Photo by Arcade Snacks https://www.arcadesnacks.com/product/gummy-bears-12-flavor-2/
Believe it or not, I was young and foolish once. Now, I’m just ol…..ol….. not quite as young, and foolish. One out of two isn’t bad, right?
Thanks mainly to the grace of God, my various acts of foolishness were not fatal, or even very painful. My shenanigans were mostly of the playful, harmless, valuable life lesson teaching, variety. One of which I will now attempt to twist into a lesson about multiple sclerosis.
If the photo above didn’t clue you in, this lesson involves gummy bears. Not the sugar free ones. If that were the case, even though I’m sure there’s many a valuable lesson there, I wouldn’t be (as) inclined to share. Not sure what I mean? Here’s a link, because I shan’t elaborate.
Back in my days of being an FO in 1st Ranger Battalion, my small detachment would often travel from our little airfield in Savannah, Georgia, to locations where we could practice our skillset. On a number of these trips, we slept out at the range but made daily trips to the nearest PX for supplies. These supplies normally consisted of caffeinated beverages, assorted junk food, and once, just once, a five pound bag of gummy bears.
There were seven of us on that trip so that worked out to just under 3/4 of a pound of bears each eaten over the course of three days. At the time, it seemed like a good, cost effective, and completely doable plan, right?
Wrong.
It turns out that no human, (keep in mind we were all in our twenties at the time), can consume that weight of gummy bears in three day’s time. By the second day, just mentioning the words “gummy bears”, would earn you a string of harsh words and a round of vigorous exercise. By the third day, we still had approximately half the bag and were flicking them at road signs, etc on the long drive home.
We were young, athletic, and normally could eat so much that buffet owners locked their establishment’s doors and hid in fear. However, when it came to vast quantities of gelled corn syrup, we apparently did not know our limitations.
Do you know yours? Do you abide by them? For me, living within the limitations brought on by MS is the harder and maybe more important part. Maybe that’s because in order to live within those limitations, we have to admit that they exist; both to ourselves and to others.
Once that’s done, the burden to work around and/or accomodate those limitations falls on everyone involved. Your real friends won’t mind, but they might look to you to admit you need an accomodation before offerring one.
Multiple sclerosis, because it is consistently inconsistent, complicates this by making my limitations different than they were this morning, yesterday, last week. That can make knowing and admitting to limitations extra hard. Doable, but hard and I’m not always successful.
If you have the perfect solution to adapting to a constantly evolving set of limitations, let me know, because, while it isn’t exactly a five pound bag of gummy bears, it is hard to swallow sometimes.
The worldwide, special operations community is pretty small and over the years, I’ve been priviledged to work with and learn from, units from all over the world. The job attracts a certain kind of person, so, the personalities are very similar despite, the different equipment, tactics, and languages.
When it comes to language barriers, the right interpreter is worth their weight in gold, because they don’t just directly translate the words, but also the idioms, cultural cues, and even subtle nuances of body language and gestures. As you might imagine, this is vitally important when interacting with someone whose language you don’t speak, but maybe it’s just as important when conversing in a language thought to be common to both parties.
For example, my native language is English but back in Afghanistan in 2006, I learned that when among troops from the UK, we might all be talking in English, but we weren’t speaking the same language.
I didn’t know then, but I know now, that when a British officer slaps his knees, says, “Right!”, and stands up, that means the meeting is over and the annoying young American medic, (“Who the devil invited him to this briefing anyway?”), needs to stop asking questions and “what iffing” everything to death.
Later, his Sergeant Major had a “quiet” word with me outside the briefing room. He was of Scottish descent and though his body language was unmistakable, there were parts of his spoken English that were a little less clear.
When he began, he used many of the same words I had often heard in my own Army (universal, I guess) and I had no doubt that he was very put out with me. Then, in two separate sentences, he called me a “weapon”, so I began to relax, knowing all was well and that he obviously thought I was sharp, keen, and maybe even a bit dangerous.
I later learned that he did not, in fact, think that I was sharp, or keen. He did probably think that I was dangerous, but only to myself if I should ever be left alone and unsupervised…….. with string.
There was something lost in translation.
Remember when I talked about your healthcare team? You know, the one that I think you should be the head of? You might all be talking in English (or your native language), but you are probably not speaking the same language. I’m not suggesting that you go take a course in medical terminology, Greek, or Latin, but I am suggesting that it is very…..very important that you and your healthcare provider(s) understand each other completely.
The burden is on all parties involved, but it’s your health, so maybe it should be even more important that you understand fully and are understood fully. Like I’ve said before, both my neurologists are wonderful and know more about multiple sclerosis than I ever will, but they don’t have MS. As much as I wish it wasn’t, my MS is mine. It is unique to me and I’m (unfortunately) the expert on it. If you are not already and are capable of it, you should be the expert on yours. This includes communicating clearly about medications (including the cost and availability), pain levels, emotional changes, cognitive changes, quality of life issues, mobility problems, sensations and the lack thereof, etc, etc, etc.
Speaking the same language is even more important when communicating with your non-neuro providers. My wheelchair makes my multiple sclerosis “visible”, or at least quickly “discoverable”, but yours may not be. Your family doctor may need to be reminded that your MS related choking/aspiration risk is why you’re concerned about getting a pneumonia vaccine. Your orthopedic doctor may need to be reminded that your weak grip or inability to raise that arm on your more affected side is probably just MS and not because of a torn anything. Your optometrist needs to know that you’re seeing double, or having eye pain most likely because of your MS. Your physical terrorist……..I mean therapist needs to know when you have MS fatigue and that it’s not the same as being tired, weak, or having a bad attitude. (Mine does, I’m just giving him a hard time).
The list of examples goes on and on. Don’t let anything related to your health and well being get lost in translation. Please be clear with your providers and ask for clarity when you need it.
For the record, several of my providers think I’m a “weapon”, but they’re clear about it.
I have literally texted this photo across the house to my wife when I needed help in the shower.
I have been struggling to write this for months. I know what I want to say, but I can’t get it down in writing in a way that makes sense…..not even to me. It’s not an uncomfortable, or even embarrassing topic. It’s not difficult for me to talk about, but it is difficult for me to put into words. Does that ever happen to anybody else?
I’m pretty sure I’ve mentioned before that I use a wheelchair. “Use” a wheelchair…….that somehow sounds better than, “confined to” a wheelchair, or even, “in” a wheelchair for some reason. Semantics aside, I do “use” one, because I can’t walk. I can stand for very short amounts of time if I have something sturdy to hold onto and I do have limited movement in my feet and legs, but I cannot take a single step. My hands and arms, torso, eyes……….ok, everything from head to toe, is affected to some degree by multiple sclerosis and I need help, both mechanical and personal, in order to get through every day.
I’m not telling you that to depress you, or (gag!) elicit pity, but to make a somewhat confusing (to me anyway), amateurish point about pride, dignity, and practicality.
Back when I was a student at the Special Forces medic course, we often joked that having to constantly be a “patient” for each other erased whatever sense of pride and dignity we might have had before. If you were in a more senior class and happened to see a newer class walking down one of the hallways, staring at the floor, not speaking to, or looking at each other, you knew that they had just passed the hurdle of prostate check day, testicular exam day, etc, and that their senses of pride/dignity had taken an abrupt jolt. You get over it, of course. Eventually, you have cut the clothes off all of your fellow classmates, have poked each of them with needles, gloved fingers, and all manner of uncomfortable tubes, and vice versa and what you once considered undignified, isn’t anymore. So what, if anything changed?
Here are the “book” definitions of pride and dignity.
pride/prīd/noun
1.a feeling of deep pleasure or satisfaction derived from one’s own achievements, the achievements of those with whom one is closely associated, or from qualities or possessions that are widely admired.
dig·ni·ty/ˈdiɡnədē/noun
1.the state or quality of being worthy of honor or respect.”a man of dignity and unbending principle”
By those definitions, I actually left the medic course with more of each than I started with. Did my concept, or definition of these things change, did I realize that my personal list of things that I once thought were beneath me, weren’t, or was it just my practical side showing through?
prac·ti·cal·i·ty/ˌpraktəˈkalədē/noun
1.the quality or state of being practical.
2.the aspects of a situation that involve the actual doing or experience of something rather than theories or ideas.
If that’s the case, does that mean that I’ve decided that something is undignified, but the practical thing is to do it anyway, or does my practicality decide certain things don’t belong in the undignified category and removes them from the list? The short answer is, I don’t know. If you do, chime in with a comment.
What I do know is that my pride and dignity feel intact, but………different(?) than they were before multiple sclerosis. Did they change, or did I change because of practicality?
For example, I can put my own shoes on, but it takes me 5-10 minutes and expends energy that I need for transfering to my wheelchair, the car, and so on. My wife can slip both shoes on in well under a minute, so especially when we have places to be, this is, by far, the practical thing to do. It’s not undignified, but having someone do something for me that I had done since childhood was tough at first. Since I snapped the words, “I can do it myself!”, more than once, it was probably my pride that needed to shift rather than dignity. Maybe that means pride changes while dignity doesn’t. Do I just confuse the two and practicality is what eventually separates them?
More often than not, I need help in the shower. Again, I can wash myself, but it’s way more practical, goes faster, uses less energy, etc, if I have help. My wife is my caregiver and takes great care of me. We’ve been married almost 13 years and have three kids together, so it’s a cinch to say that she’s seen me naked and/or vulnerable before. Why then is this still a difficult area to ask for, or accept help with? Is it that, “I can do it myself!”, pride rearing its head again, or is it dignity this time? Is that why being practical about it doesn’t negate it all the way? Does practicality only work on pride? Is it that I feel like there’s a big difference between asking for the 30 seconds it takes to put shoes on and a 30 minute shower, or because I (and/or my dignity) want to keep the difference between wife and caregiver in place?
Hmm, I got some of it down in writing, but feel like I barely scratched the surface. I feel like I understand a little more, but still don’t know anything. If you thought this column was going to have all the answers, get used to disappointment. I thought learning about the physiology of MS was going to be the hard part. Turns out, an “I don’t know” answer there is a lot easier to handle.
One of the worst mistakes you can make if you have MS, (so, of course, I make it a lot), is to compare your MS to someone else’s. Everybody’s experience is so different that sometimes I wonder if it’s even the same disease. Yes, I used “experience” deliberately, because I don’t just mean symptoms, or ability. I’m including how you’re perceived, treated, talked to, and so on.
I have an aggressive form of progressive multiple sclerosis, so it’s kind of hard to ever refer to myself as “fortunate”. In many ways, though, I suppose I am……….(far too lazy to search a thesaurus for an alternative word apparently)….so…..not unfortunate?
I don’t have an invisible illness, well not anymore and if I did, it wasn’t for long, because my time between a barely noticeable limp and a wheelchair was pretty short. It is very obvious that something is wrong with me, so I don’t get questioned for using a handicapped parking space, etc. Besides the handicapped placard, I have disabled veteran license plates, so usually, the only thing I find myself explaining is that I am not wounded, I just have a disabling disease.
I don’t really deal with questioning looks, or second guesses either; not the way other people with MS do and not from people that matter. That sounded harsh, but you know what I mean, right? Strangers may occasionaly look at me and wonder if I gave up too easily, or am not trying hard enough, but because of my background in Special Forces and the Rangers, family, friends, or aquaintances assume that I’m giving it my all. For the record, they’d be wrong sometimes, but still, they normally give me the benefit of the doubt. Really, the only person who second guesses me, or acts like I’m an inconvenience…….is…..me. I am my own worst enemy.
This past holiday season really drove the point home. At two Thanksgiving gatherings, family stepped in and made it possible for me to enter their homes in my wheelchair and be included. Later, right before Christmas, with the help of several friends, I got to go to a party that I seriously considered not going to because I was afraid of being a burden.
Am I a burden? In the sense that extra things had to be done to accomodate my disability…..yes, I suppose I am, but I’m starting to realize that I’m the only one who is afraid of being a burden, or inconvenience. At this point, anyone who didn’t want to be around me is long gone and I need to stop reflexively apologizing and show genuine gratitude for the people who want my company enough to go the extra mile to have it.
I don’t like being disabled by multiple sclerosis, but I am. I don’t like being treated like I’m disabled either. Maybe it’s just semantics, but my friends and family don’t. They somehow, accomodate my disabilities while treating me like……me. Or, to put it another way, they treat me like a loved one with a disability, but not like a disabled person. Hmm, I suppose I am fortunate after all.
I’m the one who treats me like I’m disabled and for some reason, the hardest one to convince to stop doing so.
Multiple sclerosis is not very conducive to a good night’s sleep. Spacticity was my biggest problem until the baclofen pump relaxed my spasms, rigid muscles, and hyper-reflexivity. I was essentially a limp dishrag immediately after the pump implant, but the relief from spacticity and actually being able to sleep through the night was so amazing that even if I’d never improved after, (I did), it still would be worth it.
I don’t mean to imply that spacticity was the only obstacle, just the biggest. I still have an MS bladder that defies even the best planning and occasionally, whatever the opposite of fatigue is, wakes me up at odd hours and keeps me awake.If MS could just be a little more considerate and schedule fatigue during evening hours only, that would be great. It is, however, anything but considerate and accommodating.
There are a lot of perks of being able to sleep soundly again but the one I want to talk about today is dreaming. I dreamed when spacticity was at its worst, but very inconsistently and I rarely had a complete, undisturbed dream, or could remember my dreams in any sort of detail. Usually, when I dream now, (or pre-MS), I’m aware that I’m dreaming, but I can’t direct the action or otherwise control it………..so lucid? Not lucid? Lucid…ish? Meh, it doesn’t really matter. What does matter (to me, anyway) is that I sometimes dream about myself with MS. Do you?
Most of my dreams are of the…..normal(?) variety. Being late for school (even though I haven’t been to school in decades), being unprepared for a test, or a recurring dream of having an apartment in another city with important things in it that I’ve forgotten to pay the rent on, etc, etc. Like I said, most of the time I’m aware I’m dreaming but it’s like I’m watching it as a member of the audience, shouting out advice, or insisting that the main character would never do that, or let that happen.
My multiple sclerosis dreams seem to come in three flavors. Sometimes I’m surprised by my disability, (what I was once). I’ll be behaving normally in the dream, walking, running, that sort of pre-MS stuff, when I’m somehow reminded that I shouldn’t be able to do that (maybe I hear myself shouting from the audience) and like Cinderella at the ball, I struggle back to my wheelchair before the clock strikes midnight. It’s a little odd that my wheelchair is even there in a walking dream, but such is the nature of my, “Surprise!!, you’re crippled.” dreams.
Sometimes I dream about myself having MS and being aware that I have it, (what I am now). I dream about myself in a wheelchair, being fatigued, or dealing with uncooperative limbs. I even dreamed recently about being in a small fishing boat in my wheelchair and yelling from the audience, “What a load of crap. How did you even get the chair on that boat? Is it even strapped down? Just wake up! This is completely unrealistic!”.
Occasionally, I dream of getting better, (what I want to happen). One dream that sticks in my mind is of me walking on a trail in the woods using two trekking poles. In the dream, I’m aware that I have MS, but am recovering somehow, (the dream is a little vague about the “how” part). I stumble on the trail and run a few steps to keep from falling and then keep running slowly and awkwardly, laughing almost hysterically at the return of an ability that had once been taken for granted.
I know they’re just dreams and I treat them as such. Walking, much less running, may never be in the cards for me. As long as they keep it reasonably realistic most of the time, I’m ok with my dreams hoping for the future too. I mean, it’s my unspoken, subconscious hope after all, right?
“See those trees over there? That’s where I’m going”. (Photo Credit: U.S. Army)
Going to airborne school was the first step, the initial price of admission, to everything else I wanted to do in the Army. I went toward the end of my first 6 months in and did it for almost 20 years, but I never liked jumping (parachuting). I’m not phobic, but I’ve always been a little scared of heights and falling and falling from heights and hitting the ground after falling from heights. You’d think I’d have gotten used to, if not outright comfortable with it, but you’d be wrong. For me, the 100th jump was the same as the 1st. I looked out the open door of the aircraft and thought, “This is insane!!! Don’t do it you fool!!”, and then did it anyway, cursing my arms and legs for taking me out the door instead of obeying my rational, common sense, (ok…maybe a little hysterical), brain.
They even sent me to jumpmaster school later on, where I learned to set up a drop zone, check other people’s parachutes before a jump, and send them out the door at the right time. They said it would make me more comfortable with jumping if I saw everything that went on behind the scenes. Instead, I learned everything that could go wrong, including some things that I’d never even considered before.
“Good news Ben, we’re sending you to jumpmaster school”.
“What?!, I hate jumping”.
“This will make you more comfortable with it”.
“No it won’t! This is a stupid idea, I don’t want to do it”.
“Too bad. You have to”.
(You know, come to think of it, that actually sums up a lot of my experience in the Army.)
All in all, the total of my experience was really pretty blase’. Aside from a few bruises, scrapes, and sore spots, the shoulder dislocation I wrote about a couple months ago was my only real parachuting injury. I only ever had one malfunction, but it happened at night, so other than thinking it was taking my chute an awful long time to open and hitting the ground before I lowered my rucksack, I didn’t even know about it until someone else told me and obviously it worked itself out, so it hardly counts. The only other thing that sticks out in my mind is the one and only time I landed in the trees.
There’s some solid math that goes into setting up a drop zone, but that math is based on a number of factors that can change, like aircraft speed, wind speed, etc, so you plan the release point as best you can and then, if necessary, make a real world adjustment off of the first group of jumpers. On this particular occasion, I was in that first group of test dummie…..I mean jumpers. Actually, the whole group didn’t even get out of the plane. It was pretty obvious that we were exiting too close to the treeline on Luzon drop zone, so the jumpmaster stopped our little procession out the door right after the guy behind me. Five of us got out the door. The first three landed at the edge of the trees and the last two, of which I was one, landed in them.
Photo from Google Maps 2021
I was already over the trees when my chute opened and I got control of my canopy. This was a round chute, but steerable….well, turnable anyway, and I steered hard for the grass. I may have even churned my legs like a cartoon character trying to run through the air back to the top of a cliff, but after a very short amount of time, it was very obvious what was about to happen, so I started to prepare for a tree landing.
Mom, I know you’re reading this and I’d like to say that I handled the inevitable with all the grace and poise you taught me as a child, but the shameful truth is, your little boy cursed a blue streak going into those trees. The good news, if there is any, is that my vile language was said/shrieked in a very rapid and high pitched voice, so if anyone heard it on the ground, all they heard was something along the lines of, “Eeeeeeeeeeeeeeeeeeeeeeeeeesheeeheeeee!!!!”
Despite my level of concern and even though I’d never used it before, I fell right back on the training we rehearsed before every jump. I kept my feet and knees tightly together, (on a scale of good to bad, straddling a tree branch is way down on the bad end) and rotated my hands and arms in front of my face just as my feet made contact with the trees. I took the top off of a small oak, where my canopy remained, then crashed into the side of a nearby pine and slid down its trunk to the ground. I got out of my harness and went to the edge of the treeline where I met a 1st Sergeant who asked if I was ok and helped me pull my parachute out of the tree.
“Was that you we heard from the other side of the drop zone?”
“Oh…..you heard my….war cry?”
“Well, we heard a cry, yes.”
In my customary, clumsy, fashion, I will now attempt to make a comparison to multiple sclerosis. When I was first diagnosed, I stood in the doorway, thought about how much I didn’t want to go through it and cursed my arms, legs, eyes, hands, etc for obeying the disease instead of my will. Once in the air, I tried to turn away and even did some desperate, comical antics to try to avoid what was coming. For the record, you do you. If it makes you feel better and it’s not dangerous, then who am I to criticize? You might be able to pedal your way through the air to a nice soft landing in the grass, I was not. Do me the same courtesy of not being critical please. My MS isn’t your MS. What works for you may not work for me and vice versa. Fortunately there are lessons from the MS community to fall back on and prepare you for crashing into the trees. If you know where to look, there may even be a sarcastic person or two to help you pull your chute out…..and hopefully not be too hard on you for cursing your uncontrollable misfortune as it happens.*
Aside from maybe a neurology residency, there is no MSmaster school, except the schooling that each of us puts ourselves through in our quest to understand this disease. MS education can be a two edged sword. Like the jumpmaster course, it has certainly let me know everything that can go wrong. It also gives me hope that things can go right. Hope may not be a course of action, or something to base planning on for most things, but for MS, it’s sometimes all we have.
From the US Dept of Defense https://www.defense.gov/Explore/Inside-DOD/Blog/Article/2062418/airborne-school-what-its-really-like-learning-to-jump/
Given that I have primary progressive multiple sclerosis, my genetics probably aren’t all that great, but there are a few perks, one of which is my bone density. I sink like a rock in water but have never broken anything, despite all my clumsiness and mishaps. Well, I have broken my nose 3 times but that hardly counts. I wish I had a good story or 3 to go along with those incidents, but when I say, “I” broke my nose, I mean that I was the responsible party each time. I should probably make up something involving a fight, a daring rescue, or something of that sort, but there are just too many witnesses to dispute my claims.
Actually, come to think of it, my good bone density is a mixed blessing at best. I like the water and enjoy being in it, but it might be nice to be able to float. I am proud to have never broken a bone, but something’s got to give, so instead, I ended up with 2 knee surgeries, an ankle reconstruction, have a bulging disc in my neck, and have dislocated both shoulders, the right one, several times. Even though my left shoulder was only dislocated once, it is the more memorable experience because of how it happened.
When I was a young Ranger, we were doing an airfield seizure exercise at Cecil Field in Florida and while jumping in late one night my enormous watch (I like big, dumb, gadgety watches*) became tangled in the suspension lines of my parachute. When I landed, my attention went to my trapped left arm and instead of activating a canopy release assembly and deflating my chute, I started to unwrap the lines from my wrist. Unfortunately, the wind picked that moment to gust and instead of dragging me across the ground by my harness, my parachute stretched out the suspension lines wrapped around my wrist, extended my arm, and slowly pulled my shoulder out of socket.
For years, that was my 10 when asked to describe my pain on a scale from 1 to 10 with 10 being the worst pain I’d ever felt. Later on when I first dislocated my other shoulder, it happened quickly and before it popped back into place, there was a moment when I marveled at how little it hurt compared to that other incident. I suppose there’s a lot of differing factors that went into these two experiences but the general mechanism of injury was the same, something tugging me by the wrist until my shoulder dislocated, so why the big difference in the pain levels? My personal theory is that it was the mental aspect that made the difference. In one situation, I was surprised, with no time to react or resist and in the other, I knew what was about to happen, tried to stop it from happening, but had to watch it slowly happen anyway. Now that I think of it, that would have hurt me if I’d watched it happen to someone else, so I’m sure the mental factor made up a lot of, if not the majority of the difference.
MS is like that………..What, too abrupt of a segue? This is a multiple sclerosis blog, so you knew I’d eventually make some sort of comparison, right?
Like I was saying, MS is like that. Don’t misunderstand, it would still be bad (not to mention, really confusing) if I suddenly woke up like this one day, but having it slowly happen while I watch, knowing what’s happening, but powerless to stop it, feels worse somehow. For me, the parachute isn’t pulling anymore. No new lesions and no active ones in 5 years (Ocrevus?), but with no way to heal the damage (remyelinate), those demyelinated areas eventually die, and the disability continues to progress, even if the disease doesn’t.
The parachute isn’t pulling anymore, but the shoulder won’t pop back in. Great….now I’ve depressed myself.
Come on remyelination therapy.
*My home page picture was taken about 12 years after the events of this story. Note the big, gadgety watch. Joke’s on you parachute, I didn’t learn anything.
I learned an important lesson from a Marine once. No, it wasn’t which color crayon tasted the best, or whether or not one should take the paper off before eating said crayon, it was a simple acronym, a set of principles by which he lived his life. It impressed me to the point that I commited it to memory, adopted it as my own, and will now share it with you.
It’s S K A T E:
S tay out of the limelight
K eep a low profile
A void volunteering
T ake your time
E ntertain yourself
If you’re in the military and find yourself at that in-between rank, where you’re not responsible for, or in charge of anyone or anything, that’s not a bad philosophy to have and as much as I hate to give credit to a Marine’s philosophy (sigh), it’s a pretty good one for MS too.
S taying out of the limelight can be tough when you’re disabled, but you’re still you and don’t have to be upstaged by it. Friends and family will treat you like you, but you have to let them know that it’s ok…… and sometimes, how.
K eeping a low profile can be difficult for the handicapped. Especially when you’re using a wheelchair or another mobility aid, or parked in a handicapped spot. This may seem the opposite of keeping a low profile, but the trick is getting people to see you and not the handicap. When you figure out how to do that with strangers, please let me know, because I haven’t.
A voiding volunteering is crucial to conserving your ration of energy for the day. Mine isn’t really, but if your MS is invisible, I realize that this can be awkward for you and hard to understand for those who wonder why. Some will never understand and it’s not like you can wear a sign or go through the exhausting process of explaining every time, why you can’t commit to Monday what you don’t know you’ll have the energy to do on Friday.
T aking your time was never as important as it is with MS. You can still do a lot of the same things you once did, but if you actually want to complete them then you have to pace yourself. Do one task in stages, or do two things you once did in one day, on separate days.
E ntertaining yourself is vital to your mental and physical well being. No, really. Your “outlets” might have to change with your disability (mine sure have), but you still need them, even if you have to learn new ones.
In an earlier post, I mentioned that I had a baclofen pump, so I thought I’d tell you a bit about it. A word of warning, this is going to be a long one. I’ll try to condense it as best I can, but there’s no way to tell you about the pump without telling you why I made the decision to have one implanted in the first place.
Of all the symptoms of MS that I’ve ever dealt with, spacticity was the worst. The National Multiple Sclerosis Society has this to say:
Spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms (sustained muscle contractions or sudden movements). It is one of the more common symptoms of MS. Spasticity may be as mild as the feeling of tightness of muscles or may be so severe as to produce painful, uncontrollable spasms of extremities, usually of the legs. Spasticity may also produce feelings of pain or tightness in and around joints, and can cause low back pain. Although spasticity can occur in any limb, it is much more common in the legs.
Mine was pretty severe. I know this is an old depiction of the effects of tetanus and I’m not trying to compare the two, but it’s a fairly accurate depiction of what a bad moment with spacticity was like.
I took baclofen (a muscle relaxer) in pill form for a few years, but apparently I’m a lightweight and eventually I reached a point where the largest dose I could handle without falling asleep or staring at the wall and drooling wasn’t having an effect on my spacticity. After talking it over with my neurologist and a successful trial, I had an intrathecal baclofen pump implanted. This hockey puck size pump is implanted under the skin about 6 inches right of my belly button, and has a small catheter that goes around under my skin and is inserted into my spine between the L3-L4 vertebrae. From there it goes up to about the T-10 level and delivers a dose of baclofen straight to my spinal canal. Right now the daily dose is set at 64 micrograms whereas my highest oral dose was 50 milligrams. After absorption through my digestive system and crossing the blood brain barrier, who knows how much was even getting to my central nervous system? ( I’m sure there’s a way to figure that out, but I’m far too lazy) With only about a 100th of that dose going directly where it’s needed, I have all the desired effects, with no noticeable side effects.
At its worst, something would trigger it, a stretch, clothing brushing against me, a drop of water, or puff of wind, etc and I would involuntarily extend my legs, feet crossed over each other, joints at the painfull point of hyperextension, back and neck arched, and hands curled into fists with arms pulled in tight. If I was in a chair and not reclined, this would send me sliding out like an uncomfortable burial at sea. That was most common, but sometimes the opposite muscle group would dominate and my legs would draw up and I’d be thrown forward by clenched abdominal muscles. Sometimes my arms and hands would lock out straight and sometimes if it happened mid yawn, my jaw would spasm shut on my tongue or lip. If I could only have one phrase to describe the most frustrating part of MS for me, that phrase would be, “consistently inconsistent”.
In the years leading up to the pump, I became unknowingly (well maybe tacitly acceptingly) more and more dependent on the spacticity to “walk” and hold me upright. Imagine tottering around on stilts to get an idea what that was like. I would lever myself upright and swing my stiff legs out in little semi circles rather than flex them at the hip and knee to go forward, or pivot and “moonwalk” backwards into a desired position. My constantly rigid abdomen made going to the bathroom……interesting. The constant clenching affected both the act itself and the motility of my digestive and urinary tracts, resulting in a variety of incontinence issues.
I’ve got to pick on the VA for a second. They provided adult diapers and shipped them to my house in discrete, large, boxes, wrapped in black plastic……….10 at a time. The delivery driver had to make 2 trips with a hand truck to get them all in a giant tower on my front porch. There are only a couple things that are shipped “discreetly” like that, so I’m sure my neighbors either thought I was soiling myself 10 times a day, every day, for 6 months at a time, or had entered the adult toy industry in a big way.
(Experiences with the VA vary. I’m poking a little fun at them, but I’ve had a mainly positive experience. That’s another post for another time)
When the pump took effect, all the stiffness in my legs and abdomen (everything below T-10 level) was gone and without it, I went completely limp. Keep in mind, this is my experience and might have been different if I’d had the pump put in sooner, my spacticity hadn’t been so severe, I hadn’t been willing to rely on the spacticity instead of looking for an alternate solution, etc. Regardless, I spent close to a month in bed, having to rely completely on my wife to pull me to a sitting position and slide me to my wheelchair or a toilet/shower chair with a slide board. If she wasn’t a nurse with lots of experience moving patients, we would have needed help with my post op care. My first trip to the VA after the surgery had to be via ambulance because without being strapped to it, I couldn’t sit in my wheelchair very long and couldn’t begin to transfer into a vehicle.
Everything above T-10, arms, hands, and so on, is unaffected, but putting the catheter high enough to relax them wasn’t an option. The way it was explained to me was that it would have to be a cervical placement to relax my arms and there are other nerves that exit the cervical spine that are important for things like breathing, so relaxing them is less than ideal. Also, the dose to relax my legs and torso is higher than for arms, so if the pump was programmed for a dose high enough for those muscle groups, my arms would be completely limp.
I’m still experiencing incontinence but it’s different. Now instead of clenched muscles being the problem, they’re relaxed and instead of urgency because of too much pressure, there’s urgency because I have to relearn what to flex to hold it. The good news is I’m a guy so keeping a portable urinal by my recliner or bed is a convenient option.
With effort and therapy, I am slowly trying to activate muscles that haven’t been used (voluntarily) in years. Short of forming new neural pathways (neuroplasticity) to replace any that are gone, I may never. I’m being as realistic as I dare. My goal right now is to eventually stand and be able to take a shuffling step with my old walker/rollator. When and if I get there, I’ll set a new goal. If I never reach that goal, just the relaxation, comfort, and ability to sleep through the night that the baclofen pump gives me is worth it.
That was the good; now for the bad. I have a hockey puck sized metal pump inside me with a catheter that goes inside and up my spinal canal. In case you missed it, there’s a surgery involved, so there’s risks involved. Here’s mine (yes my intestines were full of gas, etc that day).
See that port in the middle? Every so often the pump has to be refilled via a needle, like this.
It looks intimidating, but really it’s not a big deal. The pump is right under the skin so the needle just breaks it and clicks into the port. In the picture, the needle looks like it’s standing up in me…but it’s not in “me”. If you absolutely can’t stand needles, you need to consider this. The battery has a certain lifespan and when it’s up, the whole pump has to be replaced, so this is a lifetime commitment to regular surgeries if you decide to continue the therapy. The pump also has to be programmed until the correct therapeutic dose is reached. You need enough tone for your muscles to be useful, but not so much for the spacticity to return. It’s been about 10 months since I had mine put in and we’re still fine tuning. Programming is done with a tablet and an attached sensor that is placed on your skin over the pump. None of this is really bad, I’m just trying to make the point that there’s a lot to consider and it’s not right for everyone.
Finally, I feel like I need to make the point that this isn’t a cure for MS. This isn’t going to give me the ability to walk back. If I ever get back on my feet and take a step again, it will be because the ability was there and being blocked by spacticity. All the pump does is remove an obstacle to something that is either there or isn’t. I don’t know if mine is there, but I intend to find out.
There’s a lot more than this overview provides. I am apparently sensitive to intrathecal baclofen too and what should have been a 1 night stay in a regular room after surgery, turned into 4 nights in intensive care, but that’s another story (I keep saying that, don’t I?). If you want to know anything specific, just ask.
