Thursday, September 22, 2016
When I have allowed myself to stray down this tangled trail, a nasty battle always breaks out between my Buddhist and existential leanings, my inner Siddhartha calmly stating that there is no such thing as coincidence while my inner Jean-Paul Sartre screams back that life is nothing but an exercise in randomness. Nothing like a philosophical brouhaha roiling around inside the noggin to ruin what might have otherwise been a decent day. In the end, these thought kerfuffles inevitably lead me to counter the “why me?” conundrum with its other half, “why not me?”. This seems to temporarily satisfy both Siddhartha and Sartre, forcing them each to retreat back to their own little corners of my mind, where the Buddha sits in quiet meditation and Sartre drinks and smokes his brains out.
I have of late been giving more thought to the “how’s” of my illness, as in “how the frack did I get so sick!?!?”. Whereas the “why” question deals more with the metaphysics of the situation, the “how” is focused more on the nuts and bolts of the disease mechanism and the circumstances that led to my getting ground-up in its gears. At first glance the “how” might seem as insoluble a question as the “why”, but by sizing up what we know about the disease and matching it with the circumstances of my own life I think I’ve come up with a reasonably plausible explanation for how I got from point A to point B (and the B stands for “Blechh”).
It’s long been suspected that Multiple Sclerosis and other so-called autoimmune diseases have strong genetic components. As scientists have begun to unravel the human genome, more and more genes have been discovered that seem to play a role in the Multiple Sclerosis disease process (click here and here). While many patients might not be able to isolate their own genetic susceptibility without a complete mapping of their DNA, in my case the genetic connection is actually quite clear.
My mom developed gestational diabetes when she was pregnant with me, and unlike the vast majority of such cases, her illness did not resolve after I was born. Stranger still, her malady turned out to be type I diabetes, otherwise known as juvenile diabetes, by far the most serious form of the disease. Type I diabetes is thought to be caused by an autoimmune attack on the pancreas, leaving it unable to produce insulin. A shake of my mom’s family tree revealed that her grandfather and uncle also had type I diabetes, indicating that there is certainly a genetic trait for the disease being passed down from generation to generation. Research has shown that the children of diabetics have a 50% greater chance than the general population of developing some sort of autoimmune disease, and here I am with not only MS but also Hashimoto’s thyroiditis, an autoimmune disease that destroys the thyroid gland. It is also suspected that I’ve had an autoimmune attack on my pituitary gland, and for a while the doctors thought I had discoid lupus, an autoimmune disease that attacks the skin.
Of course, simply having the genetic predisposition to develop a disease doesn’t on its own guarantee that a person will get sick. Given my family history, it’s likely that many of my relatives share these same funky genes, and none of them, to my knowledge, have developed diabetes, Multiple Sclerosis, or any of the other usual suspects (lupus, rheumatoid arthritis, Crohn’s disease, etc.). Somewhere along the line something needs to trigger the genetic susceptibility for disease to take hold, in effect turning the “sick genes” on. In the case of MS, scientists have long focused on the Epstein-Barr virus (EBV), a member of the herpes virus family, as a likely disease trigger.
Epstein-Barr virus is the nasty bug responsible for mononucleosis, although most people infected with EBV never do develop Mono. Instead, the initial infection can manifest as a severe cold or flu, and a person can often be infected without having any symptoms at all. Once infected with EBV, the virus stays within a patient’s body for the rest of their lives. Infection with Epstein-Barr virus is so common that it’s estimated about 90% of the adult population harbors the virus. Astoundingly, though, it’s been found that 100% of MS patients are infected with EBV. That’s right, 100%. The correlation is so high that some researchers have stated that “people who are not infected with Epstein-Barr virus do not get MS” (click here).
Sure enough, blood tests have revealed that I am indeed infected with EBV. Of course, since the vast majority of adults are also infected with Epstein-Barr virus, the virus alone can’t be the cause of Multiple Sclerosis. In conjunction with a genetic susceptibility, though, the virus may be the thing that tips the scales between health and illness.
It’s interesting to note that in its dormant state, Epstein-Barr virus takes up residence within the immune system’s B cells. Just so happens that some of the MS disease modifying drugs destroy a patient’s B cells, thereby ridding the body of much of its EBV load as well. The interferon drugs (Rebif, Avonex, Betaseron, Plegridy) also happen to be very strong antivirals. Could it be that these drugs work, at least in part, not because of their immunosuppressive or immunomodulating properties, as is commonly believed, but because they are attacking EBV in the bodies of MS patients? Not a mainstream idea to be sure, but something I think worth considering.
Epstein-Barr virus isn’t the only infectious agent that has been linked to MS. The bacteria responsible for many sinus infections have been implicated in the disease as well (click here and here). I’ve suffered from sinus infections most of my life and had endoscopic sinus surgery in 2006 to try to eradicate the problem. Unfortunately, the surgery only helped temporarily, as my sinus problems reemerged soon afterwards. So I’m two for two when it comes to possible infectious triggers for Multiple Sclerosis.
Actually, make that three for three. Exposure to toxic molds and funguses have also been linked to neurologic and demyelinating diseases (click here), and back in the 1990s, when I was living in South Florida, I spent two years working in a building that was found to be riddled with toxic molds and bacteria. At the time I was employed by a startup company, and after a few months working in their very crowded offices the company moved into a larger building that had been empty for quite some time. The facility was in pretty bad shape, with wires dangling out of the decrepit ceiling panels and a musty smell hanging in the air. Simply walking into the place felt unhealthy.
After spending about a year and a half working within those walls it was revealed that upper management had been sitting on an environmental report which stated that the building was riddled with a smorgasbord of toxic microorganisms. The sons of bitches in the executive offices had kept the report hidden until one of their administrative assistants copied it and left it on the desks of several employees. Soon after, men in hazmat suits came and sectioned off parts of the building as they decontaminated the place section by section. In retrospect, my first weird symptoms started cropping up while I worked in that building, and last year when I was tested for exposure to toxic molds the results came back positive. Wonderful.
Stress is another factor that has been linked to MS and similar diseases. Many MS patients report their first symptoms after periods of acute stress, and it’s been demonstrated that stress can bring on relapses in those patients suffering from Relapsing Remitting Multiple Sclerosis (click here). Though I’d always been neurotic and prone to worry, my years in South Florida were especially filled with stress, both of the acute type brought on by upsetting life events, and long-term simmering stress engendered by living in a place where I always felt like a stranger in a strange land.
My periods of acute stress were almost always initiated by the breakup of romantic relationships, which I inevitably took much harder than was even remotely reasonable. Losing a long-term girlfriend more often than not sent me into a period of prolonged psychological agony, during which I’d lose weight, sleep, and sense of self for months and months at a time. Yes, I know it’s hard to believe that any woman would leave a fella as oozing with charm as me, but lo and behold, there were a few who unceremoniously gave me the gate. And when they did, I imploded. Seems I had an incredible knack for zeroing in on precisely the women who would be most toxic to me and then fall for them, hard. I believe the accepted psychological term for a person who habitually engages in such behavior is “jackass”.
Soon after one breakup in 1997 I suffered from incredibly severe headaches for about three weeks, super intense searing headaches that emanated from the base of my skull and left me damn near completely debilitated. Now my MRI images reveal my one big juicy MS lesion at the very top of my spine right beneath my brainstem, precisely at the spot from which those headaches seemed to radiate. Could it be that those headaches of old were somehow involved in the formation of the lesion that is at the root of my current neurological mess?
The latter five or six years of my stay in South Florida found me enmeshed in a kind of simmering, low-level stress brought on by trying to be someone I wasn’t. I spent that time working in extremely corporate environments, shirt and tie type places that I found to be soul stifling. Though I had creative jobs within those organizations, the stress of trying to conform with corporate culture took its toll. I had once sworn I would never join the 9-to-5 workaday world, but there I was, sending myself off to prison each and every day.
Though I made several very close friends in Florida and was never wanting for a social life, I always felt somewhat alien there, my aesthetics and values simply at odds with the place and most of its inhabitants. Still, for reasons I can’t fully explain, I remained living in a place I couldn’t stand while working at jobs I hated until one final romantic breakup mercifully sent me packing back to New York, where I rediscovered the me that I’d almost forgotten existed. And then, just a few years later, the beast that had been showing glimpses of itself for years finally reared its ugly head, and I was diagnosed with MS.
There then is the “how” of my disease, as best as I can figure. Genetic predisposition? Check. Exposure to infectious triggers? Check. Periods of stress, both acute and long-term? Check. Now, if only there was some way to uncheck some of those boxes. Researchers are just starting to try to figure out how to address the genetic aspects of disease, and many biotech startups are attempting to develop gene therapies for a variety of illnesses. Scientists are working on vaccines for Epstein-Barr virus, but the work still seems to be in its early stages (click here). And though life will never be free of stress, individuals can learn techniques such as mindfulness and meditation that can help them make better life choices and reduce the impact of stress on their existence.
I wish I could say that figuring out how I got sick brings with it some sort of gratification. I suppose that on a purely intellectual level fitting the puzzle pieces together into a somewhat coherent picture is a teensy weensy bit satisfying. Then again, all of my conjecture may be completely wrong, my illness due more to the evil eye put on me by a Gypsy beggar I once crossed than to the elements identified by my keen analytical powers. Perhaps it was my destiny to wind up the Wheelchair Kamikaze, and no matter what choices I made, all roads would’ve converged at point B (as in B, for “Barf”). Okay, I’d better stop this thought train before Siddhartha and Sartre square off and pelt each other with rocks and garbage in the deepest recesses of my brain pan…
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Great article, many thanks for touching on the whys and wnerefores. You made many connections which sound valid , even to the Buddha / Sartre level ! Thanks for being a strong ' voice in the wilderness' - now I'll shut up and go, before I start sounding New AgeyReplyDelete
I agree totally. In my case, another factor is that I was a formula fed baby. This probably profoundly affected my gut microbiome. I also had too many strep throat infections as a kid, with dozens of rounds of antibiotics. Both of these factors likely contributed to my diagnosis of severe IBS from a young age, my CFS from age 12 following a bout of mono, and the UC diagnosis and severe SIBO I deal with now. I test allergic to most foods, Eating is excruciating for me and I am beyond underweight. There is some anecdotal evidence from the benefits of FMT for MS. Autoimmune diseases are the bane of the modern world.ReplyDelete
Marc, thank you for this post and, as always, your insights.ReplyDelete
...yes the "Why not me?"..question seems to put the "Why?" at ease. Is there someone else I would wish this on? No!
The How is another question...which I have recently been focused on too. (As my dad was adopted, I cannot research the genetic component) But, I realized that I had a few things happened--each following extreme stress episodes in my life-- including mono in the 1960's (EBV)... had a single bout with Herpes in the mid 1970's... major work stress in the early 1980's (which brought on the initial symptoms and diagnosis)...and finally the multiple losses of my family members from 2004-20015-- each causing this horrible disease to progress.
Whether it was your destiny or not...know that your blog means a lot and helps many of us.
As always, your post is as entertaining as it is informative. Keep 'em coming. Any topic, any amount of philosophical wanderings, any grumpiness, any information, any anger, any hope, is eagerly anticipated and always welcome. You are an international treasure to the community of MSers and allies!ReplyDelete
And, my 14 year old grandson once said to me, as we were discussing the mysteries of life and beyond, "Yia, maybe there are some things we are not meant to know". And, so I have lived by that wisdom ever since.ReplyDelete
Love ya as always,
I had mono in the 1960's and got herpes in the late 1970's.ReplyDelete
I'm glad to hear that mono may have been the trigger. I've been beating myself up thinking the herpes caused my PPMS. It may have but I didn't do anything to get mono when I was young.
Thanks for your always informative, humorous, thought provoking posts.
Marc great to see a blog entry from you. I can't figure out out other than stress. No parent was diabetic and unless my great grandfather was misdiagnosed with parkinson's its not genetic that I know. You may want to check out the Biotin and MS Group on Facebook. My legs feel a tad bit stronger, but I've only done the high dose for five months. The French Biotin study is interesting to say the least. Hugs and hang in there! Much love, JudyReplyDelete
I too had major headaches at the site of my first lesion. Doctors told me there was no way I could feel it. Oh, I did.ReplyDelete
Thank you Marc.ReplyDelete
Hello, you may have seen our post on other pages. I hope it is appropriate to post here.ReplyDelete
The Henne Group is a research organization based in San Francisco. We are looking for individuals interested in joining our panel and participate in future research projects about their experience living with Multiple Sclerosis (MS).
If you are interested or know of someone who would be, you can follow this link to sign up: http://bit.ly/THGMSstudy
If you have any questions you may call 415 - 348 - 2936
Thank you for your help
Thank you Marc for your insights. I consider you a friend though we have never met. I love your zeal and share your fighting spirit and frustrations with our common foe. You are well versed on the workings of our nemesis.ReplyDelete
I believe my time is best spent on understanding what MS is so I can understand how to undo it. I yurn to know it better so I can kill it.
I leave the whys to lie untended.
I've tried to flip the table on this beast and grow through the adversity I face. I've discovered a new me by stepping out of my old self and creating a new one.
We have a choice in how we face our challenges and I choose humor and a positive attitude until the end and it's not the end until.. .
we'll really there is no end and that's the best part.
Marc, thank you for your in-depth search for the answer we all ask.ReplyDelete
My answer to the "Why me?" question is now, and always has been, "Why not me?" I figure I am just as good a candidate for this disease as anyone (being of Northern European ancestry and living on in the Pacific Northwest). I also believe it is my Karma, and my next life has to be better than this one has been for me - forever the concurrent realist and optimist.
Are you ok?ReplyDelete
Hi, thanks so much for your concern. Yes, I'm okay, relatively speaking. Just have been suffering from a lack of inspiration and dealing with several distractions. Should have a new post up sometime soon…ReplyDelete