Filed under: Brave New World, Connections, Failure, General Musings, Health, Humor, Machado-Joseph, movies, Predictions, Preparedness, Science, Survival | Tags: arthritis, ataxia, balance, blogging, cannabis, dystonia, genetics, health, humor, jim downey, Machado-Joseph Disease, marijuana, medicine, MJD, neurology, neuromuscular disease, pain, peripheral neuropathy, restless leg syndrome, SCA3, science, self care, spinocerebellar ataxia type 3, testing, vertigo, Wikipedia
“Your love of the halflings’ leaf has slowed your mind.”
— Saruman, to Gandalf. The Lord of the Rings movie.
As I mentioned in my last post:
One of the problems that the industry has (at least in terms of medical use) is that the effects of cannabis are so varied, and standards so inconsistent, that pretty much the universal advice to new users is “just try a bunch of different things at small doses to figure out what works for you”.
So, following this standard advice, when I went to the dispensary for the first time I got a variety of different products. Tincture, edibles, flower, and a couple of pre-rolled joints. The tincture and edibles both have proven promising in my testing, taking the edge off my pain and other symptoms and helping me to sleep better. Last evening before dinner for the first time I tried to smoke some of the stuff taken from a pre-roll, so I could measure it out and be a little more careful about dosage than just lighting up a joint.
I measured out a modest amount, and put it in a glass pipe I’d also picked up. Standard little spoon-style, with a ‘carb‘ (hole on the side that controls airflow). I lit the bowl, drew the smoke into the chamber, and released the carb — and took a deep hit.
The smoke filled my lungs. And immediately I about coughed my lungs out. Hacking, spitting, coughing, tears, the whole 9 yards. Pathetic. But hey, I haven’t actually tried to smoke anything in what … four decades? But clearly, I ain’t no wizard. And I was overly generous in how much to put in the bowl.
Anyway, I went back inside after I recovered sufficiently, and sat down before the effects slammed into me. Good thing, because I was just about useless for the next twenty or thirty minutes. It wasn’t just the high, which I expected. It was also the way it seemed to suddenly multiply all the MJD symptoms I usually experience: vertigo, shaking hands, deep tremors in legs, shooting pain in the arms and feet, difficulty in eye-hand coordination, everything. All at once. About ten times worse than the usual symptoms.
I texted Martha and told her that she needed to take over dinner, that I just needed to sit and ride out the effects for an hour or so. I wasn’t worried; taking psychedelics long ago taught me how to just let the trip unfold without fighting it. The effects backed off and in an hour or so I was functional enough to get up and get some dinner, go into the living room and watch some TV while we ate. The effects then dropped off fairly completely after about four hours.
The worst thing, though? It didn’t do a damn thing for my pain. Oh well.
One strain down, others to try. But only after I get a small vape to allow me to control dosage even better, and take some of the edge off the raw smoke. Live and learn.
Jim Downey
Filed under: Brave New World, Connections, General Musings, Genetic Testing, Health, Humor, Machado-Joseph, Marketing, Predictions, Preparedness, Science, Society, Survival | Tags: arthritis, ataxia, balance, Big Medicine, blogging, cannabis, dystonia, genetics, health, humor, jim downey, Machado-Joseph Disease, marijuana, medicine, MJD, neurology, neuromuscular disease, pain, peripheral neuropathy, restless leg syndrome, SCA3, science, self care, spinocerebellar ataxia type 3, testing, vertigo, Wikipedia
So, late Wednesday FedEx delivered this:

That’s the sample collection kit for the MJD genetic test.
The paperwork included indicated that I could just take it to a local Quest Diagnostics and they would do the blood draw and send the samples off. I made an appointment for the next morning, and did just that. That done, now we just wait for the results. Ideally, I’ll get a copy of the results (I’ve formally requested one, and they should comply, since that’s part of the HIPPA guidelines) and not even have to meet with the Neurologists at the local large-institution university hospital which shall remain nameless. About the very last thing I want to do is deal with those people again. Yes, that experience has continued to annoy me.
And on that point, on one of my recent morning walks (I walk ~3 miles most mornings), I found myself walking with a couple of neighbors for part of the time. They were chatting about healthcare for another neighbor who was recently injured, and the conversation turned to the local large-institution university hospital which shall remain nameless. I mentioned that I’d recently had to deal with the Neurology Clinic there, and they both exclaimed words to this effect: “Oh, Jim, why the hell did you do that to yourself?!?!”
Yeah, the local large-institution university hospital which shall remain nameless has a bit of an image/reputation problem with the locals.
* * *
Late last week I also received my state Medical Marijuana card. I decided to apply for it, as part of my decision to be more active in managing my symptoms, whether they’re due to MJD or something else. Approval was all but certain, since on the ‘chronic pain’ criteria alone I qualified, having been on mild opioids for 10+ years. As I mentioned in one of my early posts about MJD, I’d noticed a persistent uptick in my use of my Rx pain meds (rather than just the occasional up and down variation I see over the months), particularly to aid in sleeping. Symptoms like Restless Leg/Arm Syndrome tend to disrupt my sleep in the early morning hours, contributing to spiraling problems associated with lack of sleep.
So I wanted something to help me sleep, without increasing my use of opioids or getting into a cycle of taking additional Rx meds. Many of my friends who deal with chronic pain has found MMJ (Medical MariJuana) to be efficacious in dealing with sleep problems, so I figured it was worth a try.
Let me tell you, there’s nothing like going to a medical cannabis dispensary for the first time to make one feel *REALLY* old and out-of-touch. Seriously, I gave the budtender a nice tip not only for his assistance, but also for not calling me “Gramps”.
The whole experience was a little overwhelming, even though I had done my research and spent a fair amount of time exploring products on the dispensary’s website. It’s clear that this is still an immature industry, figuring out how to do branding/marketing, communicating with different clienteles, tapping into demographic groups who are not already savvy about cannabis use.
But I was able (with the help of the budtender) to select some different products to try. One of the problems that the industry has (at least in terms of medical use) is that the effects of cannabis are so varied, and standards so inconsistent, that pretty much the universal advice to new users is “just try a bunch of different things at small doses to figure out what works for you”.
So that’s what I’m doing at present. So far, it looks promising.
* * *
Not all the tests we face in life are big. Or obvious. Or dramatic.
Sometimes they’re just a simple challenge: how to deal with this small problem. How to help someone. How to get through the day, or night.
With luck, in another couple of weeks I’ll have more information about my MJD status, and know whether and to what degree I have the disease. I was always very good at taking tests in school, and those I’ve faced in my life since I like to think I’ve passed reasonably well.
Waiting is hard. But it is just one more test to manage, piece by piece, day by day.
Jim Downey
Filed under: Connections, Feedback, General Musings, Genetic Testing, Health, Machado-Joseph, Predictions, Preparedness, Society, Survival | Tags: arthritis, ataxia, balance, Big Medicine, blogging, cardiac stent, dystonia, health, jim downey, Jujitsu, kata, Machado-Joseph Disease, martial arts, medicine, MJD, neurology, neuromuscular disease, pain, peripheral neuropathy, SCA3, science, self care, spinocerebellar ataxia type 3, vertigo, Wikipedia
As the title indicates, this is just a brief update for those following this story.
I’m still waiting for the paperwork for the genetic test to come through. This isn’t surprising, since the local large-institution university hospital which shall remain nameless moves at the speed of most bureaucratic institutions. It could show up any time, or not for weeks. We’ll see.
Since there isn’t any kind of ‘cure’ for MJD, and the disease progresses slowly, I think that unfortunately the medical community doesn’t tend to think that it is a pressing issue. If I had some kind of cancer, or a serious heart problem, testing and treatment discussions would have been much more aggressive. I know — I’ve had a serious heart problem.
I noted in my last blog post that I have no intention of continuing care with the Neurologists at the local large-institution university hospital which shall remain nameless. I have also decided that I need to take my own care into my hands for at least the time being, until I have the test results back and arrange for a new neurologist. I know what treatments are typically used to manage the symptoms of MJD patients, as well as what my family members have found helpful, at least in the early stages of the disease, and I have taken steps to use the same/similar treatments. If it turns out that I don’t have MJD, none of these steps will cause problems.
So right now everything is about mitigation. My balance and flexibility exercises have already shown positive results. The Restless Leg/Arm Syndrome continues to show up periodically. Hand cramping and tremors still happen, particularly after I have been using my hands for intense work. Episodes of vertigo still hit me, particularly when I rotate my head or bend over. Shooting pains and ongoing aches still happen in both hands and feet, though not usually at the same time.
And something new, that I don’t recall hearing about from any of my family, though it is a classic symptom of Type 3 of MJD: instances of blurry/double vision. This isn’t debilitating (at least not yet), and only happens when I am trying to focus on something up close, but it was very surprising and disorienting the first couple of times it happened. If you’ve ever worn multi-focal lenses, it kinda feels like that when you first put them on. I’ve since learned that simply shifting my focus further away resolves the problem instantly.
So that’s where things stand. While I wait for the test, I’m just doing my best to learn to cope with the symptoms. It’s been an interesting process of adjustment to my new reality, and again confirms just how plastic/adaptable humans can be.
Jim Downey
Filed under: Connections, Feedback, General Musings, Genetic Testing, Health, Machado-Joseph, Predictions, Preparedness, Science, Society | Tags: arthritis, ataxia, balance, Big Medicine, blogging, dystonia, health, jim downey, Machado-Joseph Disease, medicine, MJD, neurology, neuromuscular disease, pain, peripheral neuropathy, SCA3, science, self care, spinocerebellar ataxia type 3, Wikipedia
Yeah, I know it doesn’t scan as well. But I don’t want a noted songwriter’s lawyers to sue me. And it’s more accurate for my use.
Yesterday my sister (who, as I’ve mention, has MJD) had her semi-annual check-in with her neurologist’s office, this time a virtual chat/exam with a staff Physician’s Assistant she hadn’t worked with previously. I popped over to St Louis so I could be with her for it, as it would give me a chance to see how it was done, have an introduction to the P.A., and get a direct handle on her current condition and challenges.
And I wanted to talk a little about the difference between this virtual session and my experience with the local large-institution university hospital which shall remain nameless. Obviously, I’m not going to get into health/medicine details, and I have cleared this with my sister.
The difference was striking. Rather than an almost patronizing “I know about this, because I’m the doctor” that was the overall vibe of my exam, the P.A. shared that she herself has M.S., and so personally understands the difficulties of having a neuro-muscular disorder which may be treatable, but for which there is no cure. Even with the limitations of a Zoom call, she exuded empathy, nodding as my sister described recent challenges and changes to her condition, discussing what meds have been working and which needed to be tweaked. They went over vital stats, overall health and wellness, chatted about the possibility of different kinds of therapies which might help, and so forth. The whole thing was personal, friendly, and very helpful.
Now, my sister has a diagnosis of MJD that has been confirmed by the genetic test, and a long care history with this neurologist and their staff. So none of that is an issue, whereas in my case things are still indeterminate (frustratingly so, as I’ve noted). So that’s certainly a very big difference between us, and the care we might expect to receive.
But as my sister was discussing her symptoms with the P.A., I couldn’t help but check off how I had a less severe version of most of them. And I couldn’t help but notice how the P.A. really listened to her, and her own assessment of how she was doing, what she was experiencing. Lastly, I couldn’t help but compare the care and attention she had received versus how I had been treated in my initial exam and in follow-up communications.
Now, you might think that comment is a little harsh, given what I said in this blog post. But I haven’t mentioned here that after that post, I received a response from the Attending Neurologist which … rather curtly doubled-down on the attitude of the initial assessment, and said they knew what they were doing, he knew more about the disease than I did, and that I was presymptomatic for MJD in all their tests, whatever I might happen to think I was experiencing. Though he did grudgingly allow that the genetic test may show something, and if so they’ll address that.
Well, actually, no, they won’t. Because once I have the test results, whatever they show, I’ll be finding a new neurologist. I’ve just seen the difference in how people can be treated, and I know which way I want to go.
Jim Downey
Filed under: Brave New World, Connections, Feedback, General Musings, Genetic Testing, Health, Machado-Joseph, Predictions, Preparedness, Science | Tags: ataxia, blogging, cerebellum, Facebook, health, hypochondria, imposter syndrome, jim downey, Machado-Joseph Disease, medicine, MJD, neurology, neuromuscular disease, pain, proprioception, SCA3, science, spinocerebellar ataxia type 3, vertigo, Wikipedia
I honestly didn’t expect this.
Arrangements have now been made for the genetic test I’ve been wanting, and now I’m nervous about it.
Yeah, sure, it makes sense that I might be nervous about finding out I have MJD. That’s perfectly understandable. But I’m also weirdly nervous about finding out that I don’t have MJD.
WTF?
See, there’s a part of me that, well, as I said previously:
So there’s some small doubt in my mind sometimes as to whether I actually have the disease, or if I’m just concocting it from a variety of lesser symptoms of normal aging and my own rather rough & tumble life. And boy, wouldn’t that be embarrassing? I mean, I’ve told all my family and friends that I’ve got this happening, I’ve posted about it on Facebook, I’ve blogged about it. What if I’ve just imagined it all? What if I’ve got a case of hypochondria going on?
After all the fuss I’ve caused. After all my own worrying. After troubling friends and family. If it turns out that I don’t have it …
Well.
< deep breath >
If it turns out that I don’t have it, I’ll have dodged a bullet. It’ll just mean that I have been overly vigilant, perhaps over-reacted to some aspects of normal aging. Yeah, that might be a little embarrassing. But I think anyone who has had a health scare will understand.
And, as a friend said recently, it’s not like I’ve just invented this disease out of whole cloth. The fact that five close family members have had it in my lifetime means that it is a reasonable thing to check out, once I detected symptoms which could indicate onset.
Sometime in the next couple of days I’ll have the blood draw, and that will be sent off to Massachusetts. I should have the results back in about a month.
Keep your fingers crossed.
Jim Downey
Filed under: Amazon, Art, Book Conservation, Connections, General Musings, Health, Kindle, Machado-Joseph, Marketing, Promotion, Publishing, Science Fiction
Just over a year ago I did a write up on completing the leather bindings for Communion of Dreams. This is going to be a similar documentation of completing the leather bindings for St Cybi’s Well.
Unlike the sewing structure for CoD, the sewing for SCW is exactly the same as for the hand-bound hardcover edition. Since I have already done a thorough documentation of that process, I see no reason to repeat it here. Instead, I’ll just refer you to that original post: Turning words into books.
And likewise, a couple of months ago I did a post about the actual design of the cover of the leather edition of St Cybi’s Well, so there’s no reason to go over all of that again. You can find that post here: Well, well, well …
The first thing in doing the full edition of 14 books, I needed to cut out sufficient “stones” of bookboard to form the relief on the front cover, and get those each laid out and mounted on the heavy bookboard. This was made possible by the use of my Glowforge laser to cut through the heavy bookboard. The “stones” were laid out such that one blank space was left for the mounting of a real slice of Preseli Bluestone from the quarry at Craig Rhosyfelin on the outside of the leather:

My Kickstarter backers selected what color leather they wanted for the cover of their books, and I ordered in the leather that I didn’t already have in stock. It’s all high-quality bookbinding goatskin:

I calculated how big of a piece of leather I needed for each book, and made a jig cutting those out:

Then those needed to have reference lines laid out, the corners cut and all the edges pared down:


The Communion of Dreams leather covers had the slight raised image of the Burr Oak tree, which was made using an archival board with a thickness of 0.02″. The archival bookboard I used for the “stones” of the St Cybi’s Well design were 0.10″ — five times as thick. Because of this, some additional work was needed to make sure that the leather conformed to the “stones”.
The first step was to saturate the outside of the leather with distilled water in the area of the front cover:

The the inside of the leather was pasted out with adhesive:

And the front cover was positioned. A barrier of plastic film was put on each side, then a sheet of foam core was positioned to cover the entire front cover. That was then placed between two press boards and the whole sandwich was put into my large nipping press. The press was cranked down, and the sandwich was left to dry overnight. The next day, this is what the end result looked like:

Then I mounted the rear board, as well as the spine liner, and turned the edges in (be sure to read my Wabi-sabi post about this):

After all the covers (the bookbinding term is “cases”) were finished, I mounted the text block as per usual. At this point, they were books, but they weren’t finished.
First, I wanted to get the endpapers mounted. Typically, this would just be done by tipping in the endpaper, then pasting it out and sticking it in a press for a quick nip. But I wanted these books to be a little more hand-fitted, so I pasted out the slightly over-size endpaper, then carefully by hand laid it out in position before pressing:

This makes the hinge joint a little more flexible, and the book friendly to open and read. A small thing, but with a book of this quality, an important one. Once the endpapers were mounted, I trimmed the excess off.
The next step was to mount the thin spiral cut from sparkly blue commercial glitterpaper using the laser. This was a visual reference to a similar image in the book. The trick was to mount the narrow, somewhat fragile, spiral of paper without distortion, damage, or excess adhesive. To do this, I first positioned the off-cut of the spiral using low-tack tape:

Then I pasted out a sheet of waste paper. Carefully laying down the thin spiral on top of the waste sheet, I lightly tapped the spiral so that a thin application of adhesive was transferred to the back. I carefully lifted the spiral off the adhesive, supporting it across the center with a micro-spatula. I was then able to position it into the void of the off-cut:

Using a narrow bone folder, I then pressed the thin spiral down along the entire surface, and then removed the off-cut:

This was then given a quick nip in the press to set the adhesive.
Once all the endpapers & spirals were mounted, it was time to mount the blue “water” inside the well design:


With the “water” mounted, I masked that area and did the title etching in the laser, using the same technique I developed for the titling on Communion of Dreams:


The titling done, I added a small tip-in sheet with the colophon and edition number:

I mounted each slice of Preseli Bluestone in the appropriate place on each book. Here they all are, arranged so as to re-create the “well” design with each stone in the proper location:

And they’re all done. 9 of the 14 bindings are going to their new homes, and one is staying with me. That leaves these four bindings still available for adoption:

If you’re interested in adopting one of these books, and perhaps a matching # copy of Communion of Dreams, feel free to contact me for the details: jim@communionblog
It’s likely that given my MJD, this will be the last edition of bindings I ever do. Not a bad place to end a career. But we’ll see.
Jim Downey