Jul 182015
 
"Point Pinos" is one of two of my paintings (along with one of my wife's) hanging in the permanent art collection of the Muscular Dystrophy Association.

“Point Pinos” is one of two of my paintings (along with one of my wife’s) hanging in the permanent art collection of the Muscular Dystrophy Association.

Ten years before this blog began, and several years before the term “blogging” came into general use, IBM had taken my life in a new direction. Besides forcing me to give up a career as a writer and advertising agency owner, it had herded me into a new career as a watercolor artist. Within months of closing the doors to my ad agency, I was opening books on painting techniques, design theory and color harmony. I joined an outdoor painting group, then became a member of the San Diego Watercolor Society – one of the largest groups of its kind in the world – and soon became a board member and eventually president.

This was   my booth at the Hotel Intercontinental in 2003 for The Myositis Association national conference.

This was my booth at the Hotel Intercontinental in 2003 for The Myositis Association national conference.

This new avocation gave me such pleasure and added so much meaning to my life that I had to share the news. I talked to members of our local Myositis Association (TMA) support group and they encouraged me to take my message to the national conference that was coming up in Houston. This was in 2003. The organizers of the conference also encouraged me and gave me a booth where I could display several paintings and hand out literature.

 "Monterey Bay" (15 " x 22 ") will be auctioned  at the 2015 national conference of the myositis Association to raise money for research.

“Monterey Bay” (15 ” x 22 “) will be auctioned at the 2015 national conference of the myositis Association to raise money for research.

Twelve years later, I have once again been approached by TMA to participate in their national conference in Orlando. Of course I cannot travel there, but one of my paintings is making the trip, along with this updated version of my literature (below). The painting will be auctioned with the proceeds going to benefit research into myositis. One session of the conference is about finding purpose in life following disability, so I am very pleased to participate in this small way.

 If you click on this image of the front and back cover it will make it large enough to read.

If you click on this image of the front and back cover it will make it large enough to read.

 This is the inside of the brochure where I tell the story of becoming an artist after being diagnosed with inclusion body myositis.

This is the inside of the brochure where I tell the story of becoming an artist after being diagnosed with inclusion body myositis.

They titled this session “Act II” but if I could be there in person I might add that myositis is not necessarily a two act play. It has been nearly 5 years since I was forced to give up painting due to seriously declining strength in my hands and arms. Of course that led to yet another exciting pursuit – – writing a blog and a book taking advantage of voice recognition technology and electronic publishing. (Which reminds me, my book has been published for nearly a year and a half now and sales have slowed down considerably after beginning with quite a flourish. I didn’t publish the book to make money, in fact I have given away nearly as many as I have sold, but I am curious why it seems to have been forgotten. It was written to help people with myositis, especially those newly diagnosed, because this is not a common illness and coping with it is not a common skill. You don’t even have to pay for the book if you don’t want to because Amazon Kindle owners can read it for free. I’ve included the link below.

Feb 082015
 
 With surroundings like this I couldn't give up on photography.

With surroundings like this I couldn’t give up on photography.

 Heading out to shoot some stills and videos. See the video below to learn how my system works.

Heading out to shoot some stills and videos.


In my previous post, I explained that losing nearly all the muscles in my hands and arms and taken away my ability to hold the camera and press the shutter. Today I am happy to report that my occupational therapist has created a system that attaches to my wheelchair and restores my ability to do photography. Actually, it turns my wheelchair into a rolling tripod. Couple that with the ability to tilt, elevate, and roll, and my new system gives me more capabilities for taking stills and videos than before. Please watch the video below to see how it all comes together.
Occupational therapist John MancIl and his bag of tricks.

Occupational therapist John MancIl and his bag of tricks.

Jul 192014
 

Lately I’ve been getting less joy out of my wheelchair joystick.

As my upper body strength has declined, I have found it more and more difficult to control my wheelchair using a conventional joystick. I am able to maneuver the chair okay but when I first take hold of the joystick I need to sling my arm up and around and let it drop onto the knob. Frequently that results in me jerking the joystick in one direction or another and running my feet into a wall or backing the chair into furniture. A few months ago, my physiatrist at the MDA clinic recommended I be evaluated for an alternative control system. After trying several of them, I decided that my only hope was to try to design one myself. Before I show you my concept, let me explain what I found wrong with all of the others that were available.

The first idea was a micro joystick that would require much less strength to operate. However it had a very short “excursion” in other words the distance from zero movement to full speed was something like 1/10 of an inch. Also, it was designed to be moved with a finger. Those of you with IBM will immediately see the flaws there as our fingers are among the first parts of our bodies to lose strength. I could barely get the wheelchair through the door out of my room to try it out. Even when I tried to use my thumb, the amount of fine motor control needed far exceeded my capabilities.

The next experiment was a device that would be controlled by my chin. Once again my weakness got in the way. If I reclined the chair at all, my head collapsed back into the headrest and I no longer could even reach the chin control, let alone operate it. However this control did have a longer excursion and therefore I was able to at least get the chair out the door but I found it extremely difficult to keep it going in a straight line. Furthermore any distraction to either side that caused me to turn my head also turned the chair. Picture that happening while you’re going down a sidewalk with a steep curb!

There is another type of control that is similar to the chin control and that is a head array. We determined that it would have the same failings as the chin control for me.

There are other, more extreme types of alternative controls such as the sip and puff which uses your breath for control (another of my weaknesses). One that sounded fascinating was a trackpad system which would be very similar to using the mouse on a computer. Hwever it relies on being able to control your fingers which I can’t.

In this proposed control, my thumb rests on a miniaturized joystick. My remaining shoulder muscles would slide my hand forward and back for controlling wheelchair speed while my thumb muscle (the only one left in my hand) would control the direction left and right.

In this proposed control, my thumb rests on a miniaturized joystick. My remaining shoulder muscles would slide my hand forward and back for controlling wheelchair speed while my thumb muscle (the only one left in my hand) would control the direction left and right.

So now we get to my proposed solution. I need a flat panel to rest my hand on when I first reach for the control. I have the most strength in my thumb, so it would be ideal if the joystick were waiting for me near, but slightly forward, of where my thumb would normally rest on the flat panel. I could then make a motion quite similar to the same one I use when I am controlling the mouse on my computer. I have become skilled with those motions out of necessity.

Access Medical sent my design to a company that specializes in making alternative wheelchair controls and I will let you know if they are able to come up with something for me.

Jul 232013
 

A photo of Earth taken from nearly a billion miles away by Cassini orbiting Saturn. I am in the picture.

Living with a progressive untreatable disability like inclusion body myositis can be very difficult, but it is not rocket science––or is it? Friday, July 19, I toured the NASA Jet Propulsion Laboratory in Pasadena California, and shot lots of video footage with my new GoPro Hero 3 Black camera. It just happened to be the day that the Cassini spacecraft orbiting Saturn was going to take a picture of Earth. Many of the employees of JPL were out in the courtyard waving for the picture. You cannot see them in the video but you can hear them. I also included the picture that Cassini took of Earth, with the assumption that I am in the shot. The shakiness in the video comes from my inability to hold my hands very steady. I should have used my helmet mount, but I thought that might give security some problems.

Now about the rocket science. To begin with, it turns out the Jet Propulsion Laboratory is no longer that concerned with jet propulsion other than hitching a ride with a rocket to get to where they need to go. Their main focus these days is on robotics. Their mission control center is all about sending and receiving signals through millions and even billions of miles of space. For example, the photograph that is on this page and featured in the video showing Earth as seen from Saturn, was taken by the Cassini orbiter. if you wanted to be in the photograph (not that anybody would really know you were) you needed to be facing Saturn and smiling and waving about one hour and 20 min. before Cassini actually snapped the shutter. That is how long it takes the light waves to get from Earth to Saturn.

But on a more down to earth example, the camera I used, my GoPro, is a marvel of technology in its own right. Slightly larger than a matchbox and not much heavier, it can shoot video that is 4000 pixels wide and I control it with my iPhone. Despite being unable to move my fingers, I was able to compose a fairly complex score to go with the video using Logic Pro software on my iMac and a Korg Nanokey keyboard that is perfect for me since the keys merely need to be touched. The video editing was done using Final Cut Pro X, an amazing software program that puts the equivalent of a million-dollar video production studio onto my desktop for a cost of about $300. Finally, I am dictating this entire blog, along with tens of thousands of words that I have recently written for books in progress using Dragon Dictate voice-recognition software.

Thank you scientists everywhere, and please keep these wonderful innovations coming!

Jul 212013
 

Mike wearing GoPro

Here I am wearing my new camera. I just have to be careful not to nod my head if somebody waves to me!

Every time I think I have hit upon a pastime that I can continue to pursue despite the progression of my illness, I discover how wrong I was. When I was forced to give up work, I took up painting. That lasted for 10 years until my arms and hands became too weak to guide a brush. So I decided to take up writing a blog. But that meant I had to overcome the weakness of my fingers – fortunately voice-recognition was improving and it is a pretty good substitute. However the other part of writing a blog is photography. Over the past few months my hands and arms have become too weak to hold the camera or cell phone and press a shutter. Since part of my new “job” now that I am living at Huntington Manor assisted living is maintaining their website and blog, photography is a very important part of my work. I was about ready to throw up my hands and quit (except I cannot throw up my hands anymore) but then I was watching a NASCAR race and one of the cars was sponsored by GoPro. I had heard the name before and knew that it was some kind of camera system, so I looked it up on the Internet. I discovered that the GoPro was a very compact camera that had been designed by surfers to allow them to make videos of their rides. It soon spread in popularity and was used by skateboarders, skiers, model airplane builders, free base jumpers, and just about anyone who wished to make a video record of their exploits. It came with a waterproof housing of course but that did not interest me so much. What really caught my attention was both its light weight and the fact that it could be controlled remotely using an iPhone app.

I visited my favorite store (Amazon.com), read about the various models and ordered the GoPro Black, the one with the highest resolution. I also ordered the special mounting system that goes around the head. Now I have a camera system that I can take with me without having to hold it in my hands, and I control all of its functions from my iPhone resting on my lap. I have been using it for a couple of weeks now and have already produced a major video for Huntington Manor as well as taking the number of other photographs. It does not have a zoom, but it has the capability of taking very high resolution video, double the size of high-definition, which means that I can use video editing software to zoom in on sections that I have shot, without winding up with fuzzy, pixelated video. Below are my first videos produced using this camera.

I have included this link to the GoPro camera description on Amazon in case anyone is interested in getting one for themselves. There are three different models, but I highly recommend getting the highest resolution “Black” model which would then allow zooming in postproduction.

This is a video I made about the Huntington Manor Summer Picnic. It includes the food preparation in the kitchen as well as the event itself. All the video was shot with the GoPro camera, and edited using Final Cut Pro Xon my iMac. The background music was created using Band in a Box, The only way I can create music these days is using that program. I can use one finger to type in the chords and a simple melody and it does the rest.

Here is another video shot with the GoPro. I placed it near the bird feeders at Huntington Manor and from a distance waited for the goldfinches to arrive and then started the camera recording. The video was shot at 120 frames per second to produce the slow-motion effect.

May 292013
 

The Korg nanoKey2 keyboard doesn't have conventional piano keys, but it works well for me.

This stupid disease (Inclusion Body Myositis} wasn’t content with taking away all of my physical activities like running and playing golf and tennis and gardening and cooking. It also took away the strength in my fingers so that I could no longer type (a major loss for someone who made his living as a writer) and so that I could no longer play the piano, something I had done since I was 3 years old.

But those who know me realize I am stubborn and so I have continued to search for other outlets. Recently, I decided to take vocal lessons. I had written a song that seemed to get fairly decent response from those who heard it, but it didn’t take a very critical listener to realize that my voice was untrained. I assumed it was due to lack of practice since there was a time when I had some vocal training.

I signed up for lessons but after the first couple of sessions I realized that my voice was not getting any better, and was perhaps getting worse. Then I looked at a video of me making a speech to the San Diego City Council 6 years ago, and I realized that my voice had been much richer then.

I did some more reading and research about the voice and realized that my vocal chords were nothing more than muscles, and unfortunately, that’s what my disease feeds upon. What has been happening is my vocal cords have been becoming weaker year-by-year. This gives a certain raspiness to my voice making singing difficult for me and unpleasant for listeners. Worse yet, with this disease if you try to strengthen the muscle that the disease is already weakening, it makes the disease process accelerate. In the 2 weeks of vocal exercises, I had actually damaged my voice more.

Now what? Well, if I’m going to the be sticking around on this planet for a while longer, I need something creative to do. I had tried to learn objective C programming so that I could write apps for the iPhone, but I found that my lack of working fingers made the learning process just way too slow and I gave that up. I am currently working on my memoirs, using voice recognition technology, and that is an interesting thing to do and keeps me occupied for a couple of hours a day, but I need more than that.

I’ve always enjoyed making music, although not having the ability to strike several keys of a keyboard at the same time made it tedious and boring. Then an acquaintance told me he was creating complex musical arrangements using a program called Sibelius. This intrigued me, as it meant I could develop a multi-part composition one note at a time. So that is my latest venture and I must say it is a lot of fun even though once again I have gotten into a brand-new area that has a very steep learning curve.

One interesting new tool I have just discovered is the KORG nanoKey2 keyboard. Most electronic keyboards are built to resemble a standard piano keyboard and as a result the notes are very difficult for me to press. This one has the same layout but the keys are much shallower and require less effort to press. If you are interested, Amazon sells it:

Should anything worth sharing come of my attempts I will post it here. As a start, I am trying to do a remix of my song, “I Won’t Stand for That!”

Apr 142013
 

Preparing Work Apron for washing

When my Work Table apron gets dirty, I just remove the masonite panel and throw the cloth portion in the wash.

I have had several requests for the patterns for some of my projects. Unfortunately, by the time I was doing the videos, I had lost too much of my finger dexterity to be able to draw well enough to create a pattern. Instead, I would use voice recognition to dictate instructions to myself. Following are the instructions for making an insulated apron for use in the kitchen.

These instructions can be modified for making a work table, by replacing the insulation and batting with a piece of hard board such as Masonite and leaving one end open.

We are making an apron 24 x 17 with two twelve inch straps with velcro fasteners. (NOTE THAT THERE IS NOTHING AROUND THE NECK!)

For apron:
Cut fabric with four and five eighths inches extra on ends and five eighths extra on sides.
Result is two pieces 33.25 x 18.25.
Cut insulation and cotton batting 16.5 x 20.
baste insulation & batting together with shiny side of insulation out.
Sew two fabric sides wrong side out the long way.
Turn inside out.
Insert filling (insulation, batting, with insulation facing top).
Run stiches across short ends to lock filling in place.
Use a wide roll hem (approx 2″)at each end.
Sew long edges to lock pellon in place.
Baste layers together and use walking foot to quilt the insulated surface.

For straps:

Cut two pieces of fabric 13.25 x 6.25.
Hem the short ends.
Sew the long seams inside out.
Pull them through to be right side out.
Cut two pieces of fuzzy velcro 2″ x 5″.
Straddle the seam with the velcro and sew in place.
Fold the opposite end of each strap and sew together.
Use reinforcement stiches to attach the straps to the hems of the apron.

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

Jul 122012
 

Spray cans are very frustrating for those of us with weak fingers. Mine have gotten to the point where i needed two hands — one to hold the can, the other to push on the button with my thumb! Try painting that way, or spraying oil into a skillet, spray starch onto a shirt, or lysol onto a countertop. Then I discovered the device shown here. It works for me, and that’s really saying something! I bought mine on Amazon. In fact, I buy almost everything there. Saves time, saves money, and I can’t drive to the store anyway.

Jan 212011
 

The author photographing his favorite room.

The author photographing his favorite room.

At the risk of challenging the squeamish or offending the proper, I have decided to share my bathroom with the world.

If you are disabled, you often can appear almost “normal” when you are out and about during the day. After all, you’re dressed, you don’t stink (hopefully), and you move from place to place quite briskly with the aid of your $30,000 wheelchair. However, most people never get to see you when you are at your most disabled: when you are dressing and undressing, getting into or out of bed, or when you aren’t using the bathroom. Today, I will explain the extraordinary measures I have taken to make my bathroom a happy place.

We bought our present home about five years ago, shortly after my wife had been diagnosed with myotonic dystrophy. We realized that she would no longer be able to climb stairs, and since I hadn’t been able to do that for many years, what was the point of remaining in a two-story condo? Housing prices were still very high back then, so we were somewhat limited in our options.

Floor plan of inaccessible bathroom.

When we bought our home in 2006, it still had the original master bath as shown in this floorplan from a 1964 brochure.

We settled on Seven Oaks, a senior citizen development in the Rancho Bernardo area of San Diego. Our home had been built in 1964, and the bathroom had been left undisturbed – a monument to the shortsighted thinking of home builders of the time.

Modified ADA bathroom plan.

A few modifications turned an ancient bath into one that is modern, and completely accessible.


My first task was to redesign the bathroom in a manner that would allow me to get into it in a wheelchair and actually accomplish some of the functions one typically performs there. That redesign turned out to be simpler than I had imagined, once I realized that all I needed was the ability to close the door behind me and to transfer sideways onto a toilet or shower seat. In addition, I needed to be able to get close enough to the sink to be able to run the faucet and expectorate toothpaste. You can see my solution in the floor plans accompanying this article.

When we moved here, I was still able to stand, provided I held on to something with all of my might. Since my illness is progressive, I realized that wasn’t going to last very long – actually it only lasted about five months after we moved into the house. So I designed the toilet and shower seat to be high enough that I could slide from them back into my wheelchair when it was at its lowest level. My wheelchair has an elevating seat, so I could get into either of the other locations by raising the wheelchair high enough to slide downhill.

ADA Shower bench.

My shower bench is 23 inches high (like the toilet).

The sink was an easy matter to take care of. I simply had the entire counter and cabinets removed and then replaced the sink with a suspended model from Kohler.
A sink suspended above the floor.

My suspended sink lets me roll right up for easy access.


Those who know me well know that I am always thinking ahead. So I realized that even sliding downhill would eventually become too hard for me to accomplish. As a matter of fact, I am reaching that point right now.
An overhead lift at the opening to a shower stall.

To accommodate my overhead transfer lift, I had to design my own shower curtain. Here it is in the open position.

So I had an overhead lift system installed in the ceiling of the bathroom. Now I could use the electric lift to pick me up and then glide effortlessly across the room, right? Not so fast. There was the inconvenient matter of the shower curtain rod. It had to go. So I have been spending the last several days building a new kind of water barrier that could be moved out of the way of the lift and then replaced once I was seated in the shower.
Shower curtain stretched across shower stall.

Here is my custom shower curtain ready for use.


Several days? Yes, because my arms have become so weak that I can no longer hold an electric drill with any substantial security. In fact, I can’t even pick up what most of you would think of as an electric drill. I use one of the ultracompact lithium ion models which are not powerful enough to penetrate the 56-year-old wood surrounding my shower stall. But eventually I managed to get the various components in place.

The toilet. I have saved this for last, because I know most people don’t like to talk about this particular piece of equipment. However, for the disabled, it is almost always on our minds. When will we need one? If we find one, can we get on it? More importantly, can we get off? Reasons why I rarely travel more than a half hour from my home. Toilet mounted on ToilevatorYou see, my toilet is my friend. I had a Toilevator installed beneath the toilet, which raised it 4 inches – enough to make transfers convenient. I also added a BioBidet 1000 seat.

BioBidet 1000 toilet seat.

My BioBidet 1000 toilet seat gets the day off to a fresh start.

This wonderful device almost eliminates the need for conventional hygiene (which with fingers that don’t bend or grasp is almost impossible anyway) and it makes me look forward to the beginning of each day.

I hope none of you have been reading this over dinner.