Category: Progression

WTF?

While I do my best to concede nothing to MS, I’m not reckless. I do what my body allows. Over the years I’ve become very aware of my body mechanics and consciously think about them whenever I am moving for two reasons. The first is because if I don’t, falling becomes a real possibility because my balance is completely shot and it doesn’t take much to throw it off. As a result, I average only a few falls a year. The other reason is the progression has slowly devoured my leg. Starting in the toes and feet fourteen years ago, it has insidiously made its way to almost mid-thigh. The ankle and knee bend slightly to the right when I walk, so I know that one misstep could cause something to tear. Needless to say, I am careful to a fault whenever I am upright.

So why the hell did I wake up Wednesday morning with a stiff and swollen knee?

It had become swollen before, usually because of strain I put it under when I work outdoors, but nothing like this. The joint was uncomfortably swollen, and weaker than normal too. At first, I freaked a little because I assumed it was the MS. I never had that moment where I stepped wrong or twisted it. I never did anything where I had the searing pain followed by immediate swelling and throbbing. So how couldn’t it be the MS? I reached out to my neurologist and made an appointment to see him the next day.

As the workday proceeded, the joint got stiffer, and it became a little painful. Then I remembered a day when I was simply walking from one room in the house to another when I felt a sudden pain in the knee and the leg buckled. Body mechanics, I thought, because the pain stopped as quickly as it came, and didn’t last. It was like a bee sting in the sense that it happened unexpectedly, hurt like hell, but only for a second before it went away. It was more shocking than anything else, and once I stabilized myself the knee didn’t hurt, and my walking was no different than before the incident. I don’t remember when this happened, but it wasn’t recent, which is why I hadn’t thought of it earlier.

Maybe I should see a doctor, I thought. Just in case. Long story short, the word blood clot was discussed at one point, which really caught my attention, but ultimately an x-ray was taken and the knee joint was fine. It was swollen, but as they poked, prodded, torqued and examined the joint, I felt no pain. I thought they were going to drain the thing, but apparently there wasn’t enough fluid to warrant it. Instead, I received a tapered dose of steroids to be taken over six days, with instructions to follow up if the symptoms didn’t improve. They speculated that I could have a partial tear or some loose body floating around in there, but since there was no pain, there wasn’t any urgency. Not that I minded. I hate needles, which you might think odd since I get stuck multiple times in my arms every month, but there is a big difference between hitting a vein and sticking something much bigger into a joint. Maybe it isn’t as bad I assume, but I’m in no hurry to learn.  

I’m on day five of the meds now and there has been no improvement. It’s worse, although it didn’t start that way. The day after the examination the knee was less swollen and felt looser. I figured they were right and stopped worrying about it. I still went to see the neurologist the next day. He didn’t think it was likely that this was MS related but understood my feelings about the pace of its progression. We decided to have a new set of brain/spine MRIs because the last one I had was over five years ago, and I left his office feeling positive about things.

Three days later, I can barely walk. I know what the MS feels like in my leg, and this is different. I’ve always walked slowly and laboriously, but never gingerly. I am now because I can’t put any kind of weight on the leg without feeling pain in one spot in the knee. I’m not completely incapacitated, but when I am on my feet, I’ve been reduced to walking slowly in a straight line provided I have a cane to take some of the weight off the knee. Even inside the house, which is a first. Stairs are tough.

Well see how this feels on Monday, but I’m not optimistic. Over the next couple of weeks, I will have to shoehorn an appointment with an Orthopedist and whatever they recommend, with a plasma transfer and Ocrevus infusion, and a brain/spine MRI. Swell! I long for the old days, when I rarely went to a doctor for anything, and the only times I was in hospitals was as an employee, not every month as a patient like I am now. The main reason early retirement is not a serious consideration is because of my health insurance.

I know I’m jumping to conclusions about the knee. I’ve been off my feet most of the day, and it does feel a little better. But as you can see, the knee isn’t pretty and something still feels wrong. The only saving grace is the knee is in the leg affected by the MS, so I am used to not having the leg be able to do much. If this was happening to the good leg, I literally would not be able to walk.

So off to another doctor I go, hoping to get answers and solutions. One of the questions concerns healing with MS. If they scope the knee and repair stuff in a leg that is consumed by the effects of MS, does that impact or compromise healing? It’s a nerve thing, so I don’t think it should, but I am curious.

Regardless, this needs to get taken care of because I don’t want this to linger when the warm weather gets here. My life is sedentary enough.

Immunosuppressed In a COVID World

decisions

Being immunosuppressed in a COVID world definitely presents complications the average bear doesn’t have to navigate. MS is particularly tricky, because the reason I have the condition is my autoimmune system is on overdrive. In theory that means I should be more protected than most. After all, in order to treat the disease, the goal is to put the immune system to sleep so the body stops cannibalizing itself.

Once I started taking the intravenous meds over ten years ago, I assumed a suppressed immune system would mean I would catch everything known to mankind.  I would have bet everything I owned that I’d be sick with a cold , flu, or some godawful thing from Thanksgiving until Spring, but that never occurred. In fact, I can count the number of times I have been ill during this span on one hand, which I still think is odd, and I have no idea what this all means.

The reason this is becoming an issue is because while last month’s plasma transfer provided immediate relief from the weakness and the falling, the relief only lasted ten to fourteen days. Since then, I have been struggling with my balance and ability to move around. I literally have no strength in my ankle, my leg feels like it has no bone in it from just above the knee down, and the weakness gets worse with each passing week.

So while the plasma transfer helped, it appears my condition has regressed. The only thing I have done differently in terms of treatment (other than going two months without doing anything instead of the normal one)  is that I suspended receiving the Ocrevus infusion that was due in March. It has been over nine months since my last infusion, and the gap between treatments is supposed to be six.

So my dilemma is to whether to bite the bullet and get the damn thing. This is not the first time I have stopped taking something to my ultimate detriment, and while I cannot clinically prove the infusion has been helpful, my not getting it certainly fits a historical pattern. But I know from lab test results that this drug shuts down cells that fight infections, and that doesn’t sound like a smart thing to do.

What is most irritating about being in a high at-risk group is that you have to think about and analyze everything. This is cumbersome because nobody knows if the decision they are about to make is going to be the correct one. I go through a line of thought that asks if the decision I am about to make is balanced and thought out or impulsive. Is it selfish? It is overly conservative? Is it rational or based on fear? Is it what is best for me? Is it what is best for my family? The process can be draining.

For instance, do I avoid any kind of crowd, even if I wear a mask, if I get the infusion? Do I stay home and not visit anybody or have anybody visit me? Do I live like the boy in the bubble? Or do I throw caution to the wind and say fuck it! I was taking a lot more immunosuppressing meds than I am now and rarely got sick. Why should this be any different?

Well, the difference is the potential consequence, which could be tragic for myself and those around me. That is the rub. One bad decision and the dirt nap can become a real possibility.

While I don’t have any plans for the summer, I like to have options. A group of good friends from out of state have talked about getting together this summer, and while I’d really like to do that I’m not sure how smart that would be if I go ahead with this. I’d also like to go back to a restaurant at some point in time, and be able to visit with local friends. Part of me says why worry if the necessary precautions are taking. Then again, there is that nagging little voice that whispers, “what if?”

My gut tells me to get the infusion sooner than later. I would like some assurances, but I know there are no guarantees. I suspect that I will be reduced to a prisoner in my own house for a minimum of three months if I get the stuff, and I really don’t want that.

But what good is having options if you can’t walk more than ten feet without holding onto or grabbing something? What good is freedom if it means a complete loss of mobility and a quicker date with the wheelchair. Is the risk worth the reward? I’m thinking not, but we are heading into the best time of the year, which would make my confinement seem exponentially longer.

Do I risk being completely disabled or risk being completely dead? I obviously don’t like either choice, so the middle ground is to get the drugs then hide from the world. That is the sober reality of the situation.

I’m waiting to hear to see what my neurologist has to say about my quandary. Meanwhile, I’m trying to figure out how I’d cope with the restrictions I know the infusion would place upon me. One option that crossed my mind is to increase my MMJ intake and live in a comfortably numb state, except when I am working or sleeping, until a vaccine is developed and my sentence is over.

Now there is a thought!

 

 

 

 

Back In The Treatment Saddle

saddle

With few exceptions, I have received plasma transfers and infusions of various drugs every month since 2008. From time to time, and especially within the last year,  I’ve wondered if I really benefited from these treatments, and pondered the possibility that I have been wasting my time. You’d think I would have learned by now because history has proven that when I have stopped or suspended certain therapies, the symptoms get worse.

I was due for my semi-annual Ocrevus infusion in March, but this was the time when COVID 19 was on the verge of introducing itself to our state, and I didn’t think it was a good idea to take immunosuppressant drugs. So I received the plasma transfer and steroid infusion that month, but deferred the Ocrevus until I spoke with my neurologist.

The gist of that conversation was my logic was sound, and that it might be best to defer any future treatments as long as my symptoms were stable, giving us time to learn more about the virus and what was about to happen in our state.

April rolled around. I was feeling fine, and I planned to skip everything for another two months, but then decided to keep a May appointment I had on the books for the plasma transfer and steroids infusion, just in case.  It’s a good thing I did.

Halfway into April, the bad leg started to feel weaker, and I began to question the treatment moratorium. Then the falls started.

I don’t fall very often, maybe once or twice a year, and almost always when I am careless and not paying attention to something. That has always been a good barometer for how I am doing. During a three week span from mid April into May, I fell four times, and it wasn’t due to carelessness. My leg felt like it was turning into jelly, and walking around the house was more difficult, especially in the evening, as I was grabbing onto and leaning against anything within reach to get from point A to point B. Needless to say, this abstinence wasn’t working, so last Thursday I bit the bullet and headed back to the hospital to resume treatments, desperately hoping that I didn’t wait too long and that what I was experiencing was my new normal.

I was also wondering how different the experience would be compared to the pre-COVID days.

The drive to the hospital wasn’t all that different in terms of the traffic. It wasn’t super busy, but it wasn’t like driving through a ghost town either. I’m not sure what I expected, but what I saw was fairly normal for that time of the day.

Then I arrived at the parking garage. The floor I park on has somewhere between 150 and 250 parking spots, and the handicapped spaces, which are limited, are always full regardless of how early or late I arrive. Not only were those spots readily available, but I counted a total of 10 cars parked on the entire floor (when I left it was down to 6). I knew from my work that volume was down significantly, but looking at numbers on a spreadsheet is one thing. Actually seeing what that means has more impact, and I was honestly shocked at how empty the garage was.

The first order of business when I walked into the building was to make sure I was wearing a mask (the hospital provides them to those who don’t) and confirmed that I had an appointment (no visitors are allowed). Normally I head directly to the elevator and go upstairs to the treatment area. Instead, my temperature was taken, and I was asked a bunch of questions regarding where I have been and who I had been in contact with before I could proceed. The experience walking from where I started to the treatment area was similar to that of that parking garage: there weren’t many people around.  

The treatment area was on a different floor, having moved one floor down. The top two floors were exclusively dedicated for COVID patients, and the floor below those was being used as an ICU for these patients. The floor my treatments were usually on was left open for potential overflow.

The new treatment location was much smaller and felt claustrophobic. I was the only patient there when I arrived, and although one other patient did arrive after me, we could not see one another. In the pre-COVID days, the main treatment area was packed.

I had to keep my mask on the entire time I was at the hospital, and everybody who worked or was being treated at the hospital wore them too. I also learned a new term. When I temporarily removed my mask to drink some water after having it on for an hour and a half, the influx of fresh air was cool and refreshing. I made a comment about it, and my nurse congratulated me for experiencing my first “airgasm.”

The roads were empty during the drive home, which was a little eerie. I had left during what would normally be considered rush-hour, but the cars on the highway and the state routes were few and far in between. There were less vehicles on the road than you’d experience if you ventured out early on a Saturday or Sunday morning. The ghost-town type experience I wondered about had certainly come to fruition. I didn’t see many cars. In fact, I didn’t see much life at all.

The actual treatment experience was the same, which I expected. Finding veins was a piece of cake, presumably because I had gone more than two months without a needle stick. Later on in the evening it felt like I had more steel in my leg, and a week has gone by without any change. So I am cautiously optimistic that I dodged a bullet on the progression front. 

After speaking with my neurologist on Monday and talking about how I was doing, we decided to continue getting monthly plasma transfers and steroid infusions, but the Ocrevus will be deferred indefinitely. It has been nine months since my last dose of the drug, and I had assumed that my B cell level would be back in the low average range by now. I was shocked to learn that was not the case. The low end of average, by whatever units they measure it, is 4. My level was 0.9, so I’m not even close to normal. 

This development has changed my point of view regarding a number of items. I’ve been careful about social distancing, wearing masks and gloves when I am out, and things of that nature. But I have also been stubborn about continuing to do normal things, like shopping for groceries. So we’ll be having most of our shopping done by the online services that provide them for the indefinite future.

Then there is the whole returning to work thing. I miss the office and the people I work with, and presumed I would be returning once the state and the health system started to relax its restrictions. Now that I know my body’s ability to fight off infections is significantly compromised, I can see myself working from home much longer than I ever anticipated or wanted. That will be a different discussion for a different day, but I can’t see placing myself among crowds of people, even with a mask, until a vaccine is developed. Why take that chance?

I’m not afraid, will not become a hermit, and will venture out when necessary, but the definition of necessary has certainly changed. I guess we’ll see how it goes.

As a post-script to this narrative, I must say that the commute to and from the hospital, my employer of the last twelve years, opened my eyes. It was a wonderful experience, one that afterwards felt like I had temporarily busted out of jail. I had forgotten what it was like to feel free.

The commute was liberating. It was great to feel normal again, and to revisit the world beyond my self-imposed three mile radius. We take these mundane experiences for granted until they aren’t mundane anymore, and I didn’t realize the impact of what that really felt like until I was able to spread my wings a little.

I yearn for the day that kind of life can resume.

 

The End Game

End Game

Throughout my MS journey, I’ve never dwelled on the ultimate outcome of my progression, what I refer to as the end game. I mean, what’s the point? The end game has been the proverbial crazy relative locked in the attic. You know they’re there, and you know at some point in time there could be a reckoning, but you don’t pay much attention to it because all it does is get you cranked up. Meanwhile, you do what is necessary to keep the progression at bay and prevent that day of reckoning from occurring.

The only concession I have made to my condition, besides diet, apheresis and infusions, is this house we just built, figuring it would be better to be proactive, and create a new space that can accommodate my needs should the worst occur on my terms. In other words move when I can, leaving the emotion out of it, instead of when I have to. That decision may prove fortuitous because my symptoms have definitely progressed to the point where the end game feels closer than ever.

The symptom that first appeared twelve years ago was a subtle foot drop. Slowly but surely, the weakness progressed beyond my foot, consumed my ankle, and slowly made its way up the leg to just below the knee. Walking became increasingly difficult and annoying, but it was manageable, and even though I used a cane liberally, I didn’t need it to get around. For the longest time, the weakness and lack of control hovered in that area, and even though it made maneuvering and doing stuff harder, I didn’t think twice about any physical limitations, and never thought of myself as disabled.

Well, things have changed. Perhaps it was all the work and activity I did to help get this house ready. Maybe it was the move itself. Maybe it was the stress of this entire process, which was significant. Maybe it was a combination everything or perhaps none of this mattered, and it was simply inevitable. Regardless, the symptoms have now consumed the knee, and my foundation is crumbling.

My knee feels like a broken kickstand that is on the verge of falling off. The pin that holds it to the frame is still there, and keeps the bike upright, but barely. It is loose as hell and is constantly on the verge of popping out. My knee literally feels like it is hanging by a thread, and as a result the leg feels like it can snap in half at any time. I wear a knee brace now in addition to the AFO brace, which helps, but all it does is provide a little extra support to prevent the leg from torqueing sideways.

If I don’t plant my foot a certain way every time I step forward, all my body weight lands on the bad leg as the other leg swings through, and the results aren’t good. The knee forcefully snaps back and the leg suddenly becomes inflexible and ramrod straight, which hurts, and my body wants to lurch forward. I literally have to place my hand behind the knee and push to unlock it and get the leg working again. This can happen several times a day if I’m not careful.

Needless to say my balance is worse than ever. I am in danger of falling with each step I take, which is a first for me.

So the nagging thoughts have begun. Is this the beginning of a steady, downward slide? Is my body going to allow me to continue working full time until I planned to retire? How much longer do I have before a walker or the dreaded wheelchair become necessary? What is all this going to do to from a financial perspective? I was supposed to see my neurologist again in January, but moved the appointment up to a week from Monday. I’ve never done that before, but I need to hear what he thinks.

Of course, I know there are no definitive answers. This could be my status quo for years, or I could be in a wheelchair by summer. I have always known what the deal is, but it never became a conscious thought until now. That crazy relative has broken loose from their prison and is rampaging through the house.

I’m resilient and stubborn though. We’ll wrestle for a while, and I have no doubt I will subdue them, stuff them back into the attic, replace the door and padlocks, and focus on more important things that I can control.

At least until the next obvious progression comes along.

 

The New Normal

Normal

2019 will mark the eleventh year I have been living with MS. After it rudely introduced itself,  first on a treadmill and then a few weeks later when I was outside mowing the lawn, the symptoms weren’t that cumbersome. It took a couple of years before it permanently changed the way I walked, and the progression has been slow but steady ever since.

Some years have been worse than others on the progression front, but the result has been the same: my physical abilities are worse on December 31st than they were on January 1st.  That isn’t unusual given the nature of my beast, but as I was cruising with the blimp the other night watching a video that chronicled the Red Sox magical 2018 season, a thought occurred to me that in retrospect was both surprising and sad.

I honestly can’t remember what it feels like not to have MS.

That doesn’t mean I don’t I remember the life I once had, the one with no physical restrictions. After all, I still have the pictures and video. That was a life where I didn’t think twice about undertaking any chore,  where I could to stay outdoors in the summer heat as long as I wanted, and where I could play eighteen holes of golf on any kind of course. Those days seem so carefree and foreign now.

So yes, I remember the events. What is forgotten, however, is what it actually felt like to walk unimpededly, without thinking about every step I take. I don’t remember what it felt like wondering if every change in my body is an indication of additional slippage into the rabbit hole of progressive MS. I don’t remember what it felt like to run, go on long walks, to ride a bike, to frolic on the beach, to take the stairs without measuring each step, or not having to worry about falling in public. I don’t remember what it was like not having to worry about where the nearest bathroom is for fear of peeing myself, or not requiring a urinal within arms reach every time I am in my car.

My new normal has eclipsed everything about my old self. The mindset where everything is assumed and taken for granted is dead. I don’t remember anything about what is was like to be whole and able bodied. I don’t remember what it was like not having to go to a hospital every month to have my blood filtered and replaced, or having toxins infused in the hope that my body will stop cannibalizing itself.

I don’t think I’m unique in that regard, but I consider this disability as the death of my former self. That might be hyperbole because I obviously still reside in the land of the living. I have the same emotions, many of the old concerns, and continue to plod forward and rebel against my reality any way I can. In some ways I am better off mentally because I no longer take anything for granted, appreciate the little things more, and therefore have a better perspective on life. But it is not an exaggeration to say that I am a fundamentally different person than I was eleven years ago, and that this version of me could feel like Nirvana compared to what my status might be another eleven years from now.

This is the part of living with a chronic illness/disability that nobody talks about or explains to you. When you learn about your new reality, it’s understood at a certain level that your life will change. If you accept and adapt to that change like I did, you adjust to a failing body with as much grace and stubbornness as can be mustered. You don’t give up or give in, but in that process you also don’t realize that your previous life will be relegated to the dustbin of your memory until the day comes, like it did for me earlier this week, when you realize you can’t remember what it felt like to be the person you once were.

An argument can be made that this is a part of the aging process, but I’m not willing to concede that because I’m not even sixty yet. I’m no spring chicken, but I’m not an old geezer either. This is not the mournful lament of a man in his seventies who is acknowledging the effects of an aging body for the first time. My epiphany was the product of this neurological condition that has consumed my life over the last decade, and it caught me completely off guard.

The fact that I can’t remember any of the stuff I mentioned burst my denial bubble, at least temporarily. Not being able to remember what it felt like to have two good legs is like not being able to remember what it felt like to fall in love the first time, to lose your virginity, or to hold your infant child for the first time.

I’ll get over it, because what’s the point of crying over spilled milk? But it really does suck.

 

Measuring Stick

ruler

Winter has arrived early in New England this year. Last Thursday, six weeks before the official start of the winter season, about six inches of snow fell during rush hour, paralyzing traffic and generally raising hell with our psyches. This was followed by a period of cold rain, which left a slushy mess the following morning, and a period of much colder than normal temps that were made worse by a constant breeze. More measurable precipitation is in the forecast during the next twenty four hours, and Thanksgiving temps are supposed to be what one would expect in January. Swell.

I mention this not because I hate winter, as you have probably figured out from all the posts I wrote  last year. Nor am I writing about it because this has my nerves on edge because of its potential to raise some serious hell with our building timetable, which I will discuss in a future post.

No, the reason for pointing this out is because of what I have learned from our premature winter experience.

I don’t think my MS progresses in a typical way. Although get I flares from time to time, where something is noticeably different that does not go away, these are rare occurrences. I can count the number of times these have happened over the last eleven years on one hand. The best way to describe the nature of my progression is to use the following anlogy.

Imagine a river that runs through an unpopulated, densely wooded area that you can reach via a hiking trail. At the end of the trail, which is a scenic area, you look down about thirty feet and see the river carving it’s way through a rocky terrain. If you visit this place frequently, the sight that greets you down below doesn’t appear to change. But if you make the trip once every one or two years, you notice the erosion that the water caused since your last visit. The river is noticeably wider, and covers more terrain than you remember seeing the last time you were there.

My progression is like that. It isn’t noticeable from day to day, but every year one event takes place that clearly illustrates a progression I was not aware of, and last week’s snowfall was one such event.

Even though last week’s temperatures were the coldest of the year, they were in the low to mid forties during the day, which meant there was a lot of snow melt. While this stuff didn’t completely freeze until the sun went down, the driveways and sidewalks remained slick in isolated areas during the day. I’m always aware of the surface conditions during the winter because the last thing I want to happen is falling hard and braking something in the process, and last week was no different. I was very careful and methodical when I ventured outside, but even so, it became obvious that there was a big difference negotiating this terrain compared to the last time it snowed in March.

Moving on the slick and almost frozen surfaces was noticeably more difficult and treacherous. The most pronounced difference was my balance. More specifically, the lack of it. I could feel myself tottering from side to side, the leg always on the verge of sliding out from under me, even with a cane in hand. What I couldn’t determine is if the worsening balance was the result of less strength in the leg, or if the leg felt weaker because my balance sucked so bad.

All summer I thought I had achieved a lengthy period of status quo, and that if any progression had occurred it was minimal at worst. After all,  I hadn’t curtailed my activities, and hadn’t come close to falling even once.  I felt like I might be a little sturdier on my feet, and entertained the notion that perhaps my symptoms had actually improved, which would have been a first.

If last week didn’t hammer the point that the progression continues to stealthily advance, the shingles vaccine certainly did.

During my annual physical last summer, my primary care physician suggested I get the vaccine, explaining that while shingles is something nobody would want to have, it would be exponentially worse for someone with MS, so I consented get the shots.

The vaccine is administered twice over a three month period, and about half of the people who get it, according to Dr. Google, experience flu-like symptoms. After the first dose, I felt punky the following day but could still function at work. I received the second dose on Monday, and yesterday it kicked my ass. I literally felt like I had the flu: exhausted, body aches, fever. You name it, I felt it.

The last time I actually had the flu was years ago. I remember having a harder time getting around, bending the leg, and things of that nature, but on a scale of one to ten, with ten being the worse, I would rate the impact on my symptoms at a three or four. This week the impact was more like a seven or eight. I don’t know if it was simply the stuff in the vaccine that made things feel worse or if it was the progression of the MS, but it was infinitely more difficult to bend the leg, support my weight, and generally stay upright or move.

So it turns out I was naïve in thinking that I was actually improving. I’m not complaining, mind you, because in the scheme of things I am still doing well. But these moments can’t help but make one wonder if and when the hammer will come down at some point and take away all my mobility in one massive blow.

This possibility has always been there, but I have kept that thought locked away in the far recesses of my mind. These measuring stick moments, however, make me wonder if that doomsday scenario it close at hand,  or if this will continue to be a slow bleed.

These next few months should bring more clarity to that question, as the house gets built and we put some sweat equity into the place to save some money. That experience will either kill me or cure me, so stay tuned.

Meanwhile, I wish you all a Happy Thanksgiving.

 

Heat

summer

The summers of my youth were idyllic. I remember family vacations at cottages on the Connecticut shore, where a Good Humor truck was always parked near the boardwalk. Days would be spent frolicking in the water, crabbing, and riding bikes. Twice a week, we’d grab blankets, pillows and snacks shortly before sundown, and trek to the beach to watch a movie. The night air was warm, the sound of the waves gently lapping on the shore was always present, and the sand was filled with chairs and blankets as kids and families gathered to see what was typically a Disney movie. This was Heaven for a ten year old boy.

Days at home during the summer was spent riding bikes all over town, visiting a friend’s house to go swimming in their pool, or playing baseball all day long at one of the large grassy fields near my house. When it wasn’t raining, the only time I was in a house was to have breakfast, lunch, dinner and to sleep.

Summer was, and always has been, my favorite time of the year. The onset of summer vacation from school was wildly anticipated and celebrated, even for those of us who liked school and were good students. Summer days seemed to last forever when I was a kid, and while the new school year always arrived faster than expected, the break felt like a long period of time.

My enthusiasm for the season didn’t diminish when I became a teenager, and had to obtain a summer job. All that meant is I had less time to have fun, but fun was still to be had, and I pursued it with the passion of a religious zealot.

What is there not to like about summer?  It’s much more enjoyable to throw on a t-shirt, shorts and sandals than to bundle up in layers, struggle with a pair of boots, and find places to stash winter gloves or a hat. There are no limits to what you can do in whatever free time you have compared to the cold winter months, when darkness prevails, you’re in hibernation mode, live in sweats, and spend most of any free time you have in front of the boob tube.

Even summer chores are more pleasant. What would you rather do, mow the lawn, tend the garden, and maintain the pool, or scrape ice and shovel/plow snow?

Another thing I loved about summer was the heat. You see, I would always rather sweat than freeze, and there is something about sweating in the summer heat that appeals to the prehistoric recesses in my brain. When I lived in Southern Indiana for several years, the summers were brutally hot and humid. From Memorial to Labor Day, a typical day would involve temps in the 80’s and 90’s with extremely high humidity. I never lived in a place where it would be hotter and more uncomfortable at six in the afternoon than it was at two or three. Being land-locked, the heat would just build and increase throughout the day, which is one of the reasons they had such horrific storms. You could literally walk outside and start sweating so badly you felt as if you were melting.

But I didn’t mind it one bit.

New Englanders can wax poetic about the beauty of our autumns, and feel invigorated by spring, where everything quickly explodes into a lush green after the long winter months, but I will take summers any day of the week.

It is too bad summers don’t like me that much anymore.

I say this as we approach a stretch where we will have a week of 90 to 100 degree weather and high humidity. Once a cause for celebration it instead is a reason for caution because, unfortunately, heat and MS don’t co-exist very well.

Pretend for a minute that your body runs on a battery, which gives you the energy to work, play, move, think, concentrate, or do virtually anything. Food and rest help recharge it on a daily basis, which in turn allows you to function from day to day.

For some reason, heat drains my battery to virtually nothing the longer I’m exposed to it, and I’m not unique. Many, if not most, MS Warriors have this issue. I believe an increase in body temperature is the cause for this power drain, but I don’t know if that is the true clinical reason.

The drain occurs more quickly if I’m active while it is hot, but it has gotten to the point where I can feel a difference by simply sitting outside for an extended period of time. When humidity gets added, the effect is exponentially worse.

Imagine your body feeling completely limp, like every bone is missing. Imagine feeling so weary that the idea of getting out of your chair feels overwhelming. Imagine your  head feels like it weighs one hundred pounds. Imagine your mind feeling like a vast wasteland of emptiness, where the act of thinking feels like a herculean task. Hell, even the idea of sleeping seems like a herculean task. Your focus becomes a narrow pinpoint that centers on the thought that you can’t believe how shitty and utterly spent you feel.

I’m describing a worst-case scenario, but I’ve been there on an occasion or two. Most of the time the feeling is one of significant physical and mental fatigue, and the mental aspect is far worse than the physical.

Some warriors use cooling vests to regulate their body temps during the hot summer months. If I still lived in Southern Indiana I’d probably own several and wear them constantly in order to survive their summers, but they aren’t necessary in my neck of the woods.

My respite from the heat is a pool, which includes a deck and large umbrella that provides a lot of shade. The umbrella cures a lot of sins in terms of the heat from the sun, but nothing can escape the humidity. Nonetheless, immersing myself in the pool provides relief from the heat, and cools my body temperature immediately. It isn’t a perfect solution, because prolonged exposure to the hot sun can still make me feel like the battery is at fifty percent or less, even when I’m in the pool. But it certainly makes life more tolerable, and who doesn’t love the feel of being submerged in comfortable, crystal-clear water on a hot summer day. It brings out the kid in all of us. I especially love to float in a raft where my butt and feet are in the water, my upper body and head is resting comfortably in a semi-upright position, and a cool beverage is secure in the cup container within arm’s reach. It doesn’t get any better than that!

Every winter and summer provides a platform to gauge the pace of my progression. The struggles of maintaining a clear driveway this past winter told me there was a definite progression compared to the previous year. Now, this next week will test the theory from the heat and humidity perspective. How much of a difference will I notice compared to last summer?

When I left the house to drive to work this morning, it already felt like a sauna outside, and the sun hadn’t even risen yet. I know it’s going to feel like an oven for the foreseeable future, but I have stuff to do. So it will be interesting to find out if I feel like a rag doll when the evening rolls around.

I hope not. I don’t mind bitching about the winter, because the winter deserved to be bitched about, but I hate the thought of being a prisoner in my own house during my favorite time of the year. I can live with watching people enjoy themselves from the sidelines. Watching it from the inside is a completely different story.

 

 

 

The Silent Thief

Thief

Mute and nameless

The flare arrives

A ghost in the night

With evil intent

 

With stealth and malice

It silently leeches

Vitality and spirit

From the unsuspecting host

 

A sadistic specter

It delicately noshes

Never a glutton

Leaving room for more

 

Arrogant and smug

It leaves a calling card

Taunting the victim

Before slithering away

 

Unpredictable and unnerving

Its appetite is ravenous

Its return is ordained

To nibble once again

 

Leaving its target

Less whole than before

And filled with dread

At the inevitable outcome

The P Word

rose

There is a word that anyone who suffers from MS dreads to hear, and that word is  progression.

The primary definition of progression is “the process of developing or moving gradually towards a more advanced state.” Normally that’s a good thing, but not in our case, because if something is progressing in the MS world, it means our bodies are breaking down, and we’re basically screwed.

I’m not familiar with the relapsing-remitting world because I never lived in it. Mine was progressive right from the start, although I didn’t realize it after the initial treadmill incident. It took a period of time and one particularly shocking episode to realize that what I had was not only here to stay, but was permanently entrenched and getting worse.

Over time, I began to define progression in my own terms, and discovered that while doing whatever I could to stop the progression was a noble quest, the best I could do in reality was retard the speed in which the disease advanced. I also learned by reading what I could about MS, including the personal experiences shared on various blogs and message boards, that like the disease itself, progression is different for everyone.

In my case, it has stayed in one place. In the beginning, my progression moved at a snail’s pace, slow but consistent. The best way I can describe the way it moved within my leg is to compare it to the old mercury thermometers, like this one.

thermometer-temperature-fever-flu

For those of you who aren’t familiar with these, the mercury inside the glass enclosure rises with your temperature. Using that analogy, the mercury started in my foot and slowly moved north, as the disease doggedly consumed my right leg. Once it got to my calf, the pace of my progression changed.

From that point on, when the mercury moved north, it occurred in quick, sudden bursts. I would literally go months where I thought the progression had finally stopped when, out of the blue, it jolted upwards, moving from mid-calf to just below the knee. Thus began the period where I had these immediate and noticeable changes. The odd thing is, the progression would wobble. The weakness would move north and make things worse for a few days/weeks, then move back down, improving to where it was before the sudden change. Like a yo-yo, this would occur over a period of time before the progression finally settled on the new high level mark when it first appeared. It has progressed in this manner ever since, the most recent episode occurring several months ago when it moved to just above my knee, forever complicating my ability to walk, and every other activity that requires the use of my legs.

Is this true progression? I certainly think so, but I think my neurologist sees things a little differently. While it has progressed within the limb, which isn’t trivial, it remains confined to that limb and has not spread elsewhere. His main concern, besides doing what we can so I don’t lose complete use of the leg, is to prevent the progression from branching to my arms and hands, which would signify a significant and troublesome change. He’s told me on more than one occasion that is one of his priorities, and has actually gone as far to predict what limb would be affected next.

The yo-yo type characteristic of the way my symptoms have progressed keeps me guessing. For instance, I’m so in-tune with my body now that if I feel the slightest change, I’ll wonder if it has something to do with the MS, and if this is the start of something bad.

Here’s a perfect example. I’m a good typist. I can lay down a lot of words from the keyboard in a very short period of time, and have always had exceptional accuracy. Over the last six months however, my accuracy has gone to hell. Is there a reason for that? Does it have anything to do with the MS? Is this the beginning of it invading my hands, or am I just becoming sloppy?

This line of thinking occurs every single time there seems to be a new development. I wonder if I might be making something out of nothing, and if I dismiss whatever it is as inconsequential, I’ll invariably being thinking if that is a smart thing to do. I never call the neurologist in these situations because I don’t want to appear neurotic.

Sometimes I wish that if I’m going to realize my worst fears about living in a world of pain beyond my comprehension, becoming wheelchair bound, and completely dependent upon others, that it happen suddenly and savagely so there is no doubt. It’s the doubt and second-guessing that drives me nuts, you see. It doesn’t take long however for me to realize I am a lot better off than most (at least I think I am), and that I’m being an idiot because wishing for that to occur is insane. This realization always settles the nerves, which allows me to start compartmentalizing again, and resume my merry voyage on the SS Denial.

Hopefully it will be a long trip. It’s lasted almost eleven years so far.