I’m not going to recap the 30+ hours of presentations from this year’s Conference. We will soon post many of the presentations and Sharon will blog about various presentations and projects over the next weeks and months. I wanted to tell you a bit about what took place this year and look forward, to share some thoughts about next year… Already you ask? We spend a lot of time thinking about the Conference, trying to improve it each year, trying to make sure we provide comprehensive information to all stakeholders and working on all fronts in order to accelerate treatments that will stop the progression of the disease for all boys everywhere, that will end Duchenne. We have not yet decided on the specifics as in date/location, but we have had some conversations about the nuts and bolts.
Pat Moeschen’s keynote was amazing. Everyone attending the meeting jammed into the room and for the first time ever, no cell phone rang, no one was texting. We were all listening to Pat. I would like to say, Pat is the voice of reason, but he is more than that. Pat is the voice of joy, of laughter, of living a life. Both the expert and sibling panel were amazing as well, with full audience participation. It confirmed my belief that the voice of this community needs to be heard. Parents, Patients, Siblings. And that when this voice is raised, people listen. We will continue to raise these voices next year and the year after that and the year after that.
Breakout sessions. Caring for an individual with Duchenne is difficult and often requires decisions that we (as parents) never imagined we would be faced with. Spending time in small sessions, expressing concern, asking questions, learning from experts, assure all of us we are doing our best and more than that, we motivate researchers and clinicians to think out of the box, to understand this critical need. Amanda Becker said it exactly right in the breakout session on Ataluren. One father mentioned his son’s ejection fraction dropped 20% after discontinuing Ataluren. While there is no data to confirm a direct relationship, stopping Ataluren was the only change to his son’s regimen. As each person expressed their own experience with Ataluren and interest in participating in an access program, Amanda said that in her view any change, any loss of function and surely a change in the ejection fraction constitutes an emergency. PTC’s medical officer had never thought of Duchenne in that way. Duchenne is an emergency.
Duchenne Therapeutics Development Meeting (aka –scientific track). The room was packed and the talks intense, hopeful, promising. Some parents came away shaking their head and suggesting they were able to understand about 20% of what was said, but very thankful to have the opportunity to attend. Researchers/Clinicians agreed the meeting was successful, that a Duchenne Therapeutics meeting is important, but said they felt like they missed important sessions with parents. Parents had to choose and often felt torn, feeling the need to stay informed, but missing out on critical discussions relevant to their son’s life today. Next year’s plan will definitely include the Duchenne Therapeutics Development Meeting. We are exploring ideas about how to juggle things around a bit, which probably means adding more time to the meeting. Stay tuned.
Conference sessions felt nearly perfect – okay, I am biased. The early breakfast with Industry was informative, on both sides, as companies shared their experiences and addressed concerns. The plenary session included a broad range of topics, at first general (biomarkers, drug development, clinical trial development, multi-system trials, outcome measures) to very specific strategies such as exon skipping, utrophin, Lam iii, stem cells and viral gene therapy, and various cellular pathways involved in muscle degeneration.
The Levin family threw a lovely barbecue on Friday and by the Saturday gala, I think we were all a little foggy. The NJ staff had (nearly) killed themselves planning, preparing, and executing the Conference. Our brains were full of research, clinical care, friendships made and renewed…and HOPE. We awarded this year’s fellowship to Nick Dobes, who described his relationship with his friend Brian and one more time, we were reminded that our sons’ lives have a ripple effect throughout the community and the world and that all of us play a major role in advancing treatments. It was always obvious to me, but even more apparent when we are together, when we speak in ONE VOICE, we know we will change the world.
Looking forward to next year…
Wednesday, July 7, 2010
Wednesday, June 16, 2010
Sunday nights.
Happens every time. Mom gets on the phone. Some light goes on and your children have a question or problem that needs immediate attention. "Let me call you back."
Same with acute illness. It’s Sunday evening and you wrap up the weekend. And suddenly, your little one complains. Sometimes it is a stomach ache, easily explained by a weekend of activity and a little too much of something. Other times, it is more serious, something you cannot put your finger on, but you have the sense that this is more than you can handle.
On Sunday evening, Jen - a PPMD mom and a friend - called me. Danny was complaining of chest pain. He just celebrated his 8th birthday and in our head, should be too young to connect this with cardiac anything. But then, he has Duchenne and we have learned anything is possible. We have learned that we need to know a lot more than we do about Duchenne hearts. We have learned not to ignore the complaints of our son. While we were on the phone, I could hear Danny cry, but the cry had a little squeak to it and I felt a certain panic creeping in. It was the sound that occurs when people (adults and little ones) make when they are short of breath. We talked about the last few months, rapid progression, weight gain, going off GH and then resuming. We talked about diet, activities, fatigue, increased weakness. Jen mentioned an irregular heartbeat. If I was there, I would wish for a stethoscope or put my ear on his heart in an attempt to diagnose the rhythm. Jen and Dan left for the hospital with Danny.
In the meantime, I called our experts, Linda Cripe, Larry Markham, and Brenda Wong. Linda called immediately. Larry emailed me a bit later. We discussed the events leading up to the chest pain, discussed the last few months. And while this was later considered a ‘cardiac event’ - it was not a heart attack and not congestive heart failure - what did it mean?
The truth of the matter is that we just don’t know. Danny’s troponin levels were elevated. Troponin tests are ordered for people with chest pain, to see if they have had a heart attack or other damage to their heart. Troponin tests are used to detect and evaluate mild to severe heart injury. Normally, cardiac troponin levels are so low that they cannot be measured and in instances where there has been a heart attack, sometimes remain high for 1-2 weeks after. The test is not affected by damage to other muscles. Danny’s troponin levels increased. CK-MB also increased. CK-MB is a more sensitive marker for myocardial injury that total CK activity because it has a lower basal level and a much narrower normal range. CK-MB levels become elevated in 4-6 hours after a heart attack and peak at 10-24 hours. CK-MB measures small, but significant changes during the early hours following onset of chest pain. But here’s what we do not know. We did not have baseline tests. Trophonin and CK-MB are not done with the typical evaluation, so there is no baseline. We don’t know where Danny’s levels started, we simply know they increased. His echocardiogram was unchanged from previous.
What we can say is that Danny had a cardiac event. There was no damage to the heart. Echo was unchanged. And levels decreased.
Here’s the take-away message.
Same with acute illness. It’s Sunday evening and you wrap up the weekend. And suddenly, your little one complains. Sometimes it is a stomach ache, easily explained by a weekend of activity and a little too much of something. Other times, it is more serious, something you cannot put your finger on, but you have the sense that this is more than you can handle.
On Sunday evening, Jen - a PPMD mom and a friend - called me. Danny was complaining of chest pain. He just celebrated his 8th birthday and in our head, should be too young to connect this with cardiac anything. But then, he has Duchenne and we have learned anything is possible. We have learned that we need to know a lot more than we do about Duchenne hearts. We have learned not to ignore the complaints of our son. While we were on the phone, I could hear Danny cry, but the cry had a little squeak to it and I felt a certain panic creeping in. It was the sound that occurs when people (adults and little ones) make when they are short of breath. We talked about the last few months, rapid progression, weight gain, going off GH and then resuming. We talked about diet, activities, fatigue, increased weakness. Jen mentioned an irregular heartbeat. If I was there, I would wish for a stethoscope or put my ear on his heart in an attempt to diagnose the rhythm. Jen and Dan left for the hospital with Danny.
In the meantime, I called our experts, Linda Cripe, Larry Markham, and Brenda Wong. Linda called immediately. Larry emailed me a bit later. We discussed the events leading up to the chest pain, discussed the last few months. And while this was later considered a ‘cardiac event’ - it was not a heart attack and not congestive heart failure - what did it mean?
The truth of the matter is that we just don’t know. Danny’s troponin levels were elevated. Troponin tests are ordered for people with chest pain, to see if they have had a heart attack or other damage to their heart. Troponin tests are used to detect and evaluate mild to severe heart injury. Normally, cardiac troponin levels are so low that they cannot be measured and in instances where there has been a heart attack, sometimes remain high for 1-2 weeks after. The test is not affected by damage to other muscles. Danny’s troponin levels increased. CK-MB also increased. CK-MB is a more sensitive marker for myocardial injury that total CK activity because it has a lower basal level and a much narrower normal range. CK-MB levels become elevated in 4-6 hours after a heart attack and peak at 10-24 hours. CK-MB measures small, but significant changes during the early hours following onset of chest pain. But here’s what we do not know. We did not have baseline tests. Trophonin and CK-MB are not done with the typical evaluation, so there is no baseline. We don’t know where Danny’s levels started, we simply know they increased. His echocardiogram was unchanged from previous.
What we can say is that Danny had a cardiac event. There was no damage to the heart. Echo was unchanged. And levels decreased.
Here’s the take-away message.
- Kids (all of them) get sick when we feel least prepared or connected.
- No matter where you take your son for care, take home information about the hospital’s emergency system. All hospitals have contact information on the doctors – home phone, mobile phone. Cincinnati Children’s is developing a card with exactly this information – it will be given to every patient/family.
- If you take your son to the ER, ICU, CCU, hospital (anywhere), insist that the doctor connect with his Duchenne doctors. I realize that this request may not sit well with the ER doctor …. Excuses “I treat kids all the time, this is a busy ER, I have heard about Duchenne, I know about steroids,” but this just does not cut it because we know Duchenne is very complex, that there are few experts in the world and likely none at the ER near your home, and that there is significant clinical variability (each child is different). And the heart is a muscle too.
- Cardiac workshop. We held a cardiac workshop several years ago to discuss what we know, what we need to know, and what we might do now. We are interested in proactive care, hopefully to prevent, slow, or stop dilated cardiomyopathy.
- Advocacy. We are working on a pilot telemedicine project – hub and spoke – to connect experts to families /doctors. As clinical trials open in the US and elsewhere, close connections need to be in place for those very late nights.
Tuesday, June 15, 2010
Reversing the question – parents helping children; children helping parents. Is there a middle?
I just returned from a meeting in Europe and one of the best things about these meetings is hearing stories of families, listening to experiences, and learning about those special times when a child’s insight makes us stop in our tracks. It is not about criticism or what is wrong, right, or in between. It is just about those times when we find our hearts’ making a recording that we will remember all the days of our life.
One mom talked about all the things she was doing for her son. She described a pretty time consuming schedule that included supplements, stretching exercises, aqua therapy, as well as a very strict diet. It was pretty amazing really and I had the sense that she had achieved the perfect “10” as a mom, someone we would all look up to and wonder just how she fits everything into a 24-hour period or if she found some magic to stretch the few hours in a day. All of a sudden in the middle of her story, she had tears in her eyes as she talked about one particular evening when her son was grumpy as she started the stretching exercises. He had had a full day. As she started his stretches, he started crying. She asked if the stretch was painful. He said ‘no.’ Like all of us, she probed, asking if something went wrong at school, if his stomach was upset, if he was in pain, looking for something, anything to understand the tears. We have a natural tendency to try to ‘fix’ everything. He simply said he did not want to do the stretching tonight. With that, her fear increased and she tried to sooth him, tell him how important this was for his muscles, how much she was doing to help him. And in that very simple way that children have, he said, “You are not doing this for me, I am doing this for you.” She felt her heart breaking.
I also spoke with a father whose son is now in college. He discussed his son’s detailed agenda to include a variety of interventions squeezed in between college classes and studies. I asked about friends, about movies, about music, about laughter. This father said all that would come later. I wondered when ‘later’ was planned. This father was so worried that if something interrupted their rigid schedule, his son would lose function. He felt this regimen was essential to maintain the life his son had, the things his son was able to do at this very moment. One glitch, one change, and it would fall apart.
I remember hanging on for dear life, thinking that if I changed one thing, if I took time to breathe, time off, time to enjoy something or some activity from my previous life, things would fall apart. It felt like my life was hanging on a thread. I remember hanging everything on the future. I started sentences with ‘when this happens,’ thinking that a certain clinical trial would yield amazing results and then we would catch up on whatever it was that we missed.
Every once in a while, I think it is good to take a step back and remember, the life we are living is not a dress rehearsal, it is the real deal. There are no ‘do overs’ and no way to recover time lost. So, while we are all aggressively pursuing what we think is the best route for our sons and daughters, it is important to listen to their voice, to ensure the discipline of care includes their perspective and their opinions.
And as you make up the schedule, please include 30 minutes of laughter. It should be considered a therapeutic intervention!
One mom talked about all the things she was doing for her son. She described a pretty time consuming schedule that included supplements, stretching exercises, aqua therapy, as well as a very strict diet. It was pretty amazing really and I had the sense that she had achieved the perfect “10” as a mom, someone we would all look up to and wonder just how she fits everything into a 24-hour period or if she found some magic to stretch the few hours in a day. All of a sudden in the middle of her story, she had tears in her eyes as she talked about one particular evening when her son was grumpy as she started the stretching exercises. He had had a full day. As she started his stretches, he started crying. She asked if the stretch was painful. He said ‘no.’ Like all of us, she probed, asking if something went wrong at school, if his stomach was upset, if he was in pain, looking for something, anything to understand the tears. We have a natural tendency to try to ‘fix’ everything. He simply said he did not want to do the stretching tonight. With that, her fear increased and she tried to sooth him, tell him how important this was for his muscles, how much she was doing to help him. And in that very simple way that children have, he said, “You are not doing this for me, I am doing this for you.” She felt her heart breaking.
I also spoke with a father whose son is now in college. He discussed his son’s detailed agenda to include a variety of interventions squeezed in between college classes and studies. I asked about friends, about movies, about music, about laughter. This father said all that would come later. I wondered when ‘later’ was planned. This father was so worried that if something interrupted their rigid schedule, his son would lose function. He felt this regimen was essential to maintain the life his son had, the things his son was able to do at this very moment. One glitch, one change, and it would fall apart.
I remember hanging on for dear life, thinking that if I changed one thing, if I took time to breathe, time off, time to enjoy something or some activity from my previous life, things would fall apart. It felt like my life was hanging on a thread. I remember hanging everything on the future. I started sentences with ‘when this happens,’ thinking that a certain clinical trial would yield amazing results and then we would catch up on whatever it was that we missed.
Every once in a while, I think it is good to take a step back and remember, the life we are living is not a dress rehearsal, it is the real deal. There are no ‘do overs’ and no way to recover time lost. So, while we are all aggressively pursuing what we think is the best route for our sons and daughters, it is important to listen to their voice, to ensure the discipline of care includes their perspective and their opinions.
And as you make up the schedule, please include 30 minutes of laughter. It should be considered a therapeutic intervention!
Thursday, June 10, 2010
Washington Week in Review
Did I miss Spring? I spent the last week of May in Washington, DC. I had meetings on Monday and Tuesday centered around regulatory issues (FDA and OOPD), compounds, small clinical trials, webinars, and workshops in the planning stages and tossing around some ideas about how to design new models for trials, or how we might encourage companies to think a bit outside the box. Discussions like this are like taking a breath of fresh air into your lungs. I find them invigorating, hopeful, and promising, incredibly thankful to see the results of our early investments in research now move from the bench to the bedside . On the other side, I realize nothing will ever move fast enough for our boys.
By midweek, the conversation changed slightly to include the range of interest, opportunities, and programs focused around Rare Diseases (R.A.R.E, Every Life Foundation, Rare Disease Caucus, GrandRx, Cure the Process, etc), how the Rare Disease Community is focused on developing tools to streamline the drug development process for rare disease and the worldwide focus on RARE.
At the end of the week, I participated in my last face-to-face meeting with the Institute of Medicine Committee. I have been serving on this committee for the last year. While some of the committee members knew each other in a past life, the charge of this committee was new and quite daunting. We were charged with writing a comprehensive paper on Accelerating Rare Disease Research and Product Development in Rare Diseases and writing recommendations that are expected to result in legislation. This experience has been intimidating, amazing, and wonderful all at the same time. The committee is comprised of individuals representing a broad range of expertise –academia (clinical trial experts, epidemiology, rare disease), researchers, venture capital, drug/device executives, attorneys, and foundations. This last meeting was bittersweet. We came to the end of our investigation, reporting progress to date and making recommendations for changes that we hope will positively impact the trajectory of treatments and cures. For me, it was a incredible learning experience, to systematically go through what we now know about rare disease, what we need to know, what tools need to be developed, what processes need to be streamlined, and where resources would be useful. What was even more moving was to understand that each member of the committee had been impacted by a rare disease, that each member understood how rare disease isolates, how rare disease impacts individuals, and how we, as a country might work together to break barriers that get in the way.
Friday, May 28, 2010
Ataluren Update
As many of you know, because you participated, PTC held an open conference call yesterday to update the community about ataluren and future plans. The discussion included analysis of data from the ataluren trial and a summary of regulatory challenges. Langdon Miller (Chief Medical Officer for the trial) described PTC’s plan for regulatory interactions relating to ataluren and the effects of these interactions on potential patient access to ataluren.
And when the call was over, like many of you, I walked away from the call still frustrated, still hurting for our boys.
I understand the urgency to complete the sub-analysis and to prepare the package to establish the path forward. Like you, I worried we would again be waiting until the presentation in Naples and another call.
Time. And like you, I have watched my own two sons lose strength and felt my heart break over and over again for them and for all of you.
I reviewed this conversation in my head throughout the night and today. I wanted to have something concrete to hold onto and step-by-step I went through the call. And I made some calls.
Here is what I understand:
By the Naples meeting PTC will have completed the analysis and prepared the package for the regulatory path ahead. Keep in mind, while on the call, PTC talked about an access program and mentioned Individual IND’s. I think the risk/benefit of the individual IND is worth pursuing as each day these boys lose function. You already know, I think in increments of 5 minutes: treasuring every one of those moments and hoping to buy more. I know all of you feel the same.
This morning I spoke with PTC and asked that question in order to get some details and clarification. PTC confirmed that they are planning for individual IND’s. Planning is being done in parallel to data analysis and preparing the regulatory package. PTC is interested in understanding who/how many of the families are interested in securing an individual IND. Please contact your site coordinator and ask if they would be willing to participate in an individual IND.
I know what you are thinking, that you may have another willing physician. At the moment, PTC wants to understand:
From the FDA SITE: The sponsor is the person who takes responsibility for and initiates a clinical investigation. The sponsor may be a pharmaceutical company, a private or academic organization, or an individual. A Sponsor-Investigator is an individual who both initiates and conducts a clinical investigation and under whose immediate direction the investigational drug is being administered or dispensed. For administrative reasons, only one individual should be designated as sponsor.
I feel – PPMD feels – that it is our job to tell your stories to PTC and any other company working in Duchenne. And we will.
I have said it before – I continue to believe in the work of PTC. I believe they are committed to helping our sons and I truly credit them with being trailblazers in Duchenne treatment. I also commend them for their communication with us. Most pharmaceutical companies would remain silent in a situation like this and while we may be frustrated by the information we receive or the amount of information we have received, at least we are not listening to silence.
But we won’t sit still and we won’t sit quietly.
And when the call was over, like many of you, I walked away from the call still frustrated, still hurting for our boys.
I understand the urgency to complete the sub-analysis and to prepare the package to establish the path forward. Like you, I worried we would again be waiting until the presentation in Naples and another call.
Time. And like you, I have watched my own two sons lose strength and felt my heart break over and over again for them and for all of you.
I reviewed this conversation in my head throughout the night and today. I wanted to have something concrete to hold onto and step-by-step I went through the call. And I made some calls.
Here is what I understand:
By the Naples meeting PTC will have completed the analysis and prepared the package for the regulatory path ahead. Keep in mind, while on the call, PTC talked about an access program and mentioned Individual IND’s. I think the risk/benefit of the individual IND is worth pursuing as each day these boys lose function. You already know, I think in increments of 5 minutes: treasuring every one of those moments and hoping to buy more. I know all of you feel the same.
This morning I spoke with PTC and asked that question in order to get some details and clarification. PTC confirmed that they are planning for individual IND’s. Planning is being done in parallel to data analysis and preparing the regulatory package. PTC is interested in understanding who/how many of the families are interested in securing an individual IND. Please contact your site coordinator and ask if they would be willing to participate in an individual IND.
I know what you are thinking, that you may have another willing physician. At the moment, PTC wants to understand:
- Who is interested in an individual IND, and
- If the physician from your clinical site would be willing to act as the sponsor.
From the FDA SITE: The sponsor is the person who takes responsibility for and initiates a clinical investigation. The sponsor may be a pharmaceutical company, a private or academic organization, or an individual. A Sponsor-Investigator is an individual who both initiates and conducts a clinical investigation and under whose immediate direction the investigational drug is being administered or dispensed. For administrative reasons, only one individual should be designated as sponsor.
I feel – PPMD feels – that it is our job to tell your stories to PTC and any other company working in Duchenne. And we will.
I have said it before – I continue to believe in the work of PTC. I believe they are committed to helping our sons and I truly credit them with being trailblazers in Duchenne treatment. I also commend them for their communication with us. Most pharmaceutical companies would remain silent in a situation like this and while we may be frustrated by the information we receive or the amount of information we have received, at least we are not listening to silence.
But we won’t sit still and we won’t sit quietly.
Monday, April 19, 2010
Week in Review: 4/11-4/15
I spent the better part of the week in Washington, DC with a full agenda. On Monday, I met with Peter Saltonstall (president of NORD). One of NORD’s major interests is the FDA. You are probably familiar with our advocacy agenda, this year concentrating on several areas relevant to clinical trials – one very specifically directed toward FDA. One of our requests focused on securing additional resources for the FDA, specifically more expertise and experience on rare disease (Duchenne), communication, and collaboration with the orphan products division and efforts to harmonize interaction between EMEA (European regulatory agencies) and FDA. NORD is focused on the same issues and when voices join together with specific messages, things happen. Anne Pariser, MD is now the Associate Director of Rare Disease, a new position with FDA.
On Monday evening, I served on a NORD panel to discuss barriers facing therapies for rare diseases. I spent some time discussing barriers such as risk benefit (such as asking for definitions of risk when the condition is fatal) and discussing TIME (how minutes matter when, in progressive conditions, each minute represents cell degeneration and death). Time. Loss of function. Lost time with someone you love. And steady state. How many times have we all prayed, that Duchenne stops now. Today. Steady state, no further degeneration.
On Tuesday I met with Anne Pariser. Anne has worked for the FDA for over 10 years, working in the area of inborn errors of metabolism. She is wonderful and anxious to accelerate therapies for rare disease. We discussed exon skipping and meetings planned for Fall. And I took a left turn in the conversation. You may already be aware, NIH (NINDS/John Porter/Berch Griggs/Katie Bushby-Treat NMD) have been awarded a
grant for a multi-site steroid trial. The trial will have several arms, evaluating an intermittent regimen with daily
Deflazacort and daily Prednisone. Makes no sense to me unless, at the end of the day, should the data suggest Deflazacort has less side effects (weight gain/behavior) it would be available (and covered by insurance) for families in the US. Anne said she had no knowledge of the trial. Now she does. And John Porter is connected to Dr. Pariser. And those planning the trial are connected to Dr. Pariser and to Elizabeth McNeil (orphan products). One of the goals of this study will be to (FINALLY) have Deflazacort available and approved in the US and hopefully elsewhere. Families deserve choices…and trials must consider access to whatever they are testing. Families already have significant financial burden in Duchenne. ALL therapies must be available and ALL boys must have access without additional expense.
grant for a multi-site steroid trial. The trial will have several arms, evaluating an intermittent regimen with daily
Deflazacort and daily Prednisone. Makes no sense to me unless, at the end of the day, should the data suggest Deflazacort has less side effects (weight gain/behavior) it would be available (and covered by insurance) for families in the US. Anne said she had no knowledge of the trial. Now she does. And John Porter is connected to Dr. Pariser. And those planning the trial are connected to Dr. Pariser and to Elizabeth McNeil (orphan products). One of the goals of this study will be to (FINALLY) have Deflazacort available and approved in the US and hopefully elsewhere. Families deserve choices…and trials must consider access to whatever they are testing. Families already have significant financial burden in Duchenne. ALL therapies must be available and ALL boys must have access without additional expense.
Wednesday and Thursday I was in closed meetings with the Institute of Medicine (IOM). Our task is to produce a report (Fall, 2010) on “Accelerating Rare Disease Research and Orphan Product Development.” The report will include discussions and recommendations on discovery, drug development, FDA, the Clinical trial process, insurance, Medicare/Medicaid and devices. You might be aware of Senator Spector’s CAN legislation – $500 million for rare disease. Cross fingers and pray this legislation becomes law.
Progress!
Tuesday, April 6, 2010
Albania
During the Connect Conference last year, I was invited to speak in Albania. It is hard to say no to invitations during the Conference because the need is so clear and the impact of information so evident. So, I said yes…knowing it would be sometime in the future and maybe, depending on the circumstances, might not happen. In January, Mira contacted me reminding me of our conversation and the scheduled date, March 27. In January, the end of March seemed far away.
I met Mira some years ago. This is a story we all know well. While Mira is a neurologist, she does not see individuals with Duchenne, rather only one, her friend’s son. He was diagnosed at six. No intervention recommended. None. Therapeutic nihilism.
He started steroids at the age of 18. Mira attended our conference in Philadelphia, coming back year after year. She delivered information and advice to the family, and this young man’s quality of life improved. She learned how to buy time. At 24 years old, his echocardiogram is stable. He is on steroids, ace inihibitors, beta blockers, supplements, swims three times/week, works for his father, and enjoys spending time with his friends. For this one young man, life is good.
On March 26, I arrived in Albania. The airport was small and as I watched the luggage arrive in baggage claim, I had the sinking feeling that mine had not made the connection from Rome. With only one flight/day from Rome to Tirana, there was no chance of clean clothes anytime soon. I had been traveling for 20 hours or so and looked it! Wrinkled clothes, bad hair, and no makeup! I was scheduled to speak early Saturday AM during the Albanian Neurology Conference. Thanks to Mira’s influence, this year was focused on Duchenne. Several Coke Zero’s (could not find a Diet Coke anywhere!) later and life improved.
Mira and I went out for lunch and a short history lesson about Albania. The communists were defeated just 20 years ago. The communists’ occupation included confiscating homes, tearing down churches, persecuting religious beliefs, taking away freedom, and crushing dreams. Medical care remains under government control. Patients are able to see their doctors, but there is little access to medicines. Rare disease... well, better not to have a rare disease in Albania.
A pause. The country of Albania is beautiful. Flying in, the 60,000 ft. view is lovely. Tirana is surrounded by mountains and bordered on the West and South by the Sea. On the ground, the people are warm, friendly, and kind. But I did see something else and maybe it was best characterized by the lovely young woman that interviewed me. We talked about Duchenne and about Albania. She said, "We try but dreams of change feel impossible, a mountain too difficult to climb."
The meetings started at 8:30AM and most of the talks were in Albanian. Doctors from around the country attended the meeting as well as neighboring countries such as Kosovo. The neurologist who cares for individuals with Duchenne spoke just before me. A kind, young doctor was sitting next to me, translating phrases, though as I stared at the slides, I understood. I closed my eyes and was back in 1984. The slides on the diagnostic workup hit a nerve –clinical presentation, EMG…. EMG! It was 1984, Children’s Hospital Cincinnati. I was standing next to my beautiful son Patrick. He was 4, with his blue eyes open wide and tears falling, “Mom, make them stop” and a frustrated technician telling him to grow up. EMG means sticking needles in a nerve to measure conduction. It was horrifying then and now. In 1984, EMG was done on Duchenne. I’ll never understand why or how EMG was included in the diagnostic workup and I screamed at the tech and later the neurologist. I did not understand the rationale then and certainly not now.
But today, at this meeting in Albania, EMG was included on the slide. I thought I was tired, misread the slide. The neurologist then described their genetic testing capability, that approximately 60% of the mutations were identified. What about the rest? Recommendations for steroid use are limited to an intermittent regime. There is no registry in Albania, no access to sequencing, no thought of clinical trials. One neurologist commented “you are the first parent I have ever met.” I’m certain he meant that I was the first parent ever to speak to physicians. My talk focused around “who’s actually in charge… the doctor who sees the patient for a short time, say 2 hours/year or the patient/family who spend around 8700 hours together each year?...” As part of the Q&A, I was asked about care in the US and answered step by step: no EMG, clinical diagnosis, genetic testing (full sequencing), steroids – and on and on and on.
This was my first trip to the region and while I recall hearing sound bites of information about communist oppression in the Balkans, I did not realize the real impact. While I cannot walk in their shoes, I learned from being there, from the stories. The communist presence is still felt. The Albanian people are rebuilding, but slowly. They lack educational opportunities and infrastructure. There are remnants of communism in healthcare, doctors who deliver the ‘no hope and no help’ messages. There are remnants of communism throughout the country, in buildings and in empty spaces, where homes, churches, and businesses used to exist. There are remnants of communism in the mentality of the people, perhaps reluctant to dream that things might be different. And there are pockets of strikingly beautiful areas everywhere, storybook places, where new dreams are planted.
And, as Duchenne connects all of us, together we will fertilize and help to nourish those young plants so that boys in Albania will have opportunities and dreams.
I met Mira some years ago. This is a story we all know well. While Mira is a neurologist, she does not see individuals with Duchenne, rather only one, her friend’s son. He was diagnosed at six. No intervention recommended. None. Therapeutic nihilism.
He started steroids at the age of 18. Mira attended our conference in Philadelphia, coming back year after year. She delivered information and advice to the family, and this young man’s quality of life improved. She learned how to buy time. At 24 years old, his echocardiogram is stable. He is on steroids, ace inihibitors, beta blockers, supplements, swims three times/week, works for his father, and enjoys spending time with his friends. For this one young man, life is good.
On March 26, I arrived in Albania. The airport was small and as I watched the luggage arrive in baggage claim, I had the sinking feeling that mine had not made the connection from Rome. With only one flight/day from Rome to Tirana, there was no chance of clean clothes anytime soon. I had been traveling for 20 hours or so and looked it! Wrinkled clothes, bad hair, and no makeup! I was scheduled to speak early Saturday AM during the Albanian Neurology Conference. Thanks to Mira’s influence, this year was focused on Duchenne. Several Coke Zero’s (could not find a Diet Coke anywhere!) later and life improved.
Mira and I went out for lunch and a short history lesson about Albania. The communists were defeated just 20 years ago. The communists’ occupation included confiscating homes, tearing down churches, persecuting religious beliefs, taking away freedom, and crushing dreams. Medical care remains under government control. Patients are able to see their doctors, but there is little access to medicines. Rare disease... well, better not to have a rare disease in Albania.
A pause. The country of Albania is beautiful. Flying in, the 60,000 ft. view is lovely. Tirana is surrounded by mountains and bordered on the West and South by the Sea. On the ground, the people are warm, friendly, and kind. But I did see something else and maybe it was best characterized by the lovely young woman that interviewed me. We talked about Duchenne and about Albania. She said, "We try but dreams of change feel impossible, a mountain too difficult to climb."
The meetings started at 8:30AM and most of the talks were in Albanian. Doctors from around the country attended the meeting as well as neighboring countries such as Kosovo. The neurologist who cares for individuals with Duchenne spoke just before me. A kind, young doctor was sitting next to me, translating phrases, though as I stared at the slides, I understood. I closed my eyes and was back in 1984. The slides on the diagnostic workup hit a nerve –clinical presentation, EMG…. EMG! It was 1984, Children’s Hospital Cincinnati. I was standing next to my beautiful son Patrick. He was 4, with his blue eyes open wide and tears falling, “Mom, make them stop” and a frustrated technician telling him to grow up. EMG means sticking needles in a nerve to measure conduction. It was horrifying then and now. In 1984, EMG was done on Duchenne. I’ll never understand why or how EMG was included in the diagnostic workup and I screamed at the tech and later the neurologist. I did not understand the rationale then and certainly not now.
But today, at this meeting in Albania, EMG was included on the slide. I thought I was tired, misread the slide. The neurologist then described their genetic testing capability, that approximately 60% of the mutations were identified. What about the rest? Recommendations for steroid use are limited to an intermittent regime. There is no registry in Albania, no access to sequencing, no thought of clinical trials. One neurologist commented “you are the first parent I have ever met.” I’m certain he meant that I was the first parent ever to speak to physicians. My talk focused around “who’s actually in charge… the doctor who sees the patient for a short time, say 2 hours/year or the patient/family who spend around 8700 hours together each year?...” As part of the Q&A, I was asked about care in the US and answered step by step: no EMG, clinical diagnosis, genetic testing (full sequencing), steroids – and on and on and on.
This was my first trip to the region and while I recall hearing sound bites of information about communist oppression in the Balkans, I did not realize the real impact. While I cannot walk in their shoes, I learned from being there, from the stories. The communist presence is still felt. The Albanian people are rebuilding, but slowly. They lack educational opportunities and infrastructure. There are remnants of communism in healthcare, doctors who deliver the ‘no hope and no help’ messages. There are remnants of communism throughout the country, in buildings and in empty spaces, where homes, churches, and businesses used to exist. There are remnants of communism in the mentality of the people, perhaps reluctant to dream that things might be different. And there are pockets of strikingly beautiful areas everywhere, storybook places, where new dreams are planted.
And, as Duchenne connects all of us, together we will fertilize and help to nourish those young plants so that boys in Albania will have opportunities and dreams.
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