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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Regret

spilled milk

Regret (noun)
a feeling of sadness, repentance, or disappointment over something that has happened or been done

They say you shouldn’t have regrets, but if you’ve lived any kind of life, I don’t see how that is possible. But there is a difference between letting that regret cripple you versus making mistakes and learning from them.

I think it’s important to celebrate successes, but ultimately most people will agree that we tend to learn more from the mistakes, and then hope we don’t make the same ones over again. Sometimes MS feels like one gigantic mistake, and ultimately it is, but not one that I made, one that my genes did.

Living with MS feels a little like sliding doors, where if you went in one door versus another, what might have happened? Had I never been diagnosed with MS, would I be the same person I am 10 years later? Is anyone the same person they were 10 years ago? Of course there is no way of knowing, so is it really worth wondering?

While I would welcome giving the MS back, it is something I can’t regret, since it’s not a mistake I made. And it’s taken a long time to get here.

Stay cool…

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Processing

Processing

Processing (verb)
perform a series of mechanical or chemical operations on (something) in order to change or preserve it.

May has been a time of processing for me. I turned 50, and in April had “officially” been living with multiple sclerosis for 10 years.

Turning 50, while a milestone for sure, don’t really feel any different from 47, 48, or 49. Where it did feel different was to see my name written in front of it. As in join us for Name’s 50th birthday party. Wow!

For my 40th birthday I got MS, so I knew 50 had to be better, and so far the last two weeks have been great. I celebrated for about 10 days, although not necessarily on purpose.

Ten years ago when I was diagnosed, my neurologist told me there would come a day when the MS didn’t seem so big, and that other things would take its place. But given how sick I was in the year after my diagnosis, I couldn’t see a time where he could be correct.

The days around my birthday were filled with music, museums, personal training & Pilates sessions, dinner with my BFF, and a party with people I love, including my parents who are still very active and aim to be here for a long time (oh and I even managed to fit in work as well). And while I was tired, like anyone would be, I was overwhelmed with gratitude for all of the good wishes and people who went out of their way to celebrate with me.

I feel lucky that a combination of working from home, regular exercise, CBD/THC, disease modifying drug, and a full life, has helped to keep the MS at bay (no relapses for 2.5 years). And while people are surprised to hear I have little symptoms every day (but you look so good), if this is as bad as it gets, life will continue to be good.

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Ten

Ten

Ten (number)
equivalent to the product of five and two; one more than nine; 10

Ten – number of years, to the date, of being diagnosed with MS

April 15, 2009 – ten years of living with multiple sclerosis

Ten years ago I couldn’t see what or where I would be now.

Ten years ago I walked into a hospital in a small European city to get the results of a lumbar puncture from two weeks prior. Like a movie, I stood outside of the hospital for 15 minutes, knowing that might life would never be the same coming out on the other side. I took a deep breath and in I went. I met with the resident on duty, a name I’m not sure I ever knew, where I was told in a hallway, that the CSF results were 99% conclusive for multiple sclerosis. What’s next? Call the clinic after the holiday. Two weeks later I came home to New York and collapsed on my family and a neurologist I met, once prior, a few months earlier.

Ten years ago, I got MS for my 40th bday, but on the verge of turning 50 (geez!) in a few weeks, I look back and recall my neurologist told me that I would be ok. And that I would likely continue to live my life with mild disease burden. 

Ten years ago, I could never have seen what he told me. Ten years ago my insides were sicker then they had ever been, and yet looking at me, I “looked so well.” I couldn’t hear people, over the buzzing, literally, that I would be ok. That I would be more than ok. 

Some nights I laid awake 3,000 miles away from home, in a foreign country, wishing that I had a terminal illness so that I didn’t have to live the rest of my life in turmoil. It wasn’t that I wanted to die, I just couldn’t envision living the way I was at that time. 

While I am fundamentally the same slightly cracked, mildly scrambled, person I was prior to the MS, what I learned is that life probably wouldn’t have been too different had I not been diagnosed with MS. Meaning, I’ve heard people say that being diagnosed was life altering for them. That they found more meaning then if they hadn’t been diagnosed. 

While I have made friends along the way as a result, and hopefully helped a few as well, I would tie this convoluted “gift” up in a bow, and give it right back to where it came from without thinking twice.

Multiple Sclerosis doesn’t just impact the people who have it. It touches everyone around it. It’s like a super old ivy growing around a building. It can look beautiful, but yet wreak hell on anything it comes in contact with, strangling everything in its path.  

People like to use war analogies for diseases (warrior, battle, fight, etc.). Or I’ve heard so many times over the years, “I could never do what you do.” Or the phrase, “you don’t know how strong you are until you have no choice.” I cry bullshit to all of it. If people get sicker, does that mean they have fought hard enough and it’s their fault? I am not a warrior, I am not special. We all have our “things” to deal with and we do in our own way. 

Ten years later I am still a grand daughter, daughter, sister, cousin, friend, business owner, music lover, foodie, traveller, part-time contrarian, ever reforming type A control-freak workaholic, and questioner of science & medicine. 

Two years ago to the day, I started this blog & social media (Facebook & Twitter). Thanks to everyone who sticks with me and it. 

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Medicine

medicine

Medicine (noun)
a compound or preparation used for the treatment or prevention of disease, especially a drug or drugs taken by mouth

As Grace Slick said so many years ago, “one pill makes you larger, and one pill makes you small…”

As we are all aware, medicines to treat multiple sclerosis are not cheap, nor are they affordable. But many of us, myself included, will agree that they are part of what keeps us moving, literally. Admittedly many of us pay little or nothing out of pocket owing to patient assistance programs, but those programs wouldn’t be needed if the cost wasn’t astronomical out of the gate. And to clarify, I am not talking about new medicines, although that’s helping to drive the problem, I’m talking about medicines that have been on the market for many years, like Avonex.

When I started on treatment in June, 2009, Avonex retailed at $26k per year. Fast forward to 2019, and take a guess, no really, take a guess what a drug approved in 2002 costs, give up? On average, about $87k per year, give or take, so a $60k increase in just 10 years. And each time I receive the insert for my quarterly supply, it goes up, and up, and up, and up. I used to feel bad about having to take a medicine that was so expensive, but considering my contributions to society, and the taxes I pay, it means I continue to contribute to the cost of developing medicines. So round and round we go.

While it’s true that the list price is rarely paid by anyone, having that be the ceiling means that people also pay more out of pocket (co-pay) when all is said and done. And people on Medicare and Medicaid are unable to participate in the patient assistance programs, thanks to president 43. Nor are government agencies able to negotiate the cost of medicines, like every other developed country, which means the United States is subsidizing the cost of research and development for the rest of the world.

Patents also factor into the costs of meds, but explaining that, would quite literally, do your head in. And most recently the skyrocketing cost of insulin and epipens, which leads to rationing (and do you take your insulin or eat?), and subsequently people being sicker, which in turn impacts the cost of their healthcare (and everyone’s).

For this post I will only be looking at people who have insurance. The next image is clear as mud since there are so many hands in the cookie jar, and because if you try to ask the cost of a medicine, you will get 100 different answers and that’s based on how the hands all negotiate the list price. Next to housing, healthcare is the biggest expense most people have, and yet we have no say in negotiating costs, unlike just about every other big expense in our lives. IMG_0613

We have the pharmaceutical company, the insurance company, the pharmacy benefits management (PBM) companies, and the consumer (general public). And some might also include politicians, since they get their share as well (contributions to the committee members referenced below), but in a different way. Though one can argue that campaign contributions also add to the high cost of medicines (see Citizen’s United – the content of the advertising speaks for itself).

Everyone above takes their cut, mind you, while I have issues with insurance companies arbitrarily deciding what medicines people should be allowed to take (a decision that SHOULD be between my doctor and me), the PBMs such as Express-Scripts (Accredo), CVS Caremark, etc. are just plain scourge of the earth. I have been doing battle with them for years. These are two of the largest PBMs thanks to monopolies and insurance companies buying them up. See the complaints for both Express-Scripts and CVS Caremark and these are just from Consumer Affairs. Facebook and Twitter are riddled with 10s of thousands of complaints about both companies.

The argument is that mail order / specialty pharmacies are better suited to taking care of medicines for diseases like MS, and I can tell you that this is just.not.true.! Imagine having to beg a giant corporation to do their job effectively, like something as basic as ordering a refill on an app, and that refill never being transferred to the specialty arm of the pharmacy. And financially, my local pharmacy has told me time and again, that they can, and do, handle specialty medicines with ease. And having that personal connection to someone is way better than talking to a toll-free number, where they couldn’t care less about whether or not your medicine is delivered on time or within proper temperature controls.

So while I will never begrudge a company making a profit, unnecessarily high costs (set by pharmaceutical companies), stop gaps (PBMs), and senior leadership salaries and bonuses, on the backs of people who need these medicines, is downright offensive. On top of that, direct to consumer marketing, only allowed in the United States, and New Zealand, is a $10b a year (U.S.) expenditure. As the saying goes, if it didn’t work, they wouldn’t do it.

Pharmaceutical companies argue that raising the cost of current medicines is what allows them to develop new and innovative treatments. However consider that basic research is typically started at the NIH, and then the pharmaceutical industry runs with it, taxpayers (us) already fund part of the development of medicines.

On Monday, February 25, congress held a public all day session with the top seven pharmaceutical companies. I have worked in the industry for almost 25 years, and even I learned from watching it. Albeit long,  it’s definitely worth it to understand the issues and challenges. And I can also say that all of the colleagues I have encountered over the years, do genuinely want to find cures and help people living with diseases. At issue is having shareholders and developing medicines for people who need them, is, in fact, an ultimate conflict of interest.

Pharmaceutical companies participating in above:
AbbVie
AstraZeneca
Bristol-Myers Squibb
Johnson & Johnson
Merck
Pfizer
Sanofi

“What keeps you up at night?”
None of heads of the companies said – the cost of medicines

Why in the United States do some think that healthcare should be a privilege, as opposed to a birth right? Cost of medicines is a highly complex issue, but does it need to be?

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Rest

Banksy - relax don't quit

Rest (noun)
the refreshing quiet or repose of sleep

The last few weeks I’ve been going non-stop with work (a good problem to have), but last night MS said, whoa Nelly, no can do, shutting ‘er down. So while I got a good night sleep, this morning my body still had other ideas.

At the beginning of this long distance marathon a day like today would make me hate myself. But now, now I know if it takes a few hours of recharging to keep going, no one is calling me to the OR, so I’m ok with it. Please don’t feel bad, because I’m not sick, just temporarily out of order.

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Life

life

Life (noun)
a principle or force that is considered to underlie the distinctive quality of animate beings

Each person’s life is different, and how each person approaches life is different. What we all do have in common is that one day we are all going to die. They say the only things that are guaranteed in life is death and taxes, but let’s face it, even taxes aren’t guaranteed in this day and age, just ask the person masquerading as our president.

I think what we also have in common is that at any given moment, life can bring you to your knees, further down that you ever thought you could go. And in the next moment, you see a sunset or a flower, and it can bring you to the highest high.

For me, MS was like that the first few years. Fortunately the last two have been quite benign. And while most days I don’t hit those soul crushing lows, the what if does stick with me buried deep. What if I wake up and my feet are numb and it lasts for months. And then I come back to, but what if it doesn’t? I’m glad we’ve been in what if it doesn’t territory for a long time.

The life moments of peace my body experiences now, where it’s almost as if I don’t have MS, are more, than less, these days. Sometimes I look up after hours of working and think, “wow I haven’t had symptoms or thought of the MS for hours” and I am just me. While some people will say that they are “me” with the MS, I do agree to a degree, but I would be happy to be me, without it.

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