time to revisit treatment goals
with a doctor or nurse—and
remember why you’re taking the
medication. “I like to remind
people that there’s a purpose to
the plan,” she says.
If a person with MS finds
taking his or her medicine truly
challenging, it’s time for a frank
discussion with a healthcare
provider about treatment
options. “When someone gets
to that place,” says Kennedy, “it
isn’t going to be long until they
say, ‘That’s it, I’ve had it.’ ”
Carrie Sammarco, DNP,
FNP-C, MSCN, a nurse
practitioner and co-author of
a forthcoming handbook for
nurse practitioners working
with people with MS, agrees.
“It’s wonderful to be able to
prescribe someone a drug
that may more effectively
manage their MS, but if
there’s something about it
that prevents a patient from
taking it, it won’t be the best
therapy for that individual.”
Each treatment for MS comes
with its own risks and benefits,
but with five injectable DMTs,
two infused therapies and
two oral medications recently
approved by the Food and Drug
Administration (FDA), people
with MS now have more
choices than they did even
five years ago.
Starting with honesty
Dr. Sammarco often begins her
consultations by asking people
how many times they’ve skipped
an injection over a given period.
“I give them permission to
be honest,” she says, because
honesty is instrumental
to developing a workable
treatment plan.
Hilary Gladstein Basis, 32,
a television producer in Los
Angeles, had no problem with
her Avonex injection for the first
three years. “My nurse told me to
just pick a spot, count to 3, and
jab the needle in. And I was fine
with it, at first,” she says. Then
Creative approaches
help people with MS
overcome injection
fatigue.
suddenly, she wasn’t. “I’d think,
‘Oh goodness, I’m jamming a
needle in my leg!’ And I’d end up
with 10 little pricks because I just
couldn’t get it in.”
Basis ended up stopping
Avonex for several months
without telling anyone—a
potentially dangerous move. “I
just kept telling myself, ‘Next
week I’ll be fine.’ I didn’t want
to admit that I didn’t want to do
it anymore.” When Basis finally
called her doctor, he sent a nurse
to teach her a new way of doing
injections. “She told me to pinch
my leg, so that my pain receptor
was feeling the pinch, and to do
the injection as slowly as I need
to. I’ve been doing it that way for
four years now with no problem.”
Pluses and minuses
DMTs taken subcutaneously,
or under the skin, must be
taken frequently since the
medication disperses throughout
the body quickly. But they can
cause soreness at the site of the
injection and break down fatty
tissue, resulting in dimpling and
pain. Therefore, it’s necessary
to rotate injection sites in
order to avoid hardening and
oversensitivity.
Lenny Moschitto, 56, the
owner of a New York City–
based women’s accessories
manufacturing company, has
used Betaseron every other day
for the past 11 years and has
reached his limit on certain areas
of his body. “My stomach has
gotten to the point where it can
be painful to do an injection,” he
says. “I won’t go near the right
side of my abdomen because it
has become lumpy and hard.”
Still, Moschitto notes, he has
not experienced an exacerbation
and his MRIs have not shown
a new lesion since he began
the injections. “It seems to be
working, which keeps me going
with it.”
For Avonex, which is injected
directly into the muscle, site
reactions are less of a problem
than psychological and physical
responses to the longer needle.
The injections are needed less
frequently, since the muscle
dispenses the medication slowly.
But, says Kennedy, “my patients
have said to me that they look at
that needle and feel as if they’re
