My MS Medication Trail…

ocrevus

To understand how yesterday, September 20, was a key step in my MS treatment journey, allow me to take you back in time with me, where we’ll glance through the therapies I’ve experienced. When I was first diagnosed on July 30, 1997, T.R. and I shared with the doctor that we did want to start a family, so I’d like to wait a bit before starting a medication (the first two injectable therapies were just becoming available). I remember, then, an appointment at his Fort Wayne office in October 1998, and before he could share with me the suggestion of beginning a medication, we handed him a positive pregnancy test report. (We’d stopped at a doctor’s office to make certain.) Dr. Stevens shared the encouraging information that MS symptoms usually decrease during pregnancy, sometimes extra bursts of energy will even come! What I found, I’m afraid, is that the extra energy isn’t quite so likely when two little ones are growing… but I digress. Em and Rach were born June 8, 1999, and while I was nursing, MS symptoms  stayed in remission. When my body wasn’t able to keep up with the growing needs of these two little ones, I started using formula also, and this was the norm by Christmas.

So it was that in early January 2000, I started Avonex – interferon beta 1-a. The nice thing is that this medication only needed taken once a week – wonderful! Two negative things: one, it made me feel like I had the flu weekly; and two, I had to give it to myself via intramuscular injection (via a long needle). This is its own story, as my loving husband, who also hates needles, learned to administer this medication. And we gave it on Sunday night – while Monday became a day that my mother often came to help with two little ones while her daughter snapped back from side effects. (They say the side effects stop after a few months –  mine didn’t.)

After about three years, when MRI scans showed disease activity – and I was tired of feeling like I had the flu weekly – we decided to try a different injectable therapy, Copaxone – glatiramer acetate. This one was given with a much shorter needle, and it had a special autoinjector pen I could use, so I didn’t have to watch the needle as it did its job. It was a daily injection, but it had very few side effects. (Copaxone is now available as an injection only given three times a week – nice improvement there!)

After less than a year, though, symptoms and MRI scans were not encouraging, so we moved to injectable medication #3, Rebif – interferon beta 1-a again. Unlike Avonex, this interferon medication wasn’t injected with a 1” needle and didn’t have flu-like side effects. It was also not as effective as we wished.

So late 2004, I was asking Dr. Stevens what he thought we should do… there was something coming that he had read about and was watching. Until it was released, he thought Betaseron – interferon beta 1-b – would give us the best results. (At this time, I was not yet using a cane daily.) The medication he had been waiting for was available January 2005, and I was the first patient in Fort Wayne to take this new medication, natalizumab – only given once a month! But then we hit a snag. On February 28, I called to schedule my March infusion, and I was told there were complications… after a while on hold, they told me the FDA had just announced that this medication was pulled from the market. So back to Betaseron for another year and a half.

During that year and a half, the cane became a necessity. But that was okay. Monthly natalizumab did return to the market, now labeled as Tysabri. There were strict limitations on how it was given, blood tests to watch for really nasty things (that had caused it to be off the market for a year and a half), but I was a proud recipient of Tysabri for almost ten years!

I say “almost” because of a 3-month break. Summer 2013, Dr. Stevens and I wished to try a new treatment option, Tecfidera – dimethyl fumarate. Finally, just two pills a day, not a needle! And he legitimately thought it would be just as effective as Tysabri. But during those three months, I went from using a cane each day to being essentially required to use a walker. And that was the end of my “no more needles” time. So Tysabri re-entered my life, and my final Tysabri infusion was July 2017.

My MS has changed over the years – originally diagnosed as “relapsing-remitting,” Dr. Stevens now classifies it as “relapsing-progressive.” Progressive forms of MS have fewer treatments available, but this spring, a new one entered the field: Ocrevus – ocrelizumab.  News stories showed promising results, and though our goal is for this medication to help prevent further progression, I can’t help hoping for a smidgen of improvement. Yesterday, I had my first half dose, and the second half will come in two weeks. Then, I will receive this infusion once every six months.

What will it do? I don’t know. I can tell you that my only reaction was a bit of an itchiness and redness that was zapped with Benedryl. So it is that September 20, 2017, marked the first page in this chapter of my medical saga – time will tell what the other pages hold.

20 Years…

Rich ticket stub

Twenty years is a long time – but sometimes, it seems like no time at all. Time is funny that way.

1997 was particularly significant for me in a number of ways. In late May, I cleaned out my middle school classroom for the last time, saying goodbye to a career that would take unexpected turns. We moved to a new town, and my husband was now much closer to his new job at Taylor University (as he had been commuting until I completed my school year… I had signed a contract, you know). In May, I also visited my eye doctor… who led me to another doctor and a diagnosis in June for probable multiple sclerosis. (Because we weren’t busy enough the first week in June, as we packed boxes to move four days later… but that’s another story.) The official diagnosis came on July 30 – yep, it was MS.

This part of the my own 1997 story took a step in August when I attended a concert of my favorite musician, Rich Mullins – the link here will lead you to a review of the concert I posted the next day. What I did not realize was that this, the final concert of his tour, would be the last of Rich’s performances I’d have the pleasure of seeing. Of the fifteen concerts of his I had attended, this was also the first one that led to tears. During “Bound to Come Some Trouble,” the floodgates let loose. Two weeks earlier, that diagnosis had come, and I really wasn’t certain what it would mean. (Attached is a clip of this song that somebody recorded at his Wisconsin concert on August 10, four days before I had my little tissue-soaking time.)

September 19 was a day like any other – I was a graduate student, commuting to Ball State for class and work during the day, and the phone call came from my younger brother that evening. I had been listening to Rich’s “Canticle of the Plains” as I could throughout the day, but now I stepped into our back yard, where I could lean against the towering oak and gaze at the stars. The lyrics of “Elijah” scurried through my head, as I teared up and wondered about that candlelight in Central Park, and what it would mean to say “Goodbye.”

So here we are twenty years later, and I still feel that my life as it is today has been enriched by the music and ministry of Richard Wayne Mullins. His songs still traipse through my head, and I’ll still be reading scripture and thinking, “So THAT’s the spot where that lyric originated!” But a huge smile came to my face last Sunday morning when our associate pastor was describing what his two-year-old son had been doing at breakfast. Music was playing, and the little fellow left his cereal at the table and felt he needed to dance before our Lord… we were told this was a Rich Mullins album that was playing. I have a feeling this would have made Rich smile. And I have no doubt that Rich’s music will continue touching countless more lives in years to come.

This year, my own story will instead mark September 20 as a significant point. As I begin new medical path for my MS treatment, a new chapter may begin in my own story. I’ll plan to listen to Rich’s music as I venture on – and I’ll post more about that tomorrow or Thursday. In the meantime, I’m thankful for the legacy of Rich Mullins on this day in particular.

Gen Con 50 – Views from the Chair (preview)

 

As the final summer before our daughters leave for college approaches its end, we’re preparing for one last adventure. And I’m looking forward to sharing these experiences on this blog!

Coming later this week – Gen Con 50: Views from the Chair. The four of us will be attending Gen Con, and unlike last year, I will be able to attend the entire week! With 2017 marking the fiftieth anniversary of this gaming convention, many special events and celebrations are scheduled, and it’s nice that we purchased our tickets several months ago. Many of my regular readers may see this as odd, but tickets for most days are sold out. I anticipate crowds everywhere, beyond those of years past.

What will a more crowded Convention Center mean for those of us with mobility issues? Time will tell. In the past, I have been pleased with the way these issues have been tackled, and I anticipate the same. My laptop will come with me to Indianapolis, and I’ll plan to share my experiences throughout the week. What will the Exhibit Hall experiences be like? Hotel? Dining venues? Restrooms and such?

If any of you have questions you’d like me to address, I’d be happy to do so – please share them in the comments below!

(See last year’s notes at https://angieknight.wordpress.com/2016/08/03/gen-con-views-from-the-chair-part-one/)

MS Awareness and Ivanhoe’s shakes

ms awareness weekI composed the following article for our small local paper, and it’s an updated version of my 2011 piece. I think this milkshake analogy is my favorite way to explain how MS doesn’t always look the same. 



MS Awareness Week, March 5-11

           As spring nears, March again brings “MS Awareness Week.”   I find this interesting, as I experience 52 of these each year, but is nice that a bit of time is set aside to share information with others.  Over 400,000 individuals in the United States face this challenge, so this week offers the chance to shine a light on information that may be new… or misunderstood.

As our friend “G. I. Joe” used to say at the end of each cartoon in the 80s, “Knowing is half the battle.”  Knowing what MS is – and what it isn’t – is helpful in gaining an understanding of this illness.  So what is multiple sclerosis?  It is an autoimmune disorder, meaning that the otherwise helpful immune system is affecting something it shouldn’t.  In this case, the white blood cells are attacking several (multiple) places on the coating of the nerves.  These attacks create scars (sclerosis).  Sounds simple, doesn’t it?  Not so fast.  Consider the nerves that run through the body, not to mention the large bundle of nerve tissue that we call the brain.  In fact, using MRI technology, scars viewed in the brain often lead to a diagnosis of MS.

ivanhoe shakes            If it is anything, MS is unpredictable.  Scientists are still uncertain as to the initial cause of this disease, there is not a certain pattern that it always follows, and it can vary widely from one individual to another.  The best area analogy I have found is the menu of Upland’s Ivanhoe’s restaurant.  Hoe’s is largely known for its 100 varieties of shakes and sundaes, and MS can vary just as much, if not more.  Some are diagnosed and may have a “vanilla acapella,” with no additional or noticeable symptoms after the initial onset.  Others, though, experience a shake not even on the menu, with ingredients they never liked to start with.  Symptoms can include fatigue, loss of coordination, heat sensitivity, slurred speech, cognitive problems… and I’ll stop there, as this is a bit disheartening.

Besides knowing what MS is, it is equally important that we realize what it isn’t.  MS is not a death sentence: though chronic, it is not fatal.  MS is also not the sign that somebody has lost his or her ability to be productive.  Every individual, like those beloved gourmet shakes, is different.  The last two homes where we lived had us next door to an individual with MS, something I certainly didn’t realize at first.  You see, MS is not obvious.  Two thirds of those diagnosed with multiple sclerosis are female, but this means that many are also male.  MS is also not age-specific.  A few are diagnosed as young as six, some in their 50s or 60s, but many in their 20s or 30s.  Many are from Western European ancestry, but this also varies.  And about a fourth of those with MS end in a wheelchair, but three fourths do not.

So why should we be aware?  More and more medical breakthroughs are on the horizon.  There are currently fourteen medications on the market to help slow MS progression, and a cure is closer each day.  In the meantime, patience and understanding are key in helping support our friends and neighbors with MS.  Now you know, and though simply knowing may not be half the battle, it is certainly a step in the right direction.

Angie Knight was diagnosed with MS in 1997 and lives with her husband and daughters in Upland. Visit her “Invisible Issues” blog at https://angieknight.wordpress.com .

So what exactly does MS look like?

Angie MRI 2006

This is actually a slide from my lovely MRI brain photo shoot in spring 2006. Brighter spots are the new active scars. 

…This is like asking what a March day in Indiana looks like. The answers will change from day to day, sometimes minute to minute. One MS descriptor I appreciate is “unpredictable” – scars in the brain can do funny things, and misfiring nerves can be quite disconcerting. I appreciate the image of this posted by MS Lifelines. Ten common symptoms were highlighted here, and I’ll focus on the few that affect me most (I understand these most clearly).

 

  • Cognitive issues: Words sometimes fail me, and I will forget things… it’s hard to tell what is MS and what isn’t, but these issues are frustrating. My thoughts also seem to process more slowly. (This definitely affects the games I choose to play!)
  • Vision: my  eyesight is already poor, but MS scars on the optic nerves sometimes keep my eyes from cooperating. My left eye likes to wander, ignoring messages from the right. In fact, my first symptom in April and May of 1997 was “optic neuritis,” and scarring on the optic nerve led to uncomfortable eye issues that stopped before I knew where they had come from.
  • Fatigue: This isn’t just a case of “I think I’m a bit tired,” but true weariness that strikes. A nap can help, but the need for a mid-day nap can be frustrating, I must admit. The analogy I often use is that of a battery. Most folks start the day with two fully-charged D batteries (8-year-olds may have three), while I have a single AA or AAA size. And on some days, I’m convinced that many have Duracell, while I have the off-brand battery that had been forgotten at the bottom of the drawer.
  • Strength and coordination: This is why people with MS are sometimes mistaken as inebriated. Walking in a straight line is more difficult than one may think! Personally, when my feet and legs stopped moving where my mind was telling them to, I agreed wholeheartedly that I was not going to drive. (Hand controls would not be a good option for me either, as my hands become flakey when my feet also stop cooperating. Not helpful.) I also used to play piano… no, I haven’t “given up,” but accepting the fact that my hands will not move in a detailed, coordinated, practiced method is a truth that I face.

If you care to watch a short video answering the MS questions, the MS Society has a nice one here:

March is MS Awareness and Education Month, but this week is specifically MS Awareness Week.On Friday, I’ll post here the op-ed piece I submitted to our local paper, the SEGway news (for South Eastern Grant County). It is a little more lighthearted than this MS laundry list of sorts. Did you know that MS is like an Ivanhoe’s shake? Visit back in a few days to see how.

Marching into Awareness

AngiewalkerAh, the month of March. For the past several years, I have been highlighting MS Awareness Month, wearing my “teacher” hat as I explain what MS is (and isn’t). This also gives me the opportunity to more openly share personal struggles of living with multiple sclerosis.

You may (or may not) have noticed something about this blog during March 2016. What was there to notice, you wonder… it seemed rather absent. The irony of last year’s “Awareness Month” is that I was more aware of my confused nervous system/immune system than I had been in the previous eighteen years. After thinking it was a dental issue that caused my mouth to feel as if was being attacked by scads of tiny, flaming pitchforks any time I tried to speak, swallow, and eat, a series of tests and MRI scans led us to the discovery that a major nerve in my tongue was quite confused. I didn’t have a cavity or worse, but the diagnosis came: “hyposlossal neuralgia.” In essence, the main nerve on the left side of my tongue, allowing me to speak and swallow and such, had a short circuit of sorts.

They say that “knowing is half the battle,” but what I really wanted to know was how to function decently despite the uncooperative tongue. For almost a month, we tried different medications to help tame the crazy nerve. The craziest part of the struggle came when medication that tamed the tongue also took away the ability for my legs to move. At all. Because I appreciate the ability to do such things as go to the restroom, this was not appreciated. So… by April, things were tamed enough. But MS Awareness Month had completely passed me by. And I had visited doctor offices and MRI machines in three different cities, very aware of MS.

So that was 2016. 2017 holds different challenges and paths, as my tongue is tamed. Usually, at least. My point here: MS is unpredictable, and those who live with it are “aware,” no matter what month it is. Over the next week or so, I will be sharing about MS in general. I’ll also share about March’s other campaign, “Disability Awareness Month.” My own journey into and through the world of MS and disability is just one story, and I hope to shine a little light to increase awareness for us all.

Gen Con: chair view (part 3)

 

If you follow my blog but not T.R.’s, you likely missed part three of this Gen Con accessibility mini-portrait. As you may have read yesterday, I left Indianapolis at that time to head home and attend a writers conference at Taylor University. But Gen Con continues, going strong as four very full days create those “Best Four Days in Gaming“.

After my views from the chair, here you can find T.R.’s “Views from behind the chair.”

If others have experiences in this area, positive or negative, I’d love to hear about them!

Gen Con – views from the chair (part one)

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Games: a frequent theme of life in the Knight house. My husband T.R. adores games, and our family enjoys them together in many ways. He not only taught a “Game Studies” course last semester at Taylor University last semester, but he helped organize a “Family Game Night” at our church in July. One reason he and I have enjoyed more games together is simple: board and card games create great activities we can experience in full despite disability.

Over the past four or five years, he has also become more a part of the professional side of gaming. Gradually, he started volunteering for a European game company that was to have a booth in Indianapolis. Then he got to know those in the industry better, and he started freelancing, primarily as a proofreader. Fast forward a few years there, and you will find all four of the Knight Family members at Gen Con.

Gen Con, “The Best Four Days in Gaming,” will find scads of people filling the Indianapolis Convention Center, even spilling into Lucas Oil Stadium this year. Estimates predict 60-70,000 attendees this year, making this event the largest Indy tourist attraction of the year, a larger financial boost for the city than the Indy 500 or NCAA finals.

IMG_0657.JPGIMG_0652How does this affect me? We arrived early, as T.R. and our daughters spent time yesterday and today helping set up a booth, where they’ll be working for a few hours each afternoon. With this large of an event, participants also pick up tickets early. And this is the second way the Convention Center really impressed me! After dinner, we decided to see if we could pick up and exchange a few tickets, changes we had made since sign-up a few months ago. A long line, twenty to thirty minutes long, we were told, snaked through a hallway then around a group of turnstiles. We weren’t certain a wheelchair could make those turns, and T.R. saw a sign near the line’s end that read “Special Services.”

The kind, patient folks helped all four of us with our ticket switches! Being in a wheelchair may not hold a lot of bonuses, but this certainly ranked up there. If this was the second, what was the first? It came in January, when Gen Con attendees are first able to reserve hotel rooms. Because we needed to reserve a handicap accessible room, we were allowed to hold a room before the official time window opened. Proof to me that sometimes, one needs to plan ahead. And ask. Also a demonstration of the professional hospitality one can find in our great state.

I already feel more encouraged about tomorrow’s Gen Con time – you’ll be hearing from me then, as I describe my “view from this chair.”

Day 27 – Thirty Days of Thanks – nineteen years and counting

thankful2

Nineteen years ago on this date, the air felt decidedly hot. And quite humid. And very sunny. (Of course it was… it was July in Indiana.)  So what made it memorable? July 30, 1997 was the day of the official word, the day that Dr. Stevens confirmed that the preliminary June diagnosis was correct: I have Multiple Sclerosis.

Nineteen years later, this journey continues. Few wish for struggles, and I admit that I do not enjoy them, but my MS path does indeed contain pieces for which I give thanks. Today’s list will focus on that:

5 things I’m thankful for, highlighted by MS in my life:

  1. Embraced Slowness –I’ve never been super speedy (as my parents and brothers can vehemently attest), but MS has enforced a movement level that has me running races with snails, and sometimes they win. But you know what we’ve discovered? When you refrain from being speedy, you notice and appreciate things you may have missed otherwise. It can be refreshing.
  2. Connections with others –More people than I can count have contacted me for assurance or advice – or commiseration – after receiving a frightening diagnosis. This was never a lesson I had planned to teach, but I’m thankful that I’m able to step in here at times.
  3. Little everyday ADA blessings –I credit the ADA for many bits of blessing, and I am thankful for things like not-too-steep ramps, early boarding for an airplane, and special seats at the theater. I read last year that we are now a part of “Generation ADA” – we have indeed come a long way. I have an understanding here that I never would have before!
  4. Learning the blessing of giving AND receiving –For some of us, giving is a lot simpler, more comfortable, more joyful than receiving. And rightly so… but I have finally realized that by being an appreciative “receiver,” I bless the life of those on the other side of the equation. For a proud and independent type of person, this wasn’t a simple lesson, but I feel that I am experiencing this truth more fully after nineteen years.
  5. Deeper family relationships –Life as it is in the Knight house requires a level of giving, understanding, patience and love that I don’t think would be if not for challenges MS brings our way. My husband and daughters are so very special, and there are bonds within our family that have been strengthened by this thing called MS.

So “Thankful for MS”? Not today. Thankful for (sometimes hidden) blessings that abound? You bet!

 

[Note about “Thirty Days of Thanks”: I continue being thankful, but writing about days 28-30 will actually begin again August 9. As mentioned above, I am indeed slow, and my energy is limited. I will be attending two conferences, and my writing time and energy will be focused there. I love adopting a mental and spiritual posture of thankfulness, and it will be fun to bring my thirty days to a proper close!]

Day 16 – Thirty Days of Thanks – Anniversary Blessings!

 

Today’s 5 Thankful things – A few of the many reasons I’m thankful for my dear husband:

  1. loverslane

    T.R. and Angie on “Lovers’ Lane” in 2008 at Green Gables

    Today is our second palindromic anniversary – And we’re both geeky enough to know and care what this means. These twenty-two years have been far from perfect, but I’m so glad we’ve enjoyed them together!

  1. T.R. is such a wonderful father to our two girls – From reading or playing catch with little ones to driving them to their junior prom, he has been there for them – a much-loved Daddy indeed!

  1. TR Angie beach chairHe finds ways to help me, even when it’s uncomfortable or highly inconvenient
    – T.R. and I have joined forces in helping define reasonable “accessibility” issues. He’ll help me find solutions to problems I knew were there, but hadn’t pinpointed.
  1. We have grown together in ways we would never have predicted – As my own roles and abilities have been redefined, he has also found ways to rework his own path to help take up the slack caused by my MS limitations. Along the way, he has further developed his skills with gardening and cooking, two things it pains me to leave behind. But I can still do a bit with this, even if vicariously.
  1. My “Knight in faded denim” is more dashing than he was in 1994 – and he was a handsome fellow then!

 

trandangiemacinac

our anniversary trip two years ago

I have so much more to write, but I’ll add specifics over the coming days. I just had to say before the end of today – Happy Anniversary, T.R. – I love you!

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