My (Progressive) Moment of Truth

“If I were you two, I think I’d plan for the worst,” Amy, my physiatrist, said to my wife and I as we all sat in the examination room.

It was just after 11 a.m., Friday, January the 18th.

January has become one of two pivotal months in terms of my MS treatment plan, and now includes my first Ocrevus infusion of the year, the first of my semi-annual neurologist and physiatrist visits and initial sessions with my physical therapist. I’ll do the whole circuit again in June.

My wife doesn’t typically accompany me on these appointments, but Amy had relocated to another city, too far away for me to be comfortable driving myself. The two had never met, and since Amy plays a pivotal role on my MS team, I thought it would be good for them to meet. Plus, the following Monday was Martin Luther King Day, and we were looking forward to a four-day weekend together.

We had just finished telling Amy what we were planning to do to better accommodate my progressing symptoms, including buying a bigger vehicle to hold and carry the rigid-body, self-propelled wheelchair Amy had ordered for me. After months of drawing up plans and meeting with contractors, we were finally ready to pull the trigger on adding a half-bathroom to the main level of our old home in order to reduce my trips up and down the stairs and to minimize accidents — of all kinds — along the way.

Neither of these solutions were inexpensive, but it keeps getting harder for me to walk, I fell a lot more last year and the stairs in our home seem to be growing in number and somehow keep getting taller, too.

We had shared our plans with her hoping for validation or direction. She diplomatically recommended a mobility van or vehicle, while adding that if we were going to renovate our home, we should add a full bath and bedroom to the ground floor of the house. She just wanted us to invest our time, effort and money effectively, she said, and that our initial fixes might be short-lived at best.

Her recommendations were wildly more expensive than what we had envisioned. It was NOT what we expected to hear.

Like so many MSers, my diagnosis in 2013 came after years of seemingly disconnected problems followed by a couple of textbook signs of MS (foot drop, special introductory episodes of “bowel and bladder” issues). Outside of being unable to lift my right lower leg one summer afternoon, though, I hadn’t had any obvious flareups or exacerbations.

I was 53 at the time.

Initially my neurologist thought I had relapsing-remitting (RRMS) MS. I asked him the standard list of questions trying to get some — any — kind of grasp of what was going to happen to me next and when. He was always positive and reassuring, yet always somewhat evasive when answering my questions.

Anxious to end my anxiety, I spent more than a little time researching disease outcomes for RRMS patients. In my mind they appeared to be potentially significant but possibly not as disabling as the progressive forms. My symptoms were comparatively mild, my neurologist obtuse-yet-positive. Much of what I read about the disease stressed maintaining a positive attitude, too.

I began to think that I might get lucky and avoid significant progression, that my symptoms might plateau, possibly even end altogether, and that mine might be a relatively benign experience.

At the time that seemed “positive” to me and my wife and I continued trying to live our new MS lives the best we could. We didn’t have a plan for doing that, or know where to turn for help, and in the sturm und drang of the disease, we just kept going without one.

My symptoms continued to worsen. By late 2016, it was apparent I had the primary progressive (PPMS) form of the disease. Given my age at onset and the types of symptoms I had, it made perfect sense.

In 2017 I made Amy the captain of my MS healthcare team. Straightforward and funny, she was the first MS-related doctor I connected with. I knew she was devoted to helping me anyway she could and I knew she would tell it like it is.

Until recently, I’ve found the unpredictability of MS, how it develops, how it progresses — or doesn’t — maddening. I’ve learned why it was impossible for my neurologist, or anyone else, to predict my ever evolving MS. I’ve also come to realize that uncertainty can’t be easy for doctors to explain to their patients and how hard it must be for them to help their patients remain upbeat at the same time.

But that doesn’t change the need to make some very challenging life decisions. Unsettling as it was, we needed to hear what Amy said that morning. To be honest it gave me a sense of relief. Because for the first time since I was diagnosed, I finally have a better sense of what to expect.

This column originally appeared in Multiple Sclerosis News Today

 

 

 

 

Effort Less: How Occupational Therapy Is Making My Life With MS Easier

“Today we’re going to talk about the ‘Four P’s,’” Stefani says. “You’ve probably heard of these already, but let’s go through them anyway.”

I look at her the way a dog tilts its head when it hears a high-pitched whistle.

Kind of like this.

“No, I haven’t,” I say.

“You’re kidding,” she says, incredulously. “How long have you had MS?”

“I was diagnosed in 2013 but I think it went undiagnosed for many years before that,” I answer.

For the longest time I’ve had the nagging feeling that my MS team and plan have been missing something. This exchange only confirms my fear.

To put a finer point on it, while plenty of articles and resources recommended that I review my “treatment plan” with my “MS specialist,” up until this year I had no idea who my specialist was, and if I had a formal plan, it must have been top-secret because no one shared that with me.

Instead, my team consisted of isolated specialists and care and treatment and drugs with seemingly no eye on how I should actually live my life with a progressive disease like MS, both now and in the future.

Yes, the National Multiple Sclerosis Society and other resources have a lot of information and even people online that I can ask for help, referrals and guidance and I am incredibly grateful for all of these resources.

Helpful as they are, they can’t be with me within the healthcare my insurance allows me to have, can’t meet with the different doctors I see or knit together the plan that’s directly applicable to my unique flavor of MS.

Not long ago, I wrote about discovering that I was in charge of building the MS treatment and team around me and how I now planned on building.

Which is where Stefani comes in.

Stephanie is an occupational therapist I began seeing in early February.

Originally, I thought occupational therapy meant addressing work, or “occupational,” issues. Getting a better desk or desk chair or computer screen, things like that. I’m simple that way.

But the American Occupational Therapy Association, Inc., says it’s far more than that.

According to the Association’s website,“Occupational therapy practitioners ask, ‘What matters to you?’ not, ‘What’s the matter with you?’ In its simplest terms, occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).” 

Stefani has prepared a comprehensive 10 visit evaluation for me and today’s visit is all about energy conservation (and the previously mentioned “4P’s”: Prioritize, Plan, Pace and Position).

At first blush, these seem pretty straightforward and sort of um, simple, so they ought to be the perfect fit for me.

“You need to start developing more efficient ways of doing every day tasks so that you can save your energy to do the things you really want to do,” she says.

Though it’s not specifically focused on MS, Stefani gives me a handout that more thoroughly explains each of the “P’s” and we work our way through it.

Some of the recommendations are pretty straightforward and make immediate sense to me. Like when I’ve got multiple things I want to get done to prioritize them and do the most important task first to make sure it gets done. Planning not just my day, but also scrutinizing activities and tasks so I don’t waste trips or effort. To rest before I feel tired and to use pursed lip breathing in order to increase my oxygen intake and corresponding energy level.

Other suggestions, like sliding objects instead of lifting them or avoiding spray cleaners because they might irritate my lungs and disrupt my breathing (and energy level as result) seem, at least at first, a little impractical.

But the net effect of the visit — and frankly, occupational therapy’s role in my MS “plan” — is to more readily pinpoint where I am likely to face MS-related challenges throughout my daily life now, how to address those challenges and how to better prepare for the future.

In a disease that so often feels like an unsolvable puzzle, surely this must be one of the pieces.

This column originally appeared at Multiple Sclerosis News Today.

How Pilates Changed My Life…And My MS, Part Three: Mariska Breland’s Pilates Hacks

Note to readers: This is the last of a three-part series focusing on the valuable role Pilates has played in my life with MS. If you missed the first two, you’ll find them here and here.

This column focuses on exercises and tips from Mariska Breland, a Pilates instructor diagnosed with relapse remitting multiple sclerosis (RRMS) in 2002. She also trains other Pilates instructors to work with MS clients.

Generally, these exercises and tips focus on balance, overhead strength and core strength. As always, make sure to check with your physician before before beginning any new exercise or routine — please!

Breland’s tips

Balance: Breland says “balance” is a combination of physical and neurological assets, including proprioception, vestibular and musculoskeletal ability and function. Unfortunately, all are subject to change because of MS progression.

1. Start by putting your “best” foot forward: Take off your shoes and socks. For those with foot drop (like me), going barefoot is the best way to actually feel the floor. So, take ’em off!

2. Keep your feet loose and mobile: The foot, Breland notes, has 33 joints, 26 bones and more than 100 muscles, ligaments and tendons. Our feet need to be very, very mobile, and using a tennis ball (or one of similar size), roll your foot over the ball in every direction, and side to side with enough pressure that you can see your toes spread out. Ideally you can curl and spread your toes with space between each toe. (It’s OK to use a toe spreader for help).

Mariska Breland does a leg lift to improve balance. (Photo courtesy of Mariska Breland)

3. Proprioceptive balance: Stand barefoot and try to lift up one leg. Hold for 10 to 30 seconds. Repeat on the other  side. To make it harder, hold your leg up and move it in and out, or forward and back.

4. Vestibular balance: The vestibular system responds well to head and eye turns, Breland says. Stand in a lunge and turn your head to the right, and then to the left. Look up and down. Repeat for 30 seconds. Make sure to hold onto something if you feel unsteady; your balance should improve over time.

Mariska Breland demonstrates a hip stability exercise. (Photo courtesy of Mariska Breland).

5. Hip stability: Come to a quadruped position (hands and knees, with hands under shoulders and knees under hips). Extend a leg back, but keep both hips on the same level. The inclination will be to dip into the leg that is on the floor; this indicates weakness in the hip stabilizers on that side. Hold for up to one minute. Switch sides.

Mariska Breland demonstrates a squat using the Magic Circle. (Photo courtesy of Mariska Breland)

6. Quadricep eccentric strength (stand to sit squat): Anyone who has struggled to get out of a chair knows that sometimes momentum is not a friend. Breland says it’s a frequent cause of falling, and hip instability or quad weakness can cause it to happen. To practice this exercise and get stronger, keep your legs hip-distance apart and slowly bend your knees, lowering yourself to a seat on a count of three to five. To progress through the exercise, choose a high seat to start and systematically move on to lower surfaces. (Make sure the chair isn’t going to move.)

Overhead strength

Getting something out of an overhead cupboard requires overhead, core and back strength to support the process and maintain balance. A “big problem with overhead strength is actually shoulder and upper-back mobility,” Breland says.  Try these to shore up your shoulders.

1. The “hanging cat” stretch” for mid-back muscles: Come to a kneeling position and rest your arms on a chair. Drop your chest between your arms and press your arms actively into the chair. Now (this is important) tuck your hips and round your back while your arms are extended. You’ll actually feel the stretch more in your lats and mid-back.

2. The big circle shoulder stretch: Do a really huge arm circle using a light weight (no more than five pounds). Shrug your shoulders up by your ears as you lift your arm high. It’s easiest to do this with your shoulder against the wall so you can make sure your circle is as big as possible. Do five repetitions in each direction.

Core Strength

Breland thinks of the core as the combination of abdominals and lower back.  A stronger core leads to better balance and fewer falls.

1. Hollow body hold (for the front of the body): Lying on the floor, lift your head and chest and pull your feet into your hips, hovering them off the floor. Try to keep your low back on the floor. Work up to holding this for one minute. It’s harder than it looks!

2. Superman (for the back of the body): Lie down on your stomach and extend your arms and legs. Lift your arms, legs, head (and chest if possible). Hold for up to one minute. Don’t forget to breathe!

Please note: When I began this series, I hoped I could combine these exercises along with the $100 home gym in one column, but it’s too much content. Normally, my columns publish every two weeks, but look for the home gym column one week from today. Sorry for the miscalculation!

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Note: This column was originally published at Multiple Sclerosis News Today