Rheumatology Visit

Preventative action is really important especially with NMO where one must try to eliminate attacks. This is done by suppressing your immune system. There are a lot of different drugs to accomplish this including Imuran, Cellcept and Rituxan. We tried Imuran but I think I was allergic to it. I couldn't stop vomiting once we got up to the dose I needed to be on. My neurologist, who we'll call Dr. S., had to bring in a rheumatologist, who we'll call Dr. R. because Dr. S. has no experience with Cellcept. Oddly enough, the Americans all use Rituxan as their first drug of choice, which is actually considered a form of chemotherapy. I asked Dr. S. about Rituxan 2 weeks ago but he tells me that he doesn't have access to this therapy - only oncology does.

Today I sat down with Dr. R. I wanted to know if he thought it was possible for us to one day get pregnant. Although he was thrilled to see that I am doing so much better than I was in the spring (I wore high heels on purpose today), he was hesitant because it hasn't even been a year since my last attack. One of the biggest challenges with a pregnancy and NMO is that most immune suppressant drugs aren't safe for a baby. So, for now, the plan is to re-visit this in January, when it has been a year. In the meantime, we'll need to get checked out to make sure we both have working parts.

Possible options to keep me protected from an attack during a pregnancy:

• get off Cellcept then use artificial insemination (or as Erin calls it, the turkey bastor method)
• use prednisone at a low dose during the pregnancy
• possibly use Rituxan before the pregnancy, provided it's safe for the baby (Dr. R. says he needs to do some homework)
• breast feeding is NOT an option because post partum is difficult and we'll need to get back on some sort of immune suppressant

While in LA, the panel of neurologists did say that doctors in France who worked with NMO pregnancies found that symptoms decreased dramatically during the pregnancy but all patients suffered extreme attacks post partum. Risky? Definitely. Frightening? Absolutely. Necessary? Debatable.

On a side note, Dr. R. did ask if we had private insurance for Rituxan. I guess it isn't offered under the universal health system in Canada. Odd. So as George Michaels says, "you gotta have faith," and that's exactly what I plan to do.