PacMan on Steroids...

. . . meet PacMan on Pulmozyme.

A few days ago, I got an email from a CF mom asking me if I'd tried "Muck Busters!" -- the new mucus-clearance video game from our friends and longtime CFF drug-development partners over at Genentech. (For more information on the game, please visit this post at CF Roundtable.) I hadn't, but I offered to download it (it's free) and give it a whirl so she could hear "a CF perspective" before passing the game along to her 9-year-old son. 45 mins, 5 levels, the start of possible carpal tunnel syndrome, and just the teeniest bit of competitive spirit later, I emailed her my thoughts and she suggested I post them on the blog as well. And here we are.

What I think is most striking about this app/game is this new notion that treatment time can and should be fun for kids, and that they should have some sense of what their treatments are actually doing for their body. I think this is an awesome idea, I just don't remember it being very popular with the pharma companies when I was young. Back then there was no "Bubbles the Fish" neb mask, no colored Vests with decorative stickers (those actually came out the year I got my transplant), and certainly no iPhone "hey, look, CF is cool!" apps. Quite honestly I wish there had been, and I'm thrilled that this disease has reached a point where children are encouraged to actually TAKE OWNERSHIP of CF, in the sense that they should understand the meds (at least a little), make the Vest their own, and yes, even have a little fun with it all. So right off the bat, kudos to Genentech for helping make CF a little easier.

That said, the game itself proved anything BUT easy, at least to my 31-year-old, half-over-the-hill fingers. There are 5 characters: Mr. P (who tunnels through mucus and breaks down DNA),  Andy Antibiotic (who sprays bacteria with his fire extinguisher), Broncho Bob (who opens airways), Shakey (who wears a vest and generates enough power to move things around on the screen), and Hydrator Hank (who uses a hose to clear the cut-up DNA off the screen). The object is to use Mr. P to tunnel through the mucus and clear it off the screen before time runs out. Bacteria get in his way and have to be removed (you have to switch characters to do that) and DNA strands have to be cut up before he can get around them. In other words, it's a little like playing PacMan  -- only in this case PacMan happens to be running around in a pair of CF lungs. Poor dude.

Right off the bat I started playing the game incorrectly, despite knowing the "rules." A CF adult to the bitter end, I was hell bent on killing as many bacteria as possible, even returning to areas already cleared of mucus to attack (bacteria will reproduce, so they're constantly popping up around the board). It got so ridiculous that my non-CF friend who was watching/playing with me had the following to say:

Her: Stop killing the bacteria! Why are you doing that?!
Me: What else should I do?
Her (excited, nearly grabbing the phone): Clear the mucus! Clear the mucus! (Yes, that happened.)
Me: But if you leave the bacteria it's going to get resistant!!
Her: (blank stare)

The point of this game is to clear mucus. Mr. P. is the star. Shakey the vest can't clear mucus -- he just moves bacteria out of the way. Broncho Bob opens airways that serve as shortcuts to the mucus -- he doesn't clear it either. Hydrator hank clear DNA remains, but he can't clear mucus, and neither can Andy Antibiotic, for obvious reasons. So for the purposes of the game you need only open airways if you plan to use the shortcuts, and you only need to hydrate your airways or clear infection if stuff is in your (Mr. P's) way. Oddly enough, you'll win more in the lower levels if you leave Hank and Bob alone altogether. Later on, they become helpful.

What's cool is that the star players make sense in CF land (Mr.P/pulmozyme, Andy Antibiotic/abx, Shakey/Vest, Hydrator Hank/HTS, Broncho Bob/bronchodialators) and the obstacles do too. The game has bacteria, "boss" bacteria (harder to kill), mucus, clogged airways, improper DNA, and -- most hilariously -- white blood cells that you can't kill at all but which will eventually run into bacteria, become inflamed, and explode obnoxious DNA all over the screen. The DNA makes the mucus harder to get through and means extra work for Mr. P. And that, my friends, is science.

All in all, I told my CF mom friend that the game is, in my opinion, totally appropriate for slightly older CFers with enough coordination to actually win a couple levels and enough understanding to know that, at the end of the day, CF is not a video game. The best thing about the game to me came with the understanding that different meds/therapies play different roles in our health, and if a game by the makers of Pulmozyme wants to place extra weight on mucus clearance above bacteria, well, can you really blame them?

So now it's your turn, adults and parents. My CF mom friend would appreciate some more feedback, and I'd love to hear your thoughts. Is this is a good thing for the CF community? Do you think it would have changed your CF experience to have games like this as a child? What are your thoughts on how to make treatments "easy" and keep kids educated about their (okay, OUR) disease? And for those of you who have played "Muck Busters!", feel free to share your experiences. Thanks!