PCORI and Me and You!! – Help Prioritize Research Topics


Forty-one stakeholders with a keen interest in Multiple Sclerosis, gathered in Washington DC on April 2, to develop, discuss and submit topics to be considered by PCORI for Comparative Effectiveness Research (CER) in MS.  In preparation for the meeting, the stakeholders were invited to submit topics for consideration and the lead science writers and researchers for PCORI consolidated the ideas into central themes; you can read those ideas in the summaries available at http://www.pcori.org/events/2015/prioritizing-comparative-effectiveness-research-questions-treatment-multiple-sclerosis. Also available at this link are the other meeting materials, a list of attendees and their affiliations, and recordings of each session.

I was invited to participate because of my connection with the PCORI funded PCORnet MS-PPRN, and my role as the lead patient representative for Accelerated Cure Project’s  iConquerMS™  (please enroll today, if you haven’t already done so!) patient powered research network.


There were four central themes identified for the day’s discussions, and we worked within an assigned group to come to a consensus of how a CER question might reflect our individual submissions.

The four groups were:

Group 1 – Comparison across DMTs, including differential effects in subgroup

Group 2 – Care Strategies

Group 3 – Non-pharmacologic and non-DMT therapy for specific symptoms and overall health


Group 4 – Timing of therapy and study design



As you might already know,  PCORI begins with the words Patient Centered, and I raised concerns that of the 41 participants, only four of us identified ourselves as people living with multiple sclerosis.  There were a few more representatives from the Accelerated Cure Project, National MS Society and the Multiple Sclerosis Foundation.  The remaining participants were connected with MS pharmaceutical companies, government agencies, managed care (both medical and pharmacy benefits) organizations and physician groups.  The patient voice was definitely in the minority in these sessions.  That said, I was a participant in group #2 and felt my ideas were well received and the chair of the discussion, Dr. Alex Rae Grant, actively sought my input at several points.


Toward the end of the day, we reconvened and each group presented their revised questions, and it was then opened for discussion. There was little discussion or debate about the proposed questions and the chair of the talks turned the questions toward the people with MS who were in the room, asking for our thoughts about the day, the process and the proposed topics.  Although it felt as if there was empty time on the schedule that needed to be filled with the impromptu shout-out for our reactions, I believe we all welcomed this additional opportunity to speak to the larger issues.


The proposed CER topics for consideration for funding are now being prioritized by the 41 participants, myself included.  We have been polled electronically and asked to rank the importance of these topics, and from those rankings the PCORI decision makers will choose what might be put forth in a request for proposal (RFP) to fund Multiple Sclerosis research.  If you are familiar with PCORI, there are some restrictions on what they will fund – they must always look at CER, and the cost of treatment can never be considered.


An email was sent to all participants, and by Wednesday, April 8, I am asked to prioritize the order of these suggested topics and indicate which SIX (6) I would rank with the highest priority and add any additional comments I might wish to include to support my choices. Following are the proposed CER questions:


A: What are the comparative benefits and harms of different disease-modifying therapies in newly diagnosed relapsing, remitting multiple sclerosis on disease activity, disease progression, symptoms, and quality of life?

B: Among MS patients receiving a DMT who experience disease activity, what are the benefits and harms of continuing the same therapy versus changing to a new medication?

C: Is treatment escalation using DMTs as effective as starting treatment with higher efficacy treatments in early active, previously untreated patients?

D: What is the comparative effectiveness of smoking cessation efforts upon disease activity, progression, symptoms, and quality of life in MS?

E: What is the comparative effectiveness of stopping versus continuing therapy after a period of prolonged disease stability in patient with MS?

F: In people with progressive MS, what is the comparative effectiveness of different care delivery approaches (i.e., MS specialty center vs. community neurology; direct care vs. telemedicine; “specialized medical home” vs. community neurology delivery of care) in improving outcomes such as functional status, quality of life, symptoms, ER use, and hospitalization?

G: In people with relapsing MS within 2 years of diagnosis, what is the comparative effectiveness of changing DMT using a NEDA strategy (no relapse, no new MRI or enhancing lesion, no change in disability) vs. not changing DMT in terms of functional status, quality of life, symptoms, ER use, and hospitalization?

H: In people with relapsing MS, what is the comparative effectiveness of physician-directed vs. allied health-directed vs. navigator-directed, vs. technological-enabled self-management tools for improving initial decision making, patient care experiences, decision regret, quality of life and adherence to therapy?

I: Does an integrative model of care along with DMT in a newly diagnosed individuals affect disability progression and symptoms (physical, emotional and cognitive) compared to treatment with DMT alone?

J: What are the comparative benefits and harms of non-pharmacological and pharmacological approaches in relation to key symptoms (e.g., emotional health, fatigue, cognition, pain) in people with MS?

K: What are the comparative benefits and harms of specific dietary regimens in people with MS?

L: What are the benefits and harms of early vs. delayed treatment with DMTs, in terms of symptoms, function, QOL, and disease activity in treatment-naive patients recently-diagnosed patients (meeting McDonald criteria within 12 months)?

M: In patients who recently transitioned from relapsing to progressive MS or were recently diagnosed with SPMS, what are the benefits and harms of continuing compared to discontinuing DMTs on outcomes including but not limited to symptoms, QOL, function, disease activity, disability, and/or mortality?


Which brings me to the point I made in the meeting – I am just one person with MS and there are at least 400,000 of us in the United States alone, trying to make sense of living with multiple sclerosis.  Our perspective on what is important to study may be totally different than the perspective of these other stakeholder groups and I would like your input on this list of topics and what you believe should be prioritized.


Would you look at these topics, consider their significance to you, and tell me what you would rank toward the top of your list?   If you have reasons why they are important, I would love to hear that too.  I will consider all the comments and put those together with my own and submit ‘our’ rankings to PCORI. You don’t need to give me six but if you would at least give me a top three, that would be helpful to consult as I propose our slate.


This is due to PCORI  on Wednesday, so please help me by commenting no later than Tuesday afternoon.  Your help with this important assignment is greatly appreciated and I thank you in advance.


Be well,



A Familiar Tale


It was the daily routine: wake, dress, pop a handful of pills, and then slowly make the way out the door.    Each morning begins with the same question, what is the day going to hold?   Not daring to look back or forward, she focuses to stay in the moment – life at age 55 could be so much better but she realizes it could also be worse.  She wanders home after being out for the day, feeling the stress through her legs, torso and up into the brain.   Life is sure a challenge living with MS.  She eases into the routine of taking more pills, selecting a spot on her weary body for the next injection, and pauses to think how much better life could be if it weren’t for this damn multiple sclerosis.  Physically spent, she drops heavily into her favorite chair and the fatigue washes over her.  Almost instantly, she falls into a heavy sleep.


When she awakens, it’s with the usual sluggishness that tells her the body is again under the spell of MS and awaiting the next pharmaceutical jolt to get moving for the day.  She reaches to the table beside her and is immediately gripped by panic  –  Where are the pills?  Her home has a lineup of bottles and elixirs and syringes, all in order and serving a purpose – although not perfect, these medicines slow the progression of her MS and keep her moving. Where are they now??


She tries to stand but can’t move – looking down, she is gripped with confusion because she is not in her favorite easy chair but seated in a wheelchair.  How could this have happened ?  She was taking her medicines and although life with MS was a struggle, she was still functioning.  Why was she no longer moving on her own?  She releases the brake and wheels herself across the room and catches sight of a reflection in the mirror – it is a younger vision of herself, possibly no older than 25.  She is confused and spins around to head the other direction and is faced with a calendar hanging on the wall open to 1985. How could that be?  Slowly it occurs to her that she’s no longer in the present, but has somehow slipped into an era where there were no treatments for MS and people were left to languish, destined to finish the final years of their  lives in wheelchairs or worse.


She closes her eyes and feels the anguish of helplessness well up inside – at least in her present day there were options with disease modifying therapies.  Here there is nothing but a feeling of hopelessness.  She closes her eyes, and drops her head back, thinking of how someday things  will be different.   Surely a cure can’t be that far away, can it?


She allows herself to be lured into that almost unthinkable  thought – a world without Multiple Sclerosis – and startles to find herself whole, as if stepping out of a cloud onto a movie set.  Everything’s perfect, including her body, except for the added years. She may have aged, but she immediately recognizes she hasn’t felt this strong and connected in decades.  How could this be? She grabs a nearby computing device and quickly searches and finds that MS has been cured.  Ways to remyelinate the body were discovered in labs, a vaccination was developed, the cause of MS was found and the risk eradicated, and no one will contract this disease again.   Overjoyed, but also perplexed, she wonders how could this have possibly happened?


Reading beyond the headlines, she finds the answer –  Just as brave people with MS had offered themselves for trials to study ways to treat MS, the next generation of forward thinking people gave even more – they gave their history, their samples and their ideas, and together formed the big data that allowed researchers to deconstruct MS once and for all.   She’s left smiling with gratitude to the people who made the evolution of MS care possible.


Yes, this is a Dicken’s of a tale, but not so unimaginable.  Multiple Sclerosis research of the present, past and future is shaped by people living with MS. When we commit our time and resources to help, we build on what others have contributed to help move closer to a world free of MS.   Join me in sharing your MS history and ideas at https://iconquerms.org , the gateway to our future and the time when a cure is found.  Don’t wait until tomorrow – do it today!


Wishing you well,







Learning More about Lemtrada


The PR firm representing Genzyme Sanofi and the launch of their newest MS drug, contacted bloggers with the offer to speak with one of their neurologists about Lemtrada, the trade name for alemtuzamab.   Never one to turn down the opportunity to speak one on one with these specialists, I was happy to accept their offer and was connected with Dr. Ann Bass, from the Neurology Center of San Antonio.   Fortunately they allotted 30 minutes to talk by phone and we used every bit of that and could have used more.  There is a lot to talk about – this new MS treatment option has the MS community buzzing with excitement about the potential. Following are the questions and answers we exchanged and our discussion:

Q: Lemtrada has been approved for RRMS but will it also be studied for SPMS and PPMS? 

Dr. Bass immediately pointed out something I had not caught –Lemtrada is approved for relapsing forms of MS and that is not limited to just Relapsing Remitting MS, and it could include Secondary progressive MS. She said there are no plans for a study for its use in primary progressive MS (PPMS), and cited an older study that showed the drug, alemtuzumab showed no benefit in PPMS.   I asked if there might be doctors who would try to use it off label for PPMS and she said that would be highly unlikely because of all the serious warnings that accompany this drug, and the extreme exposure to liability a doctor would face using it in an unapproved manner.


Q: What criteria might a doctor use to decide if this would be a suitable choice for a person to try?

Dr. Bass  said the most obvious will be if a person fails two other types of drugs and is still relapsing.  This is the use the FDA approved, but she did say if a person had aggressive MS and it was deemed a medical necessity, the neurologist could strongly advocate for a person to be treated with Lemtrada as a first round of MS drugs.   She also said Lemtrada may be a good choice for someone who tests positive for the JC Virus and wants to discontinue Tysabri, because as of now they found no link between PML and Lemtrada.


Q: Lemtrada is intended to be given in multiple doses – five doses , five days apart and then nothing for a year.  At the beginning of the second year, the person is given three additional doses.  If necessary, a person might need to take additional rounds of alemtuzumab  for a third or even fourth year.  Can you share those numbers as to how many people needed additional rounds of treatment?


Dr. Bass said in the studies, 80% of the people were fine with treatment for just 2 yrs.  20% needed an additional round for the third year and 10 % needed treatment for the fourth year.    The need for additional treatments is based on finding two indications that additional treatment is needed, and could include clinical evidence, EDSS changes, or new lesions and enhancing lesions on MRI exam.


Q: Since we all respond to MS treatment in different ways how quickly would a person on Lemtrada see an improvement or would they have to wait the entire year to see cumulative improvement?

Dr.  Bass said the response is noted fairly fast, within the first few months for most people , with the full effect being felt in 6-12 months. It can take some time for the immune system to be rebooted after it is suppressed by the alemtuzumab.


Q: Many of the MS  therapies require a washout period (time without a drug so it can leave your system) before trying a different drug.  Is there a washout period if a person stops taking Lemtrada?

It is no surprise that Dr. Bass said there is a neurologist online community that regularly talks and this is a hotly debated question, because no one really knows that answer.  Their big debate is while the  lymphocytes were repopulating would there be a benefit to be on something else? The answer is not known at the present time.


Q: We then talked about side effects – there is a 30% rate of thyroid disorders reported among the people in the Lemtrada trial . What percentage of those are thyroid cancers?

She said that hyperthyroidism and hypothyroidism was the majority of that number, but 5% were cases of thyroid cancer.   Of the people with the hyper/hypothyroidism, 80% were reversible with treatment after it was detected.  20% of those cases had surgery to remove the thyroid and will need a lifetime of treatment to compensate for that loss.


Q: If a person has a negative reaction to Lemtrada, can the drug be removed from the system like Tysabri?

She says the drug itself has a relatively short life in the body and it is gone quickly but it is the effect of alemtuzumab that can’t be reversed  – it is long lasting, and suppresses B cells for 6 months and T cells for 12 months.  Those effects cannot be reversed. Because of the suppressed immune system people can be more at risk for infections, but it is a catch-22 because if you treat the infections, you are counteracting the lemtrada effects  and low counts repopulate sooner and bring back the disease activity.


Q: Alemtuzamab was used for many years as Campath, a  chemotherapy drug for leukemia.  Will Lemtrada be administered the same way?

Dr. Bass says Lemtrada will be given by IV, the same as Campath, and the times will be similar.  A treatment of Lemtrada will involve the infusion to take place over 4-6 hours and that an additional 2 hours of observation, making it at least an eight hour day.  Because of the side effects of this drug which is a potent chemotherapy agent,  they recommend pretreating the person with other pharmaceutical to help counteract the side effects.

Q: Can the cost of Lemtrada, versus what it was as Campath be justified?

Dr. Bass said she had not seen the final cost for Lemtrada but feels it needs to be a personal choice and not dictated by price.  She also discussed the long term costs to a person with MS and how those might be decreased if a person with Lemtrada remains healthy and free from MS progression.


Since our interview I have thought of a few more questions, but I appreciated the openness Dr. Bass displayed discussing the pros and cons of Lemtrada.  She noted that her clinic was a trial site for Lemtrada and she had several years experience with the drug,  and she is a compensated  spokesperson for Genzyme Sanofi.


I hope this gives you some additional insight into Lemtrada and what needs to be considered if you think this might be the next drug choice for you.

Be well,



You & I Conquer MS


iConquerMS™ sounds like a solitary activity, doesn’t it? But imagine if a bunch of us with Multiple Sclerosis got together and from all of us sharing notes on our individual histories we develop new data and ideas that will give researchers a bigger look at MS from our experiences.

Moving data from being a single contributor to collecting the data from many is often called BIG DATA and iConquerMS™ is looking to create some of the biggest data yet on MS.  We can’t do this alone – we need each and every one of you to join.

iConquerMS™ is an online patient portal led by the Accelerated Cure Project (ACP),  a non-profit organization that  has the ultimate goal – to find a cure for MS.   ACP received the funding from the Patient-Centered Outcomes Research Institute (PCORI) to develop iConquerMS™.  I have been involved with ACP and this project for over a year and can say I have never worked with a more sincere and dedicated group of professionals than their small but mighty staff. They have earned my trust and respect.

Remember the part of PCORI that stands for Patient Centered?  I am proud to say that the majority of people on the Governing Board, and the other committees that are overseeing iConquerMS™ and making the critical decisions and choices are just like you and me – people with multiple sclerosis.  This project could not be more patient centered than it is already.  Patients helped design it, patients run it, and it will be successful because patients will join and contribute their own data.

As people living with Multiple Sclerosis we often complain that we aren’t recognized as experts on the disease.  Who else besides us really knows what it is like to live in a body with MS?  We have knowledge that others don’t … our own experiences.  And now, through iConquerMS™ we can share those experiences and our information and together all of us are poised to make a difference.  If you’ve paid attention to the medical news in recent years, patient centered care is part of our health care reform – isn’t it about time you and I are the important ones in our health care?

The idea behind iConquerMS™ is really quite simple  -there is a web portal at iconquerms.org where people with MS create an account, complete some basic surveys, share their health records, and propose questions that researchers might study.

I am also happy to tell you that every one of the major MS organizations in the United States have endorsed iConquerMS™, including NMSS, MSAA, MSF and CanDoMS.  Not only have they endorsed it, leaders from each of these groups participate on the various committees.  They believe in the work of ACP and what iConquerMS™ can do for the future of MS research. There is a lot more information about this project, who is involved and what you can expect on the website and I hope you will take the time to learn more.

This is my brief outline of what you can expect to do when you join me at iConquerMS™:

  • Register at iconquerms.org. You will find informed consent information that tells you the details on how your data will be used and how it will be de-identified so your individual identity is not attached to the records
  • Enter your demographic data – we really do need to know those basic things about you to help figure out where you fit in the Big Data picture
  • Complete some surveys about life with MS –you have probably done these at other times for your doctor but are very important to add to our Big Data
  • Share your electronic health records – there are great instructions on how you can do this and you can always contact someone at iConquerMS™ for help if you get stuck on this part
  • Submit your questions of what you think researchers should take a closer look at – the research committee, made up of people with MS and key scientists will sort through our questions and make recommendations
  • Then share your experiences with iConquerMS™ with everyone you know – to gather really Big Data, we are aiming for 20,000 participants and we need your help to spread the word and recruit others
  • Expect to receive updates from iConquerMS™ via email (you can always opt out of these) on data gathering and research interests

I won’t lie and tell you all of this is easy – because it isn’t. It’s going to take some time to work through all of these bits of information and iConquerMS™ is designed so you can start and stop your entry of data when you need to take a break.   But it obviously hasn’t been easy to find a cure for MS either since that hasn’t been done yet – and who knows what one key piece of our collective information might unlock the answer.

Isn’t it  worth our time and efforts to try to find the answers? I want to be able to say we conquered MS  through iconquerMS™.  This is only going to happen when we all join together and I hope you will accept this invitation and register today.

Be well,









MS Support in the headlines


It was a busy week for announcements in the media for new programs that will feature “big” names  for some big name players in MS.

The first is the news that Brigham and Women’s Hospital in Boston will team with others to open the Ann Romney Center for

Neurologic Diseases in 2016.  Romney and her husband Mitt – yes, those Romneys –  have talked openly about her life with MS and they will lead a $50 million fund raising campaign this next year.  I have not seen how much they personally donated, but the sum must have been significant to have the center  named after her.  The center will do research work on primarily five neurologic disorders: MS, ALS, Alzheimers, Parkinson’s and brain tumors.  We all know there are over 2.2 million people worldwide who live with MS, but we are just a small part of the 50 million who live with all of these diseases combined; research for these is seriously underfunded and this commitment of resources is significant.


Other news from the Boston area came from the launch of new patient outreach initiatives by MS pharmaceutical companies Biogen Idec and Genzyme.


Biogen’s MS Blueprint™ features Gretchen Rubin as the celebrity spokesperson.  Rubin authored The Happiness Project, a New York Times Bestseller, about living in the moment and allowing how we face each day shapes our future.  She will be sharing tips and

From the Biogen Idec press release, “Much like my happiness project has allowed me to focus on the positive and bring more joy to my life, the MS Blueprint program is designed to do the same for the MS community,” said Gretchen Rubin. “I believe every small step—including the activities achieved through MS Blueprint—is a victory toward living a more enjoyable life. When you feel every day reflects how you want your life to be, that’s when you’re truly happiest.”

The release goes on to explain how the program will work.  “By regularly visiting the MS Blueprint website, those impacted by MS can continue to set new goals, create new MS Blueprints, and contribute their suggestions for themes and activities they would like to see added to the site. In addition to the personalized activity plans, the website features frequently asked questions about living with MS, and a blog from Gretchen on how to incorporate happiness into your daily routine.”


I wonder if she developed the title of happiness expert during her years as a student at Yale Law School. Her bio from Wikipedia (yes, I hate to quote them but it was easily available ) reads: ‘Rubin received her undergraduate and law degrees from Yale University, was editor-in-chief of the Yale Law Journal and won the Edgar M. Cullen Prize. She clerked on the U.S. Supreme Court for Justice Sandra Day O’Connor and served as a chief adviser to Federal Communications Commission Chairman Reed Hundt. She has also been a lecturer at the Yale Law School and the Yale School of Management. She lives in New York City. She is the daughter-in-law of former US Treasury Secretary Robert Rubin. It sounds like she has a lot to be happy about every day and could probably give some tips about finances.


I took a few minutes to explore MSBlueprint and found an easy to use site, surprisingly free of any advertisements for their MS drugs, and constructed a sample blueprint list for myself to see what the site it about.  I’m not familiar with Rubin’s writings, but will soon be if I use this for a while, since it appears the helpful prompts and tips will be given in her blog.


The other program unveiled was Lights, Camera, Take Action on MS™, announced by Genzyme.  Madeleine Stowe, the television and film actor, is at the center of this new campaign.   I am not much into following the careers of people on the screen, so I didn’t know much about her. She grew up with her father who had MS, and I understand he died at a fairly young age over 20 years ago, in an era before the disease modifying therapies were available.  She can talk from her own personal experience as a caregiver for a loved one who had this disease from that time.

Stowe,  again quoting from Wikipedia – “appeared on stage and television in early career, before her breakthrough role in the 1987 crime-comedy film Stakeout. She later starred in films Revenge (1990) Unlawful Entry(1992), The Last of the Mohicans (1992), Blink (1993), Bad Girls (1994), 12 Monkeys (1995), The General’s Daughter (1999), and We Were Soldiers (2002).

Stowe had left the movie screen in 2003, and in later several years starred only in two made for television films. In 2011, she began starring as Victoria Grayson, the main antagonist of the ABC drama series Revenge. For performance in show she was nominated for a Golden Globe Award for Best Actress – Television Series Drama in 2012.”



Thanks to a promotional outreach  from a marketing firm to bloggers to talk about this program, I was able to speak by phone with Dr. Ann Bass, the director of The Neurology Center of San Antonio and the lead neurologist for this program. Lights, Camera, Take Action on MS will be comprised of  three live events held on different dates in Chicago, Orlando and Houston.  The Chicago and Orlando events will also be available to view on the web and taped for on demand viewing at their website.  Each of these events will last about two hours, and have a panel comprised of Stowe, Bass, other as yet unspecified medical lifestyle support people, and their patient ambassadors.   I won’t be anywhere near any of these locations to attend the live program and will have to settle for the rerun.


The panel members will talk about their drug, of course, because that is required by the FDA laws governing contact with potential users of their drug.  But Bass says the program will focus on more than just the Genzyme products and include mini-seminars that will offer information on ways to gain better health and be more active as people with MS.  She is particularly excited to share the perspective Stowe will add to the caregivers’ side of this disease; this is a special group of people that does so much but continues to be in the background with little support or resources


I applaud these efforts to reach more people with MS through research and patient support programs.  The patient programs come under criticism from many because ultimately the companies want to expose us to their particular product in the hopes we will use their therapy, but I find they can also provide valuable support, especially for the newly diagnosed.  No one should criticize the efforts of the Romneys to give their valuable backing with their high profile support to an important project.


Like I said, Big Names are being used for these new programs and I hope that helps to generate Money, Motivation and Knowledge, all of which we could use more of.


Be well,


Post Script – An addendum to this post on Friday afternoon 10/17:  You can add Novartis to the mix of promotions using star power for MS campaigns.  Novartis will unveil their program with David Osmond, of the Osmond family, next week.  According to the Wall Street journal – ““I Can Do This,” the new music video from David Osmond of the musical Osmond family, has the clan’s trademark upbeat positive style, with images of men and women overcoming barriers and obstacles to reach a goal.”   Clink on the link to view the video.

I guess we should stay tuned for who is next to bring on a ‘star’ to help us with our attitude toward life and activity.    Four major programs unveiled in one week might be a record for the MS world.






If you only do one thing


Do one thing today to make this a better place – 

I wrote this entry for World MS Day in May, but the message is still needed – the United Nations Convention on the Rights of Persons with Disabilities (CRPD) has still not been passed by our Senate.


 It is scheduled to be before the Committee this Tuesday, July 22.

You can read the details in in my blog, but in particular I urge you to notice that Ohio’s Rob Portman is one of the few who are holding up this important ratification. You can reach Senator Portman on twitter @PortmanPress,
FB Senator Rob Portman

Email him using his webform -https://www.portman.senate.gov/public/index.cfm/contact-form
or the old fashion way of sending a letter or making a phone call
The Honorable Rob Portman
United States Senate
448 Russell Senate Office Building
Washington, D.C. 20510-3506
DC Phone: 202-224-3353

There are others on this list who also could use hearing the voice of reason supporting this resolution.  if you need help tracking down their contact information, let me know.  I am happy to help.

I thank you and the world community thanks you.



Experience Shapes What we See


We have an assortment of wildlife living in our suburban neighborhood, much beyond the normal squirrels, chipmunks and song birds.  We have birds of prey – the red shoulder hawk in particular – that keep watch from above.  Another fox family has been born in the thick trees of our neighbor’s backyard and they wander around day and night.  In case you still wonder what does the fox say, it is an other worldly squawking and calling sound, especially in the middle of the night when we are trying to sleep.


Most recently we have an adult doe who has been making the rounds of our back yard- she wanders through, nibbling on the weeds of which there are plenty, and she doesn’t seem particularly bothered by my stepping out on the deck to watch her and snap a photo or two.   I posted this picture on my Facebook page and immediately was given a lesson in how we apply our own experiences and perceptions to a particular situation.


What do you think of when you see my pictures?


I am always in awe of these creatures even though I know they are not necessarily benign.   Many people responded to the beauty of this deer peacefully lounging in my backyard.  Who could argue with that view?





A friend immediately chimed in that she wished she could see the beauty but all she could picture was ticks.  You see, she had been ill for several years from Lyme Disease, a serious infection caused by the bite of the tick carried by deer and other wildlife.  From her experience, there was nothing beautiful in my photo.


My sister had the  flashback of having extensive damage done to her car when one of these beautiful creatures bounded onto the highway in front of her one autumn evening.  Our daughter had that same misfortune and totaled her car with a deer strike, but she saw this backyard deer and was still mesmerized by its presence.


Then there are my hunter friends  – they spend hours and more hours in fields and woods waiting to cross paths with a deer this size.  They are also the same people who process the meat and eat off their kill for many months.  Their pulse quickened a bit when they saw the picture of this deer just hanging around in my yard.



deer 2 What does this have to do with anything other than I have some interesting  photos of wildlife in my otherwise quiet neighborhood?



I offer this as an example of how people can take the same thing – in this case the deer– and come away with very different interpretations of what they see.  I see this happen quite often when people with MS read the same news or research and come away with different ideas.  Take CCSVI or the latest diets or hyperbaric oxygen treatment or any of the other unproven MS treatments and you’ll see this in full action.  There is such a strong desire, no make that a strong need, to find a cure for MS, that it is easy to interpret  the headlines into something other than what it says based on our own biases and preconceived ideas and needs.


Each cure we read about means we also must stop and wonder how are we reading the news – is it because it says what we  want  depending on our perspective and experiences, or is it based in fact?  I am a Pollyanna by nature and want to think one of these ‘cures’ might really work,  but the realist in me recognizes the science doesn’t hold up to the proof process.    That doesn’t mean I can’t still stop and wonder if the next ‘cure’ might hold up, and want to learn more about it  – but have to keep in mind my personal perspective helps to complete the story.


I will also look at this deer the next time and not only see beauty, but wonder about the ticks and look closer for any bow and arrow yielding hunters closing in.

be well,









The Advertising Pitch


We had a good laugh as my husband sorted through the coupons that arrived in our mail – it was an envelope full of special offers and near the top of the stack was a coupon for breast augmentation – only $3,850, including anesthesia.  Boy I’m glad to know at least they knock you out while you have this done.  A few more coupons down in the stack, just after the one for the $39 hour massage to celebrate a new studio opening, was an invitation to come to a local funeral home to do our pre-planning.


What happened to the simpler times when these coupons involved buy one get one free pizzas and special deals on moonlight bowling? The face of marketing has changed, complex services are being peddled as common merchandise; even the pharmaceutical companies are doing all they can to get their product or service on our radar.

Websites that talk about Multiple Sclerosis are often populated with ads – you know the ones that are promoting the latest treatments or product that might make our lives better.  The cost of maintaining a website, complete with a staff to keep the content fresh, isn’t cheap, and selling ad space to pharmaceutical companies is one way to bring in operating revenue.


Virtually all of these ads are specifically targeted to me and what they are guessing might be my interests.  Tracking of what I look at online is captured through cookies and pretty soon,  ads that mimic my interests pop up on my screen.  I was shopping for some special style of orthopedic shoe and for the next month,  my computer screen was visited by shoe ads by a variety of different manufacturers.  Of course I am regularly looking at multiple sclerosis information on line and those visits trigger ads for MS treatments to populate my viewing screen.  Often those are from reputable companies, but I also get ads for special diets and unproven surgical procedures performed in exotic locations like Costa Rica and Bulgaria.


When doing research for writing, the  search terms  I might use often lead to an interesting  assortment of pop up ads – try it yourself and see what you get if you google for MS and sexual dysfunction.   Or MS and incontinence.  Or MS and marijuana.   I’m sure you get the gist of my point, when I search the right words,  I get lots of Viagra, adult toys, catheter supplies, and bong  advertisements thrown my way.


I’m resigned to those ads and how most websites have to do business with advertisers to cover their expenses and make a profit. Most of them I could simply ignore, but I still often have trouble with some of those ads, mainly because their fancy colors and animation often interfere with my vision, focus and also the speed of my computer.  I could turn off the cookies in my computer, but many sites these days require the cookies to be set before you can even enter their website.


I found a great ad blocker software that is free – they ask for donations to support their work and I gladly give them a small amount of money to support their product – and it keeps most of the pop-up ads away from my computer.  Since I installed this software on my new laptop in February, the counter tells me I have been spared seeing   over 100,000 download ads.


I say most, because even AdBlockPlus lets some ads through – they call these ‘acceptable ads.’  It is an acknowledgement that advertising revenue is necessary to sustain most of these sites.  There is a long list of criteria that makes an ad acceptable, and this includes no animations, nothing with sound and preferably text only.


Social media sites such as Facebook and Twitter also generate income for their sites by selling prime spots on their pages to advertisers. Unfortunately, the ad-block software doesn’t stop those messages and in between messages from friends and sharing jokes and pictures of children and grandchildren, those ads slip into our feeds.


Advertisers have their fleeting chance to get us interested in their products and it takes a lot these days to get our attention since we are bombarded at what seems like every opportunity.  Whether it’s a mailing to my home or ads on my computer, most of them end up deleted or in the trash – if I am shopping for MS drugs or breast augmentations, I want to do my own searching.


Be well,






MS Relapses- It’s Complicated


Bottom line – I am in a relapse right now, and have optic neuritis for the first time that I know of, but I had no idea.  I just knew I haven’t felt good for quite some time and have seen a lot of doctors and paid a lot of copays, trying to figure it out.  It can be so hard to separate the MS from the other changes in our bodies.

Here’s the clues we either overlooked or discounted as something else –


In October, my walking deteriorated and I went back to physical therapy to do more  gait training. By December, I  developed a hammer toe, probably from doing planks in the gym with my trainer.  It’s a move where you support the body on the tips of the toes, and I could feel it was uncomfortable but I did them anyway.


I saw my podiatrist/surgeon and he gave me a plan – try orthotics for my shoes (which  I did) and come back in 8 weeks if that didn’t help.  It took a few weeks to get the orthotics right because the maker had misread the prescription and were treating me for something else.  I just knew they weren’t right and kept going back until it was sorted out.


Late February, I was unable to stand up pushing off with my right leg – I had to push off on the edge of my desk, the arms of my chair or even the back of the toilet to get to a standing position.  It then became very painful in my calf- it wasn’t red or inflamed like an infection, but nonetheless my husband dragged me to the doctor for an exam, the subsequent ultrasound did not find anything wrong, specifically looking for a deep vein thrombosis (DVT) also known as a blood clot.  This lasted about 4-5 weeks and gave me something new to work on with my trainer – standing up, thinking the repeated work on that task would benefit the muscles.  I was fairly certain since there was no DVT, this had to be associated with my hammertoe, although the pain was separated by a good 10-12 inches.


A persistent UTI created havoc and required multiple rounds of antibiotics – setting up the perfect symptoms for a pseudo-relapse which could be treated by antibiotics.


During these several months, my energy level plummeted and I saw the MS Nurse about the fatigue – we adjusted some of my meds and scheduled a follow-up.  The next time I was able to tell her it wasn’t much better so we made more adjustments to my meds.  We discussed that my annual MRI was due in June and we set it up so I could get it done one week before my next appointment with my neurologist.


Then my hammertoe foot grew to be very painful with every step , the podiatrist ordered an x-ray, and blood tests (to look for infection) and those were clear.  Then he ordered a CT scan which also showed nothing, but my foot was still painful. As a final step, he ordered an MRI, which shows I have a very nasty stress fracture, most probably caused/made worse by my gym session and especially those planks – this is not the first time I have discovered that exercise can hurt you. Consequently I spent 5 weeks i n one of those knee-high  black velcro boots  holding my foot hostage and making  my wobbly MS walking style even worse.  I was off-balance continuously and moved around as little as possible.


The MS nurse said even if I were in a relapse with all my fatigue and balance problems, they would probably not treat me for a relapse because steroids would slow the healing of the stress fracture.  Most probably the fatigue was from the injury/trauma to my leg and hauling that extra weight on my leg.


At my last annual eye exam, the ophthalmologist said I was probably about ready to move from reading glasses into prescription strength lenses.  During March Madness I noticed the picture on the television was a bit blurry and reading those small box scores were almost impossible to guess correctly. My distance vision while driving was also decreased  – I have always had virtually perfect distance vision and I attributed this change to my aging, hearing the words of my ophthalmologist- she said to call when I knew it was time for real glasses.  I did call and set up and appointment, figuring the time is now for prescription glasses .


Through this entire time, my fatigue never went away.  I have been constantly exhausted, but pushed through with doing the daily activities I had to do, such as go to work.  But there sure has not been much extras done beyond the basics.  Everyone around me suggested I slow down, but weren’t seeing that I was already at a crawl.


My brain MRI was done, and the following week I am back at the clinic for my annual neuro check.  By now, I can only read clearly to the second line of the vision chart, but I can guess at the letters on the next few lines – I have been reading that same chart several times a year, since 2008, and although I have not memorized it, I do recognize the letters and shapes easily.  I tell the nurse I have that eye appointment scheduled for next week and know I need glasses.


My neurologist starts our appointment by getting my list of symptoms – what’s bothering me.  I go through the above list and he is taking notes.  Then has says let’s look at my MRI results- he confesses he had not had time to look at it yet. Yep, lesions are still there but nothing new or alarming popped up.  BUT he looks at the radiologist’s report and say he trusts her with his films – very unusual since he has always said about other radiologists’ that he doesn’t use their reports.  She notes that it appears I have inflammation of the optic nerve, even though I didn’t have the optic nerve MRI specific test run.


Before he reads further, I tell him my guess would be my left eye – and yes, there it is, on the image and in her report.  I leave the neuro appointment with the news I have ON, a prescription for steroids in hand, and I left shaking my head that this could have been going on for the past six months and I hadn’t a clue many of my current problems could be MS and not just aging and life in general.


It was somewhat a relief to know there is an explanation for most of these symptoms,  but bothersome to me that I had not connected the dots to see it was almost all due to my MS.  No matter how much I think I know about MS, I still need that doctor to help me sort it out.   How often do you find yourself second guessing about relapses if they aren’t a dramatic change to your health?


For a change, while I’m usually saying I can’t blame everything on the MS, in this case I probably should have …. It’s hard to guess just when this relapse started, but I am thankful I didn’t spend money on new glasses.



World MS Day


It’s a rather somber thought – this isn’t a day for balloons and parties, but a call for awareness that Multiple Sclerosis is  a worldwide problem and continues to increase.  2.3 million people have now been diagnosed with MS.


Please join me in observing World MS Day 2014.

be well,