Friday, August 31, 2012

A Journey with Multiple Sclerosis

A Journey with Multiple Sclerosis

By Sharon Bosch

 

I’m embarking on the arduous undertaking of describing the last 13 years of my life so that others might gain insight, understanding, and hope from my journey.

 

I married my best friend and husband in 1998 and became the proud mom to our beautiful son in 2003. I’m a stay at home mom, but not by choice – by circumstance. On June 4, 1999, my physician diagnosed me with multiple sclerosis (MS). MS affects people in varying degrees. Some can continue to work, but for others, the ravages of the disease make working and a career impossible.

 

In the past, prior to diagnosis, I never just sat around idly, burning up daylight and wasting time. I truly enjoyed working. But – after diagnosis, I simply couldn’t work. I became a new Sharon – an ill Sharon. I could have balanced family life and a thriving career quite well; at least I think I could have. MS made it impossible for me to even try.

What Is MS?


 

The term, multiple sclerosis, means many scars or lesions. MS is a demyelinating, autoimmune disease that affects the central nervous system (CNS). I’ll give you a brief overview of the disease without boring you with all the medical jargon. Although researchers aren’t clear on the exact cause, the most common theory is that a gene defect or a virus triggers the physiological process that develops into MS. The disease damages the myelin sheath (demyelization) that surrounds and protects nerve cells. The propagation of nerve signals slows down and even stops in some cases.

 

The nerve damage, or demyelization, is caused by inflammation. Much like your body’s immune system fends off a cold, by attacking the invading virus, the body’s immune cells attack the nervous system, causing the inflammation. The inflammation can crop up anywhere along the CNS (e.g. brain, spinal cord, optic nerve).

The Nature of the Beast


 

As of 2012, approximately 2.1 million people have MS worldwide, making it the most commonly diagnosed demyelinating disease among young adults. Of those, 400,000 of them are Americans. Those numbers tell an astounding story: fully 1/5 of those with MS are US citizens. The average age of diagnosis is between 20 and 40 years of age. Although men can certainly develop MS, most of the MS population is female.

 

Episodes of the disease can last a day to several days or more and can occur at different locations of the body each time and with varying severity. The disease goes into remission for periods of time when patients do not experience symptoms, but can pop up again without warning.

Common Symptoms of MS


 

·         Numbness, tingling, or burning sensations in the hands, feet, or legs. Some people experience these symptoms all over their bodies.

·         Complete loss of sight in one or both eyes, loss of peripheral vision, loss of visual acuity (occurs when the inflammation occurs on and around the optic nerve)

·         Loss of balance, unsteady gait, spasticity

·         Heat intolerance – the core body temperature of those with MS rises quicker than in healthy people, due to issues with the thalamus gland (an organ involved in temperature regulation).

·         L’hermitte Syndrome - feeling of electrical shock that runs down the arms and legs when bending the neck to the chin.

·         General loss of coordination

·         Slurred speech

·         Bladder control issues

·         Bowel control issues

·         Cognitive difficulties

·         MS Hug – a tightening around the mid-section, which can mimic the feeling of a heart attack, or feeling as if your clothing is too tight, when it actually is not.

 

Those represent the most common, basic symptoms of MS, but there are actually a lot more of them – too many to list as I need to get on with my story. At least you get the gist; MS is no picnic.

Simple Girl, Proud Woman, Young Wife


 

I grew up in Gravesend Brooklyn – born, raised, and proud. If you were to hear me speak, I’m sure you’d detect an unmistakable accent. We were a middle class family. I had an Italian mom and a dad of Polish, Irish, and German heritage. Everyone knew everyone else in our tight-knit community. I had the typical childhood illnesses (i.e. strep throat, chicken pox). It seems like I fell ill more often than most kids in my neighborhood, but it is what it is – people just dealt with it and moved on.

 

I did the normal teenage things; perhaps a little more than some, but overall, I wasn’t a bad kid. We went out, had fun, loved clubbing, etc. I met my husband at a club on Long Island. I was 22 and he was 25. We lived together about six years before marrying. We both worked crazy hours to save money and put our wedding together, while still maintaining a household and paying the bills.

 

About six months before we married, I noticed my left hand went numb while taking a fairly hot shower. I thought it a bit odd, but due to the stress of planning the wedding and all, I chalked it up to nervous bride syndrome. The numbness and tingling only happened in my left hand and went away with time.

 

We married and resumed our lives. I walked to and from work every day, six days a week, which kept me in good shape as did all the running around in the office.

Trembling and Stumbling


 

Suddenly, I began having issues with walking. I walked like a drunken woman – swaying side to side, tripping over my own two feet. I even had trouble remembering how to perform my work duties; duties I had done day in and day out for years. The numbness returned too. This time, it never went away. I felt exhausted constantly. Regardless of how much sleep I got, it was never enough.

 

I visited my family doctor and I explained my symptoms to him. He suggested that I see a neurological specialist. A week later, I met with my neurologist. After the typical battery of tests, he ordered a blood panel to rule out Lyme disease, Lupus, and other diseases detectable in the blood.

 

It all came back clean.

 

Next, he ordered an MRI with contrast. In this procedure, a huge machine takes images of the brain. The contrasting agent illuminates any brain lesions present. My brain lit up like a Christmas tree. Not good!

 

I then had to undergo a spinal tap, also called a lumbar puncture (LP), to check for protein in the cerebrospinal fluid. Ding, ding! Of course, my fluid had protein present, indicating a blood brain barrier breach and multiple sclerosis. I also went in for a Visual Evoke Potential test to see if my optic nerve had suffered any damage. Ironically, I passed that one.

MS Hits Hard


 

Doctors officially diagnosed me on a warm Friday afternoon in June of 1999. That Monday, June 7th, I entered the hospital as an inpatient for my first steroid treatment. The steroid treatments help MS patients recover from the episodic attacks of the disease. My medical team gave me 1,000 cc (milligrams) of intravenous (IV) steroids once a day for three days. They instructed me to taper off my dosage by mouth over a three-week period and slowly recuperate at home. Six weeks after my diagnosis, I went back to work, thinking I could do all the things I did before my illness.

 

Big Mistake!

 

Six weeks after returning to work, another relapse hit me. Hard. I landed in the hospital with optic neuritis (inflammation of the optic nerve) and received 14,000 cc of IV steroids. Doctors then told me I have an aggressive form of MS and that I could no longer work. I quit with a heavy heart and much trepidation.

 

At the time of my diagnosis, MS patients had only three medications available to abate the progression of the disease: Avonex®, Betaseron®, Copaxon®, and symptomatic medications.

 

I started my first interferon medication, Betaseron®. It’s a daily subcutaneous (sub q) injection with a small needle. Side effects include flu-like symptoms, which hit me like a freight train. The purpose of this medication is to slow the progression of the disease. I was still in the throes of relapse and heavy symptoms while on the medication. My body built up antibodies to the drug, so doctors took me off of it within the first year.

A Warrior Emerges


 

Next stop, Copaxone® -- not an interferon, so comes with few side effects, but still a protein-based drug. I did those injections faithfully for about a year or so. Then I became pregnant with my son and stopped immediately.

 

After giving birth – one of the most joyous occasions of my life – I had a relapse. This is par for the course after having a baby. I did at-home IV steroid treatment and didn’t return to using Copaxone®. My son needed his new mom and I did OK.

 

As is my nature, I tempted fate one too many times. I fell, stumbled, tripped, dropped things, and lost some vision in my left eye (again). If you remember, I first felt the numbing in my left hand well before getting a diagnosis. Most MS patients have one side that’s worse than the other. The left side is my bad side.

 

When I visited my neurologist, he chastised me for not taking my medication treatments over the past four years. I had more active lesions than ever and went downhill fast. My doctor started me on Rebif®, another, newer, interferon that’s stronger than Betaseron®. Interferons give me flu-like symptoms, meaning I felt like crap – again.

 

Three years after that, I moved on from my neurologist to an MS specialist and he wants to put me on a newer, highly promising medication. Patients take the medication, called Tysabri®, via an IV infusion once per month.

 

But there’s a catch. Isn’t there always a catch?

 

Not everyone is a candidate. Those who carry the JVC-6 virus cannot take the drug. I’m waiting to see whether I carry this usually harmless virus. Sadly, over 200 people have died using Tysabri®. These people carried the virus and developed an untreatable brain disease called Progressive Multifocal Leukoencephalopathy (PML), due to viral interaction with the drug.

 

So, I wait. I wait to find out if I’m a candidate. If I am, I’ll switch very soon. It’s frightening, and I can’t say I’m all that enthused, but MS takes many things out of a person’s control. I’m no different. I’ve got to do what I’ve got to do.

 

That said, many things are in your control as an MS patient. MS cannot take away your identity, your values – your core. You are strong, intelligent, a mom, a dad; you’re anything you want to be. You may need to do things differently, but you can still do them and live life on your terms, your way, to the best of your ability. I say, “Fight the good fight. The warrior’s battle. You don’t have time for anyone or anything that gets in the way of LIVING!”

 

Sharon Bosch

MS Warrior and Survivor
 
 
 

 

 

 

 

Saturday, August 25, 2012

ON ward



Hear no evil, speak no eveil SEE NO.... WAIT I CANT REALLY SEE ANYTHING?



Am I blind? 

Will I see again?

Oh the pain

WHAT IS HAPPENING TO ME????

For many with MS, Optic Neuritis was our "relapse" that lead to our MS Diagnosis.  At least that was the case for me.  One day I am at work. Going about my day, and BAM - my eye starts watering and I feel something in my eye - at least it felt like something was in my eye.  Probably an eyelash.



I pulled at my eyelid all weekend.  I STILL CANNOT SEE!!!!  well that isnt entirely true.  I didnt see "black" which i always imagined someone without sight would see.  It was like a gray smokey cloud.  Some say its like looking through a lace curtain.

guess I better go to the doctor. (mind you I DONT DO DOCTORS - I dont EVER get sick...advil fixes everything)

my first diagnosis - I have a scratch on my eye and given drops.  I am also told my eye is very dry so asked to use eye drops for moisture.  WHEW - i can do that...

5 days later and NO improvement in the eye....but what i found fascinating is that i "forgot" I couldnt see. 

FORGET?





My right eye is the one that i couldn't see out of but my brain told my left eye to do all the work, so it compensated for my vision loss.  WOW  - our bodies are really amazing.

I went to eye doc and she reviewed,  She told me that i was permanently blind in that eye.  There was no way to fix it....

WHAT?!?!?!?!?!?!?!

Thankfully the next day I was sent to a Neuro Opthamalogist who diagnosed me with Optic Neuritis.

So what is Optic Neuritis (ON)?

  • Optic neuritis is inflammation of the optic nerve


Up to 50% of patients with MS will develop an episode of optic neuritis, and 20-30% of the time optic neuritis is the first sign of MS.

Some Symptoms of ON
  •  sudden blurred or "foggy" vision
  • pain with movement of eye
  • loss of vision
  • loss of color (washed out)
Most regain vision back - but it may not be 100%

I regained 90-95% with my right eye seeing colors as "washed out"

How do i know its ON

  • your doctor will have you take a Visual Field test to check your peripheral vision
  • they may also have you have a MRI

I have ON - what do i do?

  • Speak to your doctor and they will probably suggest you go on Corticosteroids such as IV Solu-medral,  Depending on doc's recommendation it will be 3-5 days,  It may or may not be followed by a taper of Prednisone.


Ok - I have treated my ON now what?

  • Please speak to your neurologist about starting a Disease Modifying Drug or evaluating if the one you are on needs to be changed.







Sunday, August 19, 2012

Which DMD is 4 ME?

DMD = Disease Modifying Drug
DMT = Disease Modifying Therapy


Copaxone, Rebif, Avonex, Betaseron/Extavia, Tysabri, Gilenya,  Novantrone!


These are all FDA approved DMD's for MS










Which is right for me?  How do they work?
 Copaxone



  •  daily Injection
  •  subcutaneous (little needle)
  •  can be used with auto injector
  •  synthetic protein (glatiramer acetate )
  •  daily injection
How it works -
This drug is believed to blocks T-cells which destroy myelin.

Common sides effects (that normally clear up )
injection site swelling - some get welts
fatigue
runny nose
weight gain

if any other side effects occur, consult your doctor
 List of additional Side Effects
REBIF interferon beta-1a


  •  injection
  •  3 times a week
  •  can be used with auto injector
  •  subcutaneous
  •  known as interferon beta-1a
  •  it made up of amino acids that are found naturally in the body specifically  interferon beta-1a
  •  titrate to full dose
HOW IT WORKS
Rebif is an interferon therapy. Interferons belong to a family of proteins that naturally occur in the body. Rebif contains specifically interferon beta-1a. This type of interferon is identical to the body's natural human interferon beta. The exact way Rebif works is not known.
Common side effects
flu-like symptoms - Since flu-like symptoms are a fairly common side effect during the initial weeks of treatment, it is recommended that the injection be given at bedtime. Taking acetaminophen (Tylenol®) or ibuprofen (Advil®) immediately prior to each injection and during the 24 hours following the injection will also help to relieve the flu-like symptoms.

If you experience any of the below - consult your doctor
depression
allergic reactions
liver function
seizures

 List of Rebif Side Effects

You should have blood test regularly to check your liver function and blood counts
AVONEX interferon beta 1a







  • injection
  • once a week
  • intermuscular
  • amino acid interferon beta 1a
  • often give as first medication to newly diagnosed
  • now has an autoinjector
  • titrate to full dose

HOW IT WORKS
it is believed that it stops the immune system from destoying Myelin

Common Side Effects
flu-like symptoms (fatigue, chills, fever, muscle aches, and sweating). Most of these symptoms will tend to disappear after the initial few weeks of treatment. If they continue, become more severe, or cause you significant discomfort, be sure to talk them over with your physician.
 
If you experience any of the below - consult your doctor
depression
allergic reactions
liver function
seizures
heart issues

Avonex Side Effects
You should have blood test regularly to check your liver function and blood counts
BETASERON/EXTAVIA -interferon beta 1b

 

  • injection
  • subcutaneous
  • every other day
  • made of amino acids
HOW IT WORKS
it is believed that it stops the immune system from destoying Myelin

Common Side Effects
flu-like symptoms (fatigue, chills, fever, muscle aches, and sweating). Most of these symptoms will tend to disappear after the initial few weeks of treatment. If they continue, become more severe, or cause you significant discomfort, be sure to talk them over with your physician.
If you experience any of the below - consult your doctor
depression
allergic reactions
liver function
seizures
heart issues

Betaseron/Extavia side effects


Gilenya (fingolimod)












  • First and ony Oral Medication
  • Daily pill

HOW IT WORKS
Lymphocytes are what attach disease in our immune system,  Since MS patients have a hperactive immune system, these Lymphocytes attack the Myelin,  Gilenya sequesters some of the the Lymphocytes in our Lymph Nodes.  How this actually works for MS is unknown
Common Side Effects
  • Headache
  • Flu
  • Diarrhea
  • Back pain
  • Abnormal liver tests
  • Cough


If you experience any of the below - consult your physician right away
  • vision problems
  • dizziness 
  • slow heartrate
  • infection


see Gilenya Side Effects


TYSABRI









  • IV infusion every 4 weeks (28 days)
  •  normally not given unless you are non-responsive to other therapies
  • antibody and not an interferon
HOW IT WORKS
- thought to keep white lood cells  from getting into the brain and attacking nerves which in turns is believed to result in fewer lesions

COMMON SIDE EFFECTS
  • Hives
  • Trouble breathing
  • Chest pain
  • Dizziness
  • Chills
  • Rash
  • Nausea
  • Flushing of skin
  • Low blood pressure
  • see more side effects
    Potential Serious Side Effects
    Liver Damage
    Serious infection
    PML - Progressive multifocal leukoencephalopathy


    NOVANTRONE (mitoxantrone)




    •  originally use to fight certain forms of cancer
    •  IV infusion every 3 months
    •  there is a lifetime maximum with this drug (8-12 doses over 2 years)
    HOW IT WORKS
     It acts in MS by suppressing the activity of T cells, B cells, and macrophages that are thought to lead the attack on the myelin sheath.
    SIDE EFFECTS
    As this is an agressive drug, that was designed for chemo there is a list of potential side effects, such as weakened immune system and cardiac issues.  See list of side effects by visiting the NMSS website  - click here SIDE EFFECTS


    WHAT IS RIGHT FOR ME???
    We all respond to medication differently. It is important to speak to your doctor about your options. Have your doctor educate you on the different medications and TOGETHER - decide what you will try. This choice should be made TOGETHER



    RESEARCH and go into doc well informed.
    No matter which you decide to go on, the important thing to remeber is always be on a DMD.  Until there is a cure, this is our opportunuity to try and reduce our relapses and disease progression.  The drugs listed above have all been approved by the FDA.  Be weary of presented "CURES" or quick fixes.  They sadly dont exist and often times its just a scheme to get your money and create false hope.

    Along with a Medication, you should eat healthy and remember to MOVE IT

    *** Information in this blog regarding each drug was borrowed from the National Multiple Sclerosis Society and each drugs Websites.

    Saturday, August 11, 2012

    Vacation or Staycation?





    Summer is coming to a close.  (hope this heat is too)

    Kids are heading back to school soon (if not already)

    Did you get your summer vacation in?

    I have heard from many that they wish they knew of some wheel chair accessible places. 

    Well i found this great website www.disabilitytodaynetwork.com

    This is an all inclusive site that has "channels" of information about travel, products, and much more


    When you click on TRAVEL - its lists companies that either tell us what is accessible or refer you to Travel Groups designed to assist us


    as there are so many destinations in the world that have made their cities or attractions accessible. i encourage you to research that particlular city to get more detail information.

    In my research i have found that most major attractions have ensured that they accomade those with disabilities....here is an example for those traveling to see Mickey Mouse in either Orlando of California  http://www.wdwinfo.com/wdwinfo/disabgeneral.htm

    How about a Cruise?  Most Cruise lines are accessible to us and have room accomadations to fit our needs.  Visit the Cruise Critic for their top choices of crusie lines

    Dont want to travel to a different town/state? 

    Nothing better (and less expensive) than a staycation.

    Rent Movies - Go to Movies - Camp out in your living Room or Back yard.  Do you have an Amusement Parks, historical landmarks in your area to vist?  Most places give a resident discount.
    Is there a lake or beach nearby?  How about campgrounds where you can enjoy a nice picnic (if its not too hot)

    I am not sure if anyone watches Push Girls on Sundance Channel (I recommend it if your dont - these girls dont have MS - but are wheelchair bound)


    Its about 5 women who are wheel chair bound.  They dont let their disability stop them.  On the last episode they went Skiing.  Yes many ski resorts have special equipment to accomadate us all.  They swim, dance... THEY ADAPT,  They dont say I cant do it until they try.

    So as this summer comes to a close - Enjoy time with your family and friends....try something new...if you want to travel to a specific place, look them up online to ensure they are accessible to you...if you want to stay in...HAVE A BLAST!!!! 


    Use your QR Code App

    Sunday, August 5, 2012

    Best of the Best





    I am sitting here today...watching the Olympics, which i am glued to every 2 years whether it be summer or winter.  I love the friendly competition,  I love the fact that polictics and war among the countries are not seen.  These athletes are here to show the world their craft among their fellow brothers/sisters.  We are seeing the BEST OF THE BEST.  After each match they congratulate each other.  Those who may not win do not dispay anger or resentment for the winners.  Their is true sportsmanship at these games.


    The Olympians truly care about the other players.  There is no backstabbing or name calling going on.  This is a community that sticks together.  Do they all agree on EVERYTHING?  NO...frankly if everyone agreed on everything in this world it would be a VERY boring place.  


    The are making new friend and that opens them to making life changing connections. 

    We at SecureACure4MS have been truly blessed this past year by the friends we have made.  People like you are approaching us with knowledge and expertise in an area and you want to Share it with the rest of our community.  YOU care.  Sharon and I are soo happy that we can be the platform to let your voice be heard.


     SecureACure4MS was given that platform by many of you so that we could be hearde.  Those of you that have opened your doors to us, we are truly greatful.


    So as I watch the Olympics and see this "community" of Olympians coming together, I cant help but be overjoyed, knowing that we have created our own Olympian community.  YOU are the BEST OF THE BEST to us. You are Olympians.  We are not working towards Bronze, Silver and Gold in swimming or volleyball... we are working together on making MS a thing of the past. 



    So on behalf of Sharon and I- we say thank you


    visit us at www.secureacure4ms.org