Fear

Fear

Fear (noun)
an unpleasant often strong emotion caused by anticipation or awareness of danger

There is so much to fear on a daily basis, it’s a wonder most of us can leave the house on a daily basis.

There are the types of fear that seem to lurk in the background, like dark spaces, spiders, snakes (both do I loathe the latter two!), and other things that go bump in the night.

Then there is the fear of speaking in front of people or going on a stage or singing in front of people. It’s interesting to me that when I speak with people who act or sing regularly about their ability to make themselves so vulnerable, I’m often met with responses that suggest low or lack of self esteem, which seems like such a dichotomy. How can a person willingly make themselves to vulnerable, and yet fear that very act of vulnerability at the same time.

The fear of losing loved ones and close friends, from long drawn out diseases, to sudden deaths, or just old age. The fear of going on without these people in your life.

We are moving into one of my favorite seasons, fall, although winter is my very favorite-est. And with that comes the fear of having a flare-up and living with a progressive, neurological disease can play tricks on your mind. The anxiety can help drive that fear. Different treatments like CBD or anti-depressants/anti-anxieties can help, as can exercising. Fortunately I’ve found a combination that works for me. It doesn’t stop fear from creeping in at highly inconvenient times, it just means that when it does, I have the tools and resources to help my brain realize that it is playing tricks on me.

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Choice

Choice

Choice (noun)
an act of selecting or making a decision when faced with two or more possibilities

Today is the 9th anniversary of starting on treatment for multiple sclerosis. This amounts to about 486 injections, minus illness, birthday week, and travel. Sometimes it feels like it’s been forever, since I no longer really remember a time when I didn’t feel MS. Some weeks it’s matter of fact and others it’s hard. Fortunately the last 1.5 years, it’s been 90% of the former and maybe 10% of the latter.

Statistics say that there are around 1m people living with MS in the United States, and almost 3m globally. But since MS is not required to be reported, we rely on data that is often manipulated, especially in the U.S., since it relies on diagnostic codes, which are often fudged in order to gain insurance coverage.

In 2018 we are lucky to have 16 disease modifying medicines for MS, with more to come. Just a short 20 years ago, people were sent home with steroids (maybe) and told not to move. Also, there are a host of meds for symptoms and side effects of the disease.

What we still don’t have is a cure. I hear this about MS all time, but I don’t really listen since I know how complex this neurological disease is and certainly not easy to dissect. That said, I do believe there can be better targeted treatments with less side effects. Better (and more) research in stem cells from your own body, rather than having to go through the toxic process of obliterating your immune system, like for people living with cancer.

It’s such an odd thing living with a disease that people can’t see and one that each of us experiences in very individual ways. As they say, when you’ve met one person with MS, you’ve met one person with MS. #snowflake

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Diagnosis

Diagnosis

Diagnosis (noun)
the identification of the nature of an illness or other problem by examination of the symptoms

Two weeks after my time in the hospital and being on all kinds of medicines (oral steroid taper, sleeping pills, stomach pills, you name it pills) I was told to head over to get the “official” diagnosis. I had a lumbar puncture that required about two weeks to culture and confirm what the doctors already suspected.

I spent those two weeks in between “knowing,” knowing that my life was drastically about to change. But I was also so sick at this point that I could only focus hour to hour, which sort of kept me from “going there” as much as possible.

Standing outside of the hospital, it was like something out of a movie. It was a gorgeous spring day in Basel. The birds were chirping, kids were on their way home from school for lunch (yes you read that right), people were running errands, and heading to or from work. The world around me was moving, yet I felt like I was standing in cement and couldn’t move.

I stood outside of the building for a good 15 minutes before mustering up the energy to walk thru the doors, knowing that my life would change when I did. A friend offered to go with me, but I felt like it was something I needed to do on my own. Maybe taking back a little control in a time that was so very much out of control (I HIGHLY recommend taking someone with you to something like this. HIGHLY!).

I was told to find the resident on duty, which in hindsight seemed quite odd, as usually you would meet with a specialist in private. I approached the nurses station hoping that someone spoke English so I didn’t need to go through my usual repertoire of nursery school German.

The resident on duty came to get me a few minutes later and we sat in some chairs by the elevator. I can’t recall whether or not she introduced herself, I just remember watching people going on and off the elevators. And I kept thinking, how weird is it that we’re doing this here and not in an office. Out of the corner of my ear I catch her saying “we’re 99% sure that it’s multiple sclerosis.” I think she might have referenced something about following up with the neurology clinic, meds, and a few other things, but honestly I have very little memory of the whole thing. I guess that’s the way our brain protects us from bad things.

As I was walking to the elevators I watched people getting on and off of a few minutes earlier, I was numb. I had no idea what would happen now. As I stepped back outside into the beautiful spring day, I laughed about what and how the previous conversation had unfolded. It occurred to me that it was April 15 (tax day in the U.S.). And then, in the middle of a street from the 1100s, I called home to New York and cried.

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Onset

onset

Onset (noun)
the beginning of something, especially something unpleasant

It was the summer of 2008. I had just turned 39 and was in the south of France on vacation (living in Switzerland) with a friend. I’d been working dozens of hours a week and desperately needed a holiday. Unfortunately southern Europe was experiencing the worst heat wave they’d had in over a decade. It was 100 degrees which made it hard to do anything outdoors. We hid in shops, movie theatres, and cafes.

We were staying at a lovely winery and while we did taste some of the local fare, by no means were we walking around squiffy. One night I went to bed fine, and the next day I woke up with a numb butt. I remember asking my friend if that had ever happened to her, it had not.

That started my odyssey for a diagnosis. Flash back to a few years earlier and I did crisis work for a multiple sclerosis medicine that was removed from the market and re-released after proper precautions were put into place. In the deep recesses of my mind, I knew something was wrong aside from the everyday aches and pains we experience.

The next months would come with experiencing weakness in both legs, more numbness, and a lot of fatigue. Fatigue so bad that after sitting in a movie for two hours, I would walk a dozen steps and need to sit down on a bench.

I saw my GP, chiropractor, and acupuncturist. I knew that the weakness in both legs at the same time wasn’t sciatica since I have experience with that. Your sciatic nerve is on both sides and not connected. So it’s rare that would you have it bilaterally.

My GP did all kinds of blood work to rule out potential diagnosis, which is still currently the way you also rule IN the diagnosis of MS, including lumbar puncture. Tests for Lupus, lyme disease, syphilis (latent disease can cause neurological symptoms), and a brain tumor (more on this later).

The GP finally referred me to a general neurologist who did some basic motor skills tests and said that I was fine. In the U.S. I would have pushed for more test, and they likely would have at least done a brain MRI, though it may not have shown anything at that point.

In December I had an eye issue where my eyes had trouble focusing distance. No problem seeing up close, just distance. I saw an optometrist (no issue with my prescription) and referred to the eye clinic at the University Hospital. I spent NINE hours at the eye clinic one Saturday. It was like something out of the 1600s, literally. A few days later I met with the attending physician who said I likely had strabismus. Ok, so while my dad had it as a child, I’d just had an eye exam for my contact lenses a few months prior. So NO, it wasn’t strabismus, but rather like when you get a weird rash and the doctor calls it “contact dermatitis” because they have no idea what it really is.

I went back to the general neurologist who now thought it would be good to get a brain scan. Upon receipt of those images, his next idea was to do a lumbar puncture. Playing a doctor during the day, I knew there had to be something in between a brain scan and a sticking a HUGE needle into my back.

Between the results of the brain scan and the eye issue, this was sufficiently enough to freak me out. I was going home in a few days to have knee surgery (a story for another time). So I put my dad on the mission to get me into see a neurologist back home that could help me sort the issues. Two phone calls and 20 minutes later I had an appointment with one of the top neurologists in the U.S. who I still see to this day. I call it mobilizing the Jewish healthcare mafia. We ALWAYS have a doctor to recommend.

Two days later (NYC) I was in the neurologist’s office, images in hand, and parents for support. He reviewed the images and said he saw a few more tiny brain lesions, but nothing that would give him cause for concern. He did some motor skills tests and since I was asymptomatic at that point, he didn’t consider it MS. Phew! Dodged a virtual bullet. He gave me his card and said call his mobile any time and we were on his way.

Three months went by and all was fine. Then the last week of March I couldn’t get my feet warm at all. Warm water, double socks, heating pad. My feet were constantly cold. And over the course of the week I went numb from my feet up over my stomach. Not paralyzed, but numb. I could still walk and no one was on the wiser.

I finally called my GP and although he felt it would subside it was probably time to go to the ER. I took a shower, packed some clothes, and hopped on the tram to the hospital. In hindsight I probably should have waited to text my dad because it was 10a where I was and 4a here in NYC.

They took me back into a room and I immediately called the neurologist I’d seen in NY a few months earlier. It was really important for me to have someone back home in the healthcare system who a) knew where I was and b) could be connected into the treating physician. Turns out I was at the hospital where the top MS institute in Europe is located.

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Organize

organize

Organize (verb)
to form as or into a whole consisting of interdependent or coordinated parts, especially for united action

If there’s one thing that most people know about me, it’s that I enjoy being organized and I really don’t like clutter. Please don’t even get me started about how I feel when I see someone’s phone has a zillion unchecked emails, texts, or messages! I’ve been sought after both professionally and personally for my organizational skills. Now I’m not quite Felix from The Odd Couple, but I suppose run a close second.

This started long before the MS; however, is probably more important now than ever. Being organized keeps me from (mostly) forgetting or losing things and helps with peace and calm in my home. “A place for everything and everything in its place.” [Ben Franklin]

One of the areas that it’s important to be organized is visits to your healthcare providers. People have often complained to me about one issue or another with their doctors and sometimes I respond and ask how they prepared for the visit. Crickets.

In order to get the most out of my healthcare provider (HCP) visits and form a partnership in my care, I created a template document that I fill out, and take with me, to each office visit.

For me the most important part is preparing in advance, including the reason for the visit and questions. This gives you a chance to organize your thoughts and maximize your visit.

The office visit sheet can be used as a reference and to take notes for review later.  This information can either be maintained electronically or in a binder, whichever works for you. When you live with a chronic or acute disease or disorder, it’s extremely important to be organized and have all of your files at your fingertips (test results, CDs of images, etc.).
Of note: you own your medical records! 

Format as follows and link to document [HCP office visit template]

Name complete date of birth
Office visit date

Issues for discussion
bullet points or numbers

Medicines
name, dose, administration, frequency, length of time taking
bullet points or numbers

Vitamins
name, dose, administration, frequency, length of time taking
bullet points or numbers

For more extensive record keeping you can also include family history of illnesses if known.

Keep this information on your phone for ease of access re: emergencies. Bring two copies to the visit, one for you and the other for your HCP.

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Stigma

Stigma concept.

Stigma (noun)
Medicine/Medical – a mental or physical mark that is characteristic of a defect or disease

I’ve been thinking about stigma through most of my career in healthcare communications. Having worked across just about every disease and disorder category you can think of, one of the things we’re often tasked with doing is to help “dispel” stigma around living with diseases. What I’ve learned during the 20 years in this area is that the only people who can truly smash a stigma on its head is someone living with that disease or disorder.

Now herein lies one of the problems with trying to do away with stigma, you have to talk about it publicly. It needs a face. People need to know that stigma is their partner, child, brother, sister, cousin, best friend. Whether it’s with close family and friends or on a broader platform. And in the U.S. at least, if you come out on that broader platform you potentially put your career in jeopardy. I deal with stigma every day whether someone knows I have MS or not. Stigma is all around us. In the media, online, in conversations. Our society favors the able bodied, fit, person.

I’ve seen people in wheelchairs talked over as if the person doing the talking automatically assumes said person in the wheelchair has brain damage and couldn’t possibly understand them. Or better, they shout at them. Now I’m sure I’ve been guilty of this somewhere in my life, but being diagnosed with a neurological disease magnifies those societal blips.

I have a unique story. If anyone has heard the actual way I received confirmation of my diagnosis, they know. It was funny in the moment, and it’s funny now. Combining my experience with living with MS and working in healthcare, I have attained the necessary skills to be able to help people who come after me. BUT I haven’t been able to be nearly as open as I would like due to the fear of said story-telling having a negative impact on me professionally.

Clearly my brain works, no really, it does. And in the past I have gladly accepted that even when I’ve gone through the worst of my flare-ups I can handle doing more professionally and personally then someone without MS. That said, even working in healthcare I couldn’t come out to my managers. There’s that silly stigma again. The idea that I would be looked at as less than if I made a mistake. And most times if I do make a mistake it has absolutely nothing to do with the MS. And if it does, it’s because I’ve worked too many hours and am incredibly fatigued. Under those circumstances everyone makes mistakes.

Another area of stigma surrounds mental health. For reasons unbeknownst to me we don’t treat emotional well-being as importantly as physical. And more often that not, issues with mental health are in fact physical. I don’t know too many people who would ignore having diabetes or cancer. So why do we ignore our mental health? Stigma!

People close to me know I am a total Britophile and eagerly watched Will and Kate get married, awaited both babies with baited breath and have now watched Harry come into this own. Over the last 24 hours he has given interviews detailing that he needed to seek therapy for depression. Remember when he was caught naked in Vegas? Or coming out of clubs in the wee hours? He never fully dealt with the death of his mum and his brother lovingly told him he needed help. When someone of his visibility comes out, especially in the English culture of keep calm carry on, many others feel they can as well.

One of the symptoms of MS is depression. And along with all of the meds to treat the disease and symptoms comes depression. And then you have a flare-up and you’re depressed about that! And then you’re depressed coming off of all of the meds. Screw serotonin! The depression I’d always experienced was either situational or related to being on treatment and follow-up for a flare-up. Until the end of November.

I came home from a grueling day of work and was just spiraling. I stood in my living room feeling as though I needed to head across town to the emergency room where I used to work. I could not stop ruminating. Fortunately a good friend, long distance, over instant message talked me through it. Given this was the first experience I had like this not related directly to meds, I knew medical intervention was a must. This was a Thursday night and Friday I had an appointment with my neurologist for the following Monday. A few days later I started on Zoloft. Hey stigma, how you doin’? Now how can something be a stigma when more than 15 million American adults are living with it?

Those first weeks the nausea was, well,  nauseating. One Saturday night after being out I was wandering the streets at midnight looking for Emetrol for the nausea.

I kept wondering when it was going to “kick in” harkening back to college days. Another friend assured me that I wouldn’t be turning purple or growing a unicorn horn, but that I would “just know.” Part of my fear of new meds is side effects. I would wreck any clinical trial I tried to participate in because I’m the person who gets the side effects. I get side effects no doctor has ever seen before. I’m that person.

Probably about a month into taking it, I started to feel happy. And I mean nauseatingly happy. Like the kind of happy my friends and I would make fun of. Full disclosure, I also started working out every day coinciding with taking the medicine. Fast forward several months and while yes, some say it’s a magic pill (I don’t disagree), but I was also ready for a change. And honestly, it feels GOOD to wake up happy each day. It’s allowed me to tackle something professionally I’ve wanted to do for years (saving that for another post). It’s afforded me the opportunity to start this blog and has cleared my head of “you’re not good enough” and imposter syndrome and most importantly not spending my days hating myself.

I’d like to think this is my little piece of helping to end stigma.

DĂ©but

Beginning

Multiple Sclerosis (noun)
Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system characterized by loss of some of the myelin sheath surrounding certain nerve fibers and resulting in speech and visual disorders, tremor, muscular incoordination, partial paralysis, etc.

The most intriguing part of the above description, for me, is the “etc.” Etc are the moments we live in during our day-to-day. The etc can include buzzing (paresthesia) that resembles a jack hammer, fatigue so crushing you wake up only needing to go back to sleep, numbness from your head to your toes, loss of vision (optic neuritis), issues with bladder and bowel, etc. On the bad days, the etc can leave you wanting to tweeze the hair on your head one strand at a time. The honest people admit it just sucks sometimes.

Currently there are four classified types of MS:
clinically isolated syndrome
relapsing remitting
primary progressive
secondary progressive

I live with relapsing, remitting, which means I can have an exacerbation and then go back to having little to no symptoms. There are also pseudo-exacerbations like how anything above 70 degrees sends me running for cover, but as soon as I cool down I’m ok.

People who live with these types of diseases and disorders can never forget. I don’t wake up in the morning, go through my day and get back into bed and think, “oh right I have MS.” That doesn’t happen. Even on the good days, you always remember you have MS.

For the first year I was quite ill and mistakenly thought that once I felt better I could project manage the disease and move on with life. I grossly underestimated the impact this disease would have on me both physically and emotionally. The irony? When we would sit around as teens talking about how we would want to die when we were old, my biggest fear was getting stuck in a body that didn’t work with a brain that did. Joke’s on me! But at least I do have a brain (confirmed by many, MANY MRIs).

While no one knows what the future holds, a disease like MS puts a bit more uncertainty in our already uncertain future. Did you know that humans are the only species who know they are going to die one day?

Today is the 8th anniversary of my diagnosis. While some milestones can easily go by without a thought, given it’s tax day, it’s doubly hard to forget.

I hope you will join me on this journey as I share stories, health information (of all kinds, not just MS), real facts, my life in faux pas, and just random ramblings.