NIH

A Valentine’s Day Meditation On My MS Medications: 2021

I have five exes. Five medications I allowed to enter my body because I believed they would stand up for me against my nemesis, multiple sclerosis (MS).

One of my exes hurt me. One of them stood me up— then ran into trouble with the law the morning after our one-night stand.   One was nice, but ineffectual. One of them transitioned to a long distance relationship, then went on the market, then made me a widow.  The last ex was only effective at making me blush. I am currently unattached to any medication on the commercial market.  I do have a new partner, though, one I find very satisfying. Read on.

I hooked up with Avonex in ’96. Let’s say that Avonex was like that kid who impresses all the grownups with his good looks and good manners, then insults them all behind their backs.

Avonex was my first. He caused me nothing but pain.

The day I started Avonex, my breasts were rock hard, and weeping. I had made a sacrifice for Avonex; I had weaned my sixth month old son. The Avonex needle was long, the procedure confusing. After each weekly injection, I ached all over for days. Everyone said it would get easier. I never did get used to the needle, or the muscle aches, or the joint aches, or the flu-like symptoms. Only my boobs bounced back.

Avonex and I only lasted nine months. Not my fault. I injected faithfully. Avonex didn’t hold up his end of the bargain. I had another MS attack. After all my patience, through all my pain, Avonex had done nothing to fend off MS. As soon as I got back from the hospital stay, I called it quits with Avonex. I was tired of being his pin-cushion. Cutting my ties with Avonex meant cutting off the entire Interferon family. I wouldn’t give his cousin, Betaseron, so much as a glance. Was it a clean break? No. Avonex was clingy. It took months—no—years, before I stopped feeling lingering joint pain from you-know-who. Since then, I’ve met only one girl who claimed Avonex was treating her right. I wished her good luck. Avonex just wasn’t my type.

After Avonex, I went on a series of blind dates down in New Haven in a clinical trial for rock star Tysabri. I wasn’t allowed to know if I was with the real Tysabri, or his placebo twin brother. As the lack-luster months went by, I began to suspect I wasn’t involved with the rock star I was hearing so many great things about. I sure wasn’t dancing until three in the morning, or resuming my tight rope routine. I did my due diligence, and kept making trips to New Haven for the sake of science until the study was up.

Once the Tysabri trial was over, I went for wholesome boy-next-door Copaxone. Which was better than nothing. Or so I was told. Copaxone required a shot every day.  The needle was…small. The side effects were…non-existent. Copaxone wasn’t going to hurt me. But did it help me? I couldn’t tell.

I believed in Copaxone. I had hope for our future. I shot up faithfully, day after day after day. I felt sorry for other girls, stuck with fickle meds that gave them nothing but side effects. Over the years, maybe I got too complacent. Maybe I ignored a couple of symptoms I shouldn’t have, like my fingertips going all numb and tingly.

When I relapsed on Copaxone, I did not even know it. I was shocked to learn my brain had developed a black hole. Copaxone let me down gently, which made the betrayal all the more insidious. I had no choice but to call it quits.

After I dumped boy-next-door Copaxone, I wanted to go for Tysabri. The real Tysabri. The rock star. After all those precious months I’d invested with the placebo twin in the Tysabri trial, I felt I deserved the real thing.

Tysabri and I did finally hook up, but it turned out to be a one night stand. The very next day, the Feds found out about Tysabri patients who died in the trials, and the parent company yanked Tysabri off the market. Maybe I was actually lucky to have been matched with that boring old placebo. I later learned we are incompatible.

Tysabri and me were not meant to be.

Looking back, I wonder if I got benefit from any of those early exes. I relapsed on all of them. They were all expensive, with price tags of over 1k/month. Did any of those fancy boys slow down the progress of MS even a little bit? I’ll never know. Perhaps all I got out of those medications was a sense of hope. A false hope can get a girl out of bed in the morning. Which is all very nice, but a false hope can also keep a girl from looking for The One.

When Tysabri dropped out of the picture, I had a nice long cry in the shower. Then I got online to hunt for the next dreamboat. As one does. I was desperate, so I was willing to get a little kinky. The med I chose wasn’t actually being prescribed for people with MS. It was being prescribed for organ transplant recipients. But I figured it worked the way I needed it to; it calmed the immune system. I persuaded a brilliant researcher to prescribe Zenapax off-label. The next three years were our honeymoon years. I would get a monthly blast of Zenapax through IV.  Whoah, baby! I never felt so alive. Like a superwoman. My relapses stopped. My body was fully functional. I knew not to take that gift for granted. I got fit. I got happy.

Then one day, Zenapax went away. The brilliant researcher had taken all the inventory in the United States to use in a study at the NIH (National Institutes of Health.) She changed his name to DAC-HYP, and changed the delivery method to sub-q. I was willing to be flexible. DAC and I had a long distance thing going for years. I would fly in to Baltimore, stay in hotels, meet up at the NIH. DAC continued to protect me from MS progression, but our relationship was not the same. With the sub-q injections, I no longer felt like a superwoman. But I stayed faithful.

When DAC finally got FDA approval, he changed his name again. He went on the market as Zinbryta. I thought  that once other girls with MS got to know him, they would all be changed, like I was. That happy ending was not to be. There were rumors against Zinbryta from the start. Black box warnings. A few people died in Europe. The FDA had him bumped off. I became a widow.

I kind of wanted to stay single for a while. Play the field. I found the field was full of possibilities…that were fairly ineffectual for anyone over the age 50. Nonetheless, no one likes to see an unattached MS patient. I felt a lot of pressure to move on to the next med. My doctor fixed me up with Tecfidera.

Tecfidera made me blush. But not in a good way. My skin would go hot and fierce from head to toe. I blamed myself for my reactions—don’t we all do this, ladies, when we are in a bad relationship? I thought maybe I should remember to take Tylenol. Or maybe eat more fat. Or maybe I should….

When Covid struck, I though maybe I should dump Tecfidera. Maybe I didn’t need any interference in my already complicated immune system.

For the last year, I’ve been practicing Qigong. It’s good medicine. And it doesn’t favor younger women. The only side effects so far have been health and happiness. And here’s the wild part. My husband has gotten into practicing Qigong alongside me every night. We’ve got a threesome going on.

p.s. My thanks and praises for this illustration goes to artist Robyn Singerman, TA for my Artist as Writer class this semester.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

The Greater Good

During a 2012 visit to the National Institutes of Health (NIH), I met a very pleasant young intern who had recently abandoned a career in law to take up a career in medicine, all because he’d wanted to use his talents to make the world a better place. Apparently most of the lawyers he’d met in his former life had been miserable, self-centered creatures.

He hadn’t wanted to end up like them.

So far, the intern had found the people of the NIH to be far better company than the rapacious lawyers he’d fled from. The intern observed that everyone at the NIH was there for the public good, even the patients, people who were willing to undergo trials that may or may not directly benefit them, but which would most certainly benefit others. As the intern put it, the institution was filled with do-gooders, “from the bottom up.”

I did not resent the intern for classifying patients like me as being at “the bottom” of the NIH heap. I deserved that. I myself have made a similar observation about the outstanding qualities of the good people I meet at the NIH, although in my self-serving version, “the bottom” is occupied by the NIH cab drivers —a demographic consisting primarily of highly educated immigrants, like the driver who’d earned a medical degree in his former life back in a war-torn African nation.

I don’t take anyone’s status too seriously, including my own. Status is subject to abrupt change. Things can be going fine, and then along comes a war. Or a disease. There are many paths to the NIH, indeed.

I wanted the good intern to like me. I did not correct his assumption that my primary motivation for participating in the trial for DAC HYP was a selfless one. My actual motivation was anything but selfless. DAC HYP was the only drug I’ve taken that managed to stop the progression of multiple sclerosis (MS). When I’d heard it was being taken off the North American market, I’d panicked. I’d made a few phone calls, and tracked down the doctor whom I’d initially begged to prescribe it off label.  Joining her study at the NIH was the only way I could continue to take a drug with a known benefit.

There hadn’t been any risk involved in joining the study that I hadn’t faced already. There wasn’t even a risk of my being placed in a control group and receiving a placebo. I wasn’t at the NIH to make the world a better place. I was at the NIH to continue to take a better drug.

From what I’ve overheard from other patients at “the bottom” of the NIH barrel, we are all there primarily for our own private good. Did we want our disease cured? Hell, yes. Getting to the NIH meant cutting to the head of the line. No one gets an NIH ID without having struggled for it, including those who arrive in a wheelchair.

Human beings are complex. As for those selfish lawyers the intern was fleeing? Maybe some of those miserable human beings do in fact inadvertently contribute to the greater good while in pursuit of those big fat paychecks. More power to them.

I’d like to imagine that should one of those fat cats one day get sick, and have to claw themselves to “the bottom” of the heap at the NIH, they would make their own contribution to the greater good through their rapacious pursuit of an elusive cure. The intern may think better of his former colleague should he meet that person as his patient. He may think that they have undergone some spirtual transformation. But they will be the same ambitious bastard they always were.

We all contribute to society in some way. Like the intern, I’d rather hang out with people whose positive contributions to the world are deliberate, and not inadvertent. Yet by now I’ve learned that no one’s motivations are as clear as we would like to think.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Glimpses of Gratitude, Covid-19 Style

The other day, I rolled out of bed pretty late, because I just couldn’t stop listening to Sugar Calling, the new Cheryl Strayed podcast. I heard a common thread running through Cheryl’s conversations with Alice Walker, “Whatever We Have, We Have to Work With It,” Judy Blume, “A Terrible Thing Is Happening, but the World Goes On,” and Pico Iyer, “Joyful Participation in a World of Sorrows.” When I finally meandered downstairs to make my ugly happy smoothie (cooked beet, coconut milk, ginger, five spice, spinach, and a few drops of rosewater) my husband presented me with a hand-addressed envelope out of our pile of stalemail—mail that had been untouched for 24 hours since our postal worker dropped it in the slot.
I opened a gorgeous card with a Japanese aesthetic; a collage created with scraps of handmade paper by our friend, the artist Tricia Bath. She’d incorporated a 13th Century quote from Rumi, one that resonated with the thoughts of the contemporary writers I’d heard on the podcast that morning, “Be grateful for all you receive, good and bad alike, for it may be a gift.”
Gentle Reader, I don’t blame you if you roll your eyes over another Rumi quote. Stay with me. All of us have lost something while living through this pandemic. You may assume that if I’m still blithely quoting Rumi, I haven’t yet lost enough. So far, Covid-19 has been less of a challenge for me than it has for those people who have lost their jobs, their loved ones, or their health—or for those people who have kept their jobs, and have had to take on the additional jobs previously performed by their nannies, their children’s teachers, their parent’s caregivers.
Unlike many, I am not overburdened. I am not lonely. I am not grieving. I am not bored. I am not deprived of touch or deprived of keeping in touch—I still have telephone service and wi-fi. All of this is to say, Covid-19 is a catastrophe on a grand scale, and it would be irresponsible for me, the most peripheral of its victims, to dismiss it with a platitude of gratitude.
Except.
Gratitude is not a platitude. Whenever we feel lost, gratitude is our road home.

My father’s roadside signs in Wallingford, CT

When my mom texted our far-flung family with pictures of homemade sign my father had created and posted by the side of their road, the challenge was on. The front of my house is premium real estate for thank you signs. Workers drive by on their way to the VA, Children’s Hospital, and university hospital.

I’d wanted to make signs that look uplifting, but I have crappy eye hand coordination and no visual aptitude; the best I could do was make signs that look kind of Gothic and creepy and desperate. I’m sorry about that.

Without exception, every day I encounter a gift someone has made in response to this Covid-19 catastrophe. If nothing else, I receive the gift of my husband’s delicious cooking, all made within the confines of my many allergies and sensitivities (no dairy, wheat, gluten, nightshades, egg, peanut, walnut, strawberry, mango…etc.)

On my worst Covid-19 day so far, the day of my comeuppance, I came back home laden with guilt and shame, only to be presented with a stalemail package that was unusually light; a gift from my friend, the singer, actress, and writer Barb Timmons. When I opened the package, I discovered this lovely note and origami figure.

Is it a coincidence that both of the stalemail gifts I am mentioning owe a debt to Japanese design? I think not. Mainstream white America has defined itself more by avarice than by adversity, making us less aware of the beauty, power and dignity we all do in fact possess in times of oppression and catastrophe.

I know very little of Japanese culture, but one day, when I had a few hours to spare between appointments at the NIH, I took the opportunity to visit an exhibit at the Smithsonian titled, “The Art of Gaman.” Gaman means “to bear the seemingly unbearable with patience and dignity.” The exhibit featured arts and crafts created by the internees in the Japanese American concentration camps during World War II. These objects were made by average citizens without any trained artistic skills. They were dazzling. They gave me the strength to persevere through whatever challenges awaited me back at the NIH that day.

We are not weakened by catastrophe. We are strengthened. Maybe not right away, but eventually. Gentle Reader, today is Mother’s Day. If you have not received a gift today, indulge yourself by giving one.

I am grateful for your time. Be well.

Don’t Ask for Permission. Ask for Forgiveness. Update from the NIH on which MS medications are safe and which make you more vulnerable to Covid-19.

The email I was hoping to get three weeks ago has just arrived in my inbox. The researchers running the clinical trial I skipped last week have finally come to the conclusion that maybe non-essential visits to the NIH (National Institutes of Health) are not such a good idea, after all.

The letter then went on to confirm that the MS drug I’ve been taking makes me moderately more immune-compromised, and therefore more vulnerable to Covid-19. Fortunately, I hadn’t waited for notification from the NIH, or from my neurologist. My dear friend MD (not a doctor) had prompted me to do a risk benefit analysis of taking Tecfidera in the age of Covid-19. I already knew Tecfidera is fairly useless at this stage in my disease, so it didn’t have any benefit to balance even the faintest risk. I’ve been off Tecfidera for three weeks now, and only regret that I didn’t get off it sooner.

I did go through the motions and wrote to “ask” my neurologist if he thought discontinuing my MS medication would be a good idea.

“Hello. I was wondering what you would think about my dropping Tecfidera? At this point I am more scared of Covid-19 than of MS. If Tecfidera lowers my immunity to Covid-19 even slightly, that’s not worth it to me, especially since there is little evidence Tecfidera is very effective against late stage MS. My first priority is to stay alive. What would you do, if you were me?”

I’d been off Tecfidera for two days when I got his response, “Although Tecfidera has not drop your lymphocyte but I can not say for sure it does not weakened your immune system. I understand and agree with you on holding it for now.”

One of the perks of being a lab rat is that you get to learn wonderful information from the leading minds in the field. I’d like to share the passage in the email from the principal investigator of my NIH trial. The passage outlines the role various MS medications play in potentially heightening vulnerability to threats like Covid-19. Perhaps this assessment will inspire others on MS medications to “ask” their neurologist about continuing on their drug:

“What to do if your private neurologist is prescribing you a multiple sclerosis (MS) drug.

Not all MS drugs are the same when it comes to their effect on immune system and specifically, on the part of immune system that is important for fighting viral infections such as the coronavirus.

Based on current knowledge, I believe that it is safe to start or continue any preparation of interferon beta (i.e., Avonex, Rebif, Betaseron, Extavia, Plegridy). In fact, even though we do not know if interferon beta preparations inhibit COVID19 virus, these drugs do inhibit similar viruses in a test tube and likely in humans. Therefore, there is theoretical possibility that these drugs may in fact be beneficial.

Similarly, glatiramer preparations (i.e., Copaxone, Glatopa, Glatiramer acetate) are unlikely to suppress your immunity against viruses and should be safe to start or continue.

MS patients on all other medications should be considered immunocompromised and therefore at greater risk of COVID19 infection. We have shown that when taking data from >28,000 MS patients who participated in clinical trials of these medications, the beneficial effects of all MS drugs decrease with the age of patients so that after age 53, these drugs do not slow progression of disability compared to sugar pill called placebo. This does not mean that current drugs should not be given to any person older than age 53. In fact, we do recommend these drugs to patients older than age 53 if they still experience MS relapses and if they make lot of new lesions on brain or spinal cord MRI. If you are older than age 53, have not had MS relapse for several years and your MRI is not showing new lesions, you may want to discuss with your private neurologist whether you should continue your MS drugs, especially during COVID19 threat. These drugs do lower your immunity and we have seen serious infections (with other pathogens than COVID19) in older people with MS. “

The letter also has a lovely section with advice for those of you gentle readers who do not have MS.

I am sharing that section as well:

“What should everybody do to protect themselves from COVID19 infection

Everybody, whether they are young or old, have MS, other disease or are completely healthy, are receiving immunosuppressive treatments or not, should immediately take precautionary measures consisting of:

  • Social distancing: try to keep 6 feet away from other people. After closer social contact, wash your hands with soap and water for at least 20 seconds. The virus does not survive soap and water. You do not need to use other measures if you have soap and water available.
  • Hand hygiene: wash your hands with soap and water as described above several times per day and always after close contact with other human being, or when you are outside and have touched surfaces that were touched by other people. Because you are unlikely to have soap and water when you are outside of your house, use hand sanitizers.
  • Avoid touching your eyes, face, mouth.
  • If you get fever, shortness of breath, dry cough, malaise – call your doctor. Do not go to medical centers. Your doctor will determine whether you need COVID19 screening test and will arrange for you to get the test. You should go to medical center/call ambulance only if you have problems with breathing (shortness of breath: breathing heavily, frequently and having bluish lips) – then you should not wait to talk to your doctor.
  • It does not help you if you are doing everything right, but your family members are not: the same rules for social isolation and hand hygiene must apply to your family members and anybody who enters your house.
  • Worrying will not help you. Worrying increases hormones steroids, which suppress immune system. If you allow yourself to worry, you are effectively hurting yourself. Not everything is within our control: we need to do things that are within our control and let go of the rest. Meditate, listen to birds singing outside, read books, talk to loved ones on the phone, stay positive.”

Gentle Reader, be well! Be good. But don’t be meek. Don’t wait for permission to take care of yourself!

Update 05/06/2020

Today I read that there is some evidence that Ocrevus was actually helpful for an MS patient in Italy who contracted Covid-19. I’m so happy to learn people on Ocrevus may not necessarily have to choose between protecting themselves from Covid-19 and protecting themselves from MS!

Who is Ms. Lab Rat without the Maze?

Last week, when Covid-19 still seemed an abstraction to many in the US, I made the decision to self-sequester and to drop all unnecessary activities. It was a no-brainer to drop my writing workshop at a local senior center, especially since I am immune-compromised myself. But I vacillated for days about dropping my clinic visit at the NIH (National Institutes of Health). 

Maybe that’s because I’ve formed an identity around participation in clinical trials, as this video, and indeed this blog, attests.

Currently, I am enrolled in not one, but two, clinical trials at the NIH. Participation in the first of these trials is contingent on this little lab rat reporting to the maze every six months. I’ve been a fairly compliant lab rat. But as the threat of Covid-19 became more imminent by the day, I became more and more leery of jumping back in the maze.

What if I were exposed to the virus on the airplane, or on the Metro, or at the NIH itself?

As the date of the clinic visit approached, I half expected the clinic would cancel my appointment for me. With less than a week to go, the clinic had yet to send me the usual itinerary, or to arrange my flight. The email I finally got from the clinic coordinator was not a cancellation, but rather an offer to splurge on a taxi for me. Which was a nice gesture. The clinic would be sparing me from exposure to the virus on the Metro. But…while they were at it, why not spare me from exposure to the virus in the clinic, or on the flight?

I’m embarrassed to admit that it took me days to consider the inverse of these scenarios. Rather than worrying about catching the virus from those I would encounter — why had I not been worrying about the possibility that I am myself a carrier of the virus, and could therefore pose a danger to others? What if I were to infect the clever nurses, the intrepid doctor, my fellow lab rats, and perhaps the lovely cashier at the hospital cafeteria?

I wouldn’t be able to live with myself. 

I cancelled the appointment. 

Yesterday, I was relieved to discover that my on-again, off-again fever was on again. I emailed the clinic that I had a temp of 99.6… which is next to nothing, as fevers go, but would be high enough to disqualify me from lodgings at the NIH.

The world around here is about to get a lot scarier. It’s about time I get used to the thought that it isn’t anyone else’s job to save me. I wish I hadn’t felt I needed an excuse to legitimize trusting my own sense of self-preservation over the professed concerns for my safety from the NIH. But I did. 

Was I worried that this somewhat indefinite postponement of my clinic visit would mean I lose my Lab Rat status?

Not at all. Gentle Readers, you may recall I that mentioned I was enrolled in two clinical trials. The trial I haven’t yet mentioned  is one I participate in from the safety of my home. I am one of 25 lab rats beta-testing a series of games on smartphones. These games are designed to measure neurological functions. While this smartphone app may never take the place of a clinic visit, it may yet prove helpful in situations where a patient can’t show up in a clinic. Like, ya know…in a crazy dystopian scenario where a mysterious virus is taking over the planet and an MS patient no longer feels it’s all that safe to travel. 

The TRAP Trial Begins with the Lifting of a Magic Latch (Part 5 of Ms Lab Rat’s Latest NIH Adventure)

At the close of my most recent installment of my chronicle of a Day-In-The-Life of an NIH Lab Rat, I was about to enter the phlebotomist’s cubby.
You notice I then abandoned the narrative for blog posts about light subjects such as breakfast and…biopsies. Needles. I just can’t get around them.
Gentle Reader, I am not so fond of needles. You would think, after over twenty years of self-injecting medications—once a month for Zinbryta, once a week for Avonex, once a day for Copaxone—I would be jaded by now. I am not. I squirm when I see an injection on TV. (For me, the most memorable moment of the very memorable movie Traffic occurred when the daughter of the anti-drug Czar smiles drowsily as she shoots drugs through a needle into her arm. I have yet to smile drowsily while injecting. It’s a goal.)
As I took a seat in the phlebotomist’s chair, I couldn’t help but notice a thank you note strategically posted across from the hot seat. Had I been a strategic blogger, I would have taken a picture of the note so it could later serve as the featured image of this post. But that’s not the person I am, nor the person I want to be. There was a brief period of time when I used to collect experiences for my blog. Once I realized I was collecting experiences instead of experiencing experiences, I backed off. So that’s my excuse for why there is no photo of the thank you note, or even a transcript of it. I can only offer you a paraphrase. The note went something like this:

Dear Mr. So-and-So,
Our son has undergone intolerable challenges. Somehow you managed to make the whole ordeal fun for him, and we can’t thank you enough for being a light in this very dark time.
With gratitude,
Mom and Dad of a Very Sick Vulnerable Boy

This note comforted the hell out of me. And put me on notice that I’d better not be wimpier than the Very Sick Vulnerable Boy.
By this point in my fairly vast experience with a wide variety of phlebotomists, I’ve learned that most are ordinary people, whose needles puncture flesh. But there are a few phlebotomists—a select few—whose needles create the sensation, not of a puncture, but of a lifting of a magic latch. So far, the phlebotomists I’ve encountered at the NIH fall into this latter category of elite magicians.
I did not ask this fellow to tell me more about this note he had on display. I’ve found, the hard way, that it’s best not to get personal with a health care technician when they are about to get to work. One time I asked a nurse, How was your weekend—a
seemingly innocuous question—and tears sprang to her eyes. The next thing I knew, she was telling me how her little boy had been out riding his bicycle right on their block when he got hit by a car. She then connected electrodes to the wrong place on my foot, and I endured 15 minutes of non-therapeutic electric shocks. Served me right.
So no, I did not ask this phlebotomist to tell me more about the little boy in the note. I was rewarded for my reticence. He told me—they all tell me—that I have good veins. And then he magically extracted blood from those veins, without my feeling a puncture, but rather, a lifting of a magic latch.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Breakfast Break: MS Style (part 4 of Ms. Lab Rat’s Latest NIH Adventure)

When we last left off, I, Ms. Lab Rat, was sniffing the sickly scent of powdered sugar as I passed the by-now stale gingerbread houses on display in the secular cathedral that is the NIH (National Institutes of Health.) I had time to kill before my Phlebotomy appointment, so I took the elevator to the second floor cafeteria, which has an excellent salad bar. And discovered I was too early for salad.

Here’s the deal with my new Wahls-inspired MS diet: the foods I used to associate with breakfast are off the menu. No processed foods, no gluten, no grains, no milk (bye bye breakfast cereals,) no eggs, no cheese (bye bye omelets.)

Here is a picture of what breakfast looked like for me today: IMG_9271

You’re looking at bok choy and garlic escargot simmered in homemade chicken broth, topped with kimchi and dulce. The Wahls Diet calls for the consumption of four servings of leafy green veggies a day, at least four servings of colorful fruits and veggies, a meat, a touch of seaweed, a bit of something pickled. The Wahls Diet is also very very big on homemade bone broth. So this breakfast covers pretty much all the bases. (If I were a true purest, there would have been a little knob of organ meat floating around in the bowl, too. But that’s the thing about the Wahls diet. Or maybe any diet? You can always feel you’re not quite up to par.) This breakfast was yummy, by the way. But this kind of breakfast is not easily obtained on the road. Not even in a hospital. (By the way, what’s up with hospital food? Why are there so many unhealthy choices? Topic for another blog.)

Here’s a fuller, indeed cluttered picture of what breakfast looked like for me today, when I tell the whole complicated story of my MS maintenance:

IMG_9272

You are still looking at my pretty bowl of healthier-than-thou breakfast food. You are also looking at the supplements required for the clinical trial of the Wahls Diet:

5,000 IU Vitamin D3, 1 t cod liver oil, 5000 liquid vitamin B12, 1 mg folate, multi-vitamin.

Then there’s all the stuff I have to take for my funny bladder:

AZO, macrobid, and some other antibiotic I’ll be finished with at dinner.

Then all the stuff I choose to take for my self-designed Ms Lab Rat trial:

3x 100 mg Biotin (which I am hoping will eventually fix my bladder problems and get rid of three of the items above), 500 mg Hemp oil, local hemp oil, glorious hemp oil (which has helped me sleep and dream after many sleepscarce, dreamless years), 5 mg Lithium (which I thought was doing a fine job as a mood stabilizer, though I just learned that what I take isn’t anything like a mood stabilizing dose. So let’s call it my placebo.)

This is a lot to keep track of. When I graduated from the Swank Vs. Wahls clinical trial, I got a certificate (no joke) and a private viewing of a 20 minute video of Dr. Wahls that just served to delay the seven hour drive ahead of me. No t-shirt. The only remotely useful thing I left with was a booklet to help me keep up with all the details of living in a Wahls Diet world. (I had rallied hard for an app, but there isn’t one. Yet.)  For a few weeks afterward, I kept filling in little circles every time I popped another supplement, or finished another serving of leafy greens. But eventually I ditched the booklet. I want to feel a little less obsessive, a little less persnickety. Either that, or I’d already assimilated all the expectations. My brain had become the diet app I’d been asking for.

The morning of my TRAP trial, I realized I was not going to get a Wahls breakfast, or Wahls-ish breakfast before my blood draw. I guzzled a “green” drink I purchased from a vending machine and took the elevator down to Phlebotomy. A lovely woman handed me a white stub with a number. As I glanced down to read 32, she called, “Thirty two.” It was the Christmas holiday. I was the only patient in the waiting room. I filed past untouched trays of cookies and two pots of coffee and entered the orderly hive of numbered white cubicles, wondering if I’d recognize my phlebotomist. I had been there many times before.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Teetering on the Verge of TRAP (part 3 of Ms. Lab Rat’s Latest NIH adventure)

I didn’t jump into the TRAP trial eagerly.

When I first got a pamphlet from the National Institutes of Health advising me of my eligibility for a new study, I thought perhaps there’d been some mistake. This study was designed for people with progressive MS, the most serious form of multiple sclerosis, a most serious degenerative disease. That couldn’t apply to me. I was an MS success story. I was Ms. Lab Rat, the patient who had cleverly evaded a continued barrage of MS lesions by taking a fortuitous risk on an off-label drug. In over a decade of respite from new inflammation, neurologist after neurologist  told me I was doing everything right, told me I was doing great. None of them mentioned I was slipping into the progressive form of the disease.

And yet.

I myself had not been satisfied, had not felt I was doing everything I could to stop or slow the ongoing catastrophe that is MS. As much as I was grateful for the drug I was taking, I thought for sure that the drug had worked more efficiently when I first took it back in my late 30’s, when it was delivered off-label via IV infusion. The form of the drug that I later took for an NIH study, the form that eventually hit the market as Zinbryta, came in a little tiny vial, not a whopping big IV bag, and felt that much less miraculous. Sure, I was still avoiding MS relapses, but I was also no longer swimming for hours or taking long hikes. Or even short walks.

The cover of the NIH pamphlet asked, Is your MS progressing, in spite of treatments?

I wasn’t exactly sure.

Wouldn’t some neurologist have told me if my MS had become progressive?

One would think.

Would I have wanted them to?

Hell, no. Back in 2005, I fired a neurologist for telling me my MS was never going to get any better. Which started me on the search that led to Dr. Bielekova, who actually did make my MS get better, without ever making any promises that she could. She had prescribed the drug she was researching with great reluctance, because I’d been insistent. She’d warned me there was no guarantee of success. Yet it had been a success.

As I set the pamphlet down I saw Dr. Bielekova’s name was attached to the study. While I was still mostly in denial that the pamphlet could apply to me, I did have friends with progressive MS, friends who had lost their employment, much of their mobility, and in the worst case, much of their memory. Connecting them to an NIH study could give them access to some of the most nimble minds examining this insidious disease. I picked the pamphlet back up.

The trial proposed to measure the effects of four established medications, currently treatments for other diseases, to see if they could ameliorate the effects of MS. The drug that had changed the course of my disease had originally been used to keep the immune systems of organ transplant patients from attacking the transplanted organ; Dr. Bielekova had guessed that perhaps it could likewise be used to keep the immune systems of MS patients from self-attack. Clinical trial patients like me had helped to prove her theory correct. Apparently she was looking to repeat this success.

The pamphlet didn’t make any claims of how any of these four drugs might potentially help a person with MS. Instead, it went into detail about potential side effects. Which was all very above board. But not very tempting.

Furthermore, the timing of the pamphlet was off.

The pamphlet arrived in the spring, a time of hope. I had just enrolled in a clinical trial examining the effect of diet on MS. Wouldn’t it be wonderful if a teaspoon of cod-liver here, a sprig of seaweed there, would be all it took to fix me? I could only do one trial at a time. Why not stick with the wholesome one? The one without potential side effects.

When I called the number on the pamphlet, I disclosed my participation in the diet trial right away. I explained I was asking… for a friend. The doctor I spoke with was unfamiliar to me, but warm and sympathetic. She urged me to let the NIH pay to fly me out anyway, just to keep  updated on my progress with Zinbryta. I had nothing to lose beyond a wee bit of spinal fluid, which I would easily replenish. If there were signs of progression, I would qualify for the study. If it turned out I wasn’t progressing, well, that would be good information to have.

And that was how I’d wound up back at the NIH late last June for a spinal tap.

The results came in during the July 4 holidays. I got a voice mail message that I did indeed qualify for the study. The unspoken implication was clear. I could consider myself as having progressive MS. My calls to the clinic went unreturned. I blamed the holiday. Then summer vacations.

I didn’t want to admit to myself that I was devastated. I decided to look on the bright side. While the Swank Diet I was on for my current clinical trial wasn’t yet working any wonders, maybe its competitor, the Wahls Diet, would do the trick.  And if neither diet reversed my symptoms, at least there would be TRAP to turn to. If only someone from the clinic would return my calls.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

TRAP (part 2 of Ms. Lab Rat’s Latest NIH adventure)

The vast lobby of Building 10 of the NIH was nearly vacant of the usual international mix of medical professionals and imperiled pilgrims, yet it felt cluttered. This majestic bastion of scientific research had been stuffed with numbered tables bearing garish gingerbread houses, presumably made by the in-patients and staff. It looked like a pop-up church raffle. I glanced past the hapless man marooned at the Welcome Desk and noted that the coffee shop was now barricaded by scaffolding. The scent of coffee had been replaced with insidious notes of powdered white sugar. I wondered if perhaps my system of always accepting the first appointment of a given span of available dates would finally let me down. We were three days out from Christmas. The speculation on the van was that the leading physicians would still be on vacation. I didn’t buy into that. I expected to see leading physicians. Then again, I’d also expected coffee.

I ducked into the area on my right to fill out the paperwork for meal reimbursements. Over the years, the reimbursement office has retained the right to perpetuate various iterations of needlessly awkward exchanges. The first few years I’d gone there, the cashier’s desk was an inch or two too deep for the cashier to actually reach the exchange window to grasp a lab rat’s ID or to pass a lab rat some cash. It added a bit of tension, a bit of comedy, to every exchange. After a few years of these capers, the cashier figured out she could use a pincer device to bridge the troublesome gap. Her victory was short lived. By my next visit, the entire office was moved. By the visit after, the “short-armed” cashier was gone.

The tradition of inventive obstructions was still in full force, I noticed. There was a sign in front of the office that receives reimbursement forms which instructed all form fillers to stand at a certain distance in front of the glass door, and further warned that those who did not stand would not be seen. In other words, Wheelchair Users, Begone.

Furthermore, the very layout of the office was designed to prevent eye contact, even with compliantly standing non-wheelchair users. The L-shaped desk for the sole employee in the office was set back and to the side of the glass door. The computer was placed along a wall at a ninety degree angle from the door, so that the occupant of the office effectively had her back to the door every time she looked at her computer. Once again, the office had been created to make it structurally impossible for the employee to do her job effectively.

I wish I could say this office is an anomaly in the NIH. It is not. There are doors in the MS clinic without wheelchair accommodation. If that’s the NIH plan to stop MS progression…it isn’t working yet.

The only other pilgrim there was a man sprawled out on a chair. Had he been conscious, I would have asked him if he needed me to signal to the functionary behind the glass door. Instead, I waited for the functionary to complete her personal phone call, then check her computer screen, then finally swivel somewhat to notice me standing the appropriate distance from the glass door, like a good wheelchair-free pilgrim.

She waved me in.

I used to feel unworthy of meal reimbursements. But that was before the drug the NIH tested on me came out on the market, and my monthly deliveries came with an invoice of seven thousand four hundred and something dollars per month.

I handed in my clipboard, feeling entitled to every last penny, darn it, and headed for my appointment at Phlebotomy.

The acronym for this new study? TRAP.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Addicted to Trials (Part 1 of Ms. Lab Rat’s Latest NIH Adventure)

My name is Ms. Lab Rat. I have multiple sclerosis. I am addicted to clinical trials.

It had been 32 days since I’d finished my last clinical trial in Iowa City when I slipped out of a white van on a cold December morning and surrendered my coat and my purse to the jocular security crew at The National Institutes of Health in Baltimore, Maryland. When asked by a cheerful ex-navy, “Have you been here before?” I had to smile back. I’m terrible with numbers, but by my feeble estimation, I’d been to the NIH 44 times before: once a month for three years during the trial for Zinbryta, once every six months for the three years it took for the FDA to approve Zinbryta, plus twice for initial trial visits. Gentle reader, chances are your brain is less riddled with lesions than mine. You do the math. Numbers aside, I think we can all agree; I’ve been a regular.

Back when I started the Zinbryta trial, when the drug was still fairly new to me, my life had been much more limited by my disease. I was a regular at my drug store, a regular at the places I volunteered. No one paid me to hang around. Zinbryta stopped the raging inflammation that had peppered my brain with lesions. My relapsing remitting multiple sclerosis stopped feeling so…unremitting. And gradually, I was able to get small but super-meaningful jobs. First I was hired to host creative writing sessions with a uniquely brilliant group living at an upscale assisted living center. I am in awe of the supportive creative community we have maintained. Then I was hired to teach writing classes to radical, relentless, radiant young artists at a celebrated arts college downtown. The younger generation fills me with hope for a more just, more equitable, more dazzling future. Through the years, I have maintained the same prolific community writing workshop. We all publish. Some of us publish quite a lot. Zinbryta has allowed me to expand my identity beyond MS patient, to teacher. When the security guard handed me my one-day NIH ID, you’d better believe I thanked her.

I hopped back into the white van with a couple from Georgia. The husband had spent the trip describing the career he’d had to abandon. “I want to get back to work, do what I can from a wheelchair. But first I’ve got to get this cancer under control.”

I could relate to his frustration. I could relate to his hope. Zinbryta has helped rein in my MS. It’s been necessary. But it hasn’t been sufficient. When we reached good old Building 10, I hopped out of the van. I was eager to get my MS under control.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.