Showing posts with label rare disease. Show all posts
Showing posts with label rare disease. Show all posts

Tuesday, 26 April 2016

To The Person Who Wondered If I Am Really Sick

A photo where my invisible illness is visible.
I sleep with oxygen every night.
As someone with the often invisible illness Idiopathic Arterial Hypertension (also known as PH,) I have had small incidents of strangers who have questioned the severity of my illness. I have had strangers question why I use an accessible parking spot. It really sucks trying to justify your illness (especially when it is life-threatening) to a stranger. It isn’t an easy thing to open up about, and often time these strangers aren’t asking you about whether you are disabled or not because they genuinely care about you. They are looking for validation. They want to be "right" about calling you out over a silly parking spot. Unfortunately, when you have an invisible illness this is bound to happen with strangers.

Recently I found out that someone I know asked if I was really sick. It felt like a punch to the gut. Life with an invisible and life threatening illness is so incredibility complicated and painful. I don’t understand how someone could question the validity of my illness. I figure if one person has questioned my illness, other people may have also wondered how serious it is, and how it impacts my life. Their comments made me feel extremely deserted.

I may look like a vibrant young woman who is just on the cusp of starting her adult life, but looks can be deceiving. Although I may not look ill, I have received a diagnosis. I have seen many specialists; I have gotten second opinions. My diagnosis shouldn’t be up for debate, but apparently it is. Pulmonary Hypertension is an invisible illness to the naked eye, but there are many indicators that I am sick to someone who understands the disease.

Majority of society doesn't know what signs and symptoms to look for to indicate that I have Pulmonary Hypertension. Mainstream media often depicts someone as being sick as looking pale, frail and bald. However, this isn't always the case for determining how serious an illness is. Many invisible illnesses can be well concealed, especially with the help of make up. Not only is my illness well hidden, but so is my disability. A symbol of someone in a wheelchair is often used for accessible parking spots and bathrooms, even though there are an array of different disabilities (including invisible ones.) Because of this, society weighs so heavily on being able to visibly see a disability in order to believe its validity. Regardless, there are still many different disabilities that do not require a wheelchair, or any visible medical equipment.

I can easily cover up how sick I am- to the point that many doctors ignored the fact that I was heart failure before being diagnosed. Pulmonary Hypertension isn't diagnosed through blood work. It is diagnosed through a process of elimination. For the person who doubts my illness, I can ensure you that I went through a plethora of invasive tests to receive a diagnosis.

At one point I had so much radiation exposure the technicians running the various x-ray, MRI and CT scans turned me down for another test, fearing it would be too dangerous. However, a specialist demanded that I had another CT scan, even though I had several in the past 24 hours, and even more in the last week and month leading up to my diagnosis. Dozens of vials of blood work was also ordered to rule out other underlining diseases, such as HIV.

The most invasive and effective procedure for diagnosing PH is called a Right Heart Catheter (which I had on Christmas Eve in 2013.) For this test, a tool is placed in a vein in either your groin or neck that leads to your heart. Mine was placed in my groin and the tool eventually made its way up to being directly in my heart to measure the pressure my pulmonary pressures. I was completely awake for this procedure, and was only given a small numbing in my leg. This test confirmed that I did indeed have a high pulmonary pressures, and I was officially diagnosed with Pulmonary Hypertension.

If you try to walk along side me, you may notice that I need to slow down, or may have to try and catch my breath while speaking. You might notice me gasping for air if we had to walk up a hill or some steps. People with PH are often out of breath by the time they reach the third step in a flight of stairs. I may look perfectly healthy, but I have a lung- heart disease. Those are two very vital organs that needed to do the most basic of tasks that are often taken for granted, such as going up the stairs, or bending down to tie your shoes.

Being short of breath was actually one of my first noticeable symptoms. I had my first symptom in Fall 2013. From there my symptoms progressed at an alarming rate. I was diagnosed quite quickly, as most people wait 2 years for a diagnosis. However, by the time I was diagnosed I was told that I was somewhere between a stage 3 and a stage 4.  Even though I was on the verge of dying, I still didn’t look sick to trained professionals (which delayed receiving a diagnosis before the progression of the disease kicked in.) If I didn’t received medical intervention when I did, I am not sure how much longer I would have lasted. In the weeks and days leading up to my hospitalization, I would wake up gasping for air. I had started to stop breathing in my sleep.

Pulmonary Hypertension doesn’t just make you short of breath; it narrows the arteries in your lungs. This makes it more difficult for oxygenated blood to be pumped throughout your body, causing an overloading in the heart as it desperately tries to pump blood. All this extra work causes heart failure. A symptom of PH is having an elevated heart rate- many people with PH experience a heart rate similar to someone who has run a marathon while doing a simple task; such as walking, or cleaning the house.  Many people with PH (like myself) also suffer from lower than normal oxygen saturations and dyspnea. Having low oxygen satuations also causes someone to tire very quickly because of how hard their body must work to accommodate.  Perhaps these aren’t visible symptoms, but that shouldn’t make the seriousness of an illness illegitimate. These symptoms are serious, and can escalate the progression of the disease, and can lead to organ damage and failure.


There is a huge difference between whether someone looks sick, and whether someone is sick.
Just because someone looks healthy, that shouldn't dismiss their diagnosis nor their symptoms. I can only assume that the uninformed comment about whether I was sick or not was influenced by how I appear on social media. My Instagram account is largely photos of cafes I visit, my dog, my boyfriend and little adventures I go on. Although having a life threatening illness dictates how I live my life, it does not define me as a person. I don't want to document my illness too heavily on social media. As such, I don't include many pictures of me at the hospital (although I do include them from time to time to help raise awareness for PH.) I also don't include many pictures of me wearing oxygen, or taking medications. I don't want people to pity me, or assume I am trying to get attention through my illness. Social media is also a great way to edit your life; you can only show what you chose to share. I may have a picture of me on a hill smiling, but that doesn't mean I wasn't gasping for breath, and had to take breaks to get there.  For me, I only capture what I want to remember, and what I want my friends and family to remember.

After my diagnosis I was so terrified to enjoy moments in life. I was scared that if I laughed or smiled, that would mean that I was okay with what was happening. Now it seems like I have to be afraid to laugh or smile because of how other people will perceive that. I have my bad symptoms days where I am extremely short of breath, and become even more physically limited. I spend hours each month waiting in waiting rooms of hospitals and blood labs. I also spend hours each month commuting to specialists appointments. I often feel ill as a side effect of the medications I am on. These medications are not elective, I also do not great a break from taking them. I must take them everyday like clock work. There are currently no treatment options that will cure the disease I have. The medication I have will only slow down the progression of the disease, but unfortunately, it is still considered fatal. It is difficult being in my 20's and knowing that I have a fatal illness. I am at an age where I am watching more and more of my friends get married, travel, start careers and have children. I was diagnosed several months after starting a career job, and I loved working. I was saving up to move out of my parent's house. I worked with children throughout university and received a specialization in education. To think that I am faking this disease is ludicrous. 

To the anyone who isn't sure if I am ill; please consider that not all illnesses are visible from afar. Sometimes illnesses are very easy to mask with make-up, or to filter out through social media. Just because an illness or disability is not visible does not mean that it cannot be serious or life threatening. Its visibility should not equate to its validity.

Tuesday, 5 April 2016

Subscription Box Review: Be Brave Box

This is my first subscription box review. I hope to do more in the future, and can hopefully have a give away at some point. I decided that I wanted to start reviewing subscription boxes because they seem like a great idea for people with chronic illness. When I was diagnosed with PH I was sent so many lovely flowers. Unfortunately, I had to throw out of the beautiful flowers that my friends and family sent me. As someone with a lung condition, it didn't seem like a good idea to have flowers. I felt so terrible because I knew that people who cared about sent me those flowers to let me know that they were thinking of me. Even worse, I know that they spent a lot of money on me. (I used to work at a flower shop and know how expensive arrangements can be.) I think that subscription boxes can be a great alternative to gift to someone with a chronic illness, or to treat yourself to. My best friend Melissa got me a 3 month subscription box for my birthday and I absolutely love getting a surprise each month! (Thanks Mel!)

Be Brave Box Review


Taylor, the founder of Be Brave Box
The Be Brave Box is a bi-monthly Canadian subscription box. It is a subscription box that is aimed towards people with chronic illnesses in the hopes of brightening their day. The box is said to be filled with about 5 surprise items that surround the overall theme of Be Brave Box.

Unlike other subscription boxes, the Be Brave Box was started by a 16 year old named Taylor and her father. Taylor has a rare and genetic form of Chronic Kidney disease, and was diagnosed in November 2011. She received a kidney transplant in August 11th, 2015 from her father. After her transplant she was house bound for 6 weeks because her immune system was suppressed. During this time she brain stormed the idea of the Be Brave Box. Needless to say, this box is created for people with chronic illness by someone who understands what it is like to have a chronic illness. Taylor knows what it is like to be in a hospital for days or weeks,  and the hassle of going to constant appointments, and the waiting that is involved for every appointment and medical procedure.

Taylor has stated on the Be Brave Box website that "There are always going to be good days and bad. I want Be Brave Box to be another good part of life because we just need more good in our lives."

Products received in box:

- Postcards: Three post cards made by a Canadian artist. Unfortunately, the artist is not named so I cannot credit them.
- Bracelet: Be Brave Bracelet made by Magic Mixes. The bracelet incorporates ancient Chinese symptoms that are believed to bring good luck, healthy, and protection to the wearer. The bracelet also contains Blue Howlite beads which are believed to be calming, and to help provide strengthening energies.
- Tea and Honey: Three sticks of honey, and three bags of Stash tea in pomegranate raspberry green tea, chamomile, and licorice spice.
- Bottle Cap Key Chain: made by a young lady whose daughter has Blouts disease. She creates bottle cap key chains to raise awareness for Blouts disease and other rare diseases.
- Lip Balm: Natural gingerbread scented lip balm made by HappyBeeLipBalm on Etsy.

Packaging: received in an oversized envelop sent through Canada Post. Items wrapped in red tissue paper with confetti sparkles. Personalized Be Brave Box sticker held items in tissue paper. Came with a product overview of what was in box, along with a welcome postcard from Taylor.

Cost:
- Canadian: $21 CDN for a one month subscription, shipping included. 
- International: $29 CDN for a one month subscription, shipping included. 

Over all thoughts:

The items in the Be Brave Box that I recieved
I think that the Be Brave Box is an awesome idea, and something that is needed within the chronic illness community. I admire Taylor for being so young and so ambitious along with all of the other obstacles that she faces. (I'd also like to mention that her website looks very professional!)  The packaging looked very pleasing, along with the card that detailed the items in the box. I like that this box is made by someone who understands what having a chronic illness can entail.

My favorite products are the bracelet (because of its positive message,) the honey sticks and the lip balm (it smells amazing and goes on light but offers a creamy moisturizer to the lips.) I really enjoyed that a lot of the products were made by independent people. As someone with a rare disease, I also appreciated that I got to learn about another rare disease through the key chain. I could see a lot of my other friends with chronic illnesses enjoying these items as much as I do.

I send a lot of postcards and letters to some special friends that I have made online who also have PH. The postcards contain some encouraging words, so they will be great to send out to any of my friends who are having a challenging time. The post-cards have no formatting on the blank side, and the Canadian artist is unnamed. As someone who went to art school, I really wish that I could credit the artist. I like that this box will encourage other people with chronic illnesses to send old fashioned letters. I have made a few pen pals through this experience with PH and I absolutely love moving away from technology, and sending some good old snail mail.

I believe I received one of the first Be Brave Boxes as it only launched in the new year, and is offered on a bi-monthly basis. Overall, I really enjoy the message and the theme behind this subscription box. The fact that it was created by a 16 year old is even more impressive. I thought that the items in the box fit the overall theme and message that Taylor was trying to convey, and I could see this box bringing a smile to someone's face.

Many people with chronic illnesses gear themselves towards more natural products after diagnosis. I thought that the fact that the box contained honey, and a natural lip balm along with a bracelet that contained a back message about a Chinese symbol for strength was very well thought of, and something that other people with chronic illness could enjoy and feel safer using. I would have liked to see organic loose leaf tea instead of Stash tea, although this might reflect more poorly on me than the actual box. I am a bit of a tea snob, but once you have loose leaf tea there is no turning back!

I know I got excited when I received it in the mail (it shipped fairly quickly as well.) I think that the Be Brave Box has a lot of potential, and I can see it growing in the near future. Thank you for letting me review the Be Brave Box, Taylor! It was an honour to speak to such an inspiring, young business woman!

To learn more about Taylor and the Be Brave Box please visit and follow the sites below:

http://www.bebravebox.ca/
https://www.facebook.com/bebravebox
https://www.instagram.com/bebravebox/

*If you would like me to review your product or subscription box please contact me at phightagainstph@gmai.com

Thursday, 3 March 2016

Accessibility of PAH Therapies in Canada: Part III
 - Patient Testimonials

Part III: Testimonials From PH Patients Who Are On A Treatment Not Available or Accessible in Canada


This is the third and final part of the series. The first part of the series, Access to Opsumit in Canada can be found here. The second part of the series about Treatments That Are Not Available in Canada Can Be found here.

Below are testimonials from PH patients in the US who are on inhaled PH medications that are not available in Canada. These testimonials are unpaid, and are shared by fellow PH patients in an effort to show the positive effect these medications can have for some PH patients.


"I started Tyvaso on the trial in November of 2004 at UCSD medical center. I was asked to go on the trial due to my high numbers.  I was diagnosed in April of 2004.  My mean pressure in my heart during right heart catheter was 96(normal is between 15 and 25).  I had gone years with a misdiagnosis of severe asthma.  I went in for another right heart cath to start the trial.  My numbers had come down, good news to 56 with the use of a medication called Tracleer.  While on the operating table, I took my first puffs of Tyvaso, I took nine.  I was the first patient ever to take nine puffs of the medication.  My mean pressure dropped from 56 to 46.  It was really a miracle for me.  At the end of the study my pressure was 35.  Darn right near normal.  Sadly though, I had to quit the Tracleer and start on Revatio due to liver problems.  But I have been on Tyvaso since starting.

I started going downhill a little November of 2013, I was needing evening O2, and usually I need only at night time.  At this time I was on Revatio and Tyvaso.  I had another dreaded right heart cath in March of 2014.  My doctor was happy with my pressure of 50.  But I was not.  My husband and I pressured him to add another medicine.  He decided to add opsumit, since I did so well on the tracleer and it is very closely related to tracleer without the liver complications we decided to give it a shot.  Fast forward to June of 2015.  I had an ECHOcardiogram.  I asked my doctor my "estimated" pressure as it is not as thorough as a right heart cath.  He said 29.  Wow...almost normal.  I have been feeling pretty good these days.  I am very reactionary.  I have good days and bad.  Without these medications I would for sure be in pretty bad shape of worse dead.  I have 3 adult children and a husband.  A grandson.  Also, raising my niece and nephew, ages 15 and 12."
- Julie, 48 years old
San Diego, California, USA


"I started the inhaled therapy, Treprostinil (Tyvaso), in 2011 after going back and forth with my doctors about IV therapy since my pressures were high and my physical activity was low.  They decided to try me on Tyvaso just to see how I would respond on it.  At first it was a bit difficult to fall into a routine of breathing on a nebulizer every 4 hours, but I wasn't too concerned after I started to feel better.  Before Tyvaso, I'd have a very hard time doing the simplest daily tasks like making my bed, or even showering, without getting short of breath.  Now after almost 5 years on Tyvaso, I'm able to exercise, walk long distances, go on bike rides, almost anything and everything that I wasn't able to do b efore the medication.  It has also improved my 6-minute walk test results, as well as my echocardiogram results.  Tyvaso, in conjunction with my oral medication, has improved my quality of life tremendously and I'm so grateful to have the therapy available to me."
-Reinee
Bay Area, California, USA


"In 2009 I was diagnosed with Familial Pulmonary Hypertension. At that time I was put on two different treatments. One was a long established drug Tracleer, and the other was an inhaler that had been FDA approved only months prior, Tyvaso. The doctor has switched my pill form of medication, but Tyvaso remains my main treatment. I always credit Tyvaso as saving my life. Before diagnosis I was not able to walk up a flight of stairs without getting out of breath, now I can go hiking and jogging. I can breathe easier with Tyvaso, if I am without it for a day I can feel the difference in my chest and my exercise capacity is diminished. "
- Raeana Rader, 28 years old
USA









"I was diagnosed with pulmonary hypertension after I passed out while walking into work. That
was simply too much exertion for my body. I was placed on I.V. Veletri and two oral medications. They got my symptoms under control but I had terrible side effects from the Velerti. The nausea, vomiting, diarrhea and headaches were the worst. I eventually improved so much that my doctor let me do a conversion from Veletri to Tyvaso. Tyvaso gave me my quality of life back. The only side effect I have with Tyvaso is flushing. I feel like a normal human being again. Because I am no longer on Veletri, I can take my kids swimming and no longer have to sit on the sidelines. I am able to exercise on an elliptical for an hour at a time and I have recently started taking a spin class. Tyvaso is also much cheaper than Veletri and because it is noninvasive, I do not have to worry about line infections which could be costly and detrimental to my health. I feel very blessed and grateful to have Tyvaso available to me."
- Ashley, USA

Wednesday, 3 February 2016

Accessibility of PAH Therapies in Canada: Part II


Part II: Treatments for PAH That Are Not Available In Canada

As someone with Pulmonary Hypertension, I was very disappointed to learn that a couple of potentially life altering medications that have been available for many years in the United States of America are not available here in Canada. I had assumed that because Canada offers free “universal” health care, that it also had the best interest of its patients in mind. Needless to say, I was completely shocked to learn that some prostanoid-family medications like Tyvaso (inhaled treprostinil) and Ventavis (inhaled iloprost) and Orenitram (oral tablet form of treprostinil) are not available here in Canada. These medications are a less invasive form of intravenous prostanoids such as epoprostenol (Flolan, Caripul) and subcutaneous treprostinil (Remodulin). I asked PH specialist Dr. Sanjay Mehta to answer some questions I have regarding the accessibility of of PH therapies in Canada.

Serena: Could you explain the benefits of inhaled and oral versions of treprostinil over the intravenous and subcutaneous prostanoid treatments? Do you believe that medications like Tyvaso and Orenitram should be available to Canadians with PH? Could you briefly explain why these medications are not currently available here in Canada?  Is there anything that we can do as a community to have these medications available here?



Dr. Mehta:  Treprostinil is a very effective treatment for PH. It is currently approved and available in Canada both for intravenous and subcutaneous administration as Remodulin.  Both of these approaches require an external pump and a cassette or syringe to be filled regularly, usually every 1 or 2 days. 

Treprostinil has been modified for patients to be able to take it by either breathing it in (inhaled Tyvaso in the US) or by taking a pill (oral Orenitram in the US). Both of these approaches have been shown to be effective in treating PH. Moreover, the inhaled and oral routes of drug administration clearly simplify the treatment compared with much more complex intravenous/subcutaneous treprostinil administration.  However, inhaled and/or oral treprostinil are not the best treatments for all PH patients. Inhaled treprostinil may not be as effective as intravenous/subcutaneous treprostinil, and is typically only used as an addition to other oral PH therapies in the US. Oral treprostinil is effective, but side-effects of nausea, abdominal pain, and diarrhea can be difficult for some patients. 

Ultimately, both inhaled and oral treprostinil are not available to Canadian PH patients because the pharmaceutical manufacturer never submitted an application for Health Canada approval. This is largely because of business reasons, as the PH market in Canada is much smaller than in the US, and it is expensive to launch a new medication in Canada.  Moreover, many PH medications cost less in Canada than in the US, because of government regulations. As such, the cheaper price for a new PH medication in Canada can lead to pressure on a company to reduce the price in the US, which would mean they make less money in the much bigger American market. 


Serena:  Are you able to speak to a trial for and the benefits of having Remodulin administered through an implantable pump as opposed to subcutaneous or intravenous methods? Do you foresee this implatable pump being available in Canada?

Dr. Mehta:  There was an exciting trial in the US that studied whether Remodulin could be administrated via an implantable pump, rather than an external pump.  Such an implanted pump has a reservoir of medication that could last for a prolonged period, such as a month. This reservoir could be refilled regularly, such as every month, in the PH clinic.  As a result, patients would not have to look after preparing medication every day or every second day at home, or changing tubing / cassettes / needles, which would clearly improve their quality of life.  This implantable pump for Remodulin may become available in the US in 2016, and then hopefully one day in Canada.

Serena: This concludes our two-part interview. Are you able to share any insight on any exciting and promising treatments on the horizon in Canada?

Dr. Mehta: Despite all the advances we have seen in the last years in regard to PH therapies, PAH is still a progressive, often fatal illness for which we have no cure.  Tremendous research both in Canada and around the world continues to better understand the disease and what exactly is happening to the blood vessels of the lungs to cause PAH.  There are many ideas for new treatment approaches, including both pharmaceuticals and potentially gene-therapies.  This is a very hopeful time that PAH patients will continue to benefit from this research and new therapies, until such a time when we can say to a patient, “You have PAH, but we can treat you so that it will not affect you in everyday life and will not shorten your life.”

The PHight or Flight Project would like to thank Dr. Sanjay Mehta and The Pulmonary Hypertension Association of Canada for their assistance on the Accessibility of PAH Therapies in Canada Series.

*This is the second part of a three part series. The first part of the series, Access to Opsumit in Canada can be found here. The third and final part of the series will share testimonials from PH patients in the US who are on the various medications for PH that are not available in Canada. 

Wednesday, 27 January 2016

Accessibility of PAH Therapies in Canada: Part I
 - Access to Opsumit

Part I: Access to Opsumit in Canada


In March 2015, the Canadian Agency for Drugs and Technologies in Health (CADTH) suggested that all newly diagnosed people with Pulmonary Arterial Hypertension (PAH) in functional class II or III receive the same mono-therapy approach for their treatment. This approach would take the decisions for treatment out of the hands of PH experts and place it in the hands of government bureaucrats. I asked PH specialist Dr. Sanjay Mehta* to answer some questions I have regarding the accessibility of PH therapies in Canada.



Serena:
I know that you are very involved and passionate about the PH community, and that you have been working very hard to ensure that all newly diagnosed people have access to the therapy that is best suited to their needs.Could you briefly explain why it is so important that PH specialists, like yourself, are able to treat PH patients on an individual basis and recommend a therapy suited to their needs instead of the stepwise, rigidtherapy approach suggested by the CADTH? 



Dr. Mehta:  It is one of the most basic principles of medicine: that each patient is an individual, and needs to be understood, respected, and treated as an individual. This includes doctors making decisions about the best medical treatment for a patient’s illness.  Although many patients may have the same illness, as in the case of PH, they are all still unique individuals. As such, there is no reason to expect that they respond similarly to PH medications, or that the same medication is the best one for each patient. Expert PH physicians need to consider many factors in deciding on the best initial and subsequent medical treatment for each PH patient. The decision is based on having expertise and experience in PH, understanding the patient and their other conditions, and the specific risks of each treatment.  Even in clinical studies of PH medications, all patient participants don’t respond similarly and, while some may respond well, others may not.  Importantly, in dealing with a serious, progressive illness like PH, a patient can’t afford to waste precious time “trying” anything other than the most effective, best treatment for them.

Serena:  The newest Health Canada-approved oral medication for PAH, macitentan (Opsumit) is not available to most Canadian PAH patients, as per the recent pan-Canadian Pharmaceutical Alliance (pCPA) decision to close negotiations with the manufacturer, with the impact that this drug is not approved for funding in most of Canada. 

I understand that Opsumit is generally well tolerated, and that it was tested in one of the largest and longest clinical studies of any approved PH treatment. Can you discuss some of the benefits of Opsumit? If the government continues to deny funding for Opsumit, what is the future for this medication in Canada?



Dr. Mehta:  In 2013, the Seraphin study reported on the benefits of macitentan (Opsumit) in what was at the time the largest, longest study ever in PAH patients. It showed that macitentan reduced the morbidity (severity of illness) in PAH patients, specifically reducing the risk of progressive worsening of PAH by 45% and reducing the risk of hospitalization by 50% over 3 years.  Moreover, treatment with macitentan significantly improved symptoms, quality of life, and exercise capacity in PAH patients. This is a unique study that showed for the first time the long-term benefits of treatment with a PAH medication, compared to all other PAH studies which only looked at benefits over 3-6 months. Clearly, PAH patients don’t want to just improve over the short-term, but hopefully remain well for many years!

As a result, treatment with macitentan has been strongly recommended by the most recent 2014 PH Clinical Practice Guidelines jointly published by the European Society of Cardiology and the European Respiratory Society.  Moreover, macitentan has been approved for funding in the US, and in many European countries, and many PAH patients are currently being treated with macitentan.  Notably in Canada, Quebec approved public funding of macitentan in October of 2013, such that Quebec PAH patients have complete access to macitentan as a treatment for their PAH, should their expert PH physician decide it is the best treatment for them.  Similarly, several large private insurance companies across Canada have approved macitentan coverage for their clients.  However, the pCPA recently denied funding for macitentan for the rest of Canadians (PAH patients living in all the other provinces and territories who do not have access to private health care), and indeed, has broken off negotiations with the pharmaceutical manufacturer, Actelion.

This is a very concerning development for Canadian PAH patients, most of whom have been denied access to public funding for treatment with macitentan. Moreover, this establishes a dangerous precedent whereby any and all future new PAH therapies (for example, the new oral **selexipag or Uptravi, which was just approved by the FDA in the US) may similarly not get approval for funding for Canadian PAH patients.  It would appear that Canadian and provincial governments are saying that PAH patients are doing just fine with the therapies they have available today!  Clearly, PAH patients and their physicians know otherwise;  despite treatment with the many PAH medications we have, many PAH patients remain seriously ill, limited in everyday life, and their disease continues to progress until it takes their lives, on average 7-10 years after diagnosis.  Is it reasonable to accept that?  Should we not try to further improve the health and lives of PAH patients?  Most definitely, all Canadian PAH patients and their caregivers would want us to continue to develop, test, approve and make available newer and better PAH treatments. Lack of government understanding of this critical issue is already leading to less than optimal treatment of Canadian PAH patients, as currently demonstrated by lack of access to macitentan, and likely to reoccur with lack of availability of future new PAH treatments. 

Serena:
  Thank you for sharing your thoughts on this complex issue. Is there anything that you would like to share going forward?

Dr. Mehta: 
All Canadian PAH patients and their caregivers should be heartened by the incredible progress we’ve made in the treatment of PAH, since the 1st medication, intravenous epoprostenol (Flolan) became available in 1997. Currently, 9 different medications are approved and generally available for the treatment of PAH in Canada. As a result, the quality of life and survival of most PAH patients have significantly improved. This is important to keep in mind and we should remain hopeful that, thanks to the joint efforts of dedicated advocates, members of the medical community, and PHA Canada, new treatments such as Opsumit will be made available to all PH patients in Canada. This is what we must continue to strive for.

** selexipag/Uptravi received approval by Health Canada on Tuesday, January 26th, 2016 for the treatment of PH.

The PHight or Flight Project would like to thank Dr. Sanjay Mehta and The Pulmonary Hypertension Association of Canada for their assistance on the Accessibility of PAH Therapies in Canada Series.