Big News

I just got a call from Dr. A, the neurologist who follows me when I participate in clinical trials at the NIH. She is always a delightful conversationalist. This time, topics ranged from the music of poet Joy Harjo to the mindfulness meditation of Dan Harris to the benefits of exercise. She asked about my Covid-19 quarantine routine, which includes yoga, pilates, qigong, breath work, short walks—and cold showers. Dr. A is one of the toughest ladies I know. But even she didn’t warm to the notion of a cold shower. Instead, she deftly switched topics to the motive for her call — would I be interested in participating in a new NIH study on the effects of diet on MS?


Would I? Of course I would.


As long term readers of this blog already know, this diet study would not be my first rodeo. I had participated in a trial conducted by Dr. Wahls which compares the efficacy of her eponymous diet to that of The Swank Diet. If you have a grain of common sense, you will not be shocked to learn that I found her study to be biased. I joined it in good faith, expressed a willingness to be assigned to either diet, and pressed on when I was assigned the less desirable Swank Diet. I kept scrupulous record of every food I ate, down to the last teaspoon. The low fat Swank Diet may have helped many people with MS, but it didn’t help me. On the last day of the study, I broke my fast with an avocado. Yum! Fat! I’ve been back to eating fats—healthy fats—ever since.


As soon I had control of my own diet back, I switched to the Wahls Diet I’d been waiting for—and I found the recipes lacking. This was a few years ago; I know Dr. Wahls has been tinkering with her diet every day since then. At the time I felt like her focus was entirely on feeding the brain, and not on delighting the palate. I despaired of convincing my family to adopt the diet along with me. While gripped with anxiety about facing a lifetime of stoic meals, I stumbled on this happy website, which is run by two unpretentious women with five autoimmune diseases between them. They call their diet the AutoImmune Protocol (AIP), and that’s the diet my husband and I have merrily adopted. I asked Dr. A if I could remain on AIP throughout the study. She asked a few questions about it to determine if it could fit within the framework of the diet the NIH would want me to adopt. At this point, she thinks it could work. I’m certainly not willing to go back to a SAD Diet (Standard American Diet) to provide a before and after. I have learned my lesson and will never again martyr my diet for science. I will, however, happily chart my progress teaspoon by the teaspoon, if it will help others make well informed decisions about changes they can implement to optimize their immune system.


Diet should never be about cults of personality. An impartial government study of diet and immunity will be beneficial to all of us with multiple sclerosis, whether our current diet is Swank, Wahls, or the sweet, generic-brand AIP. A diet study came out earlier this month which shows AIP can change gene expression. That’s big news—proof that diagnosis isn’t destiny.

This new NIH diet study is not yet official; it is still just a twinkle in a researcher’s eye. It won’t happen if our researchers can’t find NIH study participants willing to document our food intake (tedious) and swab at least one poop sample (odious). But if I know my NIH researchers, and my fellow lab rats, we will be up for the challenge.


In my experience so far, diet adjustments can be arduous and imprecise and emotional and sadly not entirely curative. I see them as necessary, but not sufficient. A new diet study, if done well, can help all of us struggling through autoimmune disease to direct our efforts toward our best possible outcome, whatever that might be.

Gentle Reader, may you be happy. Stay well!

Decisions, Decisions

Last Friday, I had a simple decision before me: ziplining or kayaking?

My friend Elaine and I had agreed to go ziplining—oh, two Octobers ago, and somehow our plan kept getting put off. We were on the verge of letting yet another bright autumn slip away with no zip. Neither of us wanted to be the first to admit that we are no longer in the market for thrill seeking, that a sedate afternoon of kayaking is now more our style; thus the question of which activity to pursue was still dangling by a text message thread as I entered my optician’s office for my annual exam.

I wasn’t all that keen on keeping the appointment—I already had a lifetime supply of contact lenses. This is how old I am: I am so old, I remember when “soft” lenses were not yet a thing; when contact lenses were suffocating brittle little plates. A ripped contact lens meant penury, for in those days one contact lens cost far more than today’s one year supply of soft “disposables.”

As the oldest of three, then four, severely myopic children in a family with little or no disposable income, I would have been astonished to learn civilization would eventually produce disposable contact lenses. To this day, I find the concept offensive. Why throw out a perfectly viable technological miracle?

We children wore our contacts until the lenses cracked, or until our prescriptions worsened, whichever came first. As such events occurred with horrific regularity, our severely myopic family of five, then six, was a winning lottery ticket for our local optician. I couldn’t help but resent our optician’s relative wealth. And feel deep personal shame every time I let the family finances down…again…while contributing to that mustachioed man’s vacation fund.

I’ve never quite outgrown that shame, or my indignation when suddenly little slips of plastic went from being worth hundreds of dollars each to being sold in 365-packs for way cheaper. There has never been an intermediate stage of cheap single serve contact lenses…except in my medicine cabinet. I still wear my contacts until they rip or until my prescription becomes obsolete. I keep reaching what I think must be the outer limits of nearsightedness—a -10 on what I assumed had to be a scale of -1 to -10—only to learn in subsequent visits to subsequent opticians that there are further negative integers.

Last Friday, I hit a new low: -13. And that wasn’t the bad news.

The bad news was that the flashing lights I’d sensed as coming from behind my left eyeball weren’t some silly commonplace symptom of my multiple sclerosis, as I’d assumed. The optician referred to those flashing lights as an “event” that signaled my retina was maybe thirty days from detaching. She then recommended I get an appointment thirty days out, though I should see her earlier, if “a dark curtain falls across your vision. Or an array of floaters.”

I made the appointment to be polite; I was already thinking of consulting a specialist. There had to be a more proactive approach.

I refused to enter “detached retina” on Google. Instead, I texted my husband about the problem, figuring he’d Google for me, and spare me the worst. He texted, Don’t stand on your head. Stay away from roller coasters.

Excellent! The zip-line vs. kayak decision was made for me! No zip-line.

This retina crisis was wonderful. Clarifying. I would put my affairs in order. Pronto.

Another decision—vote early or vote on Election Day?—resolved. I would vote first thing the next morning.

The future is…more and more problematic.

For months now, I’ve been looking forward to driving up to Iowa City to participate in an exciting study funded by the MS Society which will compare two popular diets to treat MS-related fatigue. I’ve been fascinated by the possibility that MS can be treatable through diet, but I’ve always been hesitant to go all-out. Joining the study is going to force me to be one hundred percent compliant, while also being a force for the greater good.

And while participation in the study has been reason enough for visiting Iowa City, I’ve also been planning to stick around town the following day for a ceremony to honor James Alan McPherson, a brilliant writer and compassionate teacher of mine from the Iowa Writer’s Workshop. Other writers I love and esteem and/or have read will be traveling from around the country to gather in his honor. I’ve been reading his work all week, revisiting some of the very themes I remember him bringing up in workshop, to little avail. Most of us students weren’t yet well equipped to respond. I, for one, was too young at the time, too narrowly focused. Which is why I’ve appreciated his words being frozen in time in his essays, waiting patiently for decades for me to finally grow up.

While I’ve lost my chance to ever talk to Jim again about Spartans vs. Athenians, I’m happy to say that at least I did have a chance to reconnect with him five years ago, at an Iowa Writer’s Workshop Seventy Fifth Anniversary Reunion. He had been sitting alone in a crowded room; unrecognizable in that he was thoroughly unacknowledged. I sat and talked with him a long time, comparing notes on living with chronic pain and chronic illness. When I left him, I didn’t expect he’d make it another five years; I don’t think he was expecting that, either. The ceremony for him will be a vast and profound validation. It will be something to see. I’ve wanted one of us to get to see it.

So I went to a retina specialist. While I carry that old grudge against opticians, I have all the respect in the world for ophthalmologists. I’d expected an ophthalmologist would be proactive, would have some sort of plan to prevent a “dark curtain” or “an array of floaters” from falling across my vision. Surely, a retina specialist wouldn’t keep me in suspense for thirty days.

The retina specialist saw me promptly. He took a very fancy picture of my eye. That was service. He said I should make an appointment to see him in thirty days, or to call him immediately , if  “a dark curtain falls across your vision. Or an array of floaters.”

I had to admit it. The optician wasn’t so far off.

But this guy is better. He has to be. He told me he can fix the problem. He told me that if I get to him early enough in the trauma, he can fix the problem in his office. But if I get there later? He can fix it in the OR.

I already knew from my husband’s Google foray that those OR surgeries take weeks to recover from.

It seemed to me, then, that it was a good thing I lived a mere ten minute walk from his office.

“So,” I ventured, “I like to travel. Do you think it’s a good idea to travel right now?”

img_5935
The specialist answered soundly, “Travel.”

I went ahead and made an appointment with him for thirty days out.

Yesterday, I packed my bags for a three day trip to Iowa City. It was a gray day; perfect for my light sensitive eyes. I made it seventy miles before I started seeing floaters, squiggly little lines wafting across the gray sky. I wondered, how many floaters constitute “an array?”

I still had four hundred miles to go. There was so much waiting for me at the other of this trip. People I haven’t seen in five years, in twenty years. People I’ve been eager to meet. But the only person I was thinking of was my husband. How awful it would be for him to get a phone call asking for a rescue. Or worse, a phone call from a far-away hospital.

I had to make an uncomfortable decision.

I could keep driving, keep asking myself, every few miles or so, is this an array?

Or I could turn around.

It wasn’t a difficult decision, after all.

Enter your email address to follow this blog and receive notifications of new posts by email.

Six Months

Note from the Rat: Reading over this 2012 blog post from my vantage point in 2016, I am so grateful to the NIH (National Institutes of Health), which has continued to supply me with the MS medication I have depended on to keep my Multiple Sclerosis in remission. This medication, which I refer to as  DAC HYP, will (hopefully) go to market with the name Zinbryta. In these intervening years since I wrote this post, all that was asked of me was that I have my liver functions checked locally every six months, and that I fly down to the NIH every six months to have more extensive testing; more bloodwork, a lumbar puncture, eye exams, typical neurologic exams, MRI’s. The length of time it is taking to get the drug approved has been very frustrating to me, as I know more and more people who have been diagnosed with MS who have no access to the medication that has worked so well for me (one brain lesion in ten years, vs many tens of lesions in the ten years previous.) My very dearest friend with MS, Debra C.,  died while waiting for access to this drug. The only comfort I can take from this long wait is that I, and the privileged few on the safety arm of this study, have accumulated more living proof that one can take this drug for years and years and years with no major side effects.  So here it is, my blog post from 2012:

 

I’ve got 6 months left on the NIH (National Institutes of Health) trial of DAC HYP. After that, I might not get further access to the drug that has kept the progress of my multiple sclerosis (MS) in check for the past 6 years.
I didn’t panic when I was told the money just wasn’t there to keep the trial participants on the drug. I probably should have. As my sister reminded me, “You think you’re doing OK, but that’s not you doing OK, that’s you on the drug.”
She’s right.
I know, because I get monthly reminders of me-off-the-drug. I can only inject DAC HYP once a month, but the effect usually seems to last only three weeks: the week preceding a fresh injection is a drag. Literally. I pretty much just drag my body around, propping it up until my next dose of DAC HYP, when the “real me” can take over again.
What will I do when there is no next injection?
I may be left dragging around a husk of myself until such time as the FDA approves the commercial release of DAC HYP. That process may take as long as two years.
How much damage can multiple sclerosis do in two years?
I can’t afford to find out. My central nervous system has undergone punishing damage already, from the many years I was on no drugs, followed by the many years I was on bad drugs.
Everyone I tell about the upcoming DAC HYP discontinuation has urged me to take another drug in its place. If I had thought there was a more effective drug out there, I wouldn’t be taking a trial drug, would I?
I’ve had plenty of disappointments with other MS drugs.
Some new ones have come out since I started my trial, and maybe those drugs will prove effective. Or maybe they’ll prove lethal. People have died on MS drugs. At times, my MS symptoms have been bad enough to make me indifferent to such a risk. The “real me”, the one on DAC HYP, doesn’t feel that desperate. We’ll see what happens when access to the “real me” runs out.
Somehow I’ve never envisioned a life after DAC HYP that would include sampling yet another MS medication. I’ve been hoping, I still hope, that I would live to switch out DAC HYP for the actual cure.
You see, I don’t want to medicate my MS. I want to vanquish it.
I’m not the only one. There is talk of an MS “cure.” It’s somewhat hyperbolic, but it’s also compelling. Dr. Wahls, a neurologist in Iowa City, used to suffer from a particularly aggressive form of MS that was rapidly debilitating and drove her into a reclining wheelchair. She fought back by eating every “brain food” she could think of, and by exercising as much as was physically possible. I wouldn’t say she is “cured” now, because I bet her lesions didn’t disappear, but she is certainly doing very well. She can stand for the duration of a TED talk. She is also biking to work, she is practicing medicine full-time, and she is starting a clinical trial to examine the effect of diet on MS. It could be, as she claims, that she has reversed a case of progressive multiple sclerosis. I hope so. Or it could be that she’s on the remitting cycle in a mislabeled case of relapsing remitting MS. I’ve ridden on the high of those cycles, myself, exercising like a fiend on my borrowed time. I’m sorry to say those times don’t last. I wish her the best. Especially since, in six months, the Wahls diet may turn out to be the best option I’ll have left.
But why wait six months?
I’ve been eating aggressively healthy brain food ever since I first heard of the Wahls diet, but now I will start eating healthier still. (This prospect terrifies my husband, who claims I already eat healthier than anyone he knows)
I am perfectly willing to trade DAC HYP for eight daily platefuls of kale, if that would help me. I am perfectly willing to lift weights, swim laps, and practice yoga with twice the intensity of my normal schedule. Indeed, how could it hurt? I can foresee only one downside to this course of action. I know I am perfectly capable of blaming myself for not trying hard enough if—or let’s face it, when—the disease strikes again.
Would blaming myself be so healthy? I don’t think so.
A number of good people have approached me to ask what I “do” to remain so healthy with MS. I say I exercise, I say I eat well, I say I do yoga. They tell me I have a “good attitude.” They tell me others, those sicker with MS, do not. That may just be oversimplifying things.
Here’s the deal: I’ve had access to a good drug. Others with MS have not. In six months, I will join their ranks. We’ll see if a mix of a “good attitude”, a good workout routine and good diet will be enough to see me through until DAC HYP goes on the market. I’m sure it’s all very necessary. I can only hope it will be sufficient.

Enter your email address to follow this blog and receive notifications of new posts by email.