Praise then darkness, and creation unfinished

I had a routine follow-up visit with my neurologist today, and it was in fact routine. The closest it got to surprising is that the doctor had a little trouble seeing my old MRIs, taken at Mount Auburn. But once I told her that they were from Mt. Auburn, and her office had told me they'd take care of having them sent, she knew where to look.

Last month's MRI found no evidence of an active MS lesion, or anything else bad, and it's basically the same as the one a year earlier. They drew some bloo for tests including B cell levels, immunoglobins, ferritin, and the usual CBC and differential. Follow-up appointment in six months, when Dr. Sloane wants to discuss lowering the gabapentin dose; we're saving that question for (when I exoect to have less going on than I do right now.

My appointment was mostly with a Dr. Azuma, who said she's a fellow at the hospital, rather than Dr. Sloane. At the end of the visit I asked if she was going to be staying at the clinic after she finishes her training, and she said yes; I asked because I liked her. I noticed that she had a separate badge saying "my pronouns are she/her/hers" attached to her hospital nametag; given *gestures at world*, it seemed like a good sign that the hospital is OK with that.

Next up, colonoscopy on Thursday. I called to ask them a few questions about things like what I can eat as part of the low-fiber diet today and tomorrow, and one about the paperwork, and got voicemail, so in the meantime I am erring on the side of caution. However, I wound up looking at MyChart, and saw that it gives the date for the colonoscopy, but not the time, and the time I remembered didn't match what I had in Google calendar. I did find that date in an email they sent me two weeks ago, which is reassuring, but definitely something I want to ask about ASAP, because the prep instructions include something to be done six hours before the procedure.

Addendum: I got through to the GI doctor's office, and got answers to my questions about the low-fiber diet and the paperwork--but it turns out that the answer to when I should stop the Imodium is, last Thursday. So I'm waiting for a call back to find out whether I need to reschedule the procedure, but will be following the low-fiber diet tonight and tomorrow morning, and not taking either Imodium or the fiber supplement until I hear back from the doctor's office.

I'm seeing the lung doctor a week after that, also a routine follow-up.

5/6: Just heard back from the GI doctor's office, who told me "I just spoke to Dr. Morgan, and she said it's fine that you took the imodium." So, continue the low-fat diet today (I have a bowl of plain yogurt here), and liquid diet tomorrow, as planned.

I had my quarterly telemedicine visit with Carmen this afternoon. That was primarily for the ritalin prescriptions (a pesky legal requirement), plus whatever else I needed to talk about. This time, my list was scheduling a mammogram and a colon cancer screening, and telling Carmen about the dental work. Carmen said I don't need a mammogram until January, so I'm not having them schedule it yet. Carmen also wants me to have a physical exam, so I'll be going to her office in person on Halloween. Annoyingly, despite that conversation, the "after visit" note from MyChart says I should be scheduling a mammogram now.

I also told Carmen that I am dealing with the heat wave in part by getting outside, and back home, early, before it gets Too Hot. This morning, I had tea, walked over to the supermarket, and got back by 8:30. The supermarket opens at 8, and I arrived ten or 15 minutes later. I very cleverly took an NSAID before going to bed last night, hoping it would still be doing me some good when I woke up, which I think it did. The ice cream section had clearly been picked over (again) but I got a pint of chocolate ice cream, and a pint of key lime sorbet, plus milk, bananas and lemons, and smoked sockeye salmon.

(Yesterday, I went out early and briefly, to take out trash and recycling.)

I haven't noticed any blurred vision in the last few days, but it's clear that the laser treatment didn't fix everything.

( eyes )

I just sent him a MyChart message, saying that I am seeing my neurologist; want to tell him about my most recent eye doctor visit; and am not sure what to say. I included that this neurologist is leaving Mt. Auburn soon, so I can't wait until after I see Dr. Lazzara on September 18 to discuss this with the neurologist.

The after-visit summary also notes the old optic nerve damage from 1999, but that hasn't changed, and isn't treatable.

I decided I've given the cryotherapy and salicylic acid treatments more than enough time, and asked the doctor for a referral to a dermatologist instead. She sent me half a dozen names yesterday, and said she would cancel my appointment (which had been for next Monday).

The cat sitter will be coming over tomorrow afternoon, to meet the cats, see where we keep the cat food etc., and get a key.

The three of us had lunch outside today, at the tables outside Kupel's bagels. The weather was on the warm side for me, and would have been too hot if Adrian hadn't found me a seat in the shade. Tomorrow and Friday are supposed to be hotter, so I will probably go to the grocery store tomorrow morning.

After lunch, Cattitude and I walked back to Comm Ave and picked up my gabapentin prescription, as well as sunscreen, deodorant, dental floss, and snacks. I hadn't realized until I picked up the prescription that the neurologist wrote me a 30-day prescription (with five refills) instead of a 90-day prescription. At this dosage, even 30 days' of pills fills a large pill bottle, but getting 90 days' supply at a time may be a little less expensive, and means fewer trips to the drugstore. I should send him a message about this, but it's not urgent.

I've gone back to doing some French on Duolingo, and should probably be emphasizing the listening practice. I now find myself thinking of some words in German, as well as Spanish, before or even instead of the French I'm looking for. (I haven't entirely put the German aside, so this isn't surprising.)

I got an email from my mother this morning, with the subject line "Charity donation."

It wasn't a scam: my mother gave a talk about the Holocaust to a college in the Berkshires (via Zoom), and they wanted make a donation in her honor to the charity of her choice. My mother asked me for suggestions, and specifically for an MS or get out the vote charity. I sent her information about the https://miracoalition.org/, which I did voter registration work for before the pandemic, and she she is forwarding my message with a note about her daughter who lives in Massachusetts.

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I had another dose of Evusheld this afternoon, and waited around for an hour in case of side effects. There weren't any, so when my one-hour timer went off, I got up and left. I made a side trip to Belmont for olives; the 73 arrived before the 71, so I took that, but I would probably have done better on Mt. Auburn Street in Watertown.

signal-boosting dreamshark's post:

The US government's test-to-treat website is live, and looks excellent. You can find
information and participating locations at:

https://aspr.hhs.gov/TestToTreat/Pages/default.aspx

It looks like every pharmacy, clinic, and hospital is listed. Searching by location returns a list of places where you can be tested for covid and get Paxlovid or molnupiravir if you test positive, and a much longer list of pharmacies etc. that will fill your doctor's prescription for one or both of those treatments.

The search returns sites that are within X distance of your location, and it's fine-grained. It defaults to ten miles, but you can increase or decrease that radius, in tenth-of-a-mile increments. They only list sites in the US, including Puerto Rico but not, as far as I can tell, Guam or the US Virgin Islands.

The treatments available at each location are listed: both Paxlovid and molnupiravir are available, although not necessarily at the same locations.

This is a HUGE leap forward from the convoluted and unworkable procedure that was in place 2 months ago when I asked my doctor about it.

The Federal Government has a Test-to-Treat program. You can find
information and participating locations at:

https://aspr.hhs.gov/TestToTreat/Pages/default.aspx

There's at least one, possibly two, anti-virals specific to COVID
available. The sooner you start taking them, the better.
Test-to-Treat is basically 'walk in, get tested, get treatment if
you're positive'.

It's not easy to keep being as cautious as I believe would be prudent for me:

I had blood drawn this afternoon to be tested for anti-covid T cells. The nearest place to have that done was in Waltham, which meant taking a Lyft there and back. I did that after lunch today.

The blood draw was quick and easy, and as long as I was in Waltham I walked from that office to Lizzy's Ice Cream, and came home with quarts of chocolate and black raspberry, and a pint of chocolate orgy. It's a nice walk, across the Charles River, and I decided that good mask + roomy store + very few customers on a weekday during school hours was an acceptable risk, since the Lyft ride home would be almost the same distance.

There aren't a lot of things I actually want to do that are within my current walking distance, since normally I'd have to walk both there and back, rather than just getting into a Lyft a fifth of a mile further from my apartment than if I had gone directly from having my blood drawn.

The problem is the temptation to think, well, I saw the dentist yesterday, and this is also medical. Well, I went to Waltham to have blood drawn, rather than paying for someone to come to my house and do it. Well, I'm already here in Waltham, and it's a nice day for a walk.

I had also let that line of thinking lead me to thinking that it would be OK for me to go see an apartment with cattitude and adrian_turtle, since it's only a block from my current location. Having thought about the rest of that, I told them that no, I would stay home and trust their judgment, just like with apartments that weren't in walking distance.

I cannot plan to not have gone to Lizzy's three hours ago. I can plan not to do that or the equivalent until conditions improve and/or that blood test tells me I have some protection against covid.

ETA: In line with the above, I've emailed Jo and asked her to please roll my Scintillation membership over to 2023. This is mostly making it official, and a little bit removing temptation.

I just heard from my doctor, via MyChart. She said she reached out to Tufts asking what the next step should be, and they told her that they might contact me directly, so I may be hearing from Tufts infectious disease, immunology, or rheumatology. (I think the rheumatology connection is that MS is an auto-immune thing as well as a neurological thing, and the MS drug that seems to be the problem here is an immune-suppressant.)

This is good to know, even though I generally answer unknown-number calls from the local area codes, because so many of them turn out to be from medical offices I want to talk to.

I am back from the ENT. My ears are fine: the odd sensation of dampness in my ears is because I'm clenching my jaw at night, which is tiring the muscles that equalize pressure in the eustachian tubes.

The doctor recommended an over-the-counter night guard, from Walgreen's or CVS, or amazon if I'd rather not go into a store. He also said stress reduction would be good, but that's not going to be a quick thing, given the state of the world.

After the doctor looked in my ears and mouth, his assistant gave me a quick hearing test. I apparently have "ridiculously good" hearing. Also, the doctor cleared some wax out of my ears before the hearing test, not because it would be a problem otherwise, but because it might affect the hearing test results.

This was a follow-up from when I saw Dr. AbdelRazek in September (which was the first time I'd seen him). We discussed my test results, in the course of which he told me that there were no earlier comparison images for the thoracic spine MRI. I knew I'd had that done since moving to Boston, so it should be in their records; I told him I'd look for the date when I got home. It turns out to have been May 2016, so might not be significantly more useful than the one he could find, from 2014, which I think he'd forgotten about when he started that conversation--but that MRI should be in their system, the test was ordered by a Mt. Auburn doctor and done in their radiology department. I have sent him the info, in any case.

Other than that, he's basically happy with what these MRIs (cervical and thoracic spine) showed, The odd blood test results from the Mayo Clinic turn out to be testing for a few obscure diseases that can mimic MS, and he said he does this with all his new patients.

However, based on one of the other blood tests from September, he wants me to increase my vitamin D dosage, because while my current blood level of 46.6 ng/mL is within the normal/healthy reference range of 30-100, for his MS patients he wants it to be at least 50. So, I'll try 4000 IU of vitamin D a day (instead of 3000) and we'll check again in four months: he asked how soon I wanted to come back, and I'd been thinking that every six months might not be frequent enough, so we'll try this. My Washington neurologist saw me every four months; Dr. Apatoff, back in New York, every three.

The visit ended with a little low-tech neurology: moving pegs into and out of a pegboard as a test of dexterity, and a pattern-matching one that assigns random symbols to the digits from 1-9, then presents you with the symbols and asks you for the numbers. Dr. Katz's office did these with pen and paper; Dr. AbdelRazek had it on a tablet computer, so touch-screen.

I also mentioned having gotten a hepatitis B booster vaccine after Carmen noticed that the tests he'd ordered didn't indicate immunity, despite my having had three doses in 2011-21. He asked why I wanted that immunity ("do you work in education?") and I said no, it's something one of my partners asked for. He also said that he wouldn't be surprised if the booster made no visible difference, and I said that yeah, if one more dose of that vaccine doesn't do the job, I'm not going to pursue it further.