Category: Personal reflections and health updates

It’s been roughly three months since I shared my ALS diagnosis publicly and posted an encouraging update on my condition. Some friends have asked for an update. Here is the latest.

The short version, and the good news, is I continue to be generally stable. I can still walk 2-3 miles at a clip, and muscle weakness remains confined to my legs.

The longer version is a bit more complicated and puzzling. Over the summer, I noticed a deterioration in my gait. It was harder to walk, I slowed, and muscles in my thigh and quads were sore. I never fell, but I felt less stable on my feet. Eventually I realized that the problem was mainly my left foot and ankle, which had become a lot weaker in a short period of time. I was having to use other leg muscles to compensate.

But at the same time, my right foot and leg — which was where the trouble first started — continue to grow stronger. The result is that I now have a right leg that feels more reliable than the left leg, a reverse of the past two and a half years. The motion sensors I wear as part of a medical project to gauge velocity and strength in my limbs have produced data that supports this observation.

There are several possible explanations, all of which are long and boring, so I’ll spare you. My hope is that the same trajectory which my right leg is taking — weakening and then re-strengthening — is what will happen to the left leg, and that the new drug for ALS I am taking (Radicava) is responsible for the re-strengthening. Time will tell.

Meanwhile, I’ve bought a walking cane, mainly as a precaution, and I’ll soon start wearing a foot brace that wraps around my calf and slides inside my shoe to help with the left foot drop. When I tried the brace on at the clinic last week it made a huge difference in my ability to walk with a better, steadier gait. That will be very liberating.

There’s a whole raft of illnesses and conditions that fall in the category of “rare diseases.” ALS is one of them. The “prevalence rate” for ALS – the percentage of a population with the disease at a given moment in time – is 5.2 per 100,000.   Because the disease typically progresses so rapidly, and because confirmed diagnosis can take a very long time,  only about 17,000-20,000 Americans  are actually diagnosed with the disease at any given moment.  That doesn’t sound like much out of a population of 330 million.

But when you reframe it, to focus on the proportion of the population that will die of ALS, the disease sounds a lot less rare.  Roughly one in 600 people die of ALS. To help you visualize this, that’s about one kid in every graduation ceremony at a large public high school. By coincidence, at any given point in time, researchers claim that the average American knows about 600 people.  So most Americans personally know or have known at least one person with ALS, more if they have lived longer and/or have a wider social network.  If you expand this to the number of people each of us knows who have been impacted by ALS (such as relatives of the person with ALS) our contact with ALS shoots up dramatically. It goes from being rare to being a scar in every community.

The small town of Davidson NC, where I live, is living testimony to this.  This story from our local web-based news site, News of Davidson, is a reminder of just how many people’s lives are affected by ALS. Six of us who live or lived in Davidson and who have ALS are featured in the story, but there are a number of other people living with ALS, from the past and present, with ties to Davidson or Davidson College.

A good friend, Charlie Slagle, passed away suddenly on July  2, and yesterday a memorial celebrating  his extraordinary life was held in Davidson NC.

Charlie was a founding member of the “gonzo golf group” I have had the privilege of playing with in an annual golf trip each summer. We had just been together on the 2019 golf trip two weeks before his death. Charlie was in fantastic shape, which made his sudden death even more of a shock.

Charlie was a legend, a bigger-than-life personality, and made a huge mark everywhere he went, including during his long tenure as men’s soccer coach at Davidson College, where he coached our team all the way to the NCAA-I  final four in 1992. I was in awe of Charlie from the moment I stepped on campus in 1991. He had unbelievable energy, always had a dozen balls in the air, was incredibly and invariably extroverted, and could make friends with an inanimate object. On our golf trips he chatted everyone up – wait staff, the starter on the course, everyone. The conversation was always the same: “so where you from?” Then, “what high school?” And with that meager amount of information, Charlie drew on his extensive recruiting experience and networking across the country, plus his prodigious memory for faces and names, to name someone – a famous athlete, a coach, a principal – from that school, to make a connection with his new acquaintance. There was no such thing as six degrees of separation with Charlie – he could always find a connection with a stranger within 1 or 2 degrees of separation. And he did this with such genuine enthusiasm and interest that it always disarmed the stranger who was about to discover they knew a person in common.

For me, Charlie was the older brother I never had (I’m the oldest in my family), constantly needling me, and setting up golf competitions within a round that I invariably lost. He gleefully mocked whatever I ordered for lunch, so much so that “Cobb salad” is now considered my middle name in the golf group. He never called me by my actual name. I was “the Minkster.” He had either a nickname or a special way of saying everyone’s name in the group. His swing was just terrible, a hunched over, choppy uber slice that left a divot that defied the laws of physics. But his shot always found the fairway, and his scores were always way better than they any right to be. Nobody could scramble like Charlie. The last round I played with him he played one of the best rounds he’d had in years, and I was glad I got to share the moment with him.

When Charlie learned I had ALS this spring, he decided to dedicate a thousand mile walk he was training for to raise money in my name for ALS research.  That gesture meant a lot to me. It was so Charlie Slagle – always a big new project, a big plan, and always looking out for others. I’m sorry he never got to complete that walk, but I’m trying to think of a way to enlist a few hundred friends of his to do a surrogate walk in his name that will total 1,000 miles between all of us.  It won’t be hard to find a few hundred friends of Charlie Slagle.

Rest in peace, Charlie, we lost you way too soon, and we will miss you.

  

I’m with my family in Sweden, visiting our Swedish relatives. My mother-in- law, Ruth, shared with me a theme from a radio broadcast she recently listened to about dealing with death and difficult diagnoses. The theme was “active hope.”

I have written a series of essays for the Joe Martin ALS Foundation entitled “I have ALS. Now What?” It is meant for people newly diagnosed with ALS. When the essays are posted on the Joe Martin ALS Foundation website I’ll share the link here. For now, in keeping with the theme of “active hope,” I share one section here, on prospects for new treatments that may soon enable us to survive the disease….

Surviving ALS? The prospects for new treatments

You have been diagnosed with ALS at a singular moment in the history of the disease. In the past, a diagnosis of ALS was followed by advice to “get your things in order” because the disease is 100% fatal. Today, we are part of a unique generation of PALS who have a chance – maybe a pretty good chance, maybe only a “puncher’s chance” —  of surviving the disease. Thanks in part to the big funding push for ALS research that the 2014 Ice Bucket Challenge made possible, a number of potential therapies have now made their way through the (unavoidably slow) research pipeline to clinical trials. Medical scientists working on ALS are now voicing optimism that a therapy will be developed in the next five years that will either dramatically slow, halt, or even reverse the disease.  

To use an over-worn cliché in the ALS community, “we’re in a race against time.”

If in fact we are getting closer to discovery of a therapy that will render ALS a chronic and not fatal disease – and it is impossible to know when this will occur – those of us with ALS today are either going to be the last cohort of PALS to die of the disease, or the first to survive it. I know which one I prefer.

The closest approximation to our situation is the discovery of a cocktail of drugs in 1995 that effectively treated HIV/AIDs. HIV/AIDs patients faced 100% mortality rates up to 1995; thereafter mortality rates plummeted, and today people with HIV/AIDs are able to live with the disease as a chronic condition.

Two factors, both outside our control, will determine if we will be able to benefit from effective therapies in time. First is the length of time it will take for these therapies to be discovered and approved, and the second is the speed of progression of the disease each of us is dealing with. One of the reasons many of us have joined ALS support and advocacy groups is to lobby hard for a big push by the National Institutes of Health (NIH) to increase funding for ALS research at this critical moment. Tens of thousands of lives potentially hang in the balance.

This is not meant to build up false hopes on our part, but it is to say we have a reasonable hope.  I have found it psychologically very helpful to keep telling myself that I will be part of the first generation of PALS who survive this disease.

Since April 2018, I having going in for quarterly consultations and tests at the Carolinas ALS Center at the Neuroscience Institute in Charlotte.  These consultations are nerve-wracking affairs for persons with ALS, as we are always fearing learning about drops in our vitals or our muscle strength (I’ll write a separate blog entry about this).

I just went back in late May for a visit and am happy to report very good news.  I have not only been holding steady in my condition, but I learned from the ALS specialist, Dr. Benjamin Brooks, that most (not all) of my leg muscles have actually increased in strength compared to a year ago, in some cases significantly so. This is pretty unusual. I left the office very happy to be an outlier.

The ALS Center’s findings are the ones that matter the most, but they are not the only yardstick I use. Two other metrics I find useful in  measuring the progression of the disease have also been positive. One is a program called Precision Medicine Program, which  provides me with motion sensors that I wear for one week each month. The exercises I do as part of that program have also shown a steady increase in my leg velocity capacity over the past four months. The other metric is my own set of observations that I record — my measurement of my performance on the elliptical, stationary bike machine, leg weights, and walking to work. None of those has seen slippage over the past year.

I’ve learned that it’s important not to over-interpret these kinds of results. The disease has its own trajectory in each person, including temporary improvements or long periods of stability before a downturn.  But even so, getting stronger is a lot better than the alternative, so I was very pleased to hear Dr. Brooks’ clinical observations.

Why the greater leg muscle strength is occurring is unknown, for now.  The most hopeful interpretation, both for me and for other persons with ALS, is that my body is responding well to the new treatment (Radicava)  that  I’ve been receiving since September.  Radicava was only approved by the FDA in 2017 and we’re still learning about its potential in slowing or stopping ALS progression. It’s part of the bigger picture of a bunch of new therapies medical researchers are developing for ALS and other neurological diseases.