The photo at the right was taken on Sunday. Kim and I are on the cliff walk near Portland Headlight, about a five minute drive from our house.
Relapsing remitting MS patients usually take one of the FDA approved disease modifying treatments. But these treatments come with varying degrees of side effects and risks. As such, patients sometimes like to enjoy short periods when they don't take any disease modifying drugs at all. This is called a treatment holiday. It’s a little gift that they give to themselves for a few weeks or even months. But MS is a persistent disease, so it’s best to not leave it untreated for very long.
There are no FDA approved treatments for primary progressive multiple sclerosis, but that doesn’t mean I don’t try stuff anyway. Most recently I used intrathecal methotrexate for two years, but my last infusion was in February. Since that time I’ve not undergone any MS treatments. I don’t refer to this a treatment holiday, however. Holidays, or vacations, are for relatively short periods of time and have a defined end date. I’ve been without treatment for my MS for six months and counting, and I see no end in sight. I’m more inclined to call this a treatment drought.
This isn’t the only time I’ve been in a drought. My first one lasted a year and a half, back in 2004 and 2005. It happened again for about a year in 2009 and 2010. And there was nothing going on for parts of 2011 and 2012.
The goal with any treatment for PPMS is to slow down or stop the disease progression. I feel that this has only happened twice since my diagnosis in 2001 (I use the word feel because, unfortunately, assessment of disease progression is somewhat subjective for PPMS). The first time was during year one of the two-plus year Rituxan trial/debacle. The second time was during year one of my two-year intrathecal methotrexate treatment. I’m inclined to give credit to each of these drugs for my temporary plateaus, and then scratch my head as to why the treatments stopped working after a year. Of course, the other possibility is that my disease has its own natural ebb and flow, and I would have plateaued during those time periods even if I hadn’t been on those treatments. I don’t think so, but I can’t be sure.
As my friend Joe pointed out recently, there are psychological benefits associated with being on a treatment, even if its effectiveness is unclear. At least we are trying. At least there’s a chance that something amazing could happen. I wouldn’t mind a treatment holiday now and then, but these long periods of time between therapies aren’t good for me, emotionally or physically.
It’s like I am wandering in the desert. I ask myself, “When will it rain again? When will this drought end?”