Sunday, September 25, 2011

Bits and Pieces: End of Summer Edition

End of summer / Fin del verano
Image by Claudio.Ar via Flickr

Well, here's another collection of various items of interest (well, at least of my interest), most of which have something to do with MS, and none of which have anything to do with the end of summer. Just thought I'd note that the seasons have changed once again, and we are now officially in autumn, my favorite time of year.

Time just whizzes by, doesn't it? I've noticed that the older you get, the faster time seems to pass, so much so that it becomes increasingly difficult to get your arms around the quickly passing days, and events unfold at breakneck speed. Remember when the two-month summer vacation from grade school seemed like an eternity, filled with innumerable dramas and intricate subplots? Now two months seem to pass in the time it takes me to let out a good yawn.

Just goes to show how subjective is our existence. I suppose this ever increasing sense that time is speeding up has something to do with the fact that as we get older, each increment of time becomes a lesser part of our lives. For example, a two-day-old infant experiences a single day as 1/2 their lives, whereas, at 48 years old, a single day represents 1/17520 of my existence. All the more reason to try to make the most of your remaining time on earth, and here I've gone and completely wasted about a minute of your precious, ever dwindling allotment of life. Please forgive me.

With that, my latest collection of flotsam and jetsam…

♦ Researchers have discovered that the brains of MS patients show a marked deficiency in substances known as Neuro-Steroids (click here). Neuro-Steroids help build brain cells and maintain their function, thus increasing their levels in patients deficient in them might not only stop MS in its tracks, but also actually repair some of the damage that the disease does to the central nervous system. Better still, drugs designed to increase the level of Neuro-Steroids are already being trialed for use in combating epilepsy and depression, meaning that, if successful, Neuro-Steroid drugs could be on the market much quicker than a newly discovered compound that has yet to hit the trial pipeline. Of course, this research is still in its early stages, but it does seem quite promising.

♦ In other drug-related news, researchers have figured out a way to deliver drugs across the blood brain barrier, an obstacle that has inhibited the treatment of many central nervous system diseases throughout the history of medicine (click here). The blood brain barrier functions to keep the brain and spinal cord out of harm’s way by carefully selecting just what substances can cross from the bloodstream into the CNS, much like the doorman at an exclusive nightclub picks and chooses amongst the riffraff clamoring to get in, only allowing entry to the anointed few deemed worthy of such a privilege, a practice that made me want to vomit even back in the glory days when I was "fortunate" enough to be one of those deemed worthy. Anyway, researchers have now figured out a way to open a temporary window in the blood brain barrier, potentially paving the way for a new level of efficiency in treatments designed specifically for central nervous system disorders.

♦ Researchers in Japan have discovered a high-tech method of analyzing cerebral spinal fluid (CSF), allowing for the differentiation between MS and other neurologic diseases (click here). This could be hugely important, as currently there is no test specific for MS, making it a diagnosis by exclusion. In other words, doctors diagnose MS primarily by eliminating other possible causes of a patient's symptoms and diagnostic test results, a process which results in a fairly wide margin of error and a misdiagnosis rate of about 5%-10% . That's right, for every 10 people reading these words, there's a good chance that one of you has been misdiagnosed. So put that in your pipe and smoke it.

♦ A bit of bad news, as simvastatin (otherwise known as Zocor) has been found to be ineffective as a treatment for MS (click here). Four or five years ago there was much buzz about the statin drugs (commonly used to treat high cholesterol) possibly being of use in the treatment of MS, potentially as an add-on to be used in addition to other therapies, but recent research results have been disappointing.

♦ In CCSVI related news, the Buffalo Neuroimaging Analysis Center (BNAC) published a comprehensive overview of all of the CCSVI research that has been done to date. The BNAC Patient Advisory Council, of which I am part, put together an easy-to-read digest distilled from the much longer piece, written specifically with patient education in mind (click here). It's done in a question-and-answer format, and should provide a nice overview of the current state of CCSVI knowledge.

♦ The Canadian province of Saskatchewan this week announced that it will be sending MS patients to Albany, New York to participate in a CCSVI treatment clinical trial (click here). Although CCSVI research is not moving along as fast as many of us wish it would, in actuality the pace of research is quickening and gaining momentum, and hopefully we will soon start to reap the benefits of that research.There is still far more about CCSVI that we don't know than we do, and getting those questions answered, dither pro or con, in the quickest possible fashion is in the best interests of all, regardless of their stance on the hypothesis.

♦ For those interested in a comprehensive and extremely well researched and well-written account of the history of the CCSVI hypothesis and the science behind it, a terrific resource is the book "CCSVI As the Cause of Multiple Sclerosis" (click here), written by Marie Rhodes, a nurse and MS patient who was at the forefront of the CCSVI movement when it was in its early infancy. The book offers a wealth of knowledge, and is even available in a Kindle version.

♦ The Multiple Sclerosis Association of America (MSAA), a terrific organization that does much to aid MS patients, is offering a couple of interesting programs that caught my eye. The first is a webinar series designed to instruct patients on taking care of their financial well-being (click here), an incredibly important topic given the fact that so many of us are either already on disability or are contemplating a potentially financially treacherous future out of the workplace. The first webinar, "Being Money Smart", is scheduled for October 6, so sign up now!

The second program is the MSAA's Annual Art Showcase, which is now accepting submissions (click here). This year's theme is "Change", and artists are encouraged to interpret this theme as creatively and broadly as they wish. The showcase is limited to two dimensional art, and doesn't include photography (boo!).

♦ For those interested in the alternative treatment Low Dose Naltrexone (LDN), Julie Stachowiak, who writes About.com's invaluable weekly column on MS, has been keeping a diary of her recent foray into the world of LDN (click here). Naltrexone is an old drug that is used to treat various addictions, but in very low doses it has been purported to alleviate the symptoms of MS and a variety of other diseases. Anecdotal accounts seem very encouraging, with many patients reporting significant improvements while taking LDN. I tried LDN early on in my MS adventures, but found it didn't do anything for me. Of course, I'm not the best example to go by, since my diagnosis is quite uncertain (click here).

Unfortunately, because Naltrexone is an off patent drug it's cheap and there's not much money to be made from it, so very few if any scientifically valid clinical trials have been done to test its efficacy on MS patients. Just another of the many travesties visited upon chronically ill patients worldwide by a medical research system driven more by the quest for profit than by the desire to alleviate the misery of millions. Harrumph.

♦ Researchers in Scotland have found that marriage between cousins is not to blame for the high rate of MS found in that region (click here). Scotland has one of the highest rates of MS in the world, approximately 1 in 500, and the islands in which the study was conducted, Orkney and Shetland, have rates higher still. Far be it for me to cast judgment, so all I'll say to those contemplating marrying a close relative is that you can put any fears about your future children being predisposed to developing MS to rest. As for fears about extra limbs, or eyeballs in the middle of their foreheads, well, that's another story…

♦ In a sad bit of news, a lion suffering from Multiple Sclerosis like symptoms in Brazil died this past July (click here). Apparently, the plight of Ariel the lion touched the hearts of many, and his story was chronicled on his own website and Facebook page. Since I believe in a just universe, I'd like to think that Ariel is now in lion heaven, where he is using his fully functional claws, paws, and powerful legs to viciously maul and tear to pieces all of the naughty wildebeests and zebras who were sent to wildebeest and zebra hell. For everything, there is a season…

As Porky the Pig might say, th-th-th-that's all folks…
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Friday, September 16, 2011

It Takes One to Know One

The Three Musketeers by Alexandre Dumas (illus...
Image via Wikipedia

Receiving a diagnosis of multiple sclerosis, or any other dire illness, instantly transports a person to a very lonely place. They are suddenly no longer one of the "healthy", but are now marked by disease. A psychological shift occurs as the freshly minted patient grapples with their new reality. Although they might have been feeling unwell for some time, most folks are quite good at denial, so much so that many simply ignore their early symptoms, rationalizing them as inconsequential quirks, and proceed to get on with life, whistling past the graveyard as they go.

Back in the summer of 1995, I remember suddenly feeling the unmistakable sensation of liquid running down my left thigh, and I wondered for a moment if I was somehow inadvertently peeing in my pants. Reaching down, I felt that my thigh was dry, so no, I had not abruptly become incontinent. After a day or so, this weird sensation subsided, but in its place was a distinct numbness on the front of my thigh, stretching all the way from my hip to my knee, a lack of feeling that persists to this day. Given the fact that I was a world-class hypochondriac, you'd think that this disturbing symptom would've sent me in a panicked sprint to the nearest doctor. But no, I chalked my numb thigh up to a little fender bender I'd been in a few months earlier, and simply attributed the lack of feeling in my leg to some kind of pinched nerve or something. End of story, or so I hoped.

Eventually, though, after years of mounting warning signs and an increasing awareness that something just wasn't right, I developed a limp in my right leg, a symptom that couldn't be ignored. After seeing a number of doctors and undergoing a series of tests, I was finally shown some MRI images that clearly depicted a large lesion at the base of my brain stem, and was told I had MS. Whammo, I was plucked from the world of the healthy and forced into a scary new place, without so much as a parting gift or a welcoming orientation. I was confused, frightened, and, despite being surrounded by loving family and friends, suddenly quite alone.

No matter how genuinely well-meaning and caring the people around me were, there was simply no way for them to really understand the maelstrom of emotions that was roiling inside of me. Outwardly, I remained relatively calm and in control. Oh, I had my moments of gushing anguish and despair, but for the most part I maintained a fa├žade of normality. Inside, though, it was as if I'd been gutted, and I felt like I was drowning, gasping for air. All of the sympathy and words of encouragement being directed my way were of little comfort, and in some ways made me feel even more singled out. Worse yet was the awkwardness of folks who decided it was probably best to leave my situation unacknowledged, and to act as if nothing had changed. While this might sound great in theory, the key word there is "act" as if nothing had changed. Suffice it to say that most people are very bad actors.

I deeply appreciated the declarations of support and affection that I received in the wake of my diagnosis, but, as beneficent as they were, they did very little to dampen the effects of the emotional nuclear bomb going off inside of me. The plain fact was that in some very real ways I was now quite alone in a crowd, as I was going through an experience that the members of my crowd not only had no personal knowledge of, but actively dreaded. Human beings are pack animals, tribal by nature, and despite being surrounded by people who genuinely cared, I was now a tribe of one.

Thankfully, I soon enough found salvation in the form of Internet chat rooms and forums. The web has a lively community of MS related sites, and although I at first felt like an intruder, reading much more than participating (lurking, it's called in forum lingo), before long communicating with fellow patients on the Internet became an elixir, and one that was quite addicting. Finally, a conduit to people who simply got it, who felt many of the feelings and experienced many of the experiences I was now going through, from whom I could learn and with whom I could share information and commiserate, no explanations necessary.

As my disease has progressed, and I have become more disabled, the need to communicate with others in similar situations has become even more vital. Like members of a secret society, we share hidden knowledge, from the indignities suffered courtesy the often maddening world of modern medicine, to the daily struggles of just doing things that not so long ago were no struggle at all. I recently had a conversation over lunch with another wheelchair person, during which we marveled at the fact that at some point in the past we'd been able to wake up, get showered, dressed, and out of the house in 45 minutes. Nowadays each of those acts could easily take more than 45 minutes, not including the periods of rest needed between each one. How could a healthy person ever really understand what it's like to try to make your way through world in which everyday objects have been turned into obstacles, from trouser buttons to socks to doors to utensils, all once mundane items now transformed into puzzles as complex as a Rubik's cube.

Fear is another factor that binds us, and what a tremendous relief it can be to talk to someone knows just what it's like to be left staring at the dark at the end of the tunnel, who has lived through those desperate moments when the worst-case scenario doesn't seem so far-fetched, when all of your best efforts at living in the moment and maintaining a stoic detachment temporarily evaporate and the ugly reality of the disease and its destructive capabilities breathes its rancid breath down your neck, whispering vile threats in your ear, threats which are far from empty. We're only human, after all, and despite our strongest efforts, such thoughts are never really all that far from the surface. When the conversation does turn to such matters, although very often laced with a heavy dose of gallows humor, the topic is usually discussed with frankness absent all denial, and speaking of what is sometimes considered unspeakable renders the sentiments expressed far less ominous than leaving them to fester in the dark recesses of the mind.

Yes, it takes one to know one, and despite the heartfelt gratitude I feel for all my healthy loved ones, friends and family alike, who have helped me get through this ordeal, the ability to connect with others who share an unwanted membership in our hideous little club has been absolutely vital. More often than not we laugh in spite of and at this insidious disease, defiant in the face of our shared adversity. We celebrate each other's victories, and mourn each other's losses, comrades in arms for the fight of our lives. Through the Internet and through this blog I've met many such folk, even if only by e-mail, and to all I say thank you, for understanding, for filling the void, for your courage and your kindness. My diagnosis may now be up in the air, but that doesn't change the inner or outer struggles I've experienced in dealing with my disease. As they say, a rose by any other name…

Now let's give this thing exactly what it deserves, a good swift kick in the ass, and if you can't kick then scratch its eyes out. Don't forget, living well is the best revenge, so live, my friends, live.
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Monday, September 5, 2011

Say It Loud, I'm a Gimp and I'm Proud!

James Brown Live 1702730001
Image by Heinrich Klaffs via Flickr

Apologies to James Brown for the title of this post, as his 1968 funk classic "Say It Loud, I'm Black and I'm Proud" (click here to listen) helped galvanize the civil rights movement in America, offering a joyous rallying cry to people who for far too long had suffered at the hands of racism and oppression. The song was not only a shout of protest, but an admonition to embrace the very thing that conferred minority status on an entire people and turn what for some had at one time been a mark of shame into a badge of honor. On top of all that, the song irresistibly generates the urge to get up and shake your groove thing. That is, of course, if you are able to get up at all.

Those of us whose disease has progressed to the point where shaking our groove things is a distant memory and has left us visibly disabled - reliant on canes, walkers, or wheelchairs - also find ourselves members of a minority group, the disabled, the inclusion in which leaves some feeling invisible, helpless, and diminished. Much of the world simply isn't designed for people who don't have full use of their limbs, and the fully functional folks who populate it can be insensitive, uncaring, ignorant, and sometimes even intolerant. Though much progress has been made in in the fight for the rights of the disabled, the struggle is closer its beginning than its end.

Throughout much of history, victims of chronic illness, particularly of the kind that deform or disable, have often been looked upon with scorn, as if getting sick was somehow a mark of shame, the afflicted somehow responsible for their own affliction. In some cultures it was considered bad luck to merely let your gaze fall upon such a person, and even in those societies with a somewhat more sophisticated purview, it was often thought best to sequester these people away, if only to keep the more fortunate from feeling uncomfortable and ill at ease. Even within the last hundred years, the Nazis saw fit to exterminate those with chronic or genetic illnesses, to keep their precious Aryan gene pool from being polluted by such wretchedness.

It's no wonder, then, that the sick can sometimes feel some vague sense of shame, wondering what on earth they'd done to deserve such a fate. The human mind seems programmed to search for reasons, yearning for clearly defined cause and effect connections in a futile attempt to make some sense of the world and our place in it. The sheer randomness of getting hit with a miserable disease is in itself unsettling; in some ways illness might be easier to deal with if we could discern some reason for our demise, if we could appease ourselves with the knowledge that our current sorry state was brought about by some heinous act we'd committed in the past. No dice, though, the truth is that in the giant poker game of life we were simply dealt a crappy hand. Remember, though, that played the right way, with just the right amount of bluffing, sometimes even a handful of rags can be turned into a winner.

As I whiz around the city in my wheelchair, I often encounter fellow members of the electric chariot club, and always attempt to give them a friendly nod and a hearty hello. Many eagerly return the favor, but others seem to fold into themselves, clearly wishing they could become invisible, embarrassed that any attention be shined on them. My heart goes out to these folks, particularly because I completely understand where they're coming from, and then some. I was once quite the prideful jackass, mortified at the thought that the wonderful me could wind up in a wheelchair, and when the day finally came and the damn thing was delivered, I stared at it for several hours feeling quite nauseated before working up the gumption to actually get in and give it a try.

I've never felt more acutely self-conscious than those first few minutes wheelchairing out on the streets of the city, thankfully with my wife by my side. Soon enough, though, I realized that most of the people on the street were so self-absorbed that they didn't even notice me, as was evidenced by their propensity to walk right into me and my mechanical monster, as if anything below chest level was invisible. Before long I chafed at the idea that some freaking wheelchair was going to define me. Screw it, I would define it. I am not a chair, a cane, a walker, or an ankle brace, I'm Marc, and maybe now an even better version than the old Marc, having survived and learned from the endless gauntlet of physical and emotional affronts so thoughtfully provided by my disease and the modern medicine machine into whose belly I've forcibly been thrust.

Chronic disabling illness provides quite the double whammy; not only must the patient deal with the sobering psychological realities of being sick, but also with the physical handicaps wrought by their affliction. I'd imagine that even for the most stalwart among us, the burden can sometimes be just about too much to bear. Despite always attempting to publicly put my best foot forward (ha ha), each landmark on the road to disability has caused me emotional turmoil and plain old heartache. I've stumbled down a path familiar to far too many, marked by a succession of assistive devices, each one more obvious and discomfiting than the last. The anticipation that preceded my needing each of these devices was undeniably gut wrenching, so much so that in retrospect I realize that I put off reluctantly accepting their help for far too long. Frantically holding on by my fingernails to a self-image that had simply ceased to be, when I finally relented and allowed these mechanical aids into my life, they brought with them much needed relief and liberation, rather than the shame and revulsion that I had been so fearfully expecting.

Overcoming the mental and physical hurdles represented by accepting my increasing vulnerability has certainly given me a new sense of perspective, and maybe even a pinch of wisdom. The strange truth is that although my disease has left me exceptionally weaker physically, it's also made me immensely stronger psychologically. Like each and every one of my fellow patients, I've overcome obstacles before which I thought I would simply shatter, and by so far surviving the raging battlefield of illness I've gained self-knowledge and an inner fortitude that I never previously could have imagined myself capable. I've witnessed bravery and guts in other patients that have oftentimes had me verging on tears, daily displays of strength often nonchalantly expressed with nothing more than a smile and a shrug. I tip my hat to all of you, and invite everyone to join me in raising a big middle finger to any thoughts of shame or self-doubt brought about by the random bad luck of being socked by a serious illness, to any notion that we as people have somehow been diminished by our disease, and to the goddamned disease itself. Having and living with MS sucks, but the challenges it presents give ample opportunity to display grace, courage, and powerful determination.

Say it loud, I'm a gimp and I'm proud!