In September '07, I was diagnosed with Multiple Sclerosis. In an effort to maintain my sense of humor while integrating this new reality into my life, I started this blog, which has become my public journal, an opinion column, and a rough draft for my book. MS prompted this project but it's also about life in general. My life, that is.
According to this CNN Medical Blog Post (which, inexplicably, is credited to the very famous Dr. Sanjay Gupta but is authored by a producer), a new study has found that there are two kinds of MS:
One type that is caused by gamma-interferon-secreting T cells
Another type caused by IL-17-secreting T cells
The study Dr. Gupta's ghost writer/colleague is writing about is from the Stanford University School of Medicine. Researchers examined the effectiveness of a beta-interferon treatment regime. Apparently, the two types of MS respond to the treatment differently in both mice and humans. (How did they give MS to the mice, I wonder? Or is that a stupid question?) It stands to reason that, if you are undergoing (or considering) this kind of treatment, doctors should know what kind of MS you have so you aren't doing self injections with just for fun with no hope of slowing the disease. Unfortunately, they have yet to develop a simple blood test to determine which type each of us has, but the National MS Society is excited about the possibilities that this study presents.
Nature Medicine produced an incredibly boring video where the Stanford University doctor in charge of the study describes the research results in incredibly boring detail:
But what about the rest of us who are getting different kinds of treatments? Not to sound completely self involved but, does this new information mean anything for MSers who are taking something other than beta-interferon? Does anyone know of similar studies that compare cellular differences between patients taking other therapies? Or, are neurologists just rolling the dice when they prescribe drugs for us, hopefully not taking into consideration the really posh pharmaceutical company lunches and the hefty speaking fees?
Julie, I've been to 4 neuros in the last 16 years that I've had ms, and, all of them have told me at one time or another, "well, let's roll the dice & try this (enter appropriate treatment here)...some things worked, some failed miserably. but you know what? that's just ms...the most frustrating disease in the world...it's kinda a schizophrenic disease...one day it'll do this, the next day it'll do that...
The whole seat-of-your-pants thing is what drives me the most crazy about this fun disease we all have... When I had breast cancer the docs would say, "ok, you have this kind of cancer, so we're going to do this..." "your cancer is estrogen positive so you need to take this drug." etc etc
MS is such an unknown...which is the main reason I don't study/research much...because you see all of these things that MIGHT happen but the docs can't even give you a hint that they will or will not. One thing I'm tired of hearing from friends and family is..."so, how is the MS? What do the doctors say?" The doctors don't say anything because they don't know anything and I have no idea how my MS is. (Sigh). :)
I'm enjoying reading the words of others who have this wonderful disease. It teaches us that, yes we surely are all unique! I have these symptoms,you have those symptoms and we both have the same disease!
MS occurs more commonly among people with northern European ancestry, but people of African, Asian, and Hispanic backgrounds are not immune.
Most people with MS are diagnosed between the ages of 20 and 50.
Two-three times as many women as men have MS.
MS is Lazy!
I just read this on an MS support group site and it made me feel better about feeling "lazy."
When the myelin covering on the nerves is lost/disappears/whatever it does, the nerves don't conduct brain messages nearly as effectively. It's kind of like the nerves have to find new pathways for the messages from the brain. So the messages are much slower in reaching their destination and it takes more energy, trying to find the right paths. This made a lot of sense to me and helped my not feel so 'lazy'.
I would love to give the proper attribution for this story but I have no idea where I found it! I think it may have been posted to an MS community site.
My best friend and I were in the diner, talking. As usual, it was very late and we were eating French fries with gravy. Like normal girls our age, we spent a lot of time in the diner while in college, and most of the time we spent talking about boys, music or trivial things, that seemed very important at the time. We never got serious about anything in particular and spent most of our time laughing.
As I went to take some of my medicine with a snack as I usually did, she watched me with an awkward kind of stare, instead of continuing the conversation. She then asked me out of the blue what it felt like to have MS and be sick. I was shocked not only because she asked the random question, but also because I assumed she knew all there was to know about MS. She came to doctors with me and she saw me walk with a cane. She had seen me cry in pain, what else was there to know? I started to ramble on about pills, and aches and pains, but she kept pursuing, and didn't seem satisfied with my answers. I was a little surprised as being my roommate in college and friend for years; I thought she already knew the medical definition of MS. Then she looked at me with a face every sick person knows well, the face of pure curiosity about something no one healthy can truly understand. She asked what it felt like, not physically, but what it felt like to be me, to be sick.
As I tried to gain my composure, I glanced around the table for help or guidance, or at least stall for time to think. I was trying to find the right words. How do I answer a question I never was able to answer for myself? How do I explain every detail of every day being effected, and give the emotions a sick person goes through with clarity.
I could have given up, cracked a joke like I usually do, and changed the subject, but I remember thinking if I don’t try to explain this, how could I ever expect her to understand. If I can’t explain this to my best friend, how could I explain my world to anyone else? I had to at least try.
At that moment, the spoon theory was born. I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said “Here you go, you have MS”. She looked at me slightly confused, as anyone would when they are being handed a bouquet of spoons. The cold metal spoons clanked in my hands, as I grouped them together and shoved them into her hands. I explained that the difference in being sick and being healthy is having to make choices or to consciously think about things when the rest of the world doesn’t have to. The healthy have the luxury of a life without choices, a gift most people take for granted. Most people start the day with unlimited amount of possibilities, and energy to do whatever they desire, especially young people. For the most part, they do not need to worry about the effects of their actions.
So for my explanation, I used spoons to convey this point. I wanted something for her to actually hold, for me to then take away, since most people who get sick feel a “loss” of a life they once knew. If I was in control of taking away the spoons, then she would know what it feels like to have someone or something else, in this case MS, being in control. She grabbed the spoons with excitement. She didn’t understand what I was doing, but she is always up for a good time, so I guess she thought I was cracking a joke of some kind like I usually do when talking about touchy topics. Little did she know how serious I would become?
I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of "spoons". But when you have to now plan your day, you need to know exactly how many “spoons” you are starting with, which you wont know until you wake up. To answer your question we’ll start your day with twelve. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out the12 spoons. She laughed and said she wanted more. I said no, and I knew right away that this little game would work, when she looked disappointed, and we hadn't even started yet. I’ve wanted more "spoons" for years and haven’t found a way yet to get more, why should she? I also told her to always be conscious of how many she had, and not to drop them because she can never forget she has MS. I asked her to list off the tasks of her day, including the most simple. As, she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon. When she jumped right into getting ready for work as her first task of the morning, I cut her off and took away a spoon. I practically jumped down her throat. I said " No! You don’t just get up. You have to crack open your eyes, and then realize you are late. You didn’t sleep well the night before. You have to crawl out of bed, and then you have to make your self something to eat before you can do anything else, because if you don’t, you can't take your medicine, and if you don’t take your medicine you might as well give up all your spoons for today and tomorrow too." I quickly took away a spoon and she realized she hasn’t even gotten dressed yet. Showering cost her a spoon, just for washing her hair and shaving her legs. Reaching high and low that early in the morning could actually cost more than one spoon, but I figured I would give her a break; I didn’t want to scare her right away. Getting dressed was worth another spoon.
I stopped her and broke down every task to show her how every little detail needs to be thought about. You cannot simply just throw clothes on when you are sick. I explained that I have to see what clothes I can physically put on, if my hands hurt that day buttons are out of the question. If my shoulders and back hurt I wont be able to put on a bra. If my hair is falling out I need to spend more time to look presentable, and then you need to factor in another 5 minutes for feeling badly that it took you 2 hours to do all this. I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons.
I then explained to her that she needed to choose the rest of her day wisely, since when your “spoons” are gone, they are gone. Sometimes you can borrow against tomorrow’s "spoons", but just think how hard tomorrow will be with less "spoons". I also needed to explain that a person who is sick always lives with the looming thought that tomorrow may be the day that a virus comes, or a treatment reaction, or any number of things that could be very dangerous. So you do not want to run low on "spoons", because you never know when you truly will need them. I didn’t want to depress her, but I needed to be realistic, and unfortunately being prepared for the worst is part of a real day for me.
We went through the rest of the day, and she slowly learned that skipping lunch would cost her a spoon, as well as standing on a train, or even typing at her computer too long. She was forced to make choices and think about things differently. Hypothetically, she had to choose not to run errands, so that she could eat dinner that night. When we got to the end of her pretend day, she said she was hungry. I summarized that she had to eat dinner but she only had one spoon left. If she cooked, she wouldn’t have enough energy to clean the pots. If she went out for dinner, she might be too tired to drive home safely. Then I also explained, that I didn’t even bother to add into this game, that she was so dizzy, that cooking was probably out of the question anyway. So she decided to make soup, it was easy. I then said it is only 7pm, you have the rest of the night but maybe end up with one spoon, so you can do something fun, or clean your apartment, or do chores, but you can’t do it all.
I rarely see her emotional, so when I saw her upset I knew maybe I was getting through to her. I didn’t want my friend to be upset, but at the same time I was happy to think finally maybe someone understood me a little bit. She had tears in her eyes and asked quietly “How do you do it? Do you really do this everyday?” I explained that some days were worse then others; some days I have more spoons then most. But I can never make it go away and I can’t forget about it, I always have to think about it.
I handed her a spoon I had been holding in reserve. I said simply, “I have learned to live life with an extra spoon in my pocket, in reserve. You need to always be prepared” It’s hard, the hardest thing I ever had to learn is to slow down, and not do everything. I fight this to this day. I hate feeling left out, having to choose to stay home, or to not get things done that I want to.
I wanted her to feel that frustration. I wanted her to understand, that everything everyone else does comes so easy, but for me it is one hundred little jobs in one. I need to think about the weather, my temperature that day, and the whole day's plans before I can attack any one given thing. When other people can simply do things, I have to attack it and make a plan like I am strategizing a war. It is in that lifestyle, the difference between being sick and healthy. It is the beautiful ability to not think and just do. I miss that freedom. I miss never having to count "spoons."
After we were emotional and talked about this for a little while longer, I sensed she was sad. Maybe she finally understood. Maybe she realized that she never could truly and honestly say that she understands. But at least now she might not complain so much when I can't go out for dinner some nights, or when I never seem to make it to her house and she always has to drive to mine. I gave her a hug when we walked out of the diner. I had the one spoon in my hand and I said, “Don’t worry. I see this as a blessing. I have been forced to think about everything I do. Do you know how many spoons people waste everyday? I don’t have room for wasted time, or wasted “spoons” and I chose to spend this time with you.”
Ever since this night, I have used the spoon theory to explain my life to many people. In fact, my family and friends refer to spoons all the time. It has been a code word for what I can and cannot do. Once people understand the spoon theory they seem to understand me better, but I also think they live their life a little differently too. I think it isn’t just good for understanding MS, but anyone dealing with any disability or illness. Hopefully, they don’t take so much for granted or their life in general. I give a piece of myself, in every sense of the word when I do anything. It has become an inside joke. I have become famous for saying to people jokingly that they should feel special when I spend time with them, because they have one of my "spoons".
Posts
Julie, I've been to 4 neuros in the last 16 years that I've had ms, and, all of them have told me at one time or another, "well, let's roll the dice & try this (enter appropriate treatment here)...some things worked, some failed miserably. but you know what? that's just ms...the most frustrating disease in the world...it's kinda a schizophrenic disease...one day it'll do this, the next day it'll do that...
ReplyDeleteLibby,
ReplyDeleteI think it's ironic that a recovering control freak like me ended up with a fly-by-the-seat-of-your-pants kind of disease.
Julie
The whole seat-of-your-pants thing is what drives me the most crazy about this fun disease we all have... When I had breast cancer the docs would say, "ok, you have this kind of cancer, so we're going to do this..." "your cancer is estrogen positive so you need to take this drug." etc etc
ReplyDeleteMS is such an unknown...which is the main reason I don't study/research much...because you see all of these things that MIGHT happen but the docs can't even give you a hint that they will or will not. One thing I'm tired of hearing from friends and family is..."so, how is the MS? What do the doctors say?" The doctors don't say anything because they don't know anything and I have no idea how my MS is. (Sigh). :)
I love your blog by the way!
I'm enjoying reading the words of others who have this wonderful disease. It teaches us that, yes we surely are all unique! I have these symptoms,you have those symptoms and we both have the same disease!
ReplyDelete