People with MS Have An Important Role to Play in The Great Big COVID-19 Experiment.

Knowledge is power. The more we know about COVID-19, the more powerful we will be. This is why we spend eight to twelve hours a day checking our iPhones.. .to possibly learn twenty two seconds worth of relevant information that might SAVE OUR VERY LIVES. Or, at any rate, to learn another snippet about “The Tiger King.”

I thought I’d pass along a bit of relevant information I’ve gleaned , because it concerns my peeps, the folks with MS. Gentle Readers without MS…stay with me. I’ll be passing along a few bits of relevant information for you, too.

I’ve been taking the threat of COVID-19 extra seriously because I’m in that subgroup that’s supposed to be afraid… very afraid: I am one of the Immune Compromised. Like many of the insured with MS, I’ve been taking very expensive medication that I’ve since read may have made me fractionally more immune compromised in the face of COVID-19. Had I been on a more effective MS medication, I may have been significantly more immune compromised. So I guess I’m glad I was on a dud of a medication? Mostly, I feel those of us with MS and medical insurance have been played for suckers to generate profits.

Anyway, I’m off my meds. Good riddance. Except. I am now experiencing weird visual symptoms that may (or may not) have been prevented had I continued with my lame MS drug. There is no way to know if I’m having a relapse without going to a doctor, and who wants to do that? I don’t have a control-group-twin sister who is still on Tecfidera.

Yesterday I read about a tool more ethical than a control-group twin sister— a global initiative that is amassing data to help people with MS and other demyelinating diseases of the central nervous system to make more informed decisions about our risks related to COVID-19. It’s a database called COViMS.

We neuro-compromised don’t have to do much to participate in this database. We just have to a) catch COVID-19, b) get tested (good luck with that!) and c) tell our doctors to use this link to fill out a brief report, though “only after a minimum of 7 days and sufficient time has passed to observe the disease…through resolution of acute illness or death.”

The form takes ten minutes to fill out, but that’s not our problem; that’s our doctor’s problem. We will either be recovered or dead.

I am always looking for a way to be useful after I am dead. (I’m not too keen on being useful during this all-too-brief period before I am dead.) For years, I’ve been wanting my dead body turned into some form of compost. Seriously, that would be a dream come true. But if that dream is not to be, having my COVID-19 struggle recorded in a searchable database will have to do.

There is, however, a small but distinct possibility that my COVID-19 struggle has already come and gone and is only now getting documented in this very small database known as my blog. I was wrapping up a session of qi gong in our back yard during an unseasonably warm and sunny day when I suddenly experienced an acute pain in my lungs. It felt like I’d inhaled asbestos mixed with the smoke from a thousand cigarettes mixed with a thousand tiny daggers. There had been a brief regrettable period in my youth when I was a two and a half pack a day smoker. My lungs felt worse than they did then. And felt worse than they did through my childhood bouts of pneumonia. There was no database to consult about my chances of surviving COVID-19. As far as I knew, being Immune Compromised meant I was about to be a goner.

Operating under this speculation, I did a few embarrassing things.

I received a text from a friend of mine, who was anticipating the arrival of three grown children from New York. She had just discovered the toilet paper shortage was real. I replied by bequeathing her our precious Costco sized trove of toilet paper, without checking in with my husband first.

I then texted my son that I was proud of him. Or that I loved him. Or that he should do good in the world. Something that could have raised an alarm.

I then called my parents. They told me to hang up and call a doctor. So I hung up and tried for a telemedicine consult through my insurance company. In order to qualify for a telemedicine consult, I had to fill out a brief questionnaire about my health status and symptoms. The questionnaire asked if I were immune compromised. I was immediately patched through.

The doctor on the other end of the telemedicine consult was a young woman who looked and sounded ten times sicker than I felt. As she asked me questions, her toddler toddled into the background, asking questions of her invisible patient in her private toddler language. The doctor informed me that I would not qualify for the COVID-19 tests in my area. She advised me to get some rest. She told me that I was breathing more freely than a patient she’d be concerned about. Feel better, she said. Feel better, I said. The toddler said something in her private toddler language. The exchange cheered me up.

I realized that even though I have MS, and had inexplicably burning lungs, that didn’t necessarily mean I had COVID-19. And even if I did have COVID-19, it was not necessarily inevitable that I was about to die. Maybe there was a chance I could live through COVID-19. At the time, there was no database to consult. Instead, I grated ginger into my tea and I rubbed tea tree oil onto my chest and I did a round of qi gong with Jeff Chand on You Tube and I consulted with my body and my breath. Within a few hours, I was updating my parents that my lungs had stopped hurting so badly. I received a text that my friend would not be needing my toilet paper, after all. I received no reply whatsoever to my text to my son; clearly, I had not freaked him out.

I went to bed with my lungs aching, but not too badly. I woke up barely feeling my lungs at all. In the two weeks since then, I’ve had one other inexplicable scare wherein my lungs hurt severely for a few hours, but mostly, my lungs have been serving me quite well. How well? A few of my college friends talked me into trying Wim Hof’s guided breath meditation on YouTube. I learned I can hold my breath for two minutes, a super-power I would have loved to have known I was capable of back in 1972 or so, when I was watching a Batman and Robin episode in which the daring duo was trapped in a room with rising water. There isn’t much we can control during this COVID-19 crisis; controlling the breath has become ever more appealing.

My friend Monica also has MS and has also had a COVID-19 scare, although we didn’t know it at the time. She announced her symptoms as we sat in a sun-drenched lobby that looked like it belonged to an upscale hotel and not a Neuroscience Center. We’d all just finished what I announced would be my final MS yoga class for the nonce…I was at that point feeling a bit apologetic about my freakish instance that COVID-19 could be on its way. Our friend Kim was sipping the kale and blueberry smoothie we’d recommended. Monica had abstained from ordering a smoothie; she explained she was recovering from battling a freakish bought of diarrhea, and was still experiencing the strangest side effect—she seemed to have lost her sense of smell. None of us yet knew these were symptoms of COVID-19. I would miss only one MS yoga class before the hospital finally cancelled its sessions. Since then, I’ve been hosting the MS yoga sessions on Zoom.

At the end of the first Zoom yoga session, Monica and I were the last two participants left on the screen. She told me she was looking forward to the COVID-19 antibody test. Wouldn’t it be cool if we’d already had the virus, and could just relax? I countered that since COVID-19 was a novel virus, we had yet to learn how effective antibodies would be, and for how long. Today on NPR I learned that those antibody tests we’ve been looking forward to do are actually riddled with false positives. It’s still too early to relax.

Even so, the unique challenge we all face is that we have to relax…at least enough to keep ourselves from developing a harmful immune response should we encounter COVID-19. And we have to stay vigilant. At least enough to keep the virus from getting to us in the first place. It’s a tricky balancing act. Those of us with autoimmune disease are uniquely positioned to have already experienced the loss of control the rest of you are now experiencing. It’s not easy to be calm in the face of imminent danger. But it is imperative. The immune component of the disease opens up an opportunity for all of us to take back some control of our health by treating ourselves well.

Gentle Reader, what have you been doing to relax?

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

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

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

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

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

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

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

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

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

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

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

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

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

I am sharing that section as well:

What should everybody do to protect themselves from COVID19 infection

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

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

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

Update 05/06/2020

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

Words of Wisdom from the New Rochelle Containment Zone

Long time readers may recall my littlest sister, PYT aka Pretty Young Thing. She doesn’t have MS, or any chronic illness. But in true little sister style, she’s managed to become the center of attention…

I am blogging as a guest of Ms. Lab Rat today. It’s always nice when my big sis invites me to share her toys.
I have lived my life blissfully outside the MS maze. Every year researchers send me their MS sibling study and I share my boringly perfect health. I take no medicine. I have no difficulties doing anything (that’s a lie of course- I have great difficulty remembering to re-apply lipstick, and I tend to be self-absorbed) but what the study is really interested in is my balance and vision, my memory and peeing.
I have achieved ‘guest lab rat’ status because of COVID-19. I may not be in an NIH study but I AM living in the center of the New Rochelle ‘containment zone’. As I write this, it is Day 3. All quiet on the Eastern front. The National Guard is here cleaning and handing out food but I haven’t seen them. I’ve been on my silent street, watching my husband successfully coax our kids off training wheels. The road has fewer cars and they can ride longer stretches without needing to stop.
I have learned how to spell quarantine from assuring concerned friends over text that we are not, in fact, trapped here. My neighbors however have been quietly self quarantined for 15 days or so. It was easy to miss the absence of their presence. I realized too late that I hadn’t been asking if they need anything from the store- they do not.
Those of us who still roam free, stand on our lawns and discuss how surreal it is to be in the middle of a pandemic we were clearly not prepared for. We speculate on the ripple effects, share how our kids are reacting, is this a new seasonal reality, what it will do to the economy…and then we stop because we don’t even know what next week looks like.
I take my son out for a drive around town- grateful that children seem to be hardy in the face of this virus. If it were otherwise, I would be losing my mind. I have 3 kids around the age where fingers go in their nose and mouth and who only wash their hands when they are caught. This experience is making much better hand washers of us all.
I’ve made a point of going to the grocery store (even tho we are well stocked) so they have some business in return for staying open. I need them to be open in a week or two.
My son wants to ride in the car attached to the front of the shopping cart- he is 6 and barely fits. I’ve never asked him to wipe down the interior before but today I do…I’ve become that mom who sees germs on all the surfaces. On the cart handle, on the check out screen, on the cash back that I request, on the enormous stack of monopoly promotion cards the cashier hands me because there are few other customers to give them to. If we don’t win a boat, vacation home and screening room the game is certainly rigged.
I stop at the ice cream store to get a celebratory “training wheels are off” cake but mostly to give the poor clerk who showed up to work today something to do. While I am there, another customer orders a large cake for the team he is coaching- he imagines they will be celebrating the end of a multi-year run. I imagine the cake collecting freezer burn …no one is showing up to celebrate with their team. But I like his determination that the milestone should not be missed.
I drive by our TaiKwonDo studio and am happy to see students in the window- only to receive an email at night saying they’ve decided to close for a while too. I worry about how small businesses will survive this My husband reminds me that we just paid 6 months of a membership for 3 kids in advance. I am okay with that- they may not be as hard hit as others. I make a mental note to go back to the local hair salon, the one I had broken up with over bad color. I’ll get the Pheobe Waller-Bridge cut.
My fear isn’t that I will get sick. As I said at the top, I am boringly healthy. My fear is that I will get someone else sick. That I carry invisible COVID creepies to someone- like our heroic lab rat -and knock them off kilter. Or worse.
I reached this conclusion a day before our local institutions. I’ve taken it more to heart, and curtailed my own commute. We were all too late to the realization that our freedom to move must change.
What opened my eyes was our mother. I had invited her to lunch, a few days earlier, in the city. She’d cancelled a trip to Spain with my father for fear of COVID-19 . She drove into NYC instead of taking the train to avoid any risk of COVID-19. And then she sat down at a table with my husband and I, having lunch with two people who were likely closer to COVID-19 than her Spanish Air B & B hosts. I had not known she would later stop by our house- a block from the Temple which was ground zero for the cluster of infections- to drop off clothing to my kids. She was diligently curtailing her life to avoid exposure to a virus and my invitation led her to come hold hands with the hotspot, give it a kiss and a hug and head home to Connecticut, to my dad, with a little threat of Coronavirus hanging around the car. Being a good mother- she has not mentioned to me the oblivious selfishness of my invitation.
So if I have any wisdom to share from inside the containment zone it is to be more aware than I had been when this virus comes to your town- and it will. To be aware of your neighbors and what they may need. To be aware of your community. To be mindful of what you may carry along with you, as you carry on about your day. There are lab rats out there and they need every single one of us to think of their safety, even when we are secure in our own.

Stories from the Future

My son and his beloved MC in Thailand

Once my son and his girlfriend MC moved to China, they literally joined the future. They have a 12 hour head start on each day. They have had a long head start on the Corona Virus. Here is what they have to say.

Last night on her Instagram story, MC described their journey this way: 


Something tells me MC was a little rattled. Her usual delivery is quite measured. I would never expect her to dismiss other people’s decisions as “stupid.” 3,000 deaths can rattle a person.

Since their vacation in Thailand, my son and MC have been hopscotching around the virus, flying to Indonesia and then to Malaysia. They’ve been able to visit at least 10 temples. They’ve been able to work from a variety of Internet cafes. They’ve been privileged to hold American and Canadian passports, respectively. They’ve been privileged in that they don’t look like they are based in China. But my son is Chinese. One quarter Chinese. From the story he posted on Instagram last night, he is well aware that this is a fraught time to be Chinese.

Every day, I field anxious questions about these two. Everyone here has been worried about them. At this point, this intrepid couple is more worried about us. They know that our freedom loving lifestyle won’t permit the kind of measures that have flattened the curve of infections in Asia. They feel returning here would not be as safe as returning to Beijing. 

Can we be responsible enough with our freedom to prove them wrong?

Be well!

Ms. Lab Rat says, wash yer paws.

Who is Ms. Lab Rat without the Maze?

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

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

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

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

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

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

I wouldn’t be able to live with myself. 

I cancelled the appointment. 

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

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

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

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

When to Disclose/When to Retreat

Here I am, last summer in Beijing, the white person facing the wrong direction while everyone else is doing tai chi .

Twenty five years after receiving a diagnosis of multiple sclerosis, I am lucky to still have the option to decide whether or not to reveal my condition to a new person or group. I’m not MS closeted, but I do like to wait until I’ve already formed an impression before I am designated/dismissed as “disabled.”  I’d rather expand peoples’ conceptions about MS than contract their conception of me.

I wasn’t sure if, or when, I would share that I have MS with the tai chi class I’ve just joined at the local rec center. The first session, I’d flowed along with everyone else and hoped I would have energy remaining for teaching my  class with college freshmen in the afternoon. Once I verified I could perform both activities in one day, I thought I’d be ready to add this new tai chi class to my schedule.   

When I went back for my second session, I stood with the other students and watched our instructor demonstrate the complete series of sweeping, balletic motions we would all be working towards. Most of the series looked like it might eventually become achievable for me. But not the kicks. 

We’d just spent the past hour meditating on our feet, then doing repetitions of the first three moves of the complex series. I’d been feeling like a badass for merely staying upright all that time. The instructor singled me out, as the newcomer, informing me I would one day be able to execute all the same moves he had just performed. 

As much as I don’t want to get in the way of reaching my full potential, I couldn’t see that my future would ever include a series of high kicks. I’d been feeling it would be enough for me to eventually execute the complete series while making smaller movements that merely approximated kicks.  

It was time to dial down the instructor’s expectations. 

So I made the call. I disclosed to the group that I have MS. 

The woman who’d been practicing beside me was baffled. She told me she’d worked with a lot of people with MS, and I don’t look like any of them. She said, I guess you know all about the latest drug.

A few years ago, I would have rattled off the good news about the latest drug, the one that had stopped my very aggressive case of MS. I would have told her how I’ve been commuting for years to the National Institutes of Health (NIH) for my doses while waiting for the FDA approval to release untold thousands of MS patients from the shackles of disease progression. Life sure didn’t turn out that way. 

I said, “There is always a latest drug. I’m here because I’m interested in the oldest treatments.” Since she was clearly a regular, I asked her how one pays for the class; she told me I could work it out the following week. We both assumed I’d be back. 

That was a week and a half ago. Since then…my son texted. His text put a check my lifestyle. 

Everyone who knows me knows I love my son. I love him more than all the pee in China. I have traveled to the other side of the planet for my son. At his request, I am now going to hunker down. 

The other day, he texted from Indonesia to remind my husband and I about the dangers of Covid-19. “There is a two-week plus lead time, so it might be wise to start hunkering down before there are any tri-state cases.”

Now, this young man happens to be living in the future. Literally. The sun rises for him 13 hours before it rises for us. He has spent the last year and half as a consultant based in China. When we visited, my husband and I saw for ourselves that China is ahead of the US in many ways, some positive—China has way more efficient mass transportation—and some negative—China has way worse air and water quality. Sadly for China, they’ve been way ahead of us with Covid-19. 

Which ought to mean, we have been given an opportunity to prepare. 

My son and his girlfriend MC managed to get out of Beijing in late January, while there was still time Thankfully, Thailand accepted them. They’ve been on the run from Covid-19 ever since. 

As an, ahem, older person with multiple chronic illnesses, it makes sense for me to take Covid-19 seriously, and to cut out all unnecessary exposures. My schedule is jam packed with transcendent, meaningful, one might say, necessary, exposures—which start to look foolhardy when viewed through the lens of Covid-19, 

Yesterday I cut out what is probably my most dangerous exposure—my weekly workshop with the over-70 set at a senior living center, who are feeling as vulnerable to this virus as passengers on a stranded luxury cruise.

I found this homage to Titanic at a train station in Nanjing.

I will miss these writers badly, but the sad truth is, our workshop was already flagging. In the five years since the workshop began, ten of the writers have died. Seven are currently out of commission with health problems, and yes, one of those seven has a very bad cough. The two writers who’d shown up for workshop yesterday didn’t blame me for getting out. I love so very many people in that complex. I hope they will be spared. 

Four of these writers have died since this picture was taken.

It was a no-brainer to decide to cut out the yoga class and the tai chi classes I’ve been taking at the local hospital…which may be the second most likely location for me to catch Covid-19. It was an easy call to suspend my gym membership. And as much as I love my yoga class at my neighborhood studio, I’d made a promise to my son. The new tai chi class will of course be the easiest unnecessary activity to cut from my schedule. Maybe some day I’ll be back. Maybe some day I’ll be doing those high kicks. It would be a shame to have fessed to a whole new community about my MS for nothing. 

I am not even considering cutting out my class at the art college. Those students are too young to catch Covid-19. Right? I counted seven students coughing yesterday. For once, I’d hoped they’d been smoking cigarettes or sucking down bong hits. 

Today, I have a fever. A mild one. 

Which caused me to call off the usual weekly writer’s workshop at my house. I can’t tell you how many workshops I’ve held while staving off a fever.

But things are different now. 

Be well!

Who Forgot Her Yoga Pants?

My husband and I love our quirky uptown neighborhood of Clifton. We love Clifton for its diversity, its walkability, its independent movie theater, its big urban park. When we moved here sixteen years ago, we noticed that there were an awful lot of eccentric looking, opinionated old folks drifting around Clifton. The scene I’m about to describe from this morning is all too typical.

Setting: Checkout counter at CVS Pharmacy on Ludlow Ave, 9:10 am

Middle aged lady, silver streaked hair in a messy bun, wears an embroidered dress, bare legs, no socks, and school-bus yellow Converses. She plops a pair of gray yoga pants onto the CVS counter.

Middle aged lady: “I walked all the way to yoga class and forgot I wasn’t wearing any bike shorts underneath.”

CVS employee: “Would you care to add a donation to fight Alzheimer’s?”

Middle aged lady: “No way. I’m not going to help you look like the good guys when you sell drugs like Benadryl, which have a 50% correlation with dementia.”

CVS employee: “Have a nice day.”

Had I been standing in line behind that middle aged lady, I might have rolled my eyes to express sympathy for the poor check out guy, who has just been lumped in with those CVS top executives choosing to ignore the mounting evidence that drugs they sell daily are largely responsible for the growing epidemic of dementia. But I didn’t get the chance to roll my eyes at that middle aged lady, because I am that middle aged lady. Doctors I trusted have exposed me to a number of anticholinergic drugs, which are in the same risky class of medication as Benadryl.

The first time I was on a drug to calm down my bladder, I noticed right away that I was not participating in conversations as fluently as usual. When it eventually occurred to me to look up the side effects of my new medication, I read about “drowsiness,” “memory problems” and “dementia.” My urogynecologist laughed at me when I complained the medicine made my thinking fuzzy. “You’d rather think? And run around having to pee?” I quit the medication and fired that doctor. Then found that every subsequent urogynecologist was equally eager to fill a prescription for an anticholinergic drug, even after I made my preferences known, even after data from study after study confirmed an eery “correlation” between these drugs and dementia. Apparently as long as big $ is being made, this “correlation” won’t be labeled a “causation.”

That’s why I’m forever grateful to Kevin, my local pharmacist at Clifton GHA. Kevin alerted me when my current urogynecologist snuck in a prescription for an anticholinergic medication, despite my stated aversion to that class of medication. From now on, I’ll add the folks at GHA to the reasons to love my quirky little uptown neighborhood of Clifton.

Gentle Reader, if you are nervous about the side effects of your own medications, don’t listen to dotty Ms. Lab Rat. Listen to the bloggers at Harvard medical school:

“One of the best ways to make sure you’re taking the most effective drugs is to dump all your medications — prescription and nonprescription — into a bag and bring them to your next appointment with your primary care doctor.”

Intermission: In Anticipation of All the Pee in China, part 2

I’ve done the worst thing a blogger could possibly do: I have posted a part 1 of a story, and then neglected to post a part 2. 

I’ve had not one good excuse—but a string of good excuses: I’ve had a UTI, then another UTI, then another UTI. (Or maybe the same UTI?) This string of UTIs led to a string of antibiotics. Which led to c-diff. Which led to the bathroom. Just as I was delayed in writing Part One of All the Pee in China because I had to run off to do Number One all the time—I have been delayed in writing Part Two because I’ve had to run off to do Number Two. 

I’m used to going to work sick (I’m always sick—I have MS) but I’ve had to cancel all my workshops. I’ve had to skip my yoga classes, and my tai chi. I’ve had to step away from my public identity. This morning I got up and put on my wellness drag: I darkened my brows, lightened the circles under my eyes, applied moisturizer to skin that is dry. My body isn’t buying it. I had twenty-four hours without a fever, but I am still not well. I need to rest. 

Gentle Reader, we will have to wait a while longer for part 2. No doing is the best thing I can do. 

Hard to Swallow

Location: Elephant Walk

Time: Another Monday night after a weekend of mass shootings

My husband and I are in our local Ethiopian/Indian restaurant. The owner is from India, his wife from Ethiopia. We are the only diners.

We’ve been seated at our usual booth. The sky outside is a vibrant post-thunderstorm blue, which reminds my husband of the skies in friendly Hawaii. We are far from friendly Hawaii. We are in Cincinnati, Ohio.

I am not seated on my usual side of the booth, facing outward. I am seated on my husband’s spot, the side facing the television. CNN is reporting on the latest mass shootings in Dayton, OH, and El Paso, Texas. Not Houston and Michigan, Uncle Joe. Not Toledo, President Trump. Dayton. El Paso. Say their names.

Protestors in Dayton are drowning out the meaningless thoughts-and-prayers speech our governor is attempting. “Do something!” The crowd roars. “Do something!”

Anyway.

As we wait for our meal, I mention that our son, who is midway through a two year contract in China, has posted on Instagram that he is not looking forward to returning to the United States.

I confess that I’d considered writing, “Then don’t return. I’d rather you live somewhere safer than somewhere closer.” But I hadn’t. I was too afraid a reply like that would manifest a cosmic comeuppance, in which our son settles somewhere with sounder gun laws (that would be anywhere) and somehow ends up getting shot. I have a lot of spooky superstitions about the power of the words I write. I am fearful they will manifest in some dark fashion. I long ago came to the conclusion that Trump has far too little accountability for the dark manifestations of the hateful words he tweets. And now this.

I am the usual subject switcher in our marital conversations. But everything is flipped tonight, so it’s my husband who switches the subject. He asks me about my morning physical therapy session. I tell him it was quite a workout.

“What did you do?”

“I swallowed. Eighty times.”

He laughs.

“You mean you sat in a room with someone and she watched you swallow eighty times? That sounds boring.”

“Boring? It’s suspenseful. You try five dry swallows in a row.”

My husband is on the other side of the swallow spectrum. If offered a glass of water with his Tylenol, he will invariably turn down the water, and take the Tylenol dry—whereas I seem to require half a glass of water at minimum to get a Tylenol down. He blithely accepts my dry swallow challenge. His first two dry swallows go easily, as we’d expected. The third swallow is an effort. The fourth is a struggle. The fifth swallow is…as painful to watch as CNN.

“That wasn’t as easy as I thought it would be.”

“I tell you, it’s a workout.”

My husband is the reason I’m going to swallow therapy. I’ve gotten in the nasty habit of choking during our meals. When he’d told me he was considering taking a CPR class, I’d told him that my friend M., who also has MS, had managed to improve her swallowing through physical therapy. He was all for my signing up.

His appetizer arrives—five pieces of ayib begomen—which are usually stuffed with collard greens but today, opposite day, the ayib begomen is stuffed with cabbage and mushrooms. He invites me to help myself to a piece.

To qualify for physical therapy. I’d had to drink barium “juice,” eat barium “applesauce” and down a barium “cracker.” It was all very cinematic.  There was a doctor to film the process, a doctor to narrate the process, and a technician to be—I don’t know, be the “gaffer” or “best boy”—one of those roles that are far down on the credits. I, of course, was the star/villain. It was revealed that when I made the motions of swallowing, I was actually stowing quite a bit of residue in my throat. The narrator doctor, the David Attenborough of the whole production, concluded that my tongue was weak.

Ouch.

I’ve never been accused of having a weak tongue before. A sharp tongue, yes. Back in the day. Never a weak tongue.

To make matters more menacing, my tongue was deemed more weak on one side than the other.

Twisted.

I taste today’s version of ayib begoman: I am a big fan of the usual collard green filling, but I appreciate the how the substitute cabbage cuts a subtle counterpoint to umami goodness of the substitute mushrooms.

Thanks to swallow therapy, I am paying attention as I chew this food. I realize my habit would be to stash half of a mouthful in my cheek, like a squirrel, and then swallow the other half. Not this time. I swallow both halves: a nice, forceful swallow. I imagine my therapist saying, “You’ve got this!” Rather than chase the ayib begoman with a demure little sip of water, as is my habit, I swig a big hearty gulp of water. Then I pat myself on the back. Yes, I do that. If I achieve something that requires a little push, I give myself a little pat.

My husband looks at me quizzically.

“My therapist tells me to think of each swallow as a push up. I just did two pushups.”

He says, “Good job. You’re not even talking with your mouth full.”

I share my revelation about my chipmunk habit. “So technically, all these years I’ve been talking to you with my mouth half full.”

It would be terrifying to blame my difficulty swallowing on multiple sclerosis. So I don’t.

If I blame my own bad habits, I can do something.

The proprietor is staring at the protestors on the screen, who are chanting in Dayton, forty-eight miles away.

Do something. Theme of the day.

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Teetering on the Edge of TRAP-MS

On my most recent trip to the NIH, I was hoping maybe I would be disqualified for the TRAP-MS study, which evaluates four existing FDA-approved medications for their potential to reverse progression in multiple sclerosis.  I don’t like that I have disease progression, and therefore qualify for the study. But if I am someone whose MS is progressing, I like the option of being first in line to take an FDA-approved medication that might help.

This was my second six month check-in to establish a baseline on my status with my new MS drug, Tecfidera.

Before I flew out, Dr. W, my NIH doctor, told me there was a  chance I’d test out of the trial, since I didn’t have much progression to medicate.  I wasn’t as optimistic about my lack of MS progression. My fall this January didn’t just fracture five bones in my face—it fractured all the routines I’d set up to live as healthily as I could with MS. I’d only just started going back to the gym. I hadn’t yet returned, wholeheartedly, to the Wahl’s-ish diet I’d been following.

During my summer exam, Dr. W had clucked at my balance— “your balance is shit”—and the lack of resistance in my right leg:—“so weak.” What would my balance be like after two months of not daring to challenge it? What would my strength be like after two months of barely any dog walks and zero visits to the gym? Thankfully, this setback didn’t prompt an MS relapse. But if there was going to be a time when my MS might be progressing, it would be now.

I’d been instructed to “take it easy” before my clinic visit. But that morning, I had pushed myself to the verge of immobility.

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As I entered Building 10, my spirits rose.  Maybe it was the profusion of plants, or maybe the profusion of people. I noted there was new art on the wall.

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I noted there was still no additional entry in the display of Presidential Visits.

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Luckily, the first appointment on my schedule was at Phlebotomy, which involved sitting, first in the waiting room, and then for the needle. That gave me some time to recover from all the walking I’d done through the airports, the Metro, and the NIH campus.

When my number was called, I got the same needle master as I’d drawn on my visit the previous summer. I recognized the fan letter he’d posted about his ability to make a two year old smile while drawing his blood.

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The testimonial hangs strategically at eye level of the person waiting to get their blood drawn. It is terribly effective at arresting any impulse to cower or cringe. Nobody wants to come off as a bigger baby than a sick two year old.

Did I, like the sick two year old, leave smiling after having my blood drawn? I doubt it. I’ve not been known to smile until after I’ve had my second breakfast.  I soon discovered that my favorite cafeteria—on the second floor in the new building—was closed for remodeling. I found my way to the alternate cafeteria in the basement of the old building. I loaded up on greens and root veggies and proteins. The meal provided all the rejuvenation I needed. By the time I stepped off the elevator on the fifth floor and rounded into the clinic, I no longer had a limp.  Seeing Diane, a nurse I’ve known since my first NIH visit, put me in the mood to smile.

Since returning to real life after my big fall, I’ve become accustomed to being greeted with “Your face looks good!” If I chose to take “looks good” as meaning anything more than “not permanently damaged,” it is because I latch shamelessly onto the positive.

Diane obviously didn’t get the memo about the five facial fractures. Instead of saying, “Your face looks good!” she greeted me with a hug and a frank assessment. “We’re getting old!”

True enough! I, for one, don’t mind looking (or getting) old. I’ve earned my silver stripes. Besides, those strands provide an instant, socially acceptable explanation for a slow or unsteady gait. It’s not that I am MS closeted—it’s just that not every distressed person stuck behind me on the staircase really wants or needs an explanation of the ravages of autoimmune disease when an assumption about the ravages of age will do.

Diane didn’t look any older, and I told her so. Diane is remarkably stable. She just doesn’t change. Case in point: the day I met her, she had just won a prize in a weight-loss competition between nurses on her floor. Here’s the catch: Diane had won by losing a mere pound and a half.  If Diane has had any weight fluctuations since then, they have probably been within the same range. Diane has had the same haircut as long as I’ve known her: same bangs, same color, same length. Diane stays Diane. I wouldn’t want her any other way.

Jen, the other dear nurse I’ve bonded with from the start—swooped in to agree with Diane’s assessment, “We are getting old!” as she grazed my cheek with a kiss. Jen’s hair was red that afternoon—her hair is a new color, a new style, every time I see her. Jen tends to pretend she’s disorganized or absentminded or late. True to form, she crafted an overly-elaborate explanation for why she couldn’t linger as she dashed off down the hall on her sturdy Doc Martens.

Diane wondered aloud, “How long have you been coming here, anyway?”

I guessed, “Maybe nine or ten years.”

Diane pulled up my file.  “Since 2010. Nine years.”

When I’d first come to the NIH, I’d been chasing daclizumab, the only drug that had managed to stop my MS relapses.  After the NIH had requisitioned all the supplies of it, I was more than grateful that there was room in the trial of the drug for me. For the three years of that trial, Diane and Jen had taken my weight and my blood every month. Once that trial was over, I was permitted to continue to take daclizumab though the NIH “safety study” while we all waited for the FDA approval. I flew in every six months for monitoring and new drug supplies. Once the drug was approved, we took what may yet be a final group photo.

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Thanks to TRAP-MS, we were back together again.

While Diane was at her computer, she got a notification on my labs. She scrolled down two screens of data.  “Your labs look good.”

I thanked her, and told her how, the last time I’d visited, I gotten my lab results on my phone just as I was about to get on my departing flight. The cholesterol was marked in red, and looked way high. I was freaking out that the diet I was on was going to give me a heart attack. Doctor Google hadn’t been much help.

“Stay away from Doctor Google. You should call us when you have a question.”

Diane scrolled up, “Your good cholesterol is what’s really high.”

Then Linh, one of the graduate students, stuck her head in the office. She was ready to give me my tests.

We started with the timed 25 foot walk. Considering I had been limping just an hour or so earlier, I wasn’t optimistic about the outcome. Still, I’ve been conditioned to give these tests my all, so when it was time to march from one masking tape line to the other, I barreled along the hall like I was on my way to lift a screaming baby out of a vat of boiling water. Then I turned around and barreled right back. My fear of falling paled in comparison to my fear of failing. I did not fall.

I announced, “My healthy appearance is a flimsy veneer.” Like the NIH don’t know that. Test by test, I went all out, competing with my better-rested summer self.

As Dr. W. examined me, she seemed gentler than last time. She didn’t push as hard for the resistance tests. She didn’t chide me for being weak. When I messed up on the heel-to-toe test, she let me re-take it. Twice. Not that I did any better.

Overall, Dr. W was enthusiastic about my condition. She told me maybe the rest I’d had was doing me some good. Or maybe the Tecfidera.

When Dr. W. called a few days later with the results of my visit, she assured me the MRI looked stable. She told me I’d actually performed better on some tests, like the peg test, than I ever have. But overall, my numbers still nudged a bit in the direction of progression. As long as there is a progression of my disease, I will continue to qualify for the study,

Dr. W wished me luck in getting disqualified from the study when she sees me next time in six months. As much as I love this crew, I would love to be too healthy to see them.