No longer a Cool Spring: Weather, MS

In my last blog, I went on about how cool, how delightful the Spring was in southern Arizona, how cool at night especially. I talked about snowy Summer Oregon in the Cascade range, 27-year Solar cycles, Not By Fire But By Ice, a book by Robert Felix about an impending Ice Age. Well, in the week since the blog's publication, the temps here in Phoenix have shown their true colors. As I write,at 1:38pm, the temperature is 106*, on it's way to 113* by 3pm. As our parish priest said one hot Oregon Summer Sunday as his entire sermon, "Friends, Hell is Hot."

It was a surprisingly moderate Spring, none the less.

Heat, as I have written several times before, is a crippling aspect of life for us multipli-sclerotics. Why? I have had almost eight years since my diagnosis to think about this, five since my retirement from active medical practice and I think the answer lies in heat's inflammatory effects. In heat, things move more quickly. Repair cardres of astrocytes trying to repair myelin munched by mindless T-Lymphocytes, themselves golem-like in their fearsome automaticity, splash hyalin material about and encase the injured neurons in concrete, rather than a gentle patina of conduction-repairing insulation. Hence the 'sclerosis.'

The Second Law of Thermodynamics predicts a general tendency for the universe to increase it's entropy, with heat and frenetic motion. I think. In any case, the spastic attempt at repair which characterises the final common pathway in MS is entropic in nature. It is inflammatory. As freshmen in medical school we were introduced to the Four Signs of inflammation: Rubor, Tumor, Calor and Dolor; Redness, Swelling, Heat and Pain. These are seen variously in patients with ongoing MS. A hot environment makes my mind fuzzy, anxious, unclear, angry. I become upset in public, irrational and 'stuck,' in the terminology of the clinical psychiatrist and speaker David Amen MD. In my worst public misbehavences, I find myself a six-foot-four, 240-pound bundle of infantile irrationality.Though ataxic, I am, after years of running, biking, backpacking, power lifting what you might call immensely strong. So. I religiously avoid or mitigate the effects of heat, social or physical. When I was still walking two to three miles a day in the heat, I carried a lump of Blue Ice wrapped in a cloth in the crown of my walking hat. It worked well.

I will try to explain what I am trying to explain as simply and succinctly as I can.

Dopamine is one of the neurotransmitters in the human nervous system. It acts as a stimulator agent when applied centrally in the CNS (central nervous system) and slows or calms action peripherally. It allows focus, attention and makes us awake, 'interesting and interested.' We feel better when we are alert.

It is naturally made in an area of the brain called the Substantia Nigra, The Black Eminence, center forward in the brain and beneath the Prefrontal Cortex. Due to its' role in regulating resting motion, a lack of DA is a sign of Parkinsons Disease. MS, thank God, has no connection with this problem.

There is a group of recently-available drugs called selective reuptake antagonists. These are wonderful things. They slow or hinder the natural process of reuptake into the distal axon of already-made neurotransmitter and of the degeneration and reabsorbance of this neurotransmitter's components, so as to provide substrate for this neurotransmitter's creation and eventual reuse in the axon. Did I say I would speak simply? Just think of a draining bathtub with the water still running (DA being made at its' usual rate) but with the drain partially blocked by a wash cloth (The effect of the reuptake antagonist). The level of the DA rises to a new, higher, steady state, and does not overflow the tub as the cloth drain obstruction slows but does not totally prevent the breakdown of dopamine.Hey presto! Without forcing the S.Nigra to make more dopamine, the level has risen and the person whose brain it is is more alert, thinking faster yet in control.

Two dopamine reuptake antagonists are Provigil and its' later incarnation, Nuvigil (modafinil and armodafinil). I have used both and love them.

Prozac is a serotonin reuptake antagonist and has had a good reputation as a settler of mental storms. Serotonin is formed in the Locus Ceruleus (blue place) in the brainstem and is made naturally from the amino acid tyrosine, which we get from eating turkey and the like. Among many other fascinating things it does which I will not mention here, lest you all go off to take a potty break forever, serotonin has a role in letting us fall asleep as well as giving us vibrant dreams.Think of what you wanted to do after stuffing yourself with turkey last Thanksgiving: Sleep. Dream...I take Xanax, a Selective Serotonin Reuptake Antagonist, next-generation Prozac. Given me for the depression that might overwhelm me as a newly-diagnosed MS patient, I explained I felt pretty good at being released for the last half of my life with an adequate disability income, the kids in college and lotsa Plans but I would gladly take it at lower-than-prescribed doses to restrain my tendency toward Obsessive Compulsive Disorder, OCD. This is an indication for the drug. All real doctors have OCD...

There are many ways to wake up, to stay awake. DA reuptake antagonists are Good Ways. Like any good thing, abuse is possible (when, after twenty years of hearing the haunting melody of "Walking In The Air" as played by George Winston I found the words sung from the 1982 European Christmas special 'The Snowman' played on UTube to the backdrop of the ISS traveling over a night Earth blazing with cities, I spent the next day and a half listening to every avatar and iteration of the three-minute song. Fortunately, I didn't have a lot to do.)

Cocaine, from the Andean Coca plant, was originally chewed in the leaf by Inca messengers taking important bits of information North and South at high altitudes as a natural way to open the lungs, eliminate stress, give renewed strength and alertness and turn the teeth green. By 1850 or before (Look It Up!) a solution was available in Europe and was used by such as Sherlock Holmes (The 'seven percent solution' praised by Holmes and abhored by Watson refers to seven grams of purified cocaine dissolved in 100 cc of normal saline or distilled water) Fifty years before that, It was used in a more 'acceptable' way by Stephen Maturin, MD as described in the Aubrey/Maturin novels of Patrick O'Brian. I have used it in my medical practice in local anesthesia and topically in a 4% preparation to constrict the ethmoidal vein and control nosebleed.

Cocaine acts as a dopamine-sorotonin-norepinephrine reuptake antagonist. It is addictive and results in an eventual 'crash', as total neurotransmitter stores are emptied. It is not your Mother's Nuvigil. Avoid it recreationally as you would the Great Pox. While you're at it, use Nuvigil carefully, under medical supervision only. Overuse can cause what I call 'empty paranoia', a result of major disruption of sleep/wake cycles.

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I am not a practicing physician any longer, though I continue daily to read medical literature and, though I have let my boards in Emergency Medicine lapse after twenty years, I retain my licence to practice in Arizona, even if I don't. Much of what I say is outdated, misinformed. I'm sure I miss a few things, like The Truth, every once in a while. Like Wikipedia, check the sources before trusting the information. I have gone over and checked what I have written as thoroughly as I can but much, like the Locus Ceruleus as the sole source of Norepinephrine in the body, has been left out and so much more. This is not a physiology textbook. It is a conversation with a past-professional who is both Affected and Concerned. Deal with it.

This pic above was taken in La Jolla, CA, essentially San Diego. What a Place! I am having breakfast with my son and daughter shortly after my son matriculated from Santa Clara University. We are visiting my girl, a junior at UCSD. Smiles, which you can't see, on all faces. Good coffee.

This is one of the hidden blessings of MS: that I have time to use on a thousand things I never before could but always wished I could.