Communion Of Dreams


Machado-Joseph Disease: wabi-sabi

“Jim Downey was a noted book artist, conservator, and author who, at the height of his skills, was betrayed by his body with the onset of Machado-Joseph Disease in his early 60s …”

That could be the opening line of my obituary some (hopefully many!) years hence. Or perhaps a change to my Wikipedia entry.

But the thing is, I don’t feel betrayed by my body. Not in the least.

Yes, I likely have MJD. And yes, it has started to cause me physical difficulties in accomplishing things, as well as additional pain, as I have been outlining here on the blog.

But we all live with limitations. Of strength. Of endurance. Of skill. Of intellect.

I can’t fly like a bird. Should I say that I am therefore ‘betrayed’ by my body? Of course not.

I can’t think as rapidly or as clearly as I could when I was, say, 40. Again, that’s not a betrayal. That’s just change that comes with being a normal human. Of living a normal life.

There’s a Japanese concept of wabi-sabi that informs a traditional aesthetic common in the culture. It has roots in Zen Buddhism, which I studied and tried to embrace as a young man. It can be a difficult concept to explain, but concerns an appreciation for that which is imperfect and/or impermanent in nature and beauty, as all life is imperfect and impermanent. A classic example of wabi-sabi is an elegant teacup which has a flaw (perhaps broken accidentally), but made more beautiful by the application of a gold filling to repair the cup and make it functional again. It is an understanding that all things can only be fully appreciated by respecting their limitations, and that experiencing the thing in the moment, as it is, with all the flaws it has.

As I noted a couple of months ago, I’ve been working to finish the leather-bound edition of St Cybi’s Well. Though this has been complicated by the onset of MJD, I’m almost finished with the edition of 14 books. As I was working to “turn in” (the process of folding the leather around the edges of the bookboard for the cover) the covering leather on one of the first of these books, I made a mistake. My hand slipped. And the tool I was using, my favorite thin bone folder, marred the cover.

Dammit.

I took a deep breath, finished what I was doing, and set the cover aside to think about it later. When these things happen, the >worst< thing you can do is panic and over-react. A lot of times if you just leave it be and revisit it later, you can usually mitigate the damage with a little careful pressure, or extra moisture, or one of several other techniques.

I turned my attention to the next cover.

And as I was finishing that one, almost the exact same thing happened. Not in the same place, but a similar, though worse, tool mark. Like this:

Gawddammit.

We all make mistakes. “It’s inherent in hand process”, as is commonly said by artisans. But making two very similar such errors?

That was likely thanks to MJD symptoms. Which I had been working through.

I quit for the day.

And as I thought about what it meant, I had to consider how I thought about myself, and my art. I am now an artist/artisan who has this additional limitation, this new part of who and what I am. Allowing that to be reflected in my art — indeed, embracing it — was the only honest thing I could do.

It was time for a little wabi-sabi.

So I did this:

A little gold leaf, to embrace the imperfection.

In fact, I added a wabi-sabi element to each of the 14 books. Because I made more mistakes as I finished the edition. Not all of them had tool marring, but many did (and, curiously, all along the top edge of the covers). I decided that for the edition to be complete, for it to reflect this particular moment in time, each needed to have a similar flaw/enhancement, though each one is unique.

Here they all are:

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’ll know more after my neurological assessment tomorrow.

As an artist, I’d be a fool deny my mistakes. Because denying them would be to deny myself, and what has brought me to this point in time. This particular, wonderful, moment.

Jim Downey



Machado-Joseph Disease: bitch, bitch, bitch

OK, this is going to sound like I’m complaining. And I am, to the extent that if this wasn’t bothering me I wouldn’t write about it. But I’m mostly writing about it as documentation: documentation for when I get the neurological assessment in a week, documentation for how things are now as a baseline to compare in the future, and documentation for anyone who wonders what this weird and rare disease is like. The truth is, presently all these elements are mostly just annoying rather than being really painful or debilitating. I’ve been so sick that I can’t get out of bed, and this ain’t it. I’ve been in significant pain where I can’t think of anything other than hurting and trying to make it stop; this ain’t that, either.

A lot of people have experienced Restless Leg Syndrome, a fairly common minor neurological disorder that isn’t very well understood. For me, it comes with a kind of itch or burning sensation, mostly on the surface of my lower legs and feet, that just makes me want to move them to avoid an unseen irritant. Now, this is one of the earliest symptoms I can point to, and it goes back at least six or seven years. Was it an indication of MJD onset, or just due to something else? Who knows. I will say that it has become more noticeable in the last few months, and now happens every day or two.

It’s also, weirdly, spread to my arms. Yeah. Exact same kinds of sensations, mostly confined to my forearms and the area around my elbows. I’ve never heard of this before, but one of the sites I checked about RLS mentions it happening to some people. I guess I qualify.

Something that is kinda like RLS, but is more intense, is a sharp, spike-like pain. It really does feel like I just stepped on a nail protruding from a plank. A nice, rough & rusty one like the one I remember as a kid, going through some dilapidated old house, that went through the sole of my tennis shoe, through my foot, and then out the top. Graphic memory, eh? Yup. And that was the exact same kind of pain I get with these spikes. These are usually a one-off, can happen to either foot, ankle or calf, or in my hands. I’ve joked with my wife that it’s just memories of my crucifixion as a rebellious slave. These are kinda rare, occurring a couple of times a week.

More common are unexpected cramps in the foot, leg, or hands. These are classic “Charlie Horse” type, and just about anyone who has over-exerted themselves at some point has experienced them. One of these happen every couple of days, and can be so intense that it leaves my affected muscle aching the next day or two. I’ve got a couple of sore feet right now due to this (one the bottom of the foot from last night, one the side of the ankle from a couple of days ago). This can also be triggered by using my hands in a repeated motion, like I do when doing book conservation. Or typing.

Related, but not as intense, is a “tightening” of the muscles/ligaments on the back of my hand or top of my feet. Makes it feel like it’s pulling my hands back towards my forearm or my feet towards my shins. Usually happens to both hands or both feet at the same time. Not really painful, just weird.

Then there are the twitches. Like a tic, or a spasm. These tend to come in clusters, lasting for a few minutes at a time, and usually just hit one hand or the other. Again, not particularly painful, but an annoying reminder that my body is not entirely under my conscious control.

I’d mentioned recently the problems with balance. Random vertigo happens rarely, but balance problem are one of the more consistent symptoms I’ve noticed. It happens when it’s dark and I don’t have a visual reference to help stabilize. It also happens if I’m moving and turn my head quickly. Or if I twist to look up and behind me.

Another frequent symptom I experience I didn’t actually know was a symptom of MJD: frequent urination. Yeah, overactive bladder. This one I’ve had for a decade or more, though I attributed it to my blood pressure meds. Maybe that was the case, but it has definitely increased in recent months, to the point where just about whenever I get up from sitting I want to pee. TMI? Sorry.

While each of these are fairly minor, together they usually conspire to do one of the things that most people who have MJD complain about: sleep disruption. Yeah, it’s hard for me these days to actually sleep solidly more than about four hours. Typically I take my usual pain meds (for chronic problems) and crash, then wake about four hours later to have a pee and take the next round of pain meds. In the past I’d usually be able to get fairly soundly back to sleep quickly, and sleep another three or four hours. Now, almost always one or more of the above symptoms will either stop me from getting back to sleep, or wake me frequently for the next couple of hours. At best, I doze in a light and fitful sleep.

So, there we go: a nice summary of where things stand for me.

Of course, that’s the physiological stuff, not the psychological stuff. Because yeah, there are stresses involved with this disease. Knowing what it can do. Knowing what it means. Knowing that there is no cure, and only limited treatments that have been proven effective. Knowing that it is rare to the point of almost being unknown by those outside a few medical specialties and the other families that have the genetic disorder. I was startled the other day when I was on Reddit (a huge online community/news site) looking for something else, and thought to see what kind of support groups exist for people with MJD. There aren’t any. None.

But then, the best estimates are that only about 3-5,000 people in the US have MJD. About one person in a hundred thousand. I’m guessing that I won’t be able to find a local support group, either.

So, thanks for being there, dear reader.

Jim Downey



Machado-Joseph Disease: It’s all in my head

I’m in this curious grey zone currently. On the one hand, I’m about 99% certain that I have the onset of MJD, for all the reasons that I’ve mentioned. On the other, I don’t yet have a diagnosis or the results of the genetic test for the disease (which is definitive).

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?

Think of it as an inverse version of imposter syndrome, and you’ll see what I mean. After all, the symptoms I have are currently episodic, lasting a few hours here or there, then disappearing for a day or three. When I’m not actually experiencing them, it’s almost easy to think that I was imagining it all. And not having the disease is how I’ve lived some 63 years of my life, so it’s the norm.

But then, there are days like yesterday.

We’d had some heavy rains, and I needed to go down into our crude basement to see how much flooding there was. It’s not a real basement, as most people think of such. Rather, there’s an area about 10×20′ that has a concrete floor, but then the floor slopes back to be just a crawlspace for the rest of the rambling structure. What passes for a foundation is a porous brick structure, and during heavy rain, it floods. Where there’s the concrete floor is where the boiler for the radiator system sits, and close by is the hot water heater. Such is the state of a 139 year old sprawling house that has seen multiple additions and changes.

Anyway, I’d installed a sump pump to deal with the worst of the flooding, and it works to do that reasonably well. But still, I usually go down and check when we have heavy storms. So that’s what I did yesterday.

After seeing that the concrete area was OK, I went further back just to look around at the rest of the crawlspace, using a flashlight. I had to crouch down a bit where the floor was rising. And the combination of bending over a bit and having a limited amount of light for visual reference triggered a quick and intense vertigo.

This is a classic MJD symptom. Because MJD is largely thought to cause disruptions in the cerebellum, people who have the disease are prone to balance and coordination problems. Without visual references to confirm my vestibular and proprioception, things got quickly out of whack.

Now, this never used to be a problem for me. I always had an exceptional sense of balance and awareness of my body in space, regardless of whether my eyes were open or closed, regardless of movement or orientation of my head. Having this happen is affirmation that my suspicions are likely correct, and I do have MJD and it’s not just my imagination/hypochondria.

I suppose either way, it’s all in my head.

Jim Downey



Machado-Joseph Disease: hands

This morning I’ve been experiencing a typical episode of one of symptoms of MJD (for me): hand weakness/spasm/pain. I’m writing about this to document the disease and to give people a sense of how odd it can be sometimes. At this point, the episodes I experience aren’t constant; they last for a few hours, then disappear for a day or three.

Now, normally I have very strong hands. Building on my basic physiology (large hands, good musculature), 30+ years of bookbinding have made my hands strong, as you would expect. But not this morning.

The first thing I noticed was a slight tingling was through my hands, extending into my forearms. Almost like they were ‘falling asleep’, or like I had held onto a vibrating machine like an orbital sander for too long.

Then there was a feeling of weakness. Like I had been handling bricks for hours, or using a heavy hammer to break blocks or beat metal. My hands were tired, though I hadn’t done any work with them. When I was making coffee, I was sincerely worried that I’d be able to hold onto the mug securely. Popping off the top of my Tramadol Rx pill bottle actually took effort.

Know how when a muscle (group) is particularly tired, it can develop a slight tremor or spasm? Like it has been over-worked and the nerve signals are getting wonky? Yeah, that’s also typical of these episodes. My hands don’t really shake like I have Parkinson’s or something. Rather, they just feel like if I demand anything much from them then they will spasm. The medical term usually applied to this is fasciculation, and is common in neuromuscular diseases like MJD. There’s an … uncertainty … or maybe an unreliability to using my hands. Motions aren’t fluid, graceful, confident. I question whether I am holding the coffee mug securely enough. My typing suffers (the number of corrections I’ve made while typing this is rather startling).

Actual pain isn’t too bad today. It’s more like an ache. But there is a memory of pain there. A hint of things to come. More than just muscle pain, but different than arthritis pain. Almost like the pain from a broken bone, partially healed. In some ways it sounds like peripheral neuropathy, though I’ve never had a diagnosis of that.

None of this is debilitating. I’ve been able to make breakfast. Get showered. Run an errand. Feed the cats. Get lunch. Even get a little bit of work done at my bench. It’s mostly just annoying. And it will likely pass in a few more hours.

But it is tiring and distracting.

I’m looking forward to seeing if there’s something we can do to help manage it, and the other symptoms.

Jim Downey



Machado-Joseph Disease: unseen

“You seem to be in pretty good shape.”

I knew what he meant. He’s known me for about 50 years, and had seen my aunt, who I went to live with after the death of my parents, deteriorate and eventually die from what was then an unnamed disease.

* * *

There are a lot of chronic diseases that have little or no visible symptoms, but yet can have the people suffering from those diseases in agony, or unable to do routine things, or seemingly drunk/stoned. Enough so that the ‘hidden disease’ story is a trope unto itself. A lot of people who try and explain what it is like have such a disease write about what it is like to have such an invisible illness or injury. And I guess this is mine.

Now, I’m not unfamiliar with this experience. As I’ve written about, I have chronic pain from a number of old injuries, the most annoying of which has been the intercostal tear I’ve had for about a decade. There’s no obvious injury, but the pain wears me down, and limits how much energy I have for social gatherings (which usually happen in the evenings) and such. When I decide that there’s something I want to do with others, it’s mostly a matter of grin and bear it until the festivities are over, then I can take the extra meds and go fall down. My extrovert batteries and pain tolerance usually get me through such occasions with no one the wiser.

But, for me at least, there’s something different about dealing with chronic pain and having an invisible (for now) illness like MJD. Perhaps that distinction doesn’t make much sense to most people. But while I know that chronic pain brings with it a whole lot of related effects, there’s a different psychological aspect to having an incurable illness.

An anecdote from some years back may explain …

At some social event, I was chatting with an M.D. I knew reasonably well, but only on a social basis. That is, they weren’t my doctor, and there was almost no chance that I would ever see them on a professional basis. And as I said, we knew one another reasonably well. Enough so that at some point the subject of MJD running in my family came up for discussion.

My friend, upon hearing this, paused, and did a mental search. He finally found the memory he was looking for, and with brows furrowed asked me, “the neuromuscular disease that’s like Huntington’s?”

“That’s right.”

The furrowed brow changed to a bare look of disgust. “Oh, that’s … nasty.”

* * *

These days, cancer has little or no stigma. But there was a time not that long ago when it did. It was spoken of in hushed tones. Doctors often would never give a patient an honest diagnosis that included the word cancer, instead using some bullshit medical equivalent. It was that feared, because it was almost uniformly incurable and the treatments for symptoms brutal. It was basically a death sentence, and one that likely meant a prolonged and painful end.

It may be hard to believe, but I remember those days. Very clearly.

And for those who know what it is, MJD engenders something of that same reaction. I’ve seen that response in the faces & behavior of people countless times. For understandable reasons: the disease is progressive, there is no cure, and treatments are fairly marginal.

* * *

“You seem to be in pretty good shape.”

I knew what he meant. He’s known me for about 50 years, and had seen my aunt, who I went to live with after the death of my parents, deteriorate and eventually die from what was then an unnamed disease.

I had expected this. In fact, I was already used to dealing with that reaction from people. Used to explaining that this news didn’t quite mean what it would reasonably be understood to mean. Particularly by those who had seen it themselves.

I nodded. And I transferred my fork from my left hand to my right, because my left hand was spasming a little, though it wasn’t noticeable. I poked a forkful of salad, raised it to eat. “Yeah, I am. For probably the foreseeable future it will mostly be a matter of managing the symptoms to the best degree possible. I’ll know more about that when I get the full workup and genetic test results, and we start trying therapies.”

My friend looked relieved, happy for me. “Good.”

We had a pleasant lunch, and a good long catch-up after. When he left, I took my pain meds, poured a drink, and thought about what the future held.

Jim Downey



Machado-Joseph Disease: Management

One of the things people with MJD have found helpful is Medical Marijuana (MMJ). It helps to moderate pain, but more importantly, some of the available strains really make a difference in allowing people with the disease to sleep through the night.

See, one of the problems with MJD is that the twitching, cramping, and pain in the hands, feet, and legs is such that it disrupts sleep. This is something that I noticed particularly in the last few months, as my symptoms started developing, and I have a long way to go before it becomes diagnosable dystonia. So of course, anything that might help me sleep better is of interest. Because the key to dealing with this disease, since there is no cure, is to manage the symptoms to the greatest degree possible. That will allow me to make the best use of my functional time each day, and get the most enjoyment out of living.

And if MMJ will allow me to do that, then I’m game. So I’ve started looking into it. The problem is that it’s damned hard to separate out the quack “MMJ can cure EVERYTHING!” stuff from real, rigorous research. Of course, the demonization of all forms of cannabis by our government over the last half century hasn’t helped. Since it is still a “Schedule I” drug as far as the federal government is concerned, there are real limitations on what kind of science can be conducted on medical applications, which just opens the door to all kinds of outlandish claims. I swear, it’s like the ‘Snake Oil’ era of patent medicine, or the insane hype that went along with radium and other radioactive quackery early last century.

There’s no rush, since I’m not going to see about getting a MMJ card (available here in Missouri) before I have a definite diagnosis, though just on the basis of my chronic pain alone I could qualify. And for the time being I can just rely on the meds I already have (opioids, OTC stuff, booze). But I have been trying to educate myself from what trustworthy sources actually are available. Which, to be quite honest, is enough to drive one to drink.

Ironic, eh?

Jim Downey



Machado-Joseph Disease: Telling.

4/11

Got together with my sister and her husband yesterday. After the usual catching-up (we only see each other in person a few times a year, since we live a couple hours apart), I told them about my conclusion that I have MJD. Since she has managed the disease for 15+ years, they know full well what the implications of my conclusion are. But my sister and I are a lot alike, and I knew that she would step back, digest the information, then engage with it rationally.

She did exactly that. Then the four of us (my wife Martha was with me) had a good conversation about the disease, what symptoms I had been experiencing, and where things go from here. Both my sister and brother-in-law were able to provide some very good suggestions and observations, offering advice and support based on their lived experience that will be invaluable to me and Martha going forward.

* * *

This morning I started letting close friends know about my conclusions, though email and Facebook personal messages. While ideally I would have preferred to tell them in person, that wasn’t practical. And besides, presenting the information in writing allowed me to shape the impact it would have (I am, after all, a fairly competent writer). This is the template I used, personalizing it some for different individuals:

Hey —.

You may have noticed that recently I’ve talked about my pain levels (particularly in my hands) being more problematic. Well, there’s a reason for that, which will become something I’ll be discussing publicly in the future: it seems I have the onset of Machado Joseph Disease. But I wanted to let my close friends know before I said anything for public consumption.

This is so far my own assessment, but I’m about 95% confident in it based on symptoms over the last six months or so, combined with family history. I’ve got an appt at the end of May with a local MU neurologist who has experience with ataxias, and will get the genetic test and full evaluation then. But there’s almost no doubt that I have it, probably with the initial onset about 3-4 years ago.

Believe it or not, I’m OK with this knowledge. I’ve always known that it was a possibility, and basically I consider myself lucky that it waited to show up until I was ~60. I know what to expect, the medical knowledge of it is much better than things were 15 years ago when my sister had onset, and her experience with it has taught her some coping skills and treatment options that will help me. It’s not good news, but the later the disease manifests, the slower it usually progresses. In many ways, this won’t be that much different than what most people experience with normal aging — in fact, I had ignored the signs of it for so long largely because I just thought it WAS normal aging.

So, there we go. Don’t feel obligated to get philosophical in responding; I wouldn’t have told you now if I didn’t know that you already care and “are there for me” in friendship.

Take care.

It’s interesting to me that the process of composing that message helped to clarify my own thinking and perspective, just as these blog entries have done. At heart, I’m a writer. And writing requires clear vision of the subject at hand, pushing me to analyze not just the facts, but also my emotional reaction to those facts.

* * *

4/12-13

Responses to the above have been interesting, and pretty much what I was shooting for. My friends/family have been supportive but not maudlin, mostly just acknowledging the news and wishing me good luck.

Of course, the text I sent out is a “best case” take on the possible paths this journey can take from here. I figured it was better to give people a heads-up, to let them start to adjust to this news. What I find out when I get the genetic test results back, combined with the assessment from the neurologist, will give me a better idea of what to actually expect. But I didn’t see the point in going more negative with my portrayal, since it is possible that will not be the case. No reason to make people more concerned than necessary at this juncture. If I need to share bad news later, I’ll deal with that, then.

Besides, I have enough to be worried about myself, without having to also deal with the worries of others. Because while I “am at peace with this news”, I am somewhat concerned by the seeming speed of the progression. But I am also aware that said speed is perceptual — going from perceiving no evidence of MJD to what I now perceive is different from the reality that the disease likely began three or four years ago, and hence I am experiencing it at this stage of progress. In other words, I’m likely three to four years into this, but just now aware of that.

For example: now that I am aware of what is going on, I recognize that I have near-constant pain in my hands and feet, and frequent pain in my lower legs. Previously, I would have just noted the pain, attributed it to other things, and then tuned it out to whatever degree possible. Because in my mind, in my perception, it “wasn’t a problem”. Now that it IS a problem, I’m paying more attention to it.

This isn’t a bad thing, per se. It’s important that I catalog the reality of what I am experiencing so that I can give an accurate assessment to the neurologist. So there’s that. It’s also important to pay attention to pain, because it is instructive, at a very basic level of survival. Don’t think so? Then just do a search for reports of what happens to people who for some reason are incapable of feeling pain. Bottom line: it ain’t pretty.

But of course, being aware of — even moreso paying attention to — more pain is, well, painful. Distracting. Annoying. So in terms of my perception, my ambient pain levels have gone up significantly in the last few weeks. I noticed recently that my use of my prescription pain meds (Tramadol, Tylenol 3 with codeine) that I’ve been on for about a decade for an intercostal tear has ticked up recently. Now, that happens, particularly when I am doing some strenuous exercise/project. There’s a sort-of natural ebb & flow to it through the year, with some months being a little higher usage, some being a little lower usage. But since we finished installing a new stamped copper ceiling in the kitchen, I haven’t been engaged in anything very physically demanding. That was six weeks ago, and I should have reverted to something closer to baseline. I haven’t.

I’ve also noticed an uptick in the amount of alcohol I’m drinking. Self-medicating, in other words. Again, this does tend to cycle, with some times of the year it being a little higher (2-3 double Scotches in the evening) and other times lower (just 1 double, occasionally 2). Years ago I stopped worrying about it, after discussing it with my doctor, because she observed that it was probably healthier for me than increasing my use of even mild opioids (the Tramadol and codeine), so long as I didn’t develop an alcohol problem.

But having both things happen simultaneously is an indication that my body has been seeking more relief from pain. Again, this does happen sometimes, if I undertake some particularly aggressive exercise project. But I haven’t. Instead, it’s probably because I’ve been more aware of the pain related to MJD.

Jim Downey



Machado-Joseph Disease: Hilarious

Wait, how can MJD be “hilarious“?

Well …

… so this morning (4/9/22), I got a call from a book conservation client. Since I screen my calls, he left a message, identifying himself, and said he was someone in the University administration. The call was otherwise fairly routine, asking if I could refer them to someone else for a small job they needed done, since I am not accepting new clients. [My website says it’s due to arthritis, which I do have in my hands, but it’s really due to the problems with the onset of MJD. I’ll change the website once I have an official diagnosis.]

I called the fellow back, as I would for anyone who called and left a message. We discussed what the client has, what he thinks he needs, etc. As is commonly the case, he didn’t really need conservation work done (the book is more valuable leaving it alone), but instead just needs a proper archival storage box. Since he’s here in town and associated with the University system, I ask if he is familiar with Special Collections at the University library, since they could easily make a custom box for him (and would likely welcome the chance to do a favor for someone in the administration). He admits that he’s only been in town for a year or two, and was mostly involved with the Medical School. So I tell him who to contact, and what to ask for, and to say I referred him. Easy, simple solution, but the sort of thing that makes people very happy for the help provided and has earned me many references and additional clients over the years.

Then, in chatting a bit, he asked why I was no longer taking clients. I explained that it was due to arthritis, and just left it at that. I told him I’d send him a text with the contact info again, just as a courtesy (as I would do for any client).

After I hung up, I looked again at the name he’d given me. It was a little unusual, and for some reason rang a bell. Then it hit me — he’s the attending physician in the Neurology Clinic I have an appointment with to evaluate my MJD in about six weeks.

I mentioned that I had an appointment with him in my follow-up text with the info I’d promised. We had a bit of a chuckle back & forth over how it’s a very small world sometimes …

Jim Downey



Machado-Joseph Disease: Adjustment.

[I’ve decided to be public about my realization that I have the onset of MJD, the diagnosis process, and then living with the disease. Given the rarity of this disease, my hope is that this series of blog posts will help educate others, and perhaps provide some insight into it and related conditions. This is the third post in the series, written about a week after the second, as I started reframe what this would mean for me going forward.]

Been an interesting week, as I have been adjusting to the new normal of having MJD (as noted in my previous post, this is now where my head is at, though I won’t have an official diagnosis for about two months yet). It’s mostly been a process of re-calibrating my body awareness: noting that I have these muscle spasms in hands, feet, and legs, that the pain levels are there, and so forth, and then just moving on with my day. Living with chronic pain from a torn intercostal muscle that’s never healed properly, along with the random aches & pains of various abuses I’ve subjected my body to over the years of living life fully, means that to a certain extent the new aches & pains associated with MJD are just more of the same.

That’s not to discount the disease, nor the pain that comes with it. That’s real. And it has an impact. More pain, even if it isn’t worse pain, takes a toll. It wears me down faster. It’s more distracting, so it makes it harder to focus on any given task, especially creative ones. For the most part, though, I can just acknowledge the pain, listen to what it is telling me, account for it, and then get on with whatever I’m trying to do. So the pain isn’t the problem.

What is the problem is the degree to which this interferes with my bookbinding/conservation work. I’d been attributing the aches and pains in my hands to arthritis for years, and in truth I actually do have arthritis in some of the joints in my hands. That’s the result of the trauma inflicted by martial arts (primarily SCA combat) for about a 15 year period when I was a young man.

But worse than the aches and pains is the stiffness, spasming, and occasional loss of control in my hands. So far, the latter has only happened after I have been working using my hands (specifically while putting up the stamped copper ceiling in the kitchen this past winter). But I know it is just a taste of things to come. Dystonia is a classic symptom of MJD, and the spasms and pain in my hands that I’ve noticed the last few years is only likely to get worse and become more of a limitation. I had already started to scale back the conservation work I do, but now I need to be thinking in terms of finishing up pending obligations, handing off clients to other conservators, and becoming officially ‘retired’ as a book conservator. That’ll be a hard adjustment to make, since so much of my self-identity is tied up with it.

* * *

(a few days later… 4/7)

Something I’ve been thinking more about is the difference in the types of pain I’ve been feeling. This is distinctly muscle pain, as opposed to the kind of pain one has from arthritic damage to a joint, or tendon damage, or a broken/bruised bone. This is the kind of thing pretty much everyone has experienced at one time or another, from over-using a muscle (or a group of muscles). It feels almost exactly like what you experience the day after a really hard physical exertion, except it also feels a bit like what you experience shortly after exhausting the muscle in exercise. Think how your calves/feet feel after a five mile hike in street shoes: tired, twitching, and sore. Then add in how your calves would feel the next day, in terms of stiffness and that deep ache. It’s unusual in my experience to have both of those at the same time, but that’s pretty much what my hands and feet/legs feel when I’m having an episode of the MJD effects.

And that’s another thing: this isn’t constant. Not yet, anyway, for me. It’s episodic, lasting for a few hours, at most a day or so. Then it fades for a while. I haven’t yet been able to identify a pattern to the episodes, unlike my intercostal tear (which usually acts up in response to a change in barometric pressure or certain kinds of exertion). It’s possible that there isn’t one, and no way to predict what might trigger an episode. I suspect that may be the case, given that the episodes typically become longer and more frequent over time, until the pain is pretty much constant.

I’m sure I’ll find out. *sigh*

* * *

4/8

Bad episode today. Spasms, twitches, RLS (Restless Leg Syndrome), and a fair amount of muscle pain. Particularly in my hands. Possibly a connection to the cold front (we’ve had spitting snow and wind today, with a hard freeze forecast for tonight)? Whatever, been a rather annoying day. Particularly so since I had been planning on getting some binding work done, and my hands are just in no shape for it, even with having had them in the microwaveable mitts I use to loosen things up.

As I noted above, this is a psychological blow, as much as anything. I’ve never really defined myself in terms of my job, but it has always been one of the interesting things about me. Conservators are so rare that it’s always a talking point when I introduce myself to someone; they always ask about what sorts of things I work on, what’s the oldest/rarest/most valuable item, et cetera. Even surgeons, who seldom suffer from a self-esteem deficit, will pause and with a note of respect ask how I got into such a profession.

I’ll miss that. And I’m honest enough to admit it.

Jim Downey



Machado-Joseph Disease: Acceptance

[I’ve decided to be public about my realization that I have the onset of MJD, the diagnosis process, and then living with the disease. Given the rarity of this disease, my hope is that this series of blog posts will help educate others, and perhaps provide some insight into it and related conditions. This is the second post in the series, written a few days after the first, as I started to come to terms with the realization.]

According to the “stages of grief” I should probably be still somewhere around either denial or anger, in reaction to the realization that I am experiencing the onset of MJD. But I’m not.

I’m not some exceptionally well-adjusted person or anything. (Well, OK, I am, but it’s taken me 60 years and working through a lot of personal trauma to get to this point.) Rather, I think that’s mostly due to the fact that I’m not really ‘grieving’ the loss of my good health or anything. In the short term, this is mostly one additional annoyance of aging that I’ll deal with. I’ve already been living with chronic pain for more than a decade, and going through the cardiac catheterization six years ago was educational in terms of forcing me to re-adjust my perception of myself as eternally young. Yeah, that whole thing actually turned out to be a great benefit for me, correcting a previously unknown heart defect, but it was still a moment when I thought that I had a serious heart condition that would end my life sooner rather than later.

So I’ve been through the experience of reframing my expectation of ‘good health’. And I’ve found it relatively easy to accept that there’s about a 99% likelihood that I have MJD.

I realized this when I was talking with the scheduling nurse from the Neurology Clinic, setting up an appointment for my initial assessment with one of the attending physicians who has an expertise in neuromuscular disorders and ataxia. She said that when the staff saw my family history of the disease (from my medical referral) it was obvious who I needed to see and why. I don’t want it to sound like she shocked me, or let the cat out of the bag — it was I who initiated that aspect of the discussion. She just confirmed it. At that point I went from being reasonably sure what my symptoms meant to being all but certain.

And I found that I was at peace with that.

Jim Downey