What a stinker of a letter Carl.
How ¥#§] annoying. To say the least. Some doctors have no idea how to treat people. Or how to write a sensitive, coherent, decent letter to a patient. (Note the word ‘patient’ - you learn to be!)
I suggest you write to him/her and ask for explanations of the what, how, when questions. You could do this by just writing (old school snail mail) or phone his/her secretary and ask if there is an email address you could address your concerns to. Often this would be the secretary’s email address - your email would then be forwarded to the neuro.
Meanwhile start looking at said ‘higher efficacy medications’: MS Decisions aid | MS Trust is a good start. Take note of their anticipated relapse reduction rate and the possible side effects for each drug.
What you’d be looking at would be Lemtrada, Ocrevus and Tysabri.
One very important question is whether in the neurologists opinion you should start on Tecfidera and change drugs only if you have further relapse(s) or whether you should be starting on the higher rated drug initially.
Don’t forget though that although the neurologist may think you should be on a more effective DMD, it is still your choice. If you prefer to start and stay on Tecfidera, then that’s what you should do.
Sue (still annoyed on your behalf!! )