Communion Of Dreams


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: 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: 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