Filed under: Brave New World, Connections, Feedback, General Musings, Genetic Testing, Humor, Machado-Joseph, Religion, Science, Society | Tags: ataxia, balance, blogging, Catholicism, confession, dystonia, genetics, health, humor, jim downey, Machado-Joseph Disease, medicine, MJD, National Organization of Rare Diseases, neurology, neuromuscular disease, NORD, pain, peripheral neuropathy, restless leg syndrome, SCAR8, science, self care, spinocerebellar ataxia type 3, testing, vertigo, Wikipedia
I wasn’t going to say anything about this, because it’s largely a distinction without a substantial difference. But I’ve had several friends ask some questions because of things I posted to social media, and I decided to just clarify the matter.
Last August, when I said this:
So, I got the genetic test results today: I have a mild version of MJD.
I lied.
Oh, it’s a small, technical lie, mostly of the misdirection variety. But it’s a lie.
I don’t actually have MJD, or Spino-Cerebellar Ataxia type 3 (SCA3), which is a genetic disease caused by a trinucleotide repeat disorder in a specific gene sequence. Instead, I have SCAR8 (it doesn’t have another name), which is a genetic disease caused by a disorder in a different specific gene sequence, and has symptoms that are like a mild version of MJD, plus a couple of other things that I’d noticed/showed up on clinical exam. Everything else I said in the post from August is true.
If you poke around online, you’ll find that there’s not much on SCAR8, because it’s even more rare than MJD (by like a factor of 10), so there’s even less known about it. But it’s in the same family of ataxias for which there’s no cure and very little in the way of available therapies. You just deal with the symptoms as best you can.
I have always been a fairly pragmatic sort of person, so I figured that since there’s really not much difference between MJD and what I have, there wasn’t a need to confuse the issue with writing about it. But it seems that one of the differences is some mild lower G.I. issues (along with messed-up signals from my body about the urge to urinate), which I had mentioned online and caught the attention of friends.
So there’s that. It doesn’t change anything in what I am doing: treating symptomatically, altering behavior as necessary to account for the disease, and getting on with life as best I can. But having been raised Catholic, I’ve now confessed to the small lie, and gotten that off my chest. 😉
Jim Downey
Filed under: Alzheimer's, Amazon, Connections, Feedback, General Musings, Kindle, Marketing, Predictions, Preparedness, Promotion, Publishing, Science Fiction, Writing stuff | Tags: Alzheimer's, Amazon, BBC, care-giving, caregiving, Communion of Dreams, direct publishing, Her Final Year, Kickstarter, mathematics, More or Less, Science Fiction, St. Cybi's Well, statistics, writing
This past weekend a broadcast of the BBC show/podcast “More or Less” caught my ear, as it was discussing the economics of conventional trade publishing. I would encourage listening to the entire thing (about 9 minutes), but the basics are:
- Of about 50,000 new titles published in a year, just 0.4% will sell more than 100,000 copies
- To ‘break even’, a title needs to sell about 5,000 copies
- Some 86% of all titles sell fewer than 5,000 copies
- Something like 15% sell fewer than a dozen copies
Whoa.
I knew the numbers weren’t good, and that I had been relatively successful with self-publishing my own books (after years of trying to land a conventional publishing deal), but I had no idea that they were that dismal.
For perspective, all three of my books broke that 5,000 threshold the first year that they were available. And two went on to break it again the second year. Total downloads (ballpark numbers) for each of my books so far:
- Communion of Dreams: in excess of 50,000 downloads from Amazon, with another ~25,000 downloads of the prior pdf before that
- Her Final Year: in excess of 11,000 downloads from Amazon
- St Cybi’s Well: in excess of 9,000 downloads from Amazon
I’ve been mildly disappointed in the performance of St Cybi’s Well, but that is largely in comparison to Communion of Dreams, which was published a decade earlier (and which has continued to see strong sales/downloads each year). This kind of puts that into perspective.
One thing I want to mention: free downloads. Yeah, that skews the numbers a bit, but not as much as you might think for the two novels. For those, free downloads account for about 15% of SCW and about 20% of CoD totals. HFY saw a much larger percentage of free downloads, but that was because we saw the book more as a public service to other care-givers than a moneypot.
Oh, and “best seller”? Other info I’ve seen indicates that about 50,000 copies is typically considered a best seller in the trade publication industry. Now, that’s for one-year sales, not cumulative sales over a decade. But still, it makes me feel pretty good about how CoD has done.
Jim Downey
Filed under: 2nd Amendment, Art, Book Conservation, Brave New World, Connections, Feedback, General Musings, Genetic Testing, Guns, Health, Machado-Joseph, Predictions, Preparedness, RKBA, Science Fiction, Travel, Writing stuff, YouTube | Tags: art, arthritis, ataxia, balance, black powder, blogging, book conservation, bookbinding, Communion of Dreams, fasciculation, genetics, guns, health, jim downey, Legacy Bookbindery, Liberal Gun Club, Machado-Joseph Disease, medicine, MJD, MMJ, neurology, neuromuscular disease, pain, peripheral neuropathy, SCA3, Science Fiction, spinocerebellar ataxia type 3, St. Cybi's Well, travel, Utah, vertigo, wabi-sabi, Wikipedia, www youtube
Recently I drove out to Las Vegas, for the first post-Covid national meeting of the Liberal Gun Club (I can be seen at several points in the video, wearing a red & white flannel shirt). It’s a drive I’ve made previously in two days (about 12 hours each day), but I decided that it would be wise for me to split it up into three days each way, to better reduce my stress and better accommodate the unpredictable episodes of MJD symptoms (since I didn’t want to take any of the painkillers or MMJ stuff that help me manage those episodes while I was driving).
It was a good decision. When I had an flair-up of symptoms, I knew that I could take a break without feeling a lot of time-pressure.
And it gave me more time to think.
To think about this past year, and where I’ve found myself. To think about the LGC event (particularly after it was over, and I could reflect upon what happened there). To think about the near-term future.
As I noted yesterday (and in this series of MJD-related blog posts generally), it’s been a challenging year. And there’s nothing like going naked (in the sense of not taking any meds) for a prolonged period of time to show you, honestly and clearly, what your real condition actually is.
Mine isn’t bad. But it is perhaps a lot worse than I had realized, in my day-to-day life. That’s because being able to take things that help manage it means that I can largely ignore the symptoms. Without those meds, though, the truth tends to be a little sharper edged (as is the pain). While teaching a black powder workshop I had hand spasms that were so bad I couldn’t hold onto the gun I was using at the time, let alone manage to load it. So much for the idea that being focused on a given task (which I was) would be enough to set aside that symptom. I verbally walked my students through the process, and we got on the other side of it fine. But it was a sobering moment.
A moment that drove home the idea that it was time for me to make some changes. Specifically, that it is time for me to pretty much completely retire from conservation work. As I noted in this blog post last May:
As a conservator, I can’t afford to celebrate my mistakes. There will of necessity come a time when I need to stop doing conservation work, out of respect for the items entrusted to my care. That time is rapidly approaching; indeed, it may already be here.
I think I crossed that line sometime this summer. So the time has come for me to (mostly) stop doing conservation work altogether, at least in terms of being hands-on.
That’s a big change for me. I’ve largely defined myself as being a book conservator for 30 years.
* * *
Western Utah is stunning. But also bleak. And more than a little alien to my Midwestern eye.
I think those vistas, and the mental space I was in on my drive home, helped me realize something else.
That I’m ready to start writing a sequel to Communion of Dreams.
I hesitate even mentioning this, since I had so many people after me about the long delays in writing St Cybi’s Well. But I decided to share it to help offset the seemingly ‘bad’ news that I need to retire as a conservator.
So here’s the deal: don’t ask how it is going, or when I expect it to be done. I’m at the very beginning of the whole process, and it is likely to take years. I may occasionally mention things about it. Or not. But asking me about it is not going to get any additional information beyond what I volunteer, and will just annoy me. You can wish me well with the writing, but leave it at that, OK?
Thanks.
Jim Downey
Filed under: Connections, Failure, Feedback, General Musings, Health, Machado-Joseph, Predictions, Preparedness | Tags: arthritis, ataxia, balance, blogging, genetics, health, jim downey, Machado-Joseph Disease, MJD, neurology, neuromuscular disease, pain, peripheral neuropathy, self care, spinocerebellar ataxia type 3, vertigo, Wikipedia
As I’ve mentioned, I’m in a long-term project to repair and repaint our 1883 historic home. Most days I put in several hours of work on it, according to what my symptoms allow.
The pic above was from yesterday, just as I was getting to work on painting the ceiling of our large carport. The six-foot stepladder is sufficient for this chore, though not ideal — I need to hold onto the roller pan or paint bucket while I work above my head. Well, just as I was getting started, I went up the ladder … and promptly dropped the roller pan. It just slipped out of my hand.
Now, like everyone, I’m occasionally clumsy. Always have been. And I’ve made bigger messes than that shown.
But in the past, my clumsiness has always been related to some other factor. I was distracted. Or I was doing something I knew was marginally safe/balanced. I’d drank too much. I had a migraine. I hadn’t slept. Et cetera.
Not this time. I felt fine. I’d had a good morning, getting in my walk and exercises. I’d had breakfast, and was sufficiently caffeinated. I’d set up everything properly to paint, and the ladder was stable. There were no unusual or unpredictable factors at play.
Except MJD.
And that was enough. My hand … just let go.
As I picked up the roller and tray, and cleaned up the mess, I was pissed off. And feeling very, very fragile. It was a rude reminder that I have a disease I can’t control. All I can do is manage the symptoms to the best of my ability.
In the end, it was just an hour or so delay before I got to painting. And a lesson in not taking things for granted I have always taken for granted.
Jim Downey
Filed under: Brave New World, Failure, Feedback, General Musings, Genetic Testing, Health, Humor, Machado-Joseph, movies, Preparedness, Science, YouTube | Tags: arthritis, ataxia, balance, blogging, cannabis, dystonia, genetics, health, humor, jim downey, Machado-Joseph Disease, marijuana, medicine, MJD, Monty Python, National Organization of Rare Diseases, neurology, neuromuscular disease, NORD, pain, peripheral neuropathy, restless leg syndrome, science, self care, spinocerebellar ataxia type 3, testing, vertigo, Wikipedia
So, I got the genetic test results today: I have a mild version of MJD.
That’s not an official diagnosis. I probably won’t have that until sometime next year, after I have different insurance (Medicare) and can find a local Neurologist to work with. Because I won’t go back in to the Neurology Clinic at the local large-institution university hospital which shall remain nameless, for reasons outlined previously. And because they didn’t bother to send me the results — which they have had for over a month — until I called them up. And they’re supposed to post all such results to the ‘patient portal’ within two days of getting them. Grrr.
But the results are clear. And since there is little or nothing that modern medicine can do for me that I’m not already doing, I’m happy to just wait.
Knowing the results makes a difference. And while it’s not good news, it could certainly be worse. I know what is going on, and what to expect. Thanks to my sister’s experience, and the experience of my other family members, I know most of the best strategies to manage the disease. Because of my age of onset (about 4 years ago, I think, so about 60 years old), and the type I have, I should experience a normal lifespan and slowly progressing symptoms. I can plan and work with this information.
I intend to continue to write about this, but those posts will probably be just occasional updates when I feel like I have something interesting to say.
Thank you for your good thoughts and support — it’s helped me these past months while I have navigated this experience.
Jim Downey
* https://www.youtube.com/watch?v=Jdf5EXo6I68
Filed under: Connections, Failure, Feedback, General Musings, Genetic Testing, Health, Humor, Machado-Joseph, Predictions, Preparedness, Science, Survival | Tags: arthritis, ataxia, balance, blogging, cannabis, CTE, dystonia, genetics, health, humor, jim downey, Machado-Joseph Disease, marijuana, medicine, MJD, National Organization of Rare Diseases, neurology, neuromuscular disease, NORD, pain, peripheral neuropathy, restless leg syndrome, SCA3, science, self care, spinocerebellar ataxia type 3, testing, vertigo, Wikipedia
Eight weeks.
8
Which, on its side, helpfully looks like the infinity symbol: ∞.
Because while it’s been eight weeks since my blood sample was drawn for the genetic testing for MJD, it feels like I’ve been waiting an eternity for the results.
Of course, it took a full month for the Neurology Clinic at the local large-institution university hospital which shall remain nameless to order the test.
And I waited two months before that to get in to see those neurologists, because I thought I needed a referral.
And I waited three months before that in order to get in to see my GP in order to explain why I wanted the referral.
Yeah, count back, and that means I have been waiting all this year in order to get a diagnosis for the disease I’m reasonably certain I have. Little wonder that NORD (the National Organization of Rare Diseases) says that typically, a correct diagnosis for someone with a rare disease (such as MJD) will take upwards of five years. I’m already most of a year in, and I even KNOW the disease actually runs in my family. Imagine what it would be like if it was just a random mystery disease, and we had to start from scratch to determine what was going on.
>sigh<
Yes, it’s frustrating. Friends and family keep asking (just being supportive, not annoying), and I keep telling them the same thing: no results yet.
Meanwhile, I continue to just deal with the symptoms as best I can. And things do continue to evolve. Balance issues are now fairly routine. Hand & feet pain and Restless Leg/Arm Syndrome less so, but seem to be happening more often. And I’ve started to experience occasional vision difficulties (focus/double vision problems) that I can usually ‘reset’ by changing my point of focus to something far away, then shift back to a closer item. It’s not an actual double image, but rather the sort of thing you experience when trying to look through the wrong part of progressive lenses, then shift your vision so things slide back into focus.
The good news is that the MMJ does help most of these symptoms quickly, and I have cut my mild opioid intake by about 50% since I figured out what worked for me.
Meanwhile, I wait. I check to see whether the results have been posted to my account on the diagnostics site or my patient portal for the local large-institution university hospital which shall remain nameless. And I get on with life.
While waiting.
Jim Downey
Filed under: Connections, Failure, Feedback, General Musings, Genetic Testing, Health, Humor, Machado-Joseph, Predictions, Preparedness, Science, Survival, tech | Tags: arthritis, ataxia, balance, blogging, cannabis, CTE, dystonia, genetics, health, humor, jim downey, Machado-Joseph Disease, marijuana, medicine, MJD, National Organization of Rare Diseases, neurology, neuromuscular disease, NORD, pain, peripheral neuropathy, restless leg syndrome, SCA3, science, self care, spinocerebellar ataxia type 3, testing, vertigo, Wikipedia
Tomorrow will be five weeks since the blood draw for my MJD genetic test.
I just checked (for the fifth time so far today), and neither my patient portal for the Neurology Clinic at the local large-institution university hospital which shall remain nameless now the diagnostics lab that handled the test has results back yet.
>sigh<
I don’t really have much to say that I didn’t say two weeks ago in this post, other than the fact that it’s been two more weeks of waiting. Everything there still applies.
But I wanted to whine a bit.
Not that it will do any good, other than allowing me to vent my spleen.
Which sometimes is enough.
Barely.
Jim Downey
Filed under: Connections, Failure, Feedback, General Musings, Genetic Testing, Health, Humor, Machado-Joseph, Predictions, Preparedness, Science, Survival | Tags: arthritis, ataxia, balance, blogging, cannabis, CTE, dystonia, genetics, health, humor, jim downey, Machado-Joseph Disease, marijuana, medicine, MJD, National Organization of Rare Diseases, neurology, neuromuscular disease, NORD, pain, peripheral neuropathy, restless leg syndrome, SCA3, science, self care, spinocerebellar ataxia type 3, testing, vertigo, Wikipedia
It’s now been three weeks since my blood samples got to the testing lab to do the genetic test for MJD.
And I’ve just checked, for the fourth or fifth time today, to see whether the results have been posted to my account on the diagnostics site. They haven’t.
I’ll check a few more times today. And though it’s unlikely that the results would be updated over the weekend, I’ll probably check several more times tomorrow and again on Sunday.
Not that I’m obsessing, or anything.
No, really.
It’s just that in an era when I have literally a dozen 15-minute tests for Covid in my bathroom, when a standard blood panel workup will be done in a couple of days, and when almost any other test results I can think of would be available in a week or so, waiting three weeks seems … excessive.
NORD (the National Organization of Rare Diseases) says that typically, a correct diagnosis for someone with a rare disease (such as MJD) will take upwards of five years. So I suppose I should just consider myself lucky that I know what to look for, and to have the resources to push for the test and get it ordered. A few weeks of waiting for the results are, in the big picture, a minor annoyance. But still, it *is* an annoyance.
Several friends have asked me what the next step is, once I get the results.
That depends on what the results are, of course.
If the genetic test shows that I fall in the zone of either possibly developing MJD (an intermediate number of CAG nucleotide repeats in the relevant DNA segment) or over the threshold considered to be definitive for MJD, then I’ll find a local neurologist who will be willing to work with me to monitor and manage the disease. No, there’s no way in hell I’m going back to the Neurology Clinic for the local large-institution university hospital which shall remain nameless, if I can avoid it.
If the test comes back and rules out MJD (I consider this unlikely, but it is possible), then I need to think about what to do. I just turned 64, so a year from now I’ll qualify for Medicare, and it might make sense to just wait until I have that before starting a series of additional neurological tests. Particularly since if I don’t have MJD, there’s really only one other thing that would explain my symptoms over the last year: CTE. That’s a diagnosis that can only be made during an autopsy, and I’m not ready for THAT test just yet, thanks.
Either way, I’ll probably continue to just manage my symptoms as best as I can, and get on with life. I’ve now experimented with enough different MMJ products to have a handle on what helps and what doesn’t, related to method of ingestion and dosage. Turns out that smoking/vaping has little or no benefit for me in dosages low enough to not trigger all my MJD symptoms, but both tinctures and edibles do have some therapeutic benefits. Small dosage edibles help me sleep longer, with less use of opioid Rx meds. And a mild dosage of tincture seems to very quickly stop Restless Leg/Arm Syndrome (as a friend said, most people don’t understand just how miserable RLS can be). Just figuring out these two things has made a significant difference in my day-to-day life already. And my balance & flexibility exercises continue to help with those issues.
Just checked: still no results posted.
>sigh<
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
Communion Of Dreams 