Tag: ALS

The Financial Cost of ALS

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by Rachel Doboga

My mother taught me it’s not polite to talk about money, politics, and religion outside close friends and the nuclear family, but as it’s ALS Awareness Month I want to make clear the monetary cost of the monster inside me.

ALS is often called “the bankruptcy disease,” and with good reason. The finances behind maintaining a decent quality of life are devastating at $250,000 a year. I have survived 8 years next month. Do the math. That’s $2 million.

This is where Medicaid and Medicare step in. I also believe I could not have lived this long without three very lucky factors.

First, I bought into private long-term disability insurance at age 24. This was through my first teaching job right out of grad school. One of my colleagues thought I was wasting my money and let me know. “You could go to the movies with that money!” However, my parents drilled into me “Better safe than sorry!” so my husband Evan and I let Hollywood pass us by.

Second, when we moved so I could be treated at a world-class clinic, we just happened to move into a state with amazing programs for people with disabilities. For example, a housing program gives interest-free loans up to $50k for down payments for first-time disabled home buyers with 10 years to pay it off.

Third, much to my shame, we rely heavily on the generosity of our families. We could never thank them enough for their support. This is hard for me to accept because I have always prided myself on being independent. I got my first job at 15 as soon as it was legal to work and before that I was a companion to a girl with autism.

For my first job, I worked at a cinema cafe, but I couldn’t get anything right. They tried me as a waitress, but I kept dropping things. Then they put me in the kitchen, but I kept messing up all the recipes except the fancy salads.

However, I was committed to working and, oddly enough, my boss was committed to keeping me. I was so friendly and sweet that he didn’t want to fire me so he made up a position for me. I was hostess, and my job was to vacuum the lobby and clean the toilets. My grandma was horrified but my parents were proud of me because I stuck with it to earn money to travel one day. At $7 / hour, I watched my savings account and independence grow. I eventually used the money to go to Russia where I met the love of my life. Relying so heavily on others makes me feel awful and ashamed.

Rejoice, for Yesterday a Miracle Happened!

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Photo by Pixabay on Pexels.com

When I read the news, I immediately started sobbing. We were about to start trach care and Evan was holding all the materials, but as soon as he saw the first tear fall, he put it all down.

“What happened? What’s going on, honey?”

I could hear the mounting panic in his voice, but I was crying too hard to type my answer – that these were tears of joy because the FDA had made the right decision and approved Tofersen, a miracle drug for people with SOD1 ALS and familial ALS. Thank God, Goddess, and Jesus Christ I don’t have either of those. I’m very, very lucky. Still I am overjoyed! I know one family who lost 33 people to ALS. They cut through generations and you’re almost guaranteed to get it.

Evan wiped my tears so I could type. “I’m so happy! Tofersen just got accelerated approval from the FDA. It’s almost like a cure for familial ALS! Everyone has been been campaigning so hard for this on Twitter. It’s a dream come true!”

I feel bad for not including him in my passion over the past few weeks, but we have been consumed by our efforts to put together a fundraiser for our dog Pickle who desperately needs veterinary care.

I go on and on. “One man was on life support and now he’s ice skating with his daughter! And another woman’s ALS clinic score hasn’t changed in 2.5 years! Mine went down every 3 months until they stopped measuring. She cooks, does laundry, does everything she shouldn’t be able to do!”

Evan raises his eyebrows, speechless.

“The FDA approving Tofersen is a huge deal for the whole ALS community because it’s the FDA recognizing a biomarker for ALS. Who knows where that could lead?! This is the 3rd ALS treatment to be approved in 6 years. Things are really ramping up! I’m not eligible for any of them because I have sporadic ALS and I’m on a ventilator, but I’m still absolutely thrilled for the rest of my community!

“I’m proud of you, honey. You contributed to this.”

“Barely. Just a few tweets and reading a lot.”

“That’s still something. I love you.”

I’m suddenly very tired. All the crying and the roller-coaster of emotion wore me out. I have a feeling this is just the first wave of joy and tears today. Evan closes the curtains and peaceful sleep takes over my Tofersen dream come true.

The Power of the Bucket List

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The approval of Radicava, the first medicine for ALS in 22 years, had me reconsidering my post that labels my belief that I will survive this disease “wild.” Then, the vessel of  my most precious dream was wrecked on jagged rocks I never saw coming.

The federal budget for 2018 calls for the complete defunding of the National ALS Registry, and the shock of learning that my own government would so callously undercut one of the most important parts of the search for a cure left me – and I imagine many others – frightened and enraged. The budget also cut funding to Medicaid and SSDI (social security disability insurance), a fact that barely sunk in. I just didn’t know how to process the realization that the registry was in danger, and Medicaid was as well. Medicaid covers machines, medication, feeding tube supplies, caregiver fees, and so much more that we could never be able to afford on our own. On top of that, if we lost the $600 per month we receive through SSDI, how would we afford the expenses Medicaid doesn’t cover, like my daily injections of B12?

I chose to focus on saving the National ALS Registry155 a campaign I am continuing to expand. Narrowing my focus and taking action gave me a chance to salvage some of my former optimism.

Then came the second hit: a health care bill drafted in the dark that slashed Medicaid so deeply that 14 million of the most expensive beneficiaries – including the ALS community – would lose coverage and very likely their lives. My joy over Radicava seemed distant, even foolish. What good is this new treatment if we can’t afford it because our insurance has been gutted or taken away? Obstacles were coming from all sides. Rising tides of depression and fear threatened to drown me. They still do.

I had to find a path back to joy and hope in the midst of the battles I had been forced to join. Enter my inspiring friend Glynis, who made a bucket list with her husband Vince after he was diagnosed with ALS. The list helped them focus on enjoying the present, no matter how hard it got, and gave them things to look forward to. I decided to follow her example, and I came up with a list that includes both things I can accomplish despite my disease and other dreams I look forward to achieving after I am cured. Now, I have something new to think about as I try to fall asleep and worry creeps in. Have a peek at the list. What would you add to your own?

  • Give people a reason to remember my name
  • Start a new tradition
  • Go to a palm reader
  • See the Northern Lights
  • Celebrate my 50th wedding anniversary

Demon in My View

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Photo by Bob Clark on Pexels.com

“I have not been

as others were –

I have not seen

as others saw…

When the rest of Heaven was blue

of a demon in my view.”

Edgar Allan Poe, “Alone”

I’m so sick of ALS. It is hitting me once again that this is my life, and even when I’m tired or sad, I won’t get a break. ALS will not stop until it kills me or a cure is found. The clock is ticking, and my murderer is stepping on my shadow.

Cathedrals: On Losing My Voice

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“In my mind I am eloquent; I can climb intricate scaffolds of words to reach the highest cathedral ceilings and paint my thoughts. But when I open my mouth, everything collapses.”

― Isaac Marion, Warm Bodies

A Brave New World

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On June 10, 2015, I shared this message with my loved ones…

“Dear family and friends: I am so sorry to have to tell to you that today I was diagnosed with ALS. I am sad and scared, but also hopeful that I will live longer than the average ALS patient because mine is a disease mostly of the upper rather than lower motor neurons. This may mean my lungs will stay functional longer than the average 5 years. No matter how many years I have left, though, I know they will be beautiful because I am so well-loved by my husband Evan and all of you. Please keep me in your wishes, prayers, loving thoughts and light, and know that I am grateful to know you.”

Then my husband and I were swept away into the dizzying rapids of ALS care…

Every three months, I will be attending a multidisciplinary ALS clinic so the progress of my disease can be assessed and I can learn new skills to keep me living comfortably. After a six hour first clinic visit in which I met with my doctor, social worker, occupational therapist, and physical therapist, I am happy to say my breathing and muscle tone are strong and my speech is in a range indicative of slower decline. At my next clinic in September, all of this will be assessed again. We are hoping for a very small amount of change, as this would mean I have slow (rather than average) progression.

“I’m fine,” I insisted, trying to be pleasant even though I was beyond overwhelmed.

Deb shook her head. “Don’t settle. If you are having trouble buttoning jeans or using a fork, tell me. We will figure it out and keep you independent as long as possible.”

Deb, my Occupational Therapist, was the 6th specialist I saw at Clinic the day everything changed. I was exhausted by endless assessments and frightened as I tried to make sense of all the information coming my way. Deb is not one for excuses, though, and I needed her pushing as badly as I needed the follow-up appointments with her where we plowed through a list of tasks that frustrated me and devised alternate ways to complete them. Deb changed my whole perspective on Clinic.

It is, as my neurologist Dr. Goslin says, a place to rewrite the story, even if we can’t change the ending.

We still check my progression, but this disease and the treatment for it no longer simply happen to me.  What I want matters. My goals matter. Deb taught me never to miss a chance to address my concerns and needs so that I can live as well and as long as possible. These hours in clinic, these people who support and hear me, keep me doing what I love. I believe that they may even save my life, keeping me strong until a medication comes out to stop this nightmare.

I have hope, and it is stronger than fear.

My blog’s name is in tribute to Meg Rosoff’s novel, How I Live Now, the ultimate tale of resilience and determination. Just as the main character Daisy learns the true nature of loss (“If you haven’t been in a war and are wondering how long it takes to get used to losing everything you think you need or love, I can tell you the answer is no time at all”), but never gives up, claiming, “Fighting back is what I’ve discovered I do best.”

I plan to use this blog to chronicle my own battle and connect with other ALS warriors. Click How to Help to find ways to join the fight to defeat ALS and care for pALS.

Endless gratitude and love to my husband Evan, who held me when I was diagnosed with a terminal illness, rocked me when I cried myself to sleep for months after, and holds my hand at every single clinic. You are the reason I fight.