Community

community

Community (noun)
the people of a district or country considered collectively, especially in the context of social values and responsibilities; society

I live in NYC, formerly known as the epicenter of COVID19 in the United States, though other states look like they might overtake New York. Whether it’s because they didn’t believe it or have poor leaders, either way the tsunami is firmly entrenched in Arizona, Florida, and Texas, among other places.

And I’m writing about community, because as someone living with multiple sclerosis, I’ve watched my online friends across the U.S. and UK go from panicking about the impact of COVID19 on them and their loved ones, to sarcasm (we stay home a lot so this is nothing new), to anger (why couldn’t companies make these adjustments to employ people with disabilities), and everything in between.

For me, the MS is actually the least of the things I worry about. I have allergy-induced asthma, so if I avoid allergens, I’m largely fine. But I know that if I catch COVID19, or any other severe respiratory illness, all bets are off and I might as well engage the old swan dive, since I never want to be hooked up to a ventilator.

Taking all of the above into account, I just can’t get past why people think face coverings are political. If you knew that a face covering could potentially keep you from getting cancer (and in some professional industries this is actually true) or diabetes, or a host of other life threatening diseases, wouldn’t you wear one? We knew condoms largely reduced cases of HIV/AIDs if you wear them correctly, and that’s considered an “invisible” disease. Though the death is horrid, so not sure how invisible it really is in the end. COVID19 is no different.

I wear a face covering while I’m outside and can’t distance. And in NYC distancing when outside, is nearly impossible. The only time I pull my mask down outside is if I am truly on a street by myself. And as soon I have a glimmer of another human being, I put it back up, and OVER my nose. Not on my chin, not over my eyes, covering my nose and mouth. Not covering your mouth and nose is like wearing a “condom on your balls” it does absolutely no good. (credit for this goes to a guy friend that said it quite matter of factly recently)

My biggest MS symptom is heat intolerance. And I don’t mean, “oy it’s hot out.” I mean over 80 with no humidity and over 70 with it, my brain starts to go pear shaped. So I don’t spend much time outdoors in the hot months, and now wearing a mask means I’m inside even more. BUT I still wear one when I go out. If I need to take it off owing to the heat, I will steel myself on a side street and make sure no one else is around.

I say all of this because I live in a community. I may not know any of the people outside of my immediate community in my building, but NYC is absolutely a community. There aren’t many other places in the world that live in such close proximity, and yet we seem to be able to manage it because (historically) we alter our behavior for the times.

Today I went for a long walk and stopped to pick up groceries and I saw people in line either without any face covering at all or standing on top of one another with them around their chin or not covering their nose. Covering your face when it’s hot sucks, I agree, but think about if you or a loved one has ever had surgery. Would you want the doctor, nurse, and other OR staff not wearing a mask or wearing it around their chin?

I wear a face covering when I’m out, regardless of the activity, because I am part of a community, and for the foreseeable future, it’s the right thing to do. And if you’re not, and there isn’t a REALLY good reason for it, you’re not a good member of the community.

Some images below that can be used on social media posts.

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Normal

normal

Normal (adjective)
conforming to a standard; usual, typical, or expected

I’ve always wondered what normal is and why anyone would want to be it? Normal always sounded so boring to me. And normal as compared to what? Is it what society says is meant to be normal? And at different points in your life there are different normals.

I remember back after I was diagnosed and so, so, so sick. The bargaining started. If only I could be my former self again. I don’t remember ever mentioning being normal.

Since COVID-19 slammed into the U.S. earlier this year, people have been talking about getting back to “normal,” but I think it’s really about stability. Humans are creatures of habit. We crave thinking that we have everything under control, when it’s really the illusion of control. We crave whatever version of normal is our own.

When you’re diagnosed with something like MS, life, which is already uncertain, has a bit more thrown into the mix. And good, bad, or other, the general population is getting a glimpse into what it’s like to live with a disability or our “normal.”

I have extreme heat intolerance, and I don’t mean like “oof it’s hot out.” I mean, if I go outside when the temps get to around 75F with humidity, my brain starts to not work properly. Or if I’m home and the building heat kicks on at 60F, I need the a/c on. So I’m largely indoors from May through September, with odd trips out here and there. My car hire bills for hot weather months might as well be a car payment and insurance.

Had trouble getting food delivered during the pandemic? Think about the elderly and disabled during regular times and compound that by 1,000 during a crisis. People who aren’t able to easily go to a market were frozen out of online delivery for weeks. I watched this unfold on Twitter re: people with cancer, MS, and other acute and chronic illnesses.

The Americans with Disabilities Act (ADA) passed in 1990, and yet companies are still not held accountable, after 30 years. People with disabilities have been looked over for jobs since the dawn of time, but literally overnight, we shifted to work from home for most of the corporate world, and suddenly, technologically, anything is possible (and in reality always has been). In theory, the “new normal,” should open doors for a lot more people. I only hope it actually does.

If we go back to the way things were, the lesson has been lost.

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New York City

Roof viewphoto: from my roof 

 

NYC (noun)
New York City comprises 5 boroughs sitting where the Hudson River meets the Atlantic Ocean. At its core is Manhattan, a densely populated borough that’s among the world’s major commercial, financial, and cultural centers. Its iconic sites include skyscrapers such as the Empire State Building and sprawling Central Park. Broadway theater is staged in neon-lit Times Square.

You’re probably wondering what NYC has to do with multiple sclerosis? Well, it’s the epicenter of COVID-19, both in the U.S. and now…globally…and where I’m from (yes, Manhattan, native in my blood & heart) and live, on my own.

I’ve worked from home for several years and while this part isn’t a big change for me, like it is for others that are now, the difference is I break that up by actually GOING OUT. Going out to eat, the movies, exercise, concerts, travel, see family & friends, and shops.

People have asked if I’m lonely, and probably not so much, although I’m a hugger, so I do miss those. Considering I haven’t touched another person in a month. I’m fairly certain living by myself has not only kept the CV away, but also keeps the MS at bay. And I haven’t thrived with MS for the last 12 years to be taken out by a virus that truly is…stupid.

I’d say the City (Manhattan) is probably half empty with so many people leaving for second homes (definitely only 1/3 left in my building).  I have friends that work at the local hospitals, and it is as bad as the news is saying, but even with that I couldn’t imagine leaving. Even with the dystopian nightmare that is happening, there is also hope.

There’s really nothing like a NYer when it comes to banding together, helping one another, and fixing the damage in the aftermath. If you haven’t read the Michael Schulman interviewing Fran Leibowitz [here] it’s really worth it. And I was saying it before the article came out!

I’m so thankful (and, I know, privileged being safe at home) for the essential people working out there across all industries: local farmers that keep the food supply going, truckers, grocery stores, environmental services in the hospitals, food delivery, caregivers, drug stores, cable & phone, and everyone else that deserves better than society has done for them historically.

While the billionaire companies have their hands out for money from the government, that they don’t even need (and they chastise every day people for doing it). Billionaires aren’t the ones doing the work keeping the country running, every day people always have, and always will.

I would like to think that things will change after the thick of the crisis is over, I am skeptical, but would love to be proven wrong. People need living wages (based on where they live), universal healthcare (access to HCPs included!), and proper vacation and sick leave. In just about every other western country, these are a right, not a privilege.

Please be safe, wash your hands, stay home, and let’s steamroll that curve! Alicia Keys got it right…[here].

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Menopause

 

Menopause

Menopause (noun)
the period of permanent cessation of menstruation, usually occurring between the ages of 45 and 55

I’m not sure how the dictionary definition of menopause could be so simplistic, since this experience is anything but, and then let us layer in multiple sclerosis on top of that, since the MS isn’t enough!

I’m writing about this a) because I’m likely going through it and b) because I haven’t seen much in the way about MS and menopause, other than I’ve heard from women with MS who have been through it. Some say they didn’t really even notice since many of the symptoms mimic each other.

These details are for women who have had regular menstrual cycles throughout childbearing years, and are never meant to take the place of questions to your ob/gyn.

Let’s start with peri or pre which is “around menopause.”  During this time you can expect to experience the early symptoms of menopause: changes in period cycle, hot flashes, sleep disturbances, and / or mood swings. This can start eight to 10 years ahead of actual menopause (during your 30s and 40s).

Symptoms of perimenopause may include: irregular periods (you can still get pregnant!), periods that are heavier or lighter than usual, worse PMS, breast tenderness, weight gain, hair changes, increase in heartbeat, headaches, loss of sex drive, difficulties concentrating, memory issues, muscle aches, Sound familiar? Yep MS!

Menopause officially beings when the ovaries produce so little estrogen that eggs are no longer released (this also causes your period to stop), and remember, women are born with a certain number of eggs and that’s it! An official “diagnosis” of menopause is when you have gone a year without having a period. Due to health and other reasons (family history) you may go through menopause earlier than the standard.

Your doctor can do blood work to check hormone levels. For someone with a history of regular periods, this might be in your early 50s. For me this is a bit more complex because my neuro told me to go on the pill (and stay on it) early on after diagnosis to help control symptoms while ovulating and during menstruation and it worked really well. So well that I haven’t had a period in over 10 years and I never plan to again!

As estrogen levels drop, you might start experiencing: hot flashes (get in line!), night sweats (nothing more fun than changing sheets half awake), depression, anxiety or irritability, more mood swings, insomnia, fatigue, dry skin, vaginal dryness, frequent urination. I’m telling you, MS can give menopause a good run for its money.

There are many options for treatment (or not), but always talk to your healthcare provider about any new or changing symptoms. Just like MS there is no reason to suffer in silence.

What has your experience with menopause (and MS) been? Please do comment!

Signed,
Sweating in 27 degree weather…period, end of sentence

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Decade

shutterstock_1502928137

Decade (noun)
a period of 10 years

My gram once told me that I was the least sentimental person she’d ever met because I was throwing out an envelope that a card came in. In reality I am a very sentimental person, but once thing I’ve never really done is looked back. Is there a difference between second guessing decisions / choices and looking back longly / wistfully? Yes.

For me this decade brought illness and pain I couldn’t have dreamt up. It brought the things that everyone goes through in 10 years, but what it gave was much more. It gave me improved health, spending more time with family and close friends, a new path professionally, and more ability to give back to others.

So while it’s a new decade for everyone, and for me personally (turning 50), Jan 1 is no different from any other new day and the ability to experience life and opportunities to help others.

I know the troubles the planet is going through seems insurmountable right now, but never underestimate the ability of one person or a small group of people, to change the world.

Wishing you a happy, healthy, prosperous, and peaceful new year!

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Treatment

Image result for treatment

Treatment (noun)
medical care given to a patient for an illness or injury

On the heels of three generics for fingolimod* being approved by the FDA for use in the U.S., I thought this post might help people understand the following:

  • Generic
  • Biosimilar
  • Cost for these medicines (including patient assistance programs)

But first an important question to ask:

Is more always better? The answer, it depends.

Generics
When people think of generics, medicines like Tylenol vs acetaminophen come to mind, which is true. HOWEVER, when it comes to medicines that treat diseases like multiple sclerosis it’s not that simple. Even with acetaminophen it’s not that simple. There are things like stabilizers for the drug that need to be taken into consideration in terms of tolerability. Generic does not equal, well, equal.

Biosimilars
Biosimilars are even more complex given how medicines like monoclonal antibodies are developed, and as it states directly in the name “similar.” Generally, the data and information necessary to demonstrate the safety and effectiveness of a reference product will include clinical trials for the disease indications being sought by the manufacturer.**

Rule of thumb for MS and other diseases is if someone is stable on treatment, you don’t want to rock that boat by changing and you can rest assured in the U.S. PBMs like CVS Caremark and Express-Scripts will remove these brands from their formularies pushing people to change meds that work for them (the former has already done it with Avonex for 2020). All this despite what doctors and people living with MS might want or need.

Costs
People assume that these medicines will be cheaper, and for complex drugs that isn’t the case. In the U.S. generics and biosimilars come out around the same cost as the brand because that is what the market will bear, and, to date, we don’t have any government body governing the cost of the medicines which are set by the pharmaceutical companies. And patient assistance programs (PAPs), while currently desperately needed, help, they also add to the problem. Pharmaceutical companies get massive tax breaks for these programs along with great PR. If the cost of medicines in the U.S. were highly regulated like they are in other countries, there wouldn’t be a need for PAPs

While above is simplified for ease of reading, this knowledge is derived from 25 years of working in clinical research and 10 years living with MS. I am always happy to answer questions or point people to information that can help. You can contact me through the website or via social media any time!

Please also see this post about medicine from earlier this year.

To further understand drug costs, check out the great work of Patients For Affordable Drugs

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* Of note: Novartis has ongoing patent disputes and fingolimod generics will not be available for the public until these suits are settled, despite FDA approval.

**accessed December 7, 2019 https://www.fda.gov/drugs/biosimilars/biosimilar-development-review-and-approval

Change

Change

Change (verb)
make or become different

Heraclitus, a Greek philosopher, has been quoted as saying “change is the only constant in life.”

Humans are creatures of habit. Most of us like the status quo, not rocking the boat, and the “idea” of a linear path. In reality, most of us experience the chaos and utter mess that life is, but in that chaos we can often find beauty.

chaos

The last couple of weeks has started a process of yet another change in my life. Not sure if it’s the whole with age comes wisdom thing, since the older I get the more I realize I don’t actually know. Or if the noises in my head have gotten quieter over the years. Or if being diagnosed with the MS 10 years ago, and what I’ve been through since has shown me I can get through nearly anything, but I’m good.

But now that I’m over the hump of “holy fuck,” which genuinely always happens. Like when I made the decision to move to D.C. years ago and had to postpone it by two months because I was having daily panic attacks. But once I make a decision it’s onward and and upward. So now, I am rather looking forward to the change.

When I started this blog several years ago, I used to jot down lists of words / topics to write about thinking that’s the way it “had” to be done, but now they just come to me, and I don’t actually write them until they are literally bursting out and I MUST get it down.

This evening after seeing Marriage Story (Noah Baumbach in all his glory), one of my favorite Lynyrd Skynyrd songs came on, you know, the one that everyone screams at OTHER concerts “ironically.” > Freebird > In it they sing about change and being free as a bird, although about changing relationships, and likely a love partner, being “free as a bird,” can be about any change in life.

“This bird you cannot change…I must be traveling on now…cause there’s too many places I’ve got to see.”

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Three

Three

Three (noun)
the third in a set or series

Three years ago I woke up overnight having a really bad flare-up. And what I’d learned by that point is that IV steroids are really just like throwing lighter fluid on a flame, more harm that good. Plus I’d never been able to tolerate the oral taper. It was also during that flare-up that I had a through the looking glass experience, and just kept following the March Hare down, down, down. Fortunately I have a great doctor that helped me through it. Combine that with the not being able to treat the flare-up hard, life was like crawling through quick quicksand for three long months.

Fast forward, three years, and I am flare-up free. Not only that, but the symptoms I do have are usually mild as long as I avoid heat and humidity, as if that’s possible four months a year in NYC.

I can’t help but wonder what the algorithm is to keep from having the flare-ups. What’s changed in that time is starting a business, working from home, friends, family, Pilates, boxing, THC/CBD, and treating depression. I’m so happy to have me back, so I guess it’s a good idea to keep doing all of the above. This has been another great year, and looking forward to the future more than ever.

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A Lot

 

A Lot
A lot (noun)
very many, a large number; also, very much.

I am a lot of
love
music
smart
tenacious
ferocity
happy
sad
mad
confident
reliable
devoted
sympathetic
fortunate
sensitive
passionate
intrigued
fascinated
inquisitive
curious
nosy
eager
anxious
brave
daring
hopeful
sarcastic
rebellious
unique
dynamic
content
spirited
soulful
pensive
reliable
empathy
caring
kind
dedicated
satisfied
strength
courage

I am a lot. Take me as I am, whatever I am.

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Cruise

 

IMG_1905

Cruise (verb)
sail about in an area without a precise destination, especially for pleasure

I said I would only ever do an Alaskan cruise, since you’re standard, to the Caribbean type deal never appealed to me. Knowing myself well, I was really spot on. While Alaska & Canada were lovely, I most loved the days at sea. They really felt like vacation, and so calm. BUT, I am hooked, but where they go makes a huge different to me. Because my main MS symptom is heat intolerance, being able to be outside in August, not only at the ports, but also on the ship at the pool, was amazing. While I love the ocean, the beach in the summer is too hot for me, as are most beach destinations, even during the winter months. So this is a great option for me. And now I’m looking at another cruise next year through Scandanavian locales.

And while I’m not plugging the cruise line, and I don’t have any mobility challenges, I was so impressed by their efficiency. Just all around, the airline industry could really learn A LOT from them.

Beyond just being on top of getting people through security, check-in, and on board, I watched as people with differently abled needs had a separate area to support them. And once on board, I would say most all of the common areas were accessible, and even the jacuzzi and pool had a lift chair. Though I suspect, like any activity, it depends on how much (or not) assistance you might need. I can’t speak to the ease of ports, but from what I could see getting on / off the ship could work for most anyone. It now makes sense to me why some of the MS orgs do cruises as a group event.

Verdict? Sleep away camp for grown-ups, but better.

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