Category Archives: MS

Fear Resistance

Beware!  MonSters wait behind the door to tomorrow!
Beware!
MonSters wait behind the door to tomorrow!

We all have fears, and for many of us they rule our day to day. For my son, they have ruled the night for weeks. In three weeks, there were only 2 nights when he did not tap me on the shoulder between 3:30 and 4:15 to report he had a nightmare. On those two nights, he woke A to play. He needed reassurance we all live. In the middle of the night, his worry blots out any ability to make good choices.

For A, it is a fear of not being accepted and loved which seems to concern her most. It’s a fear which seems aggravated by uncertainty in her ability to read emotions. I have lost count of the number of times I have heard, “Are you mad at me?” Yes, we get frustrated. Try as we might, I don’t think we understand or remember the built in pause her brain has when stressed. I keep trying to remember the built in pause might serve her well later. Taking the time to work through stressful situations is a good skill to cultivate, even if we don’t understand why she is still processing how to take off her shirt while the rest of the family waits for her to get dressed in her PJs. What is simple for one can be difficult for another, and the difficulty meeting the expectations of others is stressful. I feel that stress too.  The stress makes things more difficult, and suddenly fears of failure and the social reactions to such failure become a heavy burden making everything harder.

For me, I fear what my MS will do to me. Recently on patientslikeme.com there was a thread on why those of us taking Tysabri continue to do so in light of the risk to develop a brain infection (PML). Evidently, the risks increase over time on Tysabri, but I have never seen a risk greater than one in a hundred. Meanwhile, I know how I was progressing prior to Tysabri. I had terrible balance to the point of the only exercise I did was use a rowing machine (falling 6 inches is no big deal). I had terrible distracting headaches to the point of puking on the side of the road more than once. I had greatly decreased sense of touch below my belly button and some bladder issues which I now know is frequently a precursor of trouble walking in the future. At one point, I was hospitalized when I lost the ability to swallow. So while I fear PML, I fear my MS more.

I fear not being able to provide for my family. I fear not being the father and husband they deserve. So I take what risks I can to give me the best chance to stay “me” for as long as I can. For while I am taking tysabri, using the most aggressive treatment available, I fight the only way I can to retain any ability to help, to matter in some positive way.

I suppose we all fight our inner monsters. We do what seems most reasonable at the time whether it is seeking reassurance from our loved ones, freezing in thought and body, or acting aggressively to forestall the source of our fears. The hard part is maintaining the perspective from which we can discern when our actions are working against us, costing too much. For this, we (I) need the help of our trusted family to set us (me) straight.

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What Numbers Matter?

Sometimes numbers make me seem a little crazy like my daughters wonderful hair.
Sometimes numbers make me seem a little crazy like my daughters wonderful hair.
I asked for a long time why we cared so much about dots on an MRI if they don’t correlate well with symptoms.  As an MS patient for more than 8 years, I don’t care much about the dots on my MRI.  Still, I can appreciate the goal when we use MRI’s to determine whether our MS is “active” or whether a drug is effective.  We need a measurable, and so we pick a variable we feel gives us the most accurate way to model reality.  Is that not the reason man uses numbers for anything, to describe reality in the way which feels most accurate?
When attempting to solve a problem, one must first define exactly what the problem is.  For us patients, the temptation is to think problem begins and ends with our symptoms.  I think this has been my biggest problem with MRI’s as a measure of MS activity.  Even with a stable MRI, my symptoms progress.  This doesn’t mean MRI’s are not a valid way to measure MS.  It just means MRI’s are not accurate enough to paint the picture I am looking to use.
Over the past few years, I have come to appreciate the inherent logic in dealing with complex systems.  Complex systems are different from complicated systems in that, one can never accurately predict the impact of damage to any one place in the system. They are different from the a->b->c…->z complicated systems where one knows the impact of breaking the chain.  A complex system is more akin to a road system.  Interestingly enough, the complex system theory was designed to replicate the brain, but is more commonly used today for other system models like roads.
One of the studies I found interesting was a recent one showing brain atrophy predicted long term cognitive issues were correlated with brain shrinkage and physical issues were better correlated with flares. http://jnnp.bmj.com/content/83/3/282.long Interesting to me is that neither flares nor shrinkage accurately predicted both.
Brain shrinkage would seem to imply a less able system simply by reducing the size of the system.  Even if we can not identify the specific area of deficit, the sum of all the paths now reaches less than it once did.  If the brain shrinks, the number of alternate paths for signals to take likely shrinks too.  The alternate routes for traffic disappear and the fragility of the system increases, even if it appears traffic is moving at the time.  Shrinkage would seem likely to predict future problems.  This study seems to be validating this assumption at least in terms of cognition.  In doing so, it redefines the problem and measurement of MS.  It is no longer enough to simply look for a flare (think car crash).  One must also look to see if the map still needs folding to carry.
I owe thanks once more to http://multiple-sclerosis-research.blogspot.com for publishing multiple posts about brain atrophy in MS patients.
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On a side very cool note, after my interview last week, I was asked to participate on the American Board of Internal Medicine as a patient advocate.  I’m amazed and incredibly honored.  I can hardly wait to find out how I can help.
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