With thanks to Fiona

No, I'm not dead. Nor am I wheelchair-bound, trapped inside a crippled body, as I feared with the initial diagnosis of multifocal motor neuropathy. In fact, it's rather the opposite.

Yes, it's been a while since I've posted on this blog. From time to time over the past few years, I've thought about updating as my situation progressed, but always found something else to do instead. What prompted me to dig up this blog is that Fiona, after nearly 10 years of treating me with acupuncture, is leaving Melbourne to embark on the next stage of her life. As we reflected on our journey at my last appointment, it felt appropriate to put another chapter on this story.

How did I get here? After an initial unsuccessful attempt at TCM in March, 2010, I gave it another shot in October that year with Fiona, and embarked on what would become weekly appointments over six months (one month per year that the condition was present). The regular IVIg infusions had side effects that were worse than any benefit they delivered. Western medicine had failed to help, so it seemed reasonable to try something completely different.

As a needle-phobic, it was ironic that I was trading one big needle for lots of small ones, even more often, but them's the breaks. Indeed, learning to be comfortable (or rather, less uncomfortable) being jabbed was part of the journey.

After six months of treatment, I was feeling somewhat better. But in addition to the acupuncture, I had learned some other skills: how to breathe, and how to listen to my body. It's hard to underestimate how important those things are. After the initial intensive treatment period, we switched to monthly maintenance and an ongoing journey of looking after myself better.

As this new treatment plan progressed, the infusions reduced in frequency, as did visits to the treating neuro-physiologist. In 2014, I felt there was nothing more he needed to do, and we decided that unless anything changed, it would be my last visit.

In addition, I wanted to have a GM1 antibody blood test ("for old times sake?"). Usually, one only does a diagnostic to help make a decision, but that was not the case here. Rather, it was purely to indulge my curiosity. I had been looking after myself, and suffering few if any symptoms, and wondered if I still 'had' MMN, or if it had magically disappeared. The blood test returned a slightly elevated level of antibodies, but way below what it was the last time I was tested.

To me, that was sufficient to declare officially that I was 'in remission', whatever that even means.

Could one say that I 'beat' the disease? Hardly. No-one knows where MMN comes from or what causes it. There is no known cure. There are some treatments that work to varying degrees, and then don't work. It's not clear why. My doctor said that in some patients, MMN just "burns out". Bottom line: there is very little I can say with certainty.

Reflecting on the journey, I link my case to stress. At the time I was diagnosed, I was burning the candle at both ends work-wise, and had several additional sources of stress in my life. You might say something had to give. Now, I'm in a much better place. Life is far from stress-free, but a lot less than some twelve years ago. Most importantly, I look after myself: breathe, relax, exercise.

The analyst in me craves more scientific deductions than that, but that is unlikely. I wish I could tell other people with MMN that reducing their stress would improve their condition. For that matter, I wish there was some longitudinal research on people with MMN to understand what interventions work, and how the disease progresses. But none of that is going to happen, simply because the 'market' of people with this illness is way too small.

Looking back with Fiona on nearly 10 years of treatment, I'm very grateful to her not just for sticking thousands of needles into me (they are ultra fine gauge, and she's very good at putting them in, and I've also learnt how to breathe through it), but for teaching me so much about myself. I hope she can help many more people in her special way.

Peeling away the layers

The TCM experiment continues, with some success. Since I've been receiving regular treatment - acupuncture, cupping, and more recently a special custom blend of herbal tea, there have been some noticeable changes and improvements.

My principle objective measure is the weekly strength tests I apply, and on that basis, there is more sustained strength in three of the four fingers I test on my right hand. The strength in those fingers used to start decaying after 3 weeks or so, but are now staying stronger than ever after 5 or more weeks. In addition, I've been stretching the period between infusions past six weeks.

My index finger, unfortunately, is showing little improvement at all. It is still the weakest by far, with barely 5% of what a normal finger strength should be. The practitioner has tried several things particularly directed to the function of that finger, but with little effect.

The original diagnosis was "too much heat" (whatever that means in Chinese energy terms) and that was being treated. Since that time, as there have been improvements in that aspect of my energy balance, other issues have surfaced and continue to be treated. She compares it to layers of an onion - as one problem clears up, others problems are more visible.

The biggest challenge for me is to get in touch with my own body. I certainly feel a little more relaxed and have more energy. My New Year's resolution was to exercise more (whose isn't?) and I've been walking 3-4 times a week steadily. I'm doing that with far less fatigue than in the past. So far; so good.

One issue that doesn't seem to go away is a bicep problem, which has been with me on and off for several months now. When it first popped up, my neuro sent me for some ultrasound imaging, which showed nothing. However, the pain when flexing my bicep didn't go away. Eventually, I went for some physiotherapy, which has helped a bit. But then it recurred, and took a step backwards after I played cricket (have decided to take a break from that until it's all better). No-one is yet to give me a diagnosis, although the physio suspects it is tendonitis. Today, my neuro injected some cortisone in the area, which was a most unpleasant experience. The arm was sore for several hours, and I was also quite nauseous. If that doesn't help in a week or so, then it's off for another MRI to see what it can see.

Too much heat

Back in March, I decided to investigate some alternative therapies, and was referred to a traditional Chinese medicine (TCM) practitioner. He was quite a character - a gentleman in his early 60s - who spoke in Australian vernacular, but with a Chinese accent. His appointments ran about a month in advance, which seemed to bode well for his reputation. After feeling my pulse, looking at my tongue and my eyes, he pronouned his assessment: "you got too much heat; you need to bloody-well slow down". Yes, I work long hours (well, not as long as I used to). Yes, there is a lot of stress in my life. Yes, my mind races in overdrive all the time. Yes, I eat spicy food.

As someone brought up on western medicine, I asked the obvious question: what is the link between the diagnosis and my symptoms? No ... it doesn't work that way. The diagnosis is that I have too much heat. How that manifests itself may differ from one person to another. Fix the underlying problem, and my balance is restored, and this should result in the symptoms going away. It's a totally different approach - treat the person, not the illness - and difficult for me to get my head around.

Yet, he was a no-nonsense sort of guy. He put it quite simply: start with three treatments, and if you don't notice an improvement, then this probably won't work for you. So he went at me with needles, cupping, and a handful of other things. I cut out spicy and deep-fried foods.

Three weeks later, there was a small improvement to my "heat", but there wasn't much noticeable change, so we decided to quit there.

I was a little disappointed - I was hoping there would be an alternative therapy answer, especially after coming back from the Mayo with little encouragement. But I also needed to take a measured approach to dealing with this, and not just throw s**t at the wall hoping something will stick. Although in hindsight, it was a particularly stressful time of my life, so I thought it might be worth revisiting at some point in the future.

So a couple of weeks ago, I put out feelers in the "network" for some good TCM practitioners, identified someone, and made an appointment (didn't take a month this time), and she examined me in the usual way in our initial consultation. Her diagnosis: too much heat ...

No diagnosis, but successful treatment

Usually, when something is wrong with you, you get a diagnosis, and that leads to a course of treatment to fix what is wrong. So what happens when no-one can work out what is wrong with you?

The neurologist at first thought my sore bicep was unrelated to multifocal, but saw what he thought was a lump. After ultrasound revealed the muscle was normal, he was stumped. He suggested anti-inflammatories, but they didn't help, and there was no evidence of inflammation in any case. My pilates instructor (who is also a physiotherapist) didn't see any indication of muscle damage, and there was no trauma event that triggered this.

The only person to provide any explanation was a massuese, who said the muscle felt matted and dehydrated, which might have been because I was getting my infusions in the same arm all the time, and the "juice" flowed through the big bicep muscle. Both the nurse who administers the infusions, and my neurologist said this was nonsense from a medical perspective. Although I did get the most recent juicing in my left arm. Unfortunately, my veins aren't as prominent in that arm, so all I had to show were some nasty bruises.

After all that, the bicep pain continued, so I thought I'd try some physio - massage and ultrasound - and that is working. The physiotherapist still has no idea what the problem was, but if the shoe fits, then ...

new symptom?

Yes, it's been way too long since I've written. Miss me? Sorry, a lot has been happening and some complex reasons why I haven't updated thing here. I will probably do a few back-dated posts to talk about some of the interesting things that have been happening. In the meantime ...

For the last few weeks, I've had this weird pain in my right bicep. It happens whenever I flex it to lift something heavy. There isn't a loss of strength, but there is pain, and there wasn't anything (that I can recall) that happened to me that might have caused it. At first, I thought it was muscular, so I asked the physiotherapist that I do pilates with regularly. She said it didn't look like a muscular injury, and it hasn't been getting any better (which you'd think it would over time). If not muscular, then ...

I got in touch with my neurologist's office (who was away), and they suggested an appointment for as soon as he returned. He looked at it, and felt it wasn't related to my multifocal motor neuropathy. As I flexed the arm, he spotted what looked like a lump. He figured it was either a ganglian or a hematoma (i.e. nothing really bad), so he sent me for an ultrasound ...

The ultrasound technician looked high & low, left & right (well, actually just right, but it sounds good), and concluded that there was no swelling and no lumps!

The neurologist still thinks it's unrelated to MMN; the physio says isn't not inflamed or torn, and of course it still hurts when I use it. So what now? I'm taking some anti-inflammatories to see if that fixes it. No-one has any explanation, so it's just the usual trial and error :(

Plenty Happening

It's been a while since I've posted, and it's been an interesting few months. Since coming back from Mayo, we decided to reduce the dosage, so I've been on 33g (just one day) every 3.5 weeks. The other thing we tried was to switch to Octagam instead of Intragram P (an Australian product) in an attempt to test whether this would make any difference to side effects.

The usual side effects still seem to be happening - headaches and fluey feeling. Last treatment - about 10 days ago, there was nausea as well, so it wasn't very pleasant! While the strength tests I use seem to indicate the usual small spike after receiving treatment, something else has been happening over the last few weeks.

My right hand has become somewhat inflamed - the middle finger in particular. There is a noticeable weakness and fatigue in the hand when I use it, so much so that it gets quite sore by the end of a work day. After going for a power walk, my entire right hand feels very bloated. I have switched mouse hands to my left in an attempt to use the right hand less - that has been a huge challenge! My general practitioner sent me for some blood tests, and I see my neuro next week, so it will good to get some professional feedback and hopefully some answers.

Reflecting on Mayo

Things have settled down now. I had just a single day of treatment on Monday (half the usual dose) with the usual side effects, and rest period to get over it.

Looking back on my visit to the Mayo Clinic, I came away feeling perhaps it was a bit of a waste. It's strange - you go to a place like that with an expectation that they will find something very bad, and have the ability to fix it. Then after all the the effort, pain, and expense, and all they do is confirm something you already know! A tinge of disappointment. Yes, relief as well that there is nothing really serious or terminal. Together with that, is the sinking feeling that now I really do have to move to acceptance of my condition of multifocal motor neuropathy, and plan to deal with it for the rest of my life.

From a medical perspective, the Mayo is very impressive. The trip and the outcome has helped me reflect on the level of care I have been receiving until now. If the Mayo ranks a 10/10, then I would say that the medical resources and care available here in Melbourne, Australia probably ranks about 8/10 (my neurologist concurs with my assessment, although he would hardly be one to argue such a point). I am very fortunate to have access to excellent doctors (my neurologist did time at Mayo, and lots of other Australian doctors do same), and the public health system means that my IVIg is free.

On that basis, someone like me going to the Mayo for an assessment is only of moderately incremental value. If I lived in a small town in the US that didn't have such resources, I would have grounds to be less trustful of my diagnosis, and therefore a trip to a major centre would be easier to justify.

Of course this is all with 20/20 hindsight. Still, yet another useful lesson. Time (and quite a long time) will tell if they treatment approach suggested at the Mayo proves to be valuable.

Review with The Man

My last day at Mayo started with the onset of a headache. The little brochure they gave me said that one in three people who have a lumbar puncture experience a headache afterwards. I'm now back in Australia, but was unfortunately unable to leave the headache in the US! It's a dull, throbbing pain, punctuated by bursts of intensity whenever I laugh, cough, or suddenly move my head. What I probably need is some solid R&R time to get over the whole experience.

But back to day 5: I finally get to meet Dr Dyck for a review of all of the test results, and recommendations moving forward. He takes a bit of a history, reviews the documentation, discusses it with the other neurologist present, and confirms the original diagnosis of multifocal motor neuropathy, with conduction blocks in right and left arms. I guess the good news is that there is nothing more insidious there, and I am satisfied that enough diagnosis work has been done to find anything else that could be wrong with me. I explain the side effects that I have experienced, and also show him my hand strength measurement apparatus, and he is suitably impressed. He must be 70-odd, and his finger is able to support over 650g!

As regards dealing with the main condition, he has a few interesting insights. Considering the half-life of IVIg being ten days (contrary to what I've seen online), he is more in favour of smaller doses fortnightly rather than a bigger dose monthly.

There are two schools of thought regarding the use of IVIg for MMN: treat aggressively early on to limit the permanent degradation in hand strength, or delay/limit treatment until the condition gets more severe, because the stuff will eventually stop working. His view is more aligned with the latter: that I should take only as much of the "juice" as is needed to ensure my hand weakness doesn't severely impact my life.

It has been nearly eight weeks since my last juicing, and my hand strength has held up reasonably well - the pain that I was expecting as a result of weakness has not appeared. So I'm thinking that maybe a reduced rate might be in order. He also suggests that it's worth considering different brands of IVIg as they are produced differently, and some may be more effective than others.

He concludes with some general comments about auto-immune disorders: get plenty of sleep (I wish!), eat well, exercise, etc, ... and choose life! He asks me where that phrase comes from, and I recognize it from Deuteronomy (30:19). The quote resonates strongly with me, and I've been thinking since that time about how important my attitude is to all of this. The trip has left me with plenty to consider, as much in terms of treatment as as how to adjust my lifestyle. More once the headache subsides.

Mayo on my mind

Leaving for an assessment at the Mayo clinic in a week, and needless to say it's been on my mind a fair bit. I have no idea what to expect of the process, let alone the outcome. House used to be one of my favourite shows, but lately I cringe at all the poking and prodding (mostly the poking), and now wonder if I am about to become the "special guest star" on an episode.

I didn't have my scheduled treatment a week ago as suggested by the doctor at the Mayo. Definitely didn't miss the experience! The finger strength hasn't degraded quite too badly, which is good.

A few weeks ago, a couple of fingers on my right hand felt sore and slightly inflamed. It felt muscular, but I didn't hurt them, and I have no idea where it came from. It could be anything, but of course my first thought is that it is a new symptom. My neuro acknowledged that there is slight inflammation, but said it isn't necessarily linked. In the meantime, the symptom remains, and hasn't gotten better or worse.

Reflecting on a New Year

Having celebrated Jewish New Year last week, and on the eve of the holiest day in the Jewish calendar, Yom Kippur, I have been relfecting on the last twelve months in my life in the context of my condition. I read somewhere, that someone was asked: "how did your Jewish New Year go?", and he replied: "I'll tell you at the end of the year". We hope and pray for a good year, and that we be inscribed and sealed in the "good book", however the only test of this is time.

On that basis, my Jewish New Year of 2008 didn't go particularly well. Twelve months ago, I could not have imagined myself at this point. My life at present is burdened with uncertainty about the future, regarding my medical condition and several other major issues. The emotions are sitting at the surface just about to burst forth in uncontrollable tears (and they do, every now and then). They need an outlet, and this is a great time of year for that. Hopefully I can look back in another twelve months at a more positive year on all fronts!

I've started planning my trip to the Mayo in November. The doctor has recommended that I stay off the IVIg juice so he can see me without its influence. That means I will be without it for about eight weeks instead of the usual four. The thought of that doesn't make me feel very excited. On the other hand, I want this process to uncover some new insights, so I have to give it every chance of that.

even more juice

Blogger has been playing up lately - very annoying!


I've been tracking my hand strength for the last few months, using a "rig" consisting of a paper cup with some string attached, and a series of scientific weights. A couple of times a week, I measure how much weight each of my fingers can hold up. As you can see from the pretty picture, there are spikes, and these roughly coincide with the IVIg treatments - they seem to have their maximum effect around a week after each treatment.



The legend is a little small - the blue line at the bottom is my right index finger. There are a few interesting things going on here. Firstly, despite the treatment, the best it gets is for my right finger to have not much more than 20% (compared to the left, and the other fingers). I have found this quite disappointing. The spikes are also quite modest. Finally, the pinkie (black) is one of the stronger fingers, and this is uncommon in MMN.


So given that we are reasonably on top of the side effects, my neuro has decided to up the juice. We had been doing 0.78 g/Kg over two days as a maintenance dose, which is already at the high end. The next dose (over the next two days) will be 1.06 g/Kg - an increase of 36% or an extra hour and twenty minutes connected to the juice machine (can you tell I'm a numbers guy?).

I really shouldn't have written about this - all it's done is make me think about how long the treatment is and what I will do. Lately, I've been relaxing more during the infusions - nodding off for a nap here and there because of the phenergan. All of that certainly seems to have helped minimize the side effects. Will have to line up some extra videos to watch or maybe a book (although reading one-handed while lying in a bed is a little difficult).


And in other news, Mayo have responded in the affirmative, and I'm booked in for November. More about that in another post.

next steps

Well, it's been business as usual with the IVIg treatments, and the side effects are more manageable now that I take it easy for a few days each time. Will put up a graph of the results so far in a future post.

However, there is a new development. On a recent overseas trip, I consulted a world expert in diagnosis and specialist referrals. He is not a doctor; rather someone who is renowned for referring people to the right specialist for their specific condition or symptoms. After reviewing my case, he suggested I get in touch with Dr Dyck from the Mayo Clinic, and spoke highly of their diagnostic methodology. This made me wonder if his view was that my diagnosis was incorrect.

Then, I consulted with a spiritual healer. Her advice was that my illness is a lot worse than what we think, and that I should see a doctor in the USA for treatment. Between that and a few other uncanny comments about other matters, I am now very spooked. I'm not an overly superstitous person, however I feel strongly that there are people in the world who have vision/insights to see things that others don't. So my next step is to get in touch with the Mayo and organize something.

Heading for the third round

I guess thinking that I was on a two-month treatment cycle was just me being the eternal optimist. Maybe that is why I get these waves of melancholy and angst? It happens when I actually schedule my next treatment course. Or when I suddenly start to feel pain doing an everyday activity, like pulling off a t-shirt. Perhaps these events trigger a challenge to my natural state of optimism about everything, and that in turn causes me to think about some of the negative aspects of my life with MMN. Or perhaps I am just still learning to accept my condition, and what I really need is to adjust my expectations.

So later this week it will be another two days of juice, after a break of 5 weeks since the last treatment. This is more typical of the treatment cycle for most people with this disorder. The hospital has a new guy in charge of the unit, and I'm told he's really good with putting in IVs. We are making some adjustments to the regimen - a different premedication that should hopefully reduce or eliminate the side effects, and slowing the infusion rate so each batch goes for five hours instead of three. Will have to stock up on DVDs, but the real challenge for me will be to actually get up with the IV in my arm, walk over to the bathroom and relieve myself at some point during the infusion. I managed to do that last time without even looking at the IV site - quite an achievement!

In the meantime, my "rig" (a al Mythbusters) is all set up. It consists of a plastic basket, some ribbon, and a series of weights (the weights were originally little bags of dirt, but I've gone all out and purchased some a calibration weight set). This allows me to regularly measure the strength in my hand (actually, each finger) and record it. Creating a spreadsheet and a pretty graph of the strength measures over time, and how they are impacted by the IVIg treatment is actually something I really enjoy, being a very analytical person.

This will be my third treatment, but there is not much point keeping count. Shortly, it will just become a contiuum, like monthly board meetings or business trips. Discussed the situation with my father today, and explained to him yet again that there is no known cure and that the treatment is ongoing. What I really need right now is a good cry. The emotions are welling up just beneath the surface, and I need to share them with someone who can understand.

rock and hard place

Rock (noun): Deal with the side effects of IVIg using conventional, over-the-counter anti-inflammatories and pain medication, and just wait until they subside.
Hard Place (noun): Deal with the side effects of Prednisone, which rendered me angry, aggressive, hormonal, and bursting out of my skin.

After taking the Prednisone for two weeks, and been off it now for a few days, I've gained a deeper understanding about the nature of different types of headaches. Now that its effects have worn off, I can see Prednisone is reasonably effective in reducing the inflammation reaction to IVIg. Yes, the headaches and neck soreness have returned, so it's back to Nurofen etc to deal with that. Drugs like Excedrin don't work - there is pain, and there is pain. Because mine arises from inflammation, your typical pain killers (even strong ones) don't really do the job.

Being trapped like this between two sets of side effects has me in a bit of a down mood. Maybe I should take something for that?

'roid rage?

I really hate Prednisone. I'm finally tapering for a bit longer after being on it for just over a week at 25mg, and this time, it's really messing with me. Hard to put words on it ... I'm "edgy", not tired at night, sort-of anxious, peckish. Have put on 4-5kg in just a few days, which has made me feel bloated. Is this 'roid rage?

Whatever it is, I can't stand it. It's making me something I don't like, and I can't wait for these side effects to fade away.

It's strange that I don't recall these side effects last time I took Prednisone. This time, we did it as a premedication before the IVIg, so the circumstances and the combination of things going on in my body are a bit different. They have helped to alleviate some of the IVIg side effects, but it has been a very unpleasant journey. In addition, the Prednisone does seem to have a negative effect on my hand strength, so the benefits of the IVIg are held back somewhat. This is something that also happened in my last treatment cycle.

The good news is that my consulting neurologist from Johns Hopkins suggested something different next time. The thought of having to fiddle with doses of Prednisone each time was really depressing me. Instead, he's suggested an IV cocktail of dexamethasone plus a couple of other "mixers" as a one-shot premedication. It's a much stronger form of steroid, and because it's a short, sharp dose, the side effects should be reduced. Anyway, something else to look forward to in a couple of months ...

miscalculation

It seems that with all the extra tests I was having, I took my eye off the main game, and overshot the timing for my second treatment. With my 20:20 hindsight glasses, I probably should've done it several weeks ago. In the meantime, my hand strength has deteriorated quite rapidly in the last two weeks, and is now quite severe. Part of the delay was me not wanting to accept the notion of needing regular treatment; I have to deal with that.

The neurologists say that pain is not something that is associated with MMN. Of course, by this they mean that a nerve conduction block will not cause pain. They may be right about this. However, many people with the condition do experience pain, and I think the reason is quite simple. If your hand does not have strength to support movement in certain directions, and you actually do move it or pur pressure in those areas, then the hand collapses. The radial nerve doesn't seem to be that important when it comes to hand movement - I would think gripping (which is the median nerve) was a far more common action that needed support of motor nerves. But surprise, surprise, there are many movements where my hand and wrist collapse in pain - pulling off a t-shirt, turning a steering wheel, shaking hands, ...

Every time I see my neurologist, or discuss it with my pilates instructor (who is also a physiotherapist), I learn so much about the nervous system and biomechanics. While I'm a person who thirsts for knowledge, and people are impressed when I can explain this stuff to them in simple terms, in the back of my mind, I'm thinking "do I really need to know this?"

Anyway, I've started the premedication before the next treatment tomorrow. Hopefully, I will not experience the side effects of last time. This course is just three days, so that might also reduce the chance of side effects. I really need it to work - having my hand like this just isn't doing it for me.

next juice ...

My hand strength has degraded a fair bit in the last week, and with the protracted diagnosis phase all but complete (just a review discussion with my neurologist next week), I decided that it was finally time for my second IVIg treatment. I ought to be pleased because it has been three months since the first one, which indicates a very slow progression, but instead I'm feeling flat and depressed about it.

Approaching a second treatment course is very different from the first. While I am unable to get excited or enthusiastic about any medical procedure involving a close relationship with a needle, at least with the first treatment, I anticipated a successful outcome, and was not particularly concerned about side effects.

This time around, my anticipation is very different. I think the treatment will result in improvement to my hand strength, but the side effects are a concern, mostly because there hasn't been a satisfactory explanation as to why the headaches went on so long. This time, I am going to premedicate with Prednisone, which should help, but as always, the operative word is "should".

But the other thing that weighs down on me is the long-term future. By embarking on this a second time, I'm accepting it as a part of my life - that regular IVIg "juicings" will now be established as a regular part of my diary. While I was already advised that there is no cure, and that this is just about the only treatment, this is the moment when its permanence is truly felt.

next juice?

Well, the most recent set of test results (skeletal x-ray and MRI) are in, and everything does seem to point to MMN. Is this a good thing? Hard to tell. They're ruled out plenty of bad things, and it looks far more like MMN than CIDP. I don't know if one is better or worse than the other, so that doesn't mean a lot.

It's been over a week since I finished the Prednisone, and I have noticed a couple of interesting things. Since finishing, my hands seem to feel a bit better - a bit more freedom of movement. That seems to indicate that the Prednisone had a detrimental effect. However, along with that, the headaches have returned. They are far less intense than a couple of months ago when I had the IVIg treatment, but they are still there. Not severe enough for me for me to be taking something every day, but enough that (a) I notice, and (b) there is no answer as to why they are still there. Perhaps they are less severe because the IVIg is wearing off over time?

So now I play the waiting game. Waiting for my hands to weaken sufficiently that I will embark on the next IVIg juicing. Next time, they will premedicate me with Prednisone, which they think might help with the headaches. No-one really knows; it's a case of trial and error. More and more I feel like I'm the patient on an episode of House. The only differences are that over there in TV-land, he works it out in about 35 minutes, it's all over in 42 minutes, and the total elapsed time is a few days. My episode will being played out over years, and in that context, we've only just begun. In fact, all these medical shows are starting to annoy me. I squirm when they do tests on the patients, especially the ones with needles, and I'm starting to understand far more of the medical terms than the typical viewer.

Perhaps the only good news is that it's been some ten weeks since my first IVIg treatment, and my hands are far better than they were before the treatment. To me, that implies a longer than average cycle between treatments. You might notice that I'm not running back for more in a hurry. It's a fine-tuned balance between a rock and a hard place.

on pain and memory

Chronic pain, and muscle soreness or weakness, is a funny thing. When it's there, you know it. You notice it all the time. Whether it can be medicated or not, it's there in the front of your mind. The fact that it's chronic bears down on the mind as well, and compounds the effect. Unlike a sports injury or the occassional headache, knowing that this is something long term with no end in sight magnifies the feeling with an additional, psychological burden.

Then, if a course of treatment is successful, the symptom may just fade. And when it fades, it's almost as if it was never there. When it's absent, it was really hard to remember what the pain or weakness was like when you had it. You quickly rebound to a state of how things ought to be as if that is how it always was, and there was never anything wrong.

But after a while, the effect of the treatment may start to wear off. The weakness or pain emerges from its dormancy quite quickly, in fact much faster than its original appearance, which was a slow progression over perhaps several years. It announces to the body: "I'm baaa-aack", like a long lost friend who was never lost at all; just travelling briefly. And then you realize that the weakness and pain was never gone at all, and that the time you enjoyed when it was absent was the exception, rather than the norm - just a short dream.

This is where I am at now. After nearly two weeks on the course of Prednisone (which is now finished), and nearly two months since my initial IVIG treatment, the hand weakness reappeared almost overnight and pain a few days later. There is also some feeling of weakness in my left hand, which I've been trying to find words to describe, and of course the cramps in my calves (although I think lots of stretching helps for that).

But now, I am in no-man's land. I'm not going to have another "juicing" with IVIG because we're not sure how to deal with the side effects. But if I do nothing, then the hand weakness will just stay and get worse. Am waiting on some more test results. These might shed some light on the whole MMN vs CIDP thing, which might change the preferred treatment. The only certainty for me is what happens if I do nothing.

'roids forward and backward

Have been on the 'roids (that's steroids, as in Prednisone) for a week now, and they do seem to have had an effect. The headaches have subsided, which is good. The main thing I've been watching for are further possible side effects. Sometimes I wonder what proportion of drugs are taken to avoid side effects of other drugs, and how much goes to treat the primary condition.

Still have some more tests next week that might shed some further light on exactly what thing I have. In the meantime, it's a case of "let's try this and see what happens".

In the meantime, I've noticed in the last day that my right finger has reverted a little, and there is less movement. It seems a bit different to what it was a few months ago before any treatment. My wife thinks I'm really good at describing pain and physical sensations. This feels a little different to before - there is a noticeable heaviness and lack of desire to respond to my brain's instructions to lift. There is also the slightest tingle in the finger.

This could be a side effect of the Prednisone (unlikely, I think), or simply because the IVIG treatment was two months ago and is wearing off. Interesting to note the rate of the decay - it took weeks to start working again, but seems to have stopped working relatively quickly. I am far from ready to try another dose of the juice; still have another two weeks to wind down the Prednisone and assess its effects.

And as usual, a change like this has me feeling depressed. I almost felt like going back to bed and staying there all day. Fortunately, there is enough to do at work so here I am.