman at Brentwood High, began taking piano lessons several years ago, Fallis decided to learn, too. He drew the line, however at recitals. “She doesn’t get out of it, but I do,” he said with a chuckle.
In 2002, the family moved to Nashville, and Fallis began his affiliation with Saint Thomas Hospital. Active on a local and national level with the MS Society, Fallis currently serves as a member of the executive board for the Mid South Chapter. He also chairs the Clinical Advisory Committee for the Mid South, joining 14 other clinical advisors throughout the country to help the national organization impact quality of care on a regional level.
To see just how far treatments have come during the course of his career, Fallis said you only have to look around a room filled with MS patients. Not many years ago when he did patient talks, many of those attending were in wheelchairs or on walkers. At his most recent patient presentation, everyone was ambulatory, and only one person had a cane.
Although Fallis doesn’t think a cure for MS is imminent, he sees many reasons for optimism. “My hope is that we’ll do a much better job managing MS, and I believe that is already happening,” he concluded.
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