One way, or another

I started taking Rebif (interferon beta-1a) as a disease modifying drug (DMD) for treatment of my MS in July 2009. Injecting myself thrice weekly was no joy, but then again neither is the prospect of MS progression, so I learned to work it into my routine. Unfortunately, Rebif and I did not agree with one another. I came off Rebif in late November, and then back on it again in January 2010. That lasted only until about the end of March when I came off it for the second time, again because my lab work showed that Rebif was affecting my bone marrow and blood counts.

At this point my neurologist suggested I switch over to Copaxone (Glatiramer acetate) because it is not associated with the same side effects as Rebif (fever, aches, chills, headaches) and because it doesn't typically affect the same things that the interferon was affecting in my lab work. The downside, of course (there always is a downside) is that you need to inject Copaxone every day, not three times per week like Rebif, and Copaxone can cause skin irritation, lipoatraphy (damage to subcutaneous fat so that you develop "pits" in your skin) and it can cause muscle spasms if injected into or too close to a muscle.

I have had few to no skin issues so far, but this may happen in time. On the other hand the muscle spasms have been an issue when injecting my legs and arms because I have almost no fat to inject into (contrary to the training nurse who visited me a week and a half ago who claimed I could use an 8 mm injection depth on all sites - wrongo!). Using the automatic injector (autoject) in my legs and arms also turns out to be a nonstarter and part of the problem because controlling the depth of the injection is tricky. When the spasms start, your muscle dances as if it were hooked to a car battery and feels as if the meanest, biggest guy you know just gave you a charleyhorse. Then  did it again just for fun. The stiffness lasts through the next day.

The support nurse from Shared Solutions (who is very helpful) suggested that I manually inject at a 45 degree angle into my arms and legs to avoid the spasm issue. Two nights ago the injection into my arm was much better done manually than the previous night with the autoject, and involved much less swearing post injection. Other than some burning, all was basically fine. The manual leg injection last night was another story. I did not manage to get it into the tissue at 45 and the muscle was jumping before even half way into the injection. My SO couldn't watch it was so intense. Rah! I sent an e-mail to my support nurse and she suggested to dump using the legs and to use my abdomen as two areas to give me a total of 6 areas (abdomen X 2, butt X 2, arms X 2). Good call.