Maybe you'll start feeling better if you stop reading WebMD

Yesterday was follow up visit with my neurologist. I have been attending her office every 6 months for the past year and a half. Yesterday was a big step in our relationship.

I have been given the all clear to now only see her every year, unless I relapse. This is so exciting.

My only real symptoms are numb fingers and numb toes and bi-lateral spasticity of my lower limbs. This is pretty awesome. Now that I'm not working she is concerned that I am not getting enough exercise and wants me to walk, at minimum, 1 km per day, to find some instruction in yoga and pilates, and to consider weight/strength training for my upper body and core.

Also, we have agreed that I will have an MRI in March or April of next year to see what is going on as she is supporting my decision to go off Copaxone.

I'm not going off Copaxone because it was horrible. I am going off of it because it is a constant mental reminder that I am sick when I don't feel sick. I'm also tired of being bruised and sore in inconvenient places. Mostly, I'm just really sick of being sick.

So, we've agreed that a one year break from Copaxone is fine. If there is no change in my lesion load next year, then we'll talk about Copaxone or see if Gilenya is covered by the provincial drug plan or see what else is on the market. If there is a change, then getting back on a drug is really my only course. I have had no change in my MRI since diagnosis, so anything that happens after now will most definitely be because I went off the drugs.

So, in the grand scheme of all things MS, with 1 being "meh" and 10 being "someone kill me and put me out of my misery", I'm a 1. Maybe even a 0.5.

I am extremely fortunate that my version of MS is turning out to be more of an annoyance than a life destroying disease. I have done nothing to deserve this, unless you count listening to the best advise the doctors had for me and doing what was suggested by them as "doing something". I don't know how long this will last, and by this time next year we will find out of my decisions worked out.

Battles

I'd like to think that multiple sclerosis doesn't have something personal against me. I hate it, but I'm pretty sure that we're not in a fight with each other. My relationship with MS is not a battle. I will not defeat it, just as it will not defeat me. It's a disease doing what it is programmed to do. To call it a fight or a battle or a struggle against some sort of oppressor is to make MS out to be some kind of third world dictator with a huge sense of entitlement and delusions of grandeur.

If (When) I get sick again it will not be because I didn't fight hard enough or because I did not think positively enough or because I didn't go to Poland for "Liberation" or because I didn't go gluten and fat free or any of the other 15 to 20 other "Cures" that have been presented to me in the past three years.

It will be because I have a disease that is programmed to disable me. To grant it human feelings or actions is to, in my opinion, make light of the seriousness of what MS can do to me.

You can't reason, negotiate or put MS into exile or eject it from the community. Doing what is suggested by my healthcare team and taking the daily injection from Big Pharma is not some kind of moral failing. It's working with the best that science has to offer right now for my level of disease progression.

To personalize it, for me, makes it seem as though I am some how responsible for never getting sick again and if I am left blind or disabled or unable to stay awake it is my own fault that I just didn't *Fight* hard enough.

That is more responsibility than I am willing to take on.

Your mileage may vary.

Update.

Went for my three month follow up after starting Copaxone.

I have regained about 95% of what I lost during my first relapse. That's the great news.

My coordination is improving, I have more vestibular training to do in order to get the most out of yoga and pilates and some kinetic training to improve my cardio on the bike. My optic nerve is healing and my strength is improving on my left side. I can walk straight, walk on my toes and walk on my heels. I can stand with my legs together, arms straight out and close my eyes. I am sleeping 6 to 8 hours a night and still functioning in my day. I'm still having an unpleasant symptom that makes me feel awful about myself, but I'm not likely to get an answer on this until late this year or early in the new year because it's not something that is going to kill me. I have minimal spasticity remaining in my left leg. I am still getting nerve fatigue but she couldn't wear it out in a 15 minute test like she could last year.

I have to see the Copaxone nurse because some of my bruises have turned into spider veins which is not cool.

Since I don't have anything "interesting" going on, I won't get another MRI until A) I have a significant relapse or B) have one considered in three years. Which is good, because I don't see the point of doing an MRI on someone who is, for all intents and purposes, healthy.

I am really enjoying the Ativan. Really enjoying to the point where I think it might be wise to take the weekend off because this feeling of absolutely not giving a shit about anything can be quite habit forming. It's just so good.

And 30 of them only cost $11. Even without Fair Pharmacare I'd totally put the money out for that.

Following up with the Neuro in February 2011, after checking in with my annual poke n' prod at the family doctor and the MS neuro-psychiatrist in September.

Considering asking my family doctor to send me for a consult with a reconstructive surgeon because I would LOVE to get rid of these breasts of mine. My back, neck and shoulders are just killing me even with good, properly fitted bras. But it's still under consideration.

After those two appointments I will have a more accurate picture of what it is I need to do to save my own life.

But for now, I'm going to consider what to do this weekend since my house has been neglected for more than three weeks and that makes me feel awful about myself too.

France

Not the country, my Copaxone support nurse.

She calls me every month to check in on my "success" with the daily regimen of my injectable disease modifying drug.

It feels a bit like a pep talk but I realize that Teva pays a lot of people a lot of money to keep me on this $1,400 a month drug. I've already decided that I'm sticking it out until my next relapse, whenever that happens. I'm generally stable, with small things improving because of "Magic Hands" Ray and the physiotherapy exercises I manage to throw into each day and maybe the Copaxone.

Are the improvements because of the Copaxone? I don't really care. I'm not in a wheelchair, I've got 20/20 vision, I can generally control all of my limbs and I only need 7 hours of sleep.

When you've got MS, that's about as good as it gets. I have distinctly lowered the expectations for the remainder of my life.

It's going to be *AWESOME* living like this when I know that almost every woman I'm descended from lived to be 80+ with most of them getting beyond 85. I've probably got 50 more years of this shit to deal with.

I have my three months on Copaxone follow up with my neuro on 5 August, right after an appointment with my physiotherapist to figure out why yoga and pilates movements involving the movement of my head make me so dizzy I feel like puking.

This whole getting exercise thing is going really fucking badly.

I've been just obsessing on cigarettes and lattes for about 24 hours now, knowing that in my old life that would solve this weight problem by the first of October, but I'm pretty sure it would kill me now.

Age and MS have completely changed my problem solving skills, much to my near-instant-gratification-loving-brain's chagrin.

Oh, to be 30 again. It seems like a lifetime ago.

One foot in front of the other.

I have been walking around the block on my lunch hours for the past two weeks. At first I thought it was because of my pathological fear of getting obese, but I realize that there is a greater benefit.

My nerve fatigue in my left leg rarely happens anymore. I can easily get around two square blocks at a pretty good speed without it happening, and then make it up three flights of stairs up to my office.

I've been doing physiotherapy exercises throughout the day, going to see Ray "Magic Hands" Ranger on Thursdays for $15.75 massage therapy, walking every day, and watching what I eat (I try to make 50% of what I eat each day fresh fruit and vegetables) and the strength in my leg nerves is improving.

I walked the two blocks around my office on my lunch hour, worked the rest of the day, met Joe for some dinner and then about 8 PM walked several more blocks to the hardware store for some items to fix up the apartment tomorrow and I made it with no nerve fatigue.

I still feel like I'm talking like a three year-old who's learned not to shit her pants anymore, but what the hell.

I still don't trust my body. I know that it will betray me when I least suspect it. But it's nice to know that I've got a pretty good chance of being able to get myself into a position where I can call for help when it does.

The Copaxone has left me feeling like I've been running into a lot of door frames and table corners, along with these strange itchy lumps two or three days after shooting into my arms. The other parts of my body don't seem to react like that. My Copaxone nurse doesn't think it's anything to worry about and it will probably stop in the next month.

Whatevs... I'm not getting sicker so I guess it's doing something.

This weekend is going to be productive. It has to be, because the last two have been anything but.

Now I'm going to get in my pjs, have a CC and CCZ, and do some prioritization for tomorrow.

woo.

Go me.

World MS Day and things that are apropos of nothing.

(insert sound of one single party blower here)

I've been on Copaxone for one month now. It was really uneventful until yesterday when my injection site on my right arm was hard and itchy all day and it continued into today. Don't what that is about, so I'm going to call my Copaxone nurse tomorrow.

My symptoms are stable for the most part. Still numb fingers and toes, wonky left leg, sketchy balance and a spastic left calf. Ray of student RMT fame has been working that calf and my feet with massage therapy and I can feel my leg unwound for days a time now. I can't meet with him this week and I'm sure I will miss it.

--

I've been thinking a lot about secrets these days. I think it's because I've started writing again and my opening sentence from yesterday isn't something that I think my mother would be pleased with and I think that my grandmother would have a stroke at the mere idea of it.

I realized that for me to really write publicly about what I want to write about must wait until my grandmother has passed and my mother is senile. That makes me sad because that's going to be a long freakin' time.

I've done very little in my life that I am proud of. Two of those things have to be kept secret for the time being (See: Grandmother). The other two are really only impressive to me and that is it. Four things.

I find that I have lived much of my life waiting for better days because the present has been so crappy. I still feel like that most days I am at work. That tells me that the antidepressants work to keep me from killing myself but do not give me a false sense of happy.

Which is kind of a relief now that I consider that.

Next month will mark a year on Wellbutrin. Given how much generalized anxiety I've been having lately I'm planning on making another trip to the neuropsychiatrist - this time for some Adivan and cognitive testing.

Since Joe has decided that I am going to be an economist I need to figure out what is wrong with my brain that will hold me back from scholastic success. I'm fucking stupid all the time now and I know that some of it is related to the MS and some is probably just understimulation. There's no complex thinking in my life on a day to day basis unless I go looking for it.

I do wish things were different and I do live a lot of my life waiting for better times in the future. Maybe I'm making peace with that.

And the book says, "We may be through with the past, but the past ain't through with us."

Allergies

Blah.

Whatever trees there are in my neighbourhood I did not grow up with them. Between this pollen and the dust in my office the post-nasal drip is alternately making my nose run or making me choke and cough.

This sucks.

I've been thinking too much and too often these days. I really want to hang out with my friends.

Sometimes it's difficult to be an extrovert married to an introvert. I love the driven, sketchy artist thing Joe's got going on, don't get me wrong, but I would have people over a lot more if he actually liked people being in the house with any regularity.

So now what I want is a Salon. Every month or six weeks getting women I know together to have some wine or cocktails and just talking about stuff we're doing, or reading, or whatever. Hell I don't even need to know them, I just want to hang out with them and do something fun and interesting.

That's my brilliant thought of the week.

My Copaxone is going pretty well. I don't like the reaction I get after injecting in my thigh. I get a big hive like reaction an inch or so from the injection site for about 10 minutes. That's the only place that happens. I know that that is a pretty normal reaction that lasts about as long as it is normally supposed to, but I don't like it.

I had more I wanted to write about by my runny eyes and nose are driving me bonkers. I'm going to do my shot and then settle in for Betty White on SNL. I had to stop reading Twitter because there were too many spoilers from the east coast viewers I follow.

Jerks flaunting their ability to live in the future...

One Week

I've done 8 shots now. It's still frustrating me to give myself shots that I have to look at, even with the auto-injector. I like the speed with which the auto-injector administers the Copaxone. I find that straight from the syringe is just too fast.

I'm pleased with my progress at getting this shot integrated into my life though.

One thing I am NOT thrilled about is the CCSVI advocates clogging up my comments, following me on Twitter and sending me messages on Facebook.

I'm really happy that all these willing victims are ready to martyr themselves because it's going to take at least 5,000 people running off and getting the "liberation procedure" before we find out what the stroke risk is. Since solving the problem of my wonky left leg and intention tremor IS NOT worth the risk of being left in a wheelchair, a vegetable or dead, I'll wait, thank you very much.

I'm not going to advocate that the test and the surgery start taking place here in Canada unless every single person who has it done kicks in 2/3 the cost and signs a waiver saying they can't sue for malpractice because the surgeon didn't know how to do the procedure and it was so experimental they didn't know the inherent risks.

A vascular surgeon that my neurologist at UBC Hospital talked to thinks that the risk of stroke could be as high as 1 in 100 to 1 in 5000 depending on where the narrowing/blockage is.

Neither of those numbers is worth the risk to me right now. I want to see more study, to start training for the professionals to diagnose CCSVI and the surgeons to treat it, and to find out if the risks outweigh the benefits.

In the meantime I'm doing Copaxone and doing my physiotherapy and yoga. I know for sure that those things won't kill me.

Four

Tonight will make shot number four.

So far it's been surprisingly hassle free. I don't have the constitution to jab myself yet, so Joe has done the last two nights and tonight I will use the auto-injector because I just can't bring myself to inject myself without getting light headed.

I feel like such a baby because rationally I *know* that the needle itself does not hurt, it's the medicine going in that hurts and that doesn't hurt until pretty much after everything is cleaned up.

It's so stupid of me to be afraid like that.

I'm thinking about going in for a shower, putting on my pjs and just getting the stuff out and trying to do it without thinking about it. I'm pretty sure it won't work like that because there's a fair bit of prep to do and that leaves me time to think.

I'm tired. Maybe I should just suck it up, do the shot and go to bed with a good book.

Anticlimax

Today began with me having to face my own future.

Because people are assholes I have to travel by bus with a cane because I can't keep my balance standing up on a bus. (I also use a cane when I am going for either distance or speed because it helps my balance and that means I don't have to work as hard to walk) I sat in the first seat. It faces the wheelchair seat. Today the wheelchair seat was occupied by a woman in her late 50s/early 60s. I smiled at her when I sat down.

She said "You're so young to have a cane. You must have MS."

I admitted that I did and she said, "I went secondary progressive two years ago. I've been in the chair about 18 months." She went on to explain that she'd been diagnosed in the 90s and had been doing good for 15 years and then started going downhill and all the steroids and DMDs were powerless to stop it. She asked when I was diagnosed and when I told her she proclaimed that I was diagnosed at a "good time" because so much is changing.

Then we had to have the obligatory conversation about CCSVI and what we thought about it and weighing the pros and cons of going to Poland or Cuba or Italy to have the procedure done.

When all that was said and done we just sort of sat there looking at each other. She smiled at me, I smiled back. I realized that I must have a look of abject horror on my face because that is my MS nightmare.

(My full blown absolute terror is unending nerve pain, but the chair is right up there.)

I was also having some panic about starting Copaxone and really reevaluating why I was doing this, but I do know why now. It is very clear.

If 5 or 10 or 15 years from now I have a relapse that fully disables me I do not want to sit there thinking "What if I had done more?"

I couldn't live with that guilt knowing that I had options to put up a fight with this disease and I didn't take them. I've read the scientific literature and there's a track record with Copaxone after coming off Novantrone. There's a 15 year study showing that it does make a difference over longer periods of time.

MS doesn't come with a whole lot of options so I've got to take what I can of what's offered. When I get paid I'm walking down to Unity Yoga and asking if they'll teach someone who has to wear shoes (that has been a deal breaker for 4 other yoga studios). I'm walking every day. I'm watching what I eat and trying to manage my symptoms the best I can.

I also need to lose 30 lbs by the end of September because my cousin Angela is getting married and I am the hot sister.

My left arm has received its first shot. Its reaction is mild and it doesn't hurt. I'm just really aware of it in a way that I have never been aware of of my upper left arm before. Using the auto-injector made it really easy to get to the back of my arm and administer the shot. Tomorrow my left thigh will get the shot and I'm going to try it manually.

That should be, uh, something?

I think I am making the right decision. Joe's super supportive of the whole thing and sat through the nurse-led self-administered injection training with me. Francine was really nice and very patient.

I had convinced myself that it was really, really going to be a stabbing pain, but I didn't even feel the needle go in and thought for a moment or two that the auto-injector had misfired until I started feeling the drug coming into my arm. It was so not a big deal. I had convinced myself of much worse. Anticlimactic is probably an understatement.

I started out this day being really terrified of the future and its possibilities and I'm finishing this day feeling like I am taking an active part in trying to achieve the best future outcome that I can.

I don't like to think about tomorrow much, but tonight I'm pretty content with the choice I made today.

Finally

After 3 months, countless phone calls and cursing the very idea of 3rd party insurance, it finally happened.



Manufacturer's Suggested Retail Price = $1,410.40 per month.

Thankfully because of Joe's SFU health insurance I only had to pay $282.06, but that should have been less if the private company that administers the BC Fair Pharmacare program would stop believing that I live in Chiliwack. They can't seem to get it out of their computers that I have never been to Chiliwack, let alone would have enrolled in Fair Pharmacare from there. If I can get all of this sorted before my next prescription refill I will not have to pay another cent for any prescription until next year.

Tomorrow I call the Shared Solutions nurse to ask her to send someone over and teach me how to give myself subcutaneous injections. Joe's going to learn with me so we'll be watching the DVD that they sent me with my MS backpack. I'm sure it is riveting.

Should I take notes?

This has been a bureaucratic fucking nightmare for 3 months, mostly because no one who's used to only dealing with the government has ANY idea how to deal with a private company. The administration of Fair Pharmacare is done by a private US company and it shows. The special therapies Pharmacare program is administered by the Ministry of Health and that shows too.

But by this time next week, I should be a full time Copaxone user.

edit to mention: I got 490 Airmiles for this prescription. It costs just over 3000 for a single return ticket to Ottawa.

*le sigh*

I am slowly coming to accept that the job I have is the job I have. At this point I've been out of a resume worthy job for over a year, and the job I've got is probably the best I can do at this point.

This makes me want to cry, because everything I'm really good at doing is not a skill set my boss is looking for. It is the same thing every single day. Download and print his email, open his mail, transcribe the emails or letters he dictates, make his photocopies, file.

Lather, rinse, repeat.

I'm grossly underpaid for the kind of high maintenance this guy is, and he's acting like I should be glad to have his pittance. No extended benefits, not even an MSP kick-in, no extra vacation. I've been warned by the woman who works for the accounting arm of his company that he will try to pay me out the two weeks rather than give me the two weeks vacation I am entitled to under BC law.

Great.

At this point, this is it and it pays the rent and keeps the wolves at bay. But my goodness it's boring. The only thing that is good about it is that he doesn't dock my pay when I go to the doctor and I can wear yoga pants and baseball caps to work if I want to.

I haven't come to a level of acceptance that allows me to put this job on my resume yet, but I am sure as the fog of denial lifts it will come to be.

On the Copaxone front:

My Pharmacare coverage is in place leaving me on the hook for $1500. I want my extended medical to pay that $1500. My neurologist sent in all the forms (I know this because the insurance company called to confirm the DIN of Copaxone because it was missing).

It took them TWO WEEKS to send the forms to the Administrative Department that Signs Off on Such Things and now it has been another two weeks. Still no word. The last time Joe called (he is the primary, I'm the dependent.) they were very clear that when it was approved *THEY* would call *HIM*.

For my American readers, I got "government health care" in 48 hours. My private insurance company is still thinking about $1500 worth of $18,000 a month later.

The private sector is *so* much more efficient, my lily white ass.

My MS backpack is here!

These are the contents of my MS backpack. I had it delivered to my workplace today. I am not even going to go into how Purolator screwed up the delivery of this backpack THREE TIMES, but I guess the fourth time is a charm.


Because I enjoy lists, I will list what is in my ugly, lame backpack.

1. Insulated lunch bag with cold pack insert - This is for taking my Copaxone outside.

2. Refrigerator lock box. Presumably the pre-filled glass syringes should be in a box that is locked. The keys are magnetic and they'll be stuck to the fridge door and say "COPAXONE" on them, so it's not going to take a rocket scientist to get my fits out of the fridge. I realize that this lock box is probably more for the safety of children who live in the home, but I'm far more likely to have a junkie break in looking for drug paraphernalia than a small child near my fridge. Not that a junkie break in is at all likely either.

3. Autoject2 - This is an auto-injector. It is patented and has registered trademarked name.

4. Needle clipper - I guess in case the needles that come on the pre-filled glass syringes are too long.

5. Travel box and travel card - Holds a week full of syringes. It has a card that states what Copaxone is, why it has been prescribed to me and what temperature it needs to be stored at.

6. Wing extender with instruction sheet - It makes the end of the syringe wider for your fingers to hook onto as you inject. The instruction sheet makes it seem very simple.

7. DVD - Self-Injection Training - I'm guessing that this the feel-good, runaway, smash hit of the spring. I have to watch it before the nurse comes over to teach me how to do it.

8. Injection pad - I hope this is covered in the DVD materials, because I can't for the life of me figure out what it's for.

9. Daily Planner - "Rotating injection areas and injection sites is important because it may prevent short-term and long-term skin reactions related to any kind of subcutaneous injection." Rotating your areas/sites is important to keep your skin "from becoming hard, sore or indented from repeated injections."

Awesomesauce.

10. Compress - Hot/Cold - To help combat normal subcutaneous injection site reactions, apply the cold compress for 5 minutes before the injection and for 5 minutes after.

YAY!

11. Injection support mat - It gives you directions for everything you need to do your injection, either manually or by auto-injector.

12. Patient's Guide to Understanding MS - (Comes with a map of possible injection sites) - This book looks like the world's skinniest recipe book except instead of Appetizers, Entrees and Desserts it's got tabs for Multiple Sclerosis, Copaxone and Support.

13. Brochure - "All Shared Solutions nurses are professionals who specialize in MS; most have been certified by the International Organization of MS Nurses (IOMSN), a group committed to excellence in MS patient care. (Certification requires at least 2 years of experience with MS patient care.) My nurse's name is France and she's in Montreal. I practice my French with her. She is kind enough to tolerate my anglophonie ass.

BUT WAIT THERE'S MORE!!!!!!!!!!!

14. A copy of the Shared Solutions privacy policy, in both French and English.

15. One of those neck cooler things that you soak in water and wear around your neck to keep the blood going to your brain cooler.

16. My nurse's business card.

17. A copy of the latest issue of MSDialogue - Science, medicine and support for those whose lives are affected by MS. It comes with an invite to get a free subscription.

and finally...

18. A pen.

NOW, if our private insurance would just hurry up and approve my drug exception form and cover the $1,750 deductible on my Fair Pharmacare, I can actually get the nurse over here and start this stupid drug.

If private insurance is so much better than single payer, why did it take 48 hours for me to get approval for Copaxone by the government program, but three weeks after receiving the forms my private insurer is still thinking about paying $1,750. For the whole year. It's not even like that's a monthly fee.

Efficiency my ass, I say.

My MS backpack.

I wanted to do a blog post about it, but it hasn't arrived yet.



Other than that I'm busy with hockey and hoping against hope that the HRT fixes my Premature Ovarian Failure soon.

Flow Chart to MS DMDs

I don't think I can fully explain how much I love flow charts. Pie charts and bar grafts too. Unfortunately I don't want to do tables and all that so I will just number this one.

Special Therapies Pre-Treatment and Special Therapies Treatment Phase

Pre-treatment Phase

Step 1 - Referral to Special Therapies Program

I was referred to the STP by my neurologist who screened me for inclusion in the program based on the BC Pharmacare's prescribing criteria

Step 2 - Patient Education (3 hour group session)

This is what I attended today where I got this awesome flow chart

Topics covered

- review of what MS is
- description of available drugs & how they are administered
- clinical trial study results
- side effects profile and management
- patient expectations
- Pharmacare coverage

According to the facilitator, this patient education program was mandated by BC Pharmacare to help lessen "prescriber bias". The four drugs were approved by Pharmacare around the same time and knowing that one or two of the drug companies had funded hundreds of thousands of dollars of research in the province they wanted to make sure that patients were getting access to the drug they wanted to take, not the one their neurologist wanted them to to fund his/her research. Every person who is going to start an MS medication in the province of BC has to take this education session.

Step 3 - Patient to call Special Therapies Program secretary with drug choice.

I don't have to do this one because my drug choice is already made. My doctor has already filled out the forms, I just had to go to this session because it's the rules.

Step 4 - Pharmacare approval (takes approx. 1 week)

As far as I know, I already have my approval.

Step 5 - Package to be sent to patient
- bloodwork requisitions (if you are on beta-interferons)
- Pharmacare approval note (for secondary insurers, if they require it.)
- neurologist letter (for additional insurance back up or for travel)
- travel tips

Step 6 - Bloodwork screening (not required for Copaxone)
- bloodwork must be done before prescription given to patient

Step 7 - Prescription given to patient

Step 8 - MS Clinic will send requisition to company support program for home start by RN


Treatment Phase

Day 1 - Injection training and drug initiation - home RN start

- first injection done with home nurse teaching

48 hours & 1 week - Follow-up phone calls

- You will receive a phone call from the Support Company Nurse regarding side effect management and support

Month 1 & Month 3 (approx) - Follow-up clinic visit - (optional)

- injection site reactions
- side effect management
- monitor bloodwork results (Avonex, Betasteron and Rebif - monthly for 6 months)

Month 6 - Optional clinic visit

- Monitor bloodwork results (not required for Copaxone)

Month 11 - Monitor bloodwork results (have blood test 1 month prior to appointment) [not required for Copaxone]

1 year - Annual review - make appointment with neurologist

- prescription renewal
- check injection sites and Special Therapies treatment issues

Pharmacare approval needs to be renewed each year with the prescription, and that's important because most private insurers won't cover the full cost of the medication without Pharmacare kicking in 70% of the cost, which is $1600 a month. Approval is never denied unless you no longer meet the residency requirement. The 30% will be covered by most private insurers up to your drug coverage percentage. (Ours is 80%.) This is going to cost me $96 a month out of pocket until my annual maximum has been reached. (The 80% of the 30% counts toward the annual maximum, btw.) I don't know what that is yet, because I haven't filed my 2009 taxes yet.

Thus ends the fabulous flow chart of MS drug therapy in the province of British Columbia.

*bows deeply*

I don't have anything nice to say...

so I am not saying anything at all.

No wait, I'll say this:

Spending half a day learning about injectable MS drugs, how to load an auto-injector, how to fill a syringe and how to deal with the side effects of Copaxone is preferable in all ways to going to work tomorrow.

Oh yeah, baby.