Beth

The last days of my beautiful wife who passed away October 11, 2012.

Sep 262013
 

You can get the full news release from the Novartis website. See link at bottom of article

When I was diagnosed with sporadic inclusion body myositis (sIBM) in 1996, my doctor and I agreed that it was pointless to try any of the drugs available at that time as trials had shown them to be ineffective and experiences have shown that their side effects could be very serious. Once in a while new ideas would be brought forth, but I always evaluated them from two criteria: 1. Did their mode of action seem to make sense for this particular disease, based on what we knew about its behavior? 2. Had any studies been done that produced empirical data supporting their claims?

Of course there were numerous anecdotal testimonials but I discounted those since IBM is such a slow-moving disease and since our physical performance can vary so much over time due to psychological influences and general health. In other words, placebo effects could easily fool people into thinking a regimen was working. There was also the gender factor. Although I have yet to see any data confirming this, my own observation has been that females tend to be more likely to benefit from treatments that are not of any use to males. My theory is that hormones must play a role in the disease one way or another.

So when the new drug from Novartis (BYM338) was given breakthrough status by FDA, I took notice. From what I have read, the mode of action seems to make sense. They believe they have identified an enzyme that restricts the development of new muscle cells and that it is an overabundance of that enzyme causing IBM patients to lose strength. BYM338 blocks the action of that enzyme, allowing muscle cells to reproduce unchecked. The drug has been through two stages of clinical trials including one that showed significant benefits when compared to a placebo. Now they are launching phase 3 which will be a much larger trial. Since the drug has received breakthrough status, a smaller proportion of trial participants will be receiving placebo, so if you are in the trial, there is a very good chance you would be receiving the real thing.

Now for the disappointment. My doctor at the MDA clinic called the researchers on my behalf to see if I could get into the trial. However, due to my advanced stage of disease, I am non ambulatory, and that is an exclusion from the trial. The reason is that they use the 6 minute walk test as a method of determining drug effectiveness. This is a standard test used in many different types of illnesses and thus it would be very difficult to persuade them not to use it. On the other hand, since one of the reasons they got Breakthrough Designation is that this illness is life-threatening in its later stages, I think it is a little unfair that they do not include a trial that focuses on those of us who are at those late stages and may not have time to wait for general availability of the drug.

Follow this link to all the study details.

As always, I caution you to do your own research about any medical topic I discuss. I am not a doctor, even though, like most of us with this disease, I may have more knowledge about IBM than most physicians other than those who received their education after 1990 and are interested in neuromuscular illnesses.

Here is the link to the Novartis website which is the best place to start for gathering information about the medication.
http://www.novartis.com/newsroom/media-releases/en/2013/1723765.shtml

Sep 232013
 

As a disease like inclusion body myositis progresses, it does more than produce the physical changes you expect. It also has a way of taking over your life. It seems that every day I spend more time trying to find solutions to living with IBM than I do actually living. It is like I had just taken the most demanding job imaginable and simply have little time for a personal life.

This may be why I am able to tolerate my current living situation. Even though I am in a very comfortable room with a perfectly large bathroom and am surrounded with just about every assistive device you could think of, it still is not what a normal person would consider ideal. The other residents are nice people, at least the ones who are capable of speaking, but for the most part they are either older than I am by many years or have other issues that prevent forming a personal bond.

About two hours of every day is spent taking care of basic physical needs such as getting up, toileting, bathing, eating, etc. The rest of the time I generally spend at my computer working on the website and blog for Huntington Manor, updating my own blog and my wife’s memorial site, visiting friends on Facebook and posting to the various support groups related to my illness. Every so often I need to tilt my wheelchair back to a horizontal position to help avoid pressure sores and circulation problems and during that time, since I am basically staring at the ceiling or the sky (see video below), I generally focus on meditation. I usually spend one or two hours out of each day looking up information about living arrangements, adaptive equipment, etc., or making phone calls about the same issues. Then there are the doctor visits which usually happen one or two times a week. Even though the appointments themselves are not that long, they involve 8 to 10 miles of wheelchair riding for the round-trips, or even longer bus rides. If there is time left over, my latest Netflix treat awaits.

As I write this, I am not sad or bitter, I am simply amazed by the way I have been so completely taken over by IBM. Up until a year ago, my post-retirement time was more likely to be spent dealing with my wife’s myotonic muscular dystrophy, as it was a disease even more complex and, as we now know, more life-threatening than mine. But that seemed like a worthwhile pursuit and as long as there was hope for making her better, what else would I be doing?

Now here is where this analysis gets a little weird. When I look at the lives other people live, I do not feel envy. if I had to describe what I feel I would say it was puzzlement. Dining out, games, camping, trips to the beach, all the things I can no longer do, I don’t really miss. Somehow I feel like what I am doing is actually entertaining.

My biggest regret about the way I live is that I wish it could be more meaningful. I am sure everyone starts having such feelings as we begin to realize that one of these days will be our last. But I have a unique opportunity since I have almost no obligations other than arranging for the assistance I need to keep me healthy. I keep returning to writing in the hopes that someday I will write something that really has meaning. I am sure that makes me one of about half a billion writers who feel the same yearning.

Unfortunately, making the decsion to “write something meaningful” isn’t enough. I am reminded of the scene in Funny Farm where Chevy Chase is sitting at his typewriter, having left his job in the city to pursue a career as a novelist. He types the title, puts in another sheet of paper, types “Chapter One,” shoves the carriage return (something young writers may not know about) and sits staring at the empty page. For days.

One of the nice things about voice recognition is that an empty screen and listening microphone can’t apply the same pressure. Eventually it will hear some background noise and start typing random words, frequently expletives. For that matter I can just start talking gibberish and Dragon Dictate will not even raise an eyebrow as it spits the words onto the screen.

See what I mean?

A two minute sample of garden meditation.

Feb 192013
 

My wife had myotonic dystrophy. It was the underlying cause of her early death. Although we knew of her condition for the past 7 years, we were unaware just how life-threatening it could be. Unfortunately, her doctors were also ill informed since myotonic dystrophy is not a common illness. I am presenting some information here in the hopes that it could be useful, and even life extending, for others who may have myotonic dystrophy.

Myotonic dystrophy is caused by a defect in a specific area of chromosome 19 called DMPK (dystrophia myotonica-protein kinase).  It is normal for protein sequences to repeat a few times, however when a particular sequence in this region repeats more than 35 times, a person is said to be affected by myotonic dystrophy. This was discovered in the early 1990s and since then, suspected cases can be confirmed by a genetic test. Myotonic dystrophy is an inherited disease. It is passed from parent to child in an autosomal dominant fashion. This means that if one parent has the disease, their offspring each have a 50% chance of also being affected. Moreover, the disease tends to become worse with each successive generation. Thus, if a parent had a mild form of the disease, their child could have a classic or even a congenital form.

Myotonic dystrophy is classified based on the number of times the protein sequence is repeated. Fewer than 35 repeats–normal, no disease indicated. 35 -100 repeats–mildly affected by myotonic dystrophy. (However, their offspring have a 50% chance of developing the illness, possibly in a stronger form.) 100 – 1000 repeats–the person has the classic form of myotonic dystrophy. Beth had 212 repeats and was seriously affected..

Until 1992, myotonic dystrophy was one of many neuromuscular diseases that was difficult to diagnose with certainty. Since that time, the availability of genetic testing means that a person can be determined to either have the disease or not. Unfortunately, having this diagnostic capability for such a short time means that there have been many undiagnosed cases and therefore there are large numbers of people today who may be at risk for the illness and not know it. In my wife’s case, we will never know for certain which of her parents had the disease, although we are fairly certain it must have been her mother. For those with the mild form, they may have a normal life span with little physical symptoms. The most typical symptom would be early-onset cataracts, the possibility of diabetes, and the typical myotonia (the inability to relax one’s grip easily).

Beth wobbling along at the edge of the Grand Canyon in 2004. A year later she would be diagnosed with myotonic dystrophy.

For those with the classic form, there are many symptoms affecting various muscles and organs. These include weakening of muscles in the forearms and hands, calves and feet, shoulders back and face, and diaphragm. Those weaknesses can affect a person’s ability to walk, keep their balance, perform fine motor skills with their hands, and breathe. Men may experience infertility. Women with this form of myotonic dystrophy frequently have difficulty with childbirth. (My wife suffered through many hours of unproductive labor before eventually giving birth via cesarean section to our first child.)

Weakness in the facial muscles can cause a person’s appearance to change rapidly. There can be loss of hair on the front of the scalp, drooping eyelids and an open mouth. These weaknesses can also cause frequent jaw dislocation, and difficulty swallowing.

Cataracts are very common, and an alert ophthalmologist can be the first to raise the possibility of myotonic dystrophy with the patient because the types of cataracts have a distinctive appearance when they are caused by myotonic dystrophy.

There is an increased likelihood of diabetes and cancer among those who have the classic form of myotonic dystrophy. They will also be more likely to have digestive and intestinal issues.

There are numerous hormonal consequences, including reduced sex drive, early infertility, insulin resistance, and thyroid problems. There can be increased chance of gallbladder inflammation, problems with the pancreas, and chronic constipation.

The most common causes of death for those with myotonic dystrophy are respiratory failure and cardiac arrest.  Most articles you will read about myotonic dystrophy recommend yearly EKGs because there is the likelihood that cardiac arrhythmia may develop. What they don’t say, is that there should also be a 24 hour Holter study done from time to time, as this is more likely to catch an arrhythmia that comes and goes. Thanks to having an autopsy performed following my wife’s death, we now know that she had been having episodes of insufficient blood flow to her brain for some time that had not been detected by either the annual EKG or MRIs. The MRIs would have shown more if we could have used contrast medium with her but unfortunately her kidneys had been damaged to the point where contrast medium was not possible. She died when a combination of factors overwhelmed her.

It is especially important that an anesthesiologist know about a patient’s status with myotonic dystrophy as the patient will be at much higher risk of respiratory issues.

Here are some things to look for:

An unusual walking gait where the foot seems to slap down on the ground, preventing the normal flowing motion of a healthy walking motion.  There may also be an increased likelihood of falling.

Early-onset cataracts, especially “Christmas Tree” cataracts on the back of the lens.

Difficulty relaxing ones grasp on an object.

Excessive sleepiness.

Download large format poster.

Important disclaimer: I am not a medical professional and what is on this page should not be considered medical advice. I have read a great deal about my wife’s illness and have attempted to present the information in a more readable fashion here. I am providing you with the links to my sources. You should also know that I’m only covering the mild and classic forms of type I myotonic dystrophy. There is also the congenital form which can affect infants at birth and type II myotonic dystrophy where a different gene is affected and the disease is generally not as severe.

http://mda.org/sites/default/files/In_Focus_MMD.pdf
http://en.wikipedia.org/wiki/Myotonic_dystrophy
http://medicine.yale.edu/neurology/divisions/neuromuscular/md.aspx
http://ghr.nlm.nih.gov/condition/myotonic-dystrophy

Feb 092013
 

Mike and Beth at a winery in Washington state, 1998

Beth and I visited a winery near Seattle on a 1998 driving trip along the coast to celebrate our 24th anniversary. I had been diagnosed two years earlier and was still getting around using forearm crutches. Beth wouldn't be diagnosed for seven more years.

Over the past several months, I have spent quite a bit of time browsing forums that deal with loss. Loss of a loved one, loss of ability, loss of strength and mobility. It makes me sad to hear of so many people who feel that no longer being able to walk, or no longer having the companionship of a loved one, means that life is no longer worthwhile.

I went from being a low handicap golfer, avid hiker and runner, enthusiastic traveler, to being confined to a wheelchair and now being confined to an 11′ x 15′ room, especially when the weather is too bad to go out for a wheelchair ride. My wife of 38 years died in October, far too young, due to her own rare disabling disease (myotonic muscular dystrophy).

I definitely grieve the loss of my wife and loss of strength and loss of the life I once had. At least once a day that grief will be strong enough to make me stop whatever I’m doing and shed a tear. In fact, during the first couple of months after my wife died, the grief was so intense that it was quite painful physically. Rather than avoid it, I chose to accept that pain, experience it as deeply and fully as possible, and in that way let it help me heal. Years ago, a meditation instructor taught our class how to get rid of a headache. He said when you felt it coming on to focus on the pain as intensely as you could. Try to describe it, determine its focal point, trace it throughout your body. The remarkable thing was that once a person focused intensely on the pain it usually went away. It seems that pain is trying to send us a message and if we can pay attention, it won’t have to shout so loud. So that is Part One of how I deal with grief and loss; I embrace the pain and let it heal. In fact, I pick a fight with it by writing this blog and the new blog I have created celebrating Beth’s life.

Part Two is realizing that my life is about so much more than what I have lost. I have the comfort of feeling surrounded by family, even though many of them live far away. Beyond that, life is so exciting right now due to the advances of technology. My computer provides a window into a world that I could never have imagined when I was growing up. I can use Google Earth Street View and visit nearly any city or countryside in the world just by moving my mouse. One moment I can be “walking” beside the Eiffel Tower, the next I can be riding along the Pacific Coast Highway at Big Sur. Recently I have developed a keen interest in computer programming and have discovered the wonderful online courses offered by Stanford University. In fact I was just watching a lecture (on iTunes) by a Stanford computer professor and marveling at how much I felt like I was right in the room. That prompted me to add this article to my blog.

In a few minutes, the caregiver will deliver my dinner, attach my mobile arm support, place a bib around my neck, and I can enjoy my meal while watching the latest Batman movie on my computer. So yes, my life is populated by loss and grief, but they are joined by new sources of fulfillment. I hope that others in my situation are finding their own joy as we continue this surprising journey.

Nov 092012
 

BethTimeLine30x20sm

A visual snapshot of Beth's life.

The first time I held Beth’s hand, she looked into my eyes and my heart was stolen. The last time I held Beth’s hand, she closed her eyes and my heart was broken. But the glorious years in between have been more than worth the agony I am feeling now.

The places we went, the love we shared, the friends we made, the children we raised …

Our favorite things to do together were traveling and throwing parties. I always suspected that both were just excuses for a new wardrobe, but as beautiful as she was who could possibly say no?

We would travel by car usually. I liked to drive and she liked to sleep. Once in a while she would wake up long enough to see something along the way. When we returned, Beth would take those visual memories and turn them into incredible works of art. One was Maui jungle, where she managed to distill a week of driving around the island onto a 2″ x 3″ piece of zinc. That image won major awards and the edition of prints sold out.

When I was forced to retire due to my disability, I took up painting as well and we enjoyed our trips even more. We would come home to our studio and commit memories to paint and paper. This was a very happy time. But then I became even more disabled to the point where we could no longer be away from home at night. Beth began losing her eyesight and was diagnosed with her own physically disabling disease.

For a while, we continued to paint, drawing upon the memories of previous journeys. But for the past 2 years, painting simply stopped. Beth couldn’t see well enough and I couldn’t move my hands well enough and the focus of our lives turned to helping each other get by.

And now Beth is gone. But she is still helping me get by. Because she has left me with a lifetime of beautiful memories.

Her loss gives me great pain, but it is a small price to pay for the richness that she has left behind. Beth, I will always love you and I will forever thank you, for having been my wife.

Oct 192012
 

My daughters and I have spent the last few days working on Beth’s obituary. This is a task that should not be put off until the death of a loved one. There is so much we would want to tell people about my wife, their mother. But there is also the reality. To begin with, people reading the newspaper and scanning the obituaries are generally not likely to want to read a long story about how much someone meant to you. What’s more, at $10 a line, indulging in excess sentiment could quickly become very expensive–money that should be better used. So when it came right down to it, we realized the important facts of her life trumped the depth of our loss and the breadth of our love. Here is the finished product as it will appear in Sunday’s paper.

Obituary for Elizabeth Shirk

Obituary for Elizabeth Shirk as it will appear Sunday, October 21, 2012.

Oct 142012
 

Beth at Art Reception

Beth at an art reception last year.

Three nights ago I got those terrible phone calls. The first was from my wife’s new assisted-living facility. She was being rushed to the hospital. The second call was from my daughter who was on her way to meet the ambulance and said she would send her husband to get me. When I got inside the emergency room my daughter met me and said “brace yourself, it’s very bad”. Beth, my wife of 38 years was lying on the bed, a ventilation mask over her face, her chest heaving in response to the high amount of pressure they were using to force air and oxygen into her lungs. My daughter explained that without that she could not survive. Although my wife had a Do Not Resuscitate order, my daughter made the decision to allow them to take this extra step to keep her alive until I could be at her bedside and to give us time to bring our two daughters down from Orange County.

So we talked with her as her body struggled. She managed one-syllable answers and at one point opened her eyes and squeezed my hand. Then our daughters arrived and we gathered around and told Beth how much we loved her (although there really were no words that could possibly say how very much that was).

Beth on the beach with our daughters.

Each summer Beth and our daughters would stay at the beach in La Jolla for a couple of glorious weeks.


The doctor gave her pain killer and a sedative, then removed the mask. We held Beth and continued to talk with her as she struggled to breathe on her own. All too soon, she took her last breath and I felt her fingers relax their hold on mine. My wife, my soulmate, the mother of our children, was gone.

As I write this, there is no way to describe the agony. If I could, I would change places with her in an instant, but I can’t. Somehow I have to make sense of a life that doesn’t include Beth and try to use the time I have left to continue to write and help the world know more about the wonderful woman it has lost.

Spring Ahead Watermedia Painting by Beth Shirk

One of Beth's last works of art, Spring Ahead won many awards and now hangs in my room.

Oct 092012
 

Beth at Sunshine Week One

Beth in the patio of the memory care facility shortly after moving in.

I really appreciate the words of sympathy and encouragement that I have received regarding the latest setback in our lives. I wish I could say that Beth is adjusting to life in the memory care facility, but so far she is not. Just 5 days after moving in, she tried to get up in the middle of the night because she thought I was in the room and wasn’t answering her. She fell and was transported to the hospital. Fortunately no broken bones, just bruises.
I am now trying to learn more about her disease. Not easy since the doctors couldn’t give us a diagnosis beyond some kind of dementia with psychosis but not Alzheimer’s. I’m trying to find a caregiver support group. Not being able to drive and having the terrible public transit system that we do in San Diego just makes matters more complicated. The one good thing about all of this is that I go days at a time without even remembering that I have iInclusion Body Myositis (or that Beth has Myotonic Muscular Dystrophy).

Sep 282012
 

Beth on cousin's deck in Englewood, FLA

Beth on the deck of my cousin's apartment on the Gulf coast of Florida, about 39 years ago.

Forty years ago, when Beth and I met, we fell so hopelessly in love we were willing to uproot both of our lives so that we could spend the rest of our years together. We were inseparable, holding hands wherever we went, even on our way to the laundromat where we would sit together and watch our clothes dry. We had two beautiful daughters, now with families of their own. I learned to share her love for art, and we began our retirement intending to spend the rest of our lives painting together. When I became disabled 15 years ago, she helped me cope. Then she became disabled a few years later, as though we needed to share that too.

For the past year or so, Beth has been leaving me. Not out the door or to the arms of another, much farther than that. Her brain is taking her slowly but certainly to a place that I can not visit nor even comprehend. And now this terrible illness, yet to be named despite two weeks of trying by a team of UCSD doctors and psychiatrists, has progressed to the point that the unthinkable is happening. In order for her to receive the kind of care she needs and deserves, she must move to a special facility, and there is no place for me. I can visit as often as I wish, and I will. But when I return to my room, with its ceiling lifts and hospital bed and accessible fixtures, there will be no soft greeting to make this austere environment feel like home. Even worse is knowing that she will also be alone without the hope that I might rescue her from the tigers and lions, snakes and assassins and all the other evil images that come stalking as the light fades. I hope this new place, and new medicine, will make them go away. But even so, I know that the illness has also taken her ability to understand the reasons we are apart. Beth will only know that I am not there, and wonder why the person who once happily spent hours helping her pick curtain fabric has vanished into the murky night.

Aug 042012
 

Note: At the time this series of articles was written, my wife Beth was still with us. She died October 11, 2012.

There is downsizing, and then there is moving to assisted living. Downsizing presents difficult choices of what to keep and what to take with you. Moving to assisted living presents impossible choices.

One way we managed to deal with it was to simply not make many of the decisions. Instead we had our daughters go through our stuff and make a lot of the choices for us, without us being present. Did we agree with every choice? Of course not. But it at least it let us whittle things down to a manageable size.

Another way to approach it is to choose between what you really need and what you think you simply can’t live without. In my case, since I knew I was going to continue to do work in the website design and graphics arts field, I definitely had to take all of my computer gear and cameras. Plus my manuals on software and programming. Beth wanted all of her art supplies, of course.

How do you downsize this?

How do you downsize this?

Clothing was also easier for me, since I really can’t wear standard clothes anymore. I just needed to bring along half a dozen of my specially constructed pants, and a dozen or so shirts. Plus some jackets.

Beth wanted to bring enough to fill several closets so we compromised by storing winter clothes off site and bringing all of her summer clothes. Then we will have to make the switch in the fall and hope we guess right on the weather. I also gave her half of my closet for coats.

Then there are the keepsakes. How could we possibly get rid of any of the vases that people had given us over the years? Well we had to, and every few days we will remember one that would’ve been just perfect for a particular location or occasion. The other really big issue was Christmas decorations. We have been allowed to store some here underneath the facility in their basement, but that still begs the question of what we will do with them come holidays. Perhaps we will be able to use some in a common area here at Huntington Manor.

It’s my belief that the key to this whole process is to try your best to live in the present. Every time we start thinking about things we left behind it becomes difficult. But in truth, nothing we left behind is needed for our daily lives. And the real memories aren’t stored in vases or garment bags. They are in the mind.

Which reminds me to return to working on my first book, “The Society of the Creek.” It is a book about childhood, written for an adult audience. I plan to post some excerpts here.

Index for this series of articles about assisted living.

Introductory article plus updates.

Is it time for assisted living?

Making the decision to move to assisted living, emotionally, practically and financially.

How we chose the facility we did.

Deciding what to take, what to leave, how to adjust our expectations.

What life in assisted living has been like.

How can we make assisted living better for the physically disabled?