Throwing in the towel with Rebif

[doublevision1]

My Rebif saga has come to a conclusion.  After staying off of it for five weeks and seeing a reduction in my liver enzymes, I took just one 22mcg shot again last week and already my liver is not tolerating it.  The MS clinic called this morning to say no more shots (darn, I took one last night) and so I am done with Rebif for good.  

I guess I was overly optimistic when I started my shots last week as I picked up another $1500 worth of syringes at the pharmacy.  Thankfully these were paid for by the provincial government and not out of my pocket.  Oh well, at least I got the Airmiles.

So it's on to Copaxone I go.  I sure hope I do better on it.  I never was on Rebif long enough for it to do any immune-modulating good.  I hope I don't have the terrible reactions that Ess and a few others here have.  Wish me luck!

BTW, still not a word more about Novantrone, which, according to my neuro was supposed to be my Plan B if Rebif didn't work out.  His words, at my last appt with him in April.  What is up with that??  Regardless, for whatever reason for the flip-flop, I am glad to be trying something less aggressive at this point.  It really is my only first line option, since as you know the other options are both interferons like Rebif.

It will be interesting to hear what the folks at Brigham have to say.  July 29 cannot come soon enough!



db

[doublevision1]

I found your comment above to be most reassuring, re: what one can generally expect from a clinical fellow in terms of knowledge level, so thanks for that.  

As far as bedside manner/attitude goes, yep, it's pretty much the luck of the draw.

So far, of the 4 neuros and 2 neurology residents I've seen in the past two years, I experienced a bad attitude (mainly, just abrupt and impatient) from just one of them, which was from one of the residents.  He saw me on two different occasions, under the supervision of the on-call neuro first, and later, under my current MS specialist.  My diagnostic process seemed to be aligned with his neurology rotation.  Lucky me!  I liked that he observed both of the experienced neuros dealing with me respectfully and compassionately.  Hopefully some of this will rub off on this brash young doctor.  I must admit though, he does do a mean LP.

However I digress.  I'm keeping an optimistic attitude towards my visit to Brigham.  I believe that there is always something to be learned from each step one takes on the search for answers.


db

[Quixotic1]

Generally yes, the Fellows answer to an Attending.  In my case, I presented every patient immediately to the attending and then sometimes the attending would see the patient with me afterward and sometimes just direct me as to what to do.  A second year Fellow should have an awesome amount of knowledge.  So, that should be good.  However, the full-professors tend to set the attitude for the up-and-coming docs.  I think this is how the dismissive attitude gets perpetuated.

The fellows have fewer patients to care for and often have more time to spend with you.  So you get lots of up-to-date raw knowledge and time versus more experience.  What you might lose is the years of seeing a disease's variations.  Fellows do often tend to be more rigid in their thinking.

The bedside manner is partly born in.  Some people are just more empathetic than others.

Quix

[doublevision1]

Plan B was supposed to Novantrone followed by Copaxone.  I guess now it is Copaxone, and then Plan C is Novantrone if need be (to be followed by Copaxone again, perhaps?).

I just got the name of the neuro I will see in Boston and he is a clinical fellow.  He completed his residency just two years ago.  Darn, I was really hoping to get someone with more experience.  I know that they are squeezing me in at a busy time.  This MD appears to be about five years behind my neuro (who I do think is very good despite my desire for second opinion) in experience.  

On the other hand the on-call resident who saw me in hospital last year was fantastic and knowledgeable in MS, so maybe the fact the this MD in Boston is less experienced does not necessarily mean this won't be a worthwhile appt.  I can't find much info on him on the internet, I suppose because he is so new at it.

Does a clinical fellow in the U.S. work under the close supervision of a full-fledged neuro?  ie: would a neuro have to review their findings or supervise their examination of me??


db

[Quixotic1]

Hmmm...don't I remember that Plan B was Novantrone followed by Rebif?  Now that the Interferons are off the table, Plan B may need to be rethought.  

Quix