Tuesday, April 20, 2010

Prayers for BobRobert and Steve

BobRobert and Steve

Steve began his blog near the beginning of 2009 and I have been following his journey as partner, spouse, and caregiver to BobRobert. BobRobert was diagnosed only 3 short years ago and for almost half of the time since then, Steve has been sharing stories of their life and his experiences with the MS community.

Here is his original telling of their MS story (posted in November 2008 as a comment on HealthCentral) and again on his blog in February 2009.
First Year with PPMS
Anonymous
Friday, November 28, 2008 at 05:52 PM

My partner was diagnosed with MS in April 2007 at the age of 46. He had been experiencing tingling in the hands, bladder control issues, and short periods (1-2 hours) where his legs would just give out without notice. Within months, it became clear he had one of the most aggressive forms of MS anyone had ever seen.

He started using a cane in July. A walker in September. In October, as we boarded a flight to start a 2 week vacation celebrating our 15th anniversary, he took his last steps. And as he lost the use of his legs, they took on a life of their own, constantly jumping with painful spasms. His November MRIs were a complete bust due to all of the movement. By April 2008, the spasms had left his legs and started in his arms.

In those early days, I remember the bladder control issues as being a really difficult challenge. We didn't discover condom catheters until after that 2 week vacation, and instead relied on a hand-held urinal for emergency situations. We learned to always scan an unfamiliar location for either a wheelchair accessible rest room, or a secluded corner where he could use the urinal.

October also brought the first complaints of occasional abdominal pain. We initially mistook the pain for neuropathy. Big mistake. Two days before Thanksgiving, the pain had become unbearable and a fever started to spike. I wheeled him down to the emergency room, where they drained 2 liters of urine from his bladder. Who would have thought that a bladder that leaked so frequently could at the same time be holding on to so much? They kept him overnight to treat an acute bladder infection, and then for another 2 weeks of rehab so that he could learn how to use an intermittent catheter and gain some upper body strength.

When he came home from the hospital in December, the weakness in his legs had spread to his trunk, requiring the addition of a hospital bed, hoyer lift, and commode to our apartment. We didn't have an accessible shower or tub, so bed baths became the routine. But the intermittent catheterization was not keeping his bladder under control, so in January he had suprapubic cystotomy surgery. That was probably the happiest day he had had since they drained the 2 liters.

Then there was the neuropathy that started in July. His feet were either burning or freezing, with periods of feeling like he was walking on glass. By the time he became wheelchair bound, the pain had spread to his legs and rear. [Conventional and alternative neuropathy treatments provided limited relief.]

February through April 2008 brought a plateau to the symptoms. Things weren't getting better, but at least they weren't getting worse.

One of the biggest frustrations with PPMS has been the lack of any recommendable course of treatment. With RRMS, you have your interferons and Copaxone, which reduce the frequency and severity of attacks. But none of these have proven to help him with his one big, neverending attack.

I almost wish this wasn't classified as MS. Everyone seems to know somebody who has MS, but we've yet to find anybody with MS who can commiserate with what we've been going through. The closest we've found was a social worker we met in January who had worked with a client with the same type of symptom progression. She was reluctant to give any details, but we were starving for any kind of insight into what the future may hold, so we insisted. She told us that the client's decline went on for 2 years before he passed away from respiratory failure. That information oddly gave us some comfort.
Steve and BobRobert were married in October 1992 and have been together for almost 20 years. Unfortunately for the last 3 of those years, MS has aggressively asserted itself into their lives.

With the recommendation of his neurologist, BobRobert has been under hospice care since January. But it is just this week that the decision was made to keep BobRobert comfortable and to allow his body to rest.

BobRobert was transferred to Christopher House and he and Steve are surrounded by family and friends. I hope that this brings comfort to them both as BobRobert is dying.

Please keep them both in your thoughts and prayers, and perhaps stop by Steve's blog to leave a kind word. Although we have never met, my heart goes out to them right now.

Big hugs to you both!!

Sunday, April 18, 2010

Folic Acid: Mouth Sores vs. Cancer Risk

Ouch. Last Wednesday or Thursday, I noticed that I must have burned the roof of my mouth. I didn't remember eating anything so hot that it could singe the skin, but the tenderness in one spot let me know that I must have.

Friday it still hadn't really healed over. In fact, it seemed to be worse. Saturday afternoon, I realized that I had another tender spot in my mouth and a slight metallic taste was developing. Sometime in the afternoon, I realized what was really going on.

I have developed some mouth sores. Ouch and yuck. Why are these showing up now?

Last month when I visited with my rheumatologist, she asked if I had ever developed mouth sores before. No, I haven't. Why did she ask this? I take methotrexate.

Methotrexate is used to treat different types of cancer, but it is also used to treat rheumatoid arthritis. Methotrexate is an antimetabolite and antifolate drug which inhibits unusal rapid cell growth.

One of the many possible side effects of methotrexate is mouth ulcers, or mouth sores. To help prevent this and other side effects, it is customary to take supplementary folic acid which comes in 400mcg (otc) or 1mg (prescription). I had been taking 1.2mg daily for the past three years.

Based on research published in the Journal of the American Medical Association last fall (and other research studies), my rheumatologist suggested that I stop taking folic acid. Why, do you ask?

High doses of folic acid have been associated with an increased risk of developing lung cancer. The risk remains small, but an increase is an increase. Since I had not experienced many of the nasty side effects of methotrexate, my doctor simply wanted me to stop the folic acid, which may or may not have been helping to alleviate those potential side effects.

Well, one month off of the daily supplementation and I am beginning to develop mouth problems. So on the way home from a busy day accompanying several students at solo festival, I stopped at the grocery store.

My shopping list was short: Folic Acid!!

I immediately took four tablets as soon as I got home and will do so daily until my mouth feels good again. Hopefully at that point I can decrease the amount I need to keep the sores away without increasing the risk of cancer, especially since cancer has run in my family.

Hopefully, it won't be too long before my mouth is in tip top shape once again. :)

Friday, April 16, 2010

Festival Practices and Crazy Schedules

The past week or so has become crazy around here!! Tomorrow is the first of two Solo and Ensemble Festival events in the area and I am accompanying many different students as they play their solos.

What this means is that I have had to practice with many different students in preparation for their performances. I am beyond exhausted and stressed.

My hands have been getting tired, but thankfully, they are holding up pretty well. My right eye is tending to the blurry side, but the left eye is staying strong.

Two weeks ago, my eye was so blurry before I went to bed that I knew if it were as blurry in the morning, I would have been going to the ER to get hooked up with some Solumedrol. It didn't seem as blurry that next morning.

But it has been going in and out, randomly, from day to day. Can I get away without calling this a mild case of optic neuritis? I don't have time for steroids. Period.

Tomorrow, my day starts at 8am at a school 30-40 minutes from my own home. Then I have to get to a different school to play for two other kids. A driving lunch break back to the original school to accompany another dozen kids from 1:00-3:30pm.

Trust me. This is a crazy schedule. I'm already exhausted just thinking about it. Fortunately, it hasn't been extraordinarily hot lately, so hopefully the schools won't be heat saunas.

I've got my fingers crossed that everything goes smoothly. Wish me luck.

In about 5 minutes, I'm going to go watch one of my horn students perform in a school production of Grease. She is a "pink lady." Should be a nice diversion. :)

Til later, be well.

Wednesday, April 14, 2010

"I choose my own..."

Recently I was contemplating (now don't get me thinking).

What if... the internet and blogs went CRAZY and started linking to random things, and we had no control over it.

What if... those links went to sources that we've never read, but it appears we are vouching for the validity and relevance of the material.

What if... Lisa tries her hand at haiku. A poet I'm not. ;)


I choose my own...

Links to articles.
Links to the best resources.
Links to my own blogs.

Research is needed
to find good sources to which
I prefer to link.

Links are like footnotes
providing confidence to
those who will follow.

To follow links and
find new stuff I hadn’t read
can be a shocker.

My sources, vetted,
are hand-selected, so please
leave linking to me.

And if you so choose
you are welcome to create
links to my own blog.

Good day!

Tuesday, April 13, 2010

Vitamin D and Multiple Sclerosis: My Numbers

Last month, I was catching up on the doctors' visits and routine blood work. While at the neurologist's office, I picked up an order for the appropriate laboratory tests which would satisfy the needs of all three of my doctors (neurologist, rheumatologist, internist), including a test to measure vitamin D levels.

    One blood draw + One laboratory report

    = Three satisfied doctors + One happy patient

When requesting to have your vitamin D levels checked, it is important to ask for the 25(OH)D(3) or 25-hydroxyvitamin D test which is necessary to detect true deficiency.

In September 2008, I measured severely deficient in vitamin D at 7.8 ng/mL. Since then, we have been randomly checking the progress on my attempt to increase those levels. So far the highest I have obtained is 44 ng/mL.

Vitamin D Deficiency

As you begin to read the vast amount of research conducted on vitamin D and its effect on various diseases, you will soon see that finding a recommendation for optimum serum levels can be difficult. For one thing, the recommendations have changed dramatically over time. For another, there are two different measuring systems referenced in the literature.

    nanograms per millilitre (ng/mL) or nanomoles per litre (nmol/L)

For simplicity, here is a chart which summarizes the current recommendations:

    25(OH)D Levels and Health Implications

You can see how my measly 7.8 ng/mL is nonexistent. Last month's results came back at 36 ng/mL. Good, right? 36 ng/mL measures "sufficiency." Well, not really.


Read this post in its entirety:

Vitamin D and Multiple Sclerosis: Where Do I Stand?