Some thoughts on having an MRI scan

I had another MRI scan recently and I thought it might be an idea to put some thoughts down about what it is and what the experience is like being inside one of these machines, but firstly, what is it:

What is an MRI scanner?

Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases, MRI gives different information about structures in the body than can be seen with an X-ray, ultrasound, or computed tomography (CT) scan. MRI also may show problems that cannot be seen with other imaging methods. source

There are two types of MRI scanner, open and closed. I've never seen an open scanner, the scanner I've been in in our local neuro department is closed. Here is a picture I got from the web showing a typical MRI scanner:

Flickr link

So, what's it like as a patient?

Getting a limb scanned, I imagine, simply means being partially entered into this machine on the sliding bed that the operator controls and moves you in or out to the desired position, but in the case of any neurological condition, like MS, they insert you head first and put you in the machine to the full extent. In the case of a head or neck scan it's very important that the patient doesn't move at all, so your head is placed inside a smaller tube (something like a motorcyclist's helmet, but more open) and some foam pads are inserted at either side of your head to make you fit. Of course, this is after they've given you earplugs to wear (as the scanner is quite noisy) and sometimes it gets quite hard to hear what the staff are saying to you. This is easily remedied by saying something like, "Speak up! I can't hear you!"

The scanning room and preparation

The actual scanning room is kept quite warm to make it comfortable and because you've probably had to leave your regular clothes in a locker in a nearby changing room and put on one of those dreadful hospital gowns - don't worry, everyone looks terrible in them. This is so that no metal is accidentally brought into the room as anything with iron (Fe) in it will heat up in the presence of a strong magnetic field. The staff will also ask you to remove jewellery or metal hair clips and ask you if you have any metal pins or clips within your body, following surgery. Metal fillings are OK, but you would be asked to remove any metal dentures as a precaution. I use a metal walking stick and even that was replaced with a wooden one for the duration of my visit to the scanning room.

Someone will go over your medical history with you and ask you to sign a consent form.

Getting the scan

The scanner itself is a long and fairly narrow metal tube. Some people find this very claustrophobic and simply can't do it, although I have heard of patients being offered sedation to help calm there nerves. I have never found this a problem, although when getting my most recent scan after about 45 minutes I was getting uncomfortable and simply wanted to move a bit, so I got to the point that I was keen to get out, but I've never been panicky as I can imagine some people might find it. You are given a button or squeezy ball to press in the event of you really needing to get out in a hurry, so there is a 'get out clause' if you really can't go through with it.

One thing I quite like is a mirror is fitted at an angle above your eyes so that you can see out the open end of the scanner and watch the person doing your scan through the glass of the control room. I either watch him/her or simply lie with my eyes shut. There is a speaker in the scanner so that the operator can speak to you, but this is woefully quiet in my experience - not surprising with a head surrounded by foam and ears stuffed with earplugs! I've asked a couple of times that they turn the volume up, but it's never sounded very good. When I have heard what is being said, it's things like, "Just setting up for another scan, now...", "This scan takes six minutes...", "You're doing really well!" So, if you can't hear them it's not as if you're missing anything important, such as, "Do you want a cup of coffee?"

I've heard that in some scanning rooms they play music, but I've never been treated to that, or maybe I haven't heard it because of all the foam around my ears.

The scanner is very noisy, so any thoughts (certainly, in my case) of falling asleep are forgotten, however, I personally try to relax as much as possible and drift of into my own thoughts to pass the time. The sounds are intermittent, but regular. They remind me of an old type of school fire alarm than gave a horrible metallic sound. The MRI scanner's sound starts and stops and the ear plugs do help. The sounds only occur when they're actually doing a scan, you get a rest in between scans.

Contrast medium

Every time I've had a scan, they've also used a contrast medium. This is a chemical that produces a different appearance on the scan and hopefully allows the medical team to see things they wouldn't ordinarily see without it. If you are to get this, you are brought back out of the scanner and get an injection into a vein in your arm. Some people feel the cold running up their arm as it goes in, but I've never felt this. Then it's back in for another scan - and by this time you're becoming quite an expert.

When it's over

When the scan is finished, you are brought out of the scanner on the electric bed that you are still lying on and foam, then earplugs are removed. The staff, in my experience, sit you up and insist you take a minute to get your balance back and then it's all over. Last time I was in for a scan I suggested that patients should be given a cup of tea and a chocolate biscuit as a reward, like the Blood Transfusion Service do, but although I managed to get a few chuckles from the staff I was unsuccessful.

Getting the results

The results are not generally available immediately. The scans are sent to your consultant who updates you at your next appointment. If it's urgent that the results are known more quickly, then you'd no doubt know a short time later.

Conclusion

The scan isn't painful in anyway, it just takes a bit of time. If you have a problem with small spaces it could be difficult for you, or not possible at all. The staff, in my experience, are excellent and do their best to put you at ease and guide you through the procedure. My only bugbear is they speak too quietly through the MRI speaker, despite knowing you've got earplugs in!

Thinking of giving to a charity this Christmas?

Katie Davis - Amazima Ministries

Katie left her American dream life to visit Uganda and help out in an orphanage. She was still in her teens at the time and simply felt she couldn't go home and leave these starving and sick children with no help. She's now 24 years old, the adoptive mother of 14 little girls who call her mother. She has set up Amazima Ministries to feed hungry children and adults and provide health care and education. She tells her story in the book Kisses from Katie, which is available through Amazon and available in Kindle version too. If you're thinking of making a donation to a charity this Christmas, then look no further. Visit Amazima Ministries for further information on how to donate.

Pregabalin withdrawal

Neuropathic pain (neurogenic pain)

Neuropathic (or neurogenic) pain is pain caused by damaged nerves, which might occur for a number of reasons, one of which is MS.

 

Normally, the nerves pick up a signal that a part of your body is inflamed or injured and transmits that message back to your brain causing you to feel pain in that area of your body, alerting you to the fact that something is wrong. In neuropathic pain, it's the damaged nerves themselves that cause the problem. The injury to the nerve fibres causes haphazard signals to be sent back to the brain and since there is no normal pattern to the nerve signals, the pain perceived can be difficult to describe to a doctor - but often has the charactaristics of a hot or burning sensation and be persistent in nature. Often, the classic over-the-counter pain killers have little or no effect and formulating a treatment strategy can be very difficult for the physician and most definitely for the patient.

One of my earliest symptoms in MS was a very severe burning pain specifically located to the left side of my head. It was as if a hot poker was being inserted into the left side of my brain. It was awful. I was taking maximum doses of ibuprofen and paracetamol and got little relief. My GP at the time, tried fentanyl (opioid) skin patches, tramadol and some other drug that I can never remember the name of. The fentanyl and tramadol had little effect on the pain but made me as high as a kite - and then gave me cold nauseaus sweats when 'coming down'. Awful, in a word.

Around this time, I was seeing a neurologist for the first time and I told him about the symptoms and he recognised it as the description of a neuropathic pain and recommended gabapentin at a dose of 900mg, daily. This was an immediate improvement on anything I had tried before, but again, caused a euphoric high which lasted a few weeks. My family were greatly amused at this time as I commented on how beautiful trees were and such like. Luckily, most of that passed, but there was always an element of my emotions and mental state being affected.

The pain got worse and I noticed a strange thing: that when the medication was failing to deal with all the symptoms that I began to feel ill, but not necessarily having any pain in the first instance. I felt ill in the sense that I had to sit still and lay my head back and do nothing. After a while, the pain would return and I recognised this as some sort of 'halo effect' surrounding the pain. Really hard to describe, but it was as if this was a precursor to the arrival of the pain.

I increased my dosage of gabapentin. The problem is that this is really an anti-seizure drug which works by quietening down the brain. So, basically, you almost knocked yourself out. Life for a while consisted mostly of sleeping and little else.

I discussed this with my doctor who suggested I try pregabalin. This is like the next generation from gabapentin and has a maximum daily dose of 600mg. I was advised to try to come off the gabapentin before starting on the pregabalin, but no one took into account that that meant the pain would return - so I did reduce, but got started with the pregabalin fairly quickly.

It was definitely an improvement and didn't make me sleep as the gabapentin had done in higher doses of 1200mg or more. However, the euphoric stage hit me again and although it did work, it only took about 50% of the pain away.

The whole episode was incredibly tiring (as anyone who has had chronic pain knows) and still I was looking for a better solution.

Pain specialist

A dear friend who goes to the same Church as I do, asked me if I'd ever seen a pain specialist as she knew of someone who might be able to help. So, to cut a long story short, I was referred to see a consultant who dealt with oncology patients, but also ran a pain clinic.

The clinic was held in the Beatson Hospital, which is the cancer treatment centre for Glasgow and the west of Scotland. He asked me lots of questions and paid particular attention to the distribution of the pain. He also ordered up copies of the MRI scans to make sure that there was nothing arthritic going on in my neck, which I hadn't thought of. He also asked me about areas on numbness throughout my body and just took his time getting a full picture of what was going on. He then asked me to start on a low dose of nortriptyline, which is an old type of medication used for depression, but found to have some value in treating neuropathic pain when used in low doses.

Two things happened: Firstly, the pain vanished instantly. Secondly, I slept most of the time - but that did wear off after two or three weeks, luckily.

So, for the first time in more than two years I was pretty well pain-free. I was delighted and it made a huge difference to my life. I asked one of the doctors at the pain clinic if I should try to come of the pregabalin. He understandably took the attitude, "Leave well alone!" So, for the best part of two years now I've been on a combination of both these drugs and I must say, they've worked well.

So, why would I decide in recent days that I wanted to come off the pregabalin? Well, I have two reasons. Firstly, I wasn't sure if the pregabalin was necessary anymore as the nortryptyline might be all I needed - I didn't know. Secondly, I have had increasing problems with fatigue and I wanted to see if removing this medication would give me more energy. Easier said than done, let me tell you.

I reduced the dosage of pregabalin about six months ago and went through a bit of a withdrawal, but one day last week I simply forgot to take it. In the late evening, when I realised that I'd not taken it, I decided to see if I could get off the drug altogether. I probably should have discussed this with my doc first of all, but it all happened spontaneously - and that's the honest truth.

The first couple of days were very difficult. I had this craving to take the tablet as I felt I needed it - I wasn't in any pain but not taking it simply left this void inside. I felt ill, yet I couldn't sleep. I felt strangely vulnerable and fragile. I'm now at the stage of having been off the drug for a week and the craving for the drug has gone - I'm much more settled, but still having difficulty sleeping. I've just had to accept this and tried to live my life around a much changed sleep pattern. I think it will eventually get back to normal, but, it's just the result of stopping a drug that, quite frankly, my body has become dependent upon. It's given me some insight into what people must go through when they come off hard drugs they're addicted to, at least in a small way.

So, have I got more energy? It's hard to tell, just yet. I think it's too early to say - I'm still going through (hopefully) the tail end of the withdrawals. I do have a little pain back, but nothing I'm too concerned about. I can live with it.

I'll no doubt return to this subject next time and let you know how I'm getting on. Thanks for reading.

Fatigue in MS

Has it really been that long?

I have that feeling I got in high school when I turned up for a class and hadn't done the homework. You know the feeling of, 'I might be in trouble here'? It's been a while since I updated my blog, over a year in fact. Are you still there? Sorry about the delay.

Fatigue

If I was asked to put all the symptoms of MS on front of me and asked to pick the one I was most conscious of, it would be fatigue more often than not. Yes, from time to time there are acute symptoms which obscure normal life and absorb pretty well all of my attention for a month or two, but overall, fatigue is the one that forces me to take note of it again and again. Daily, actually.

Let me explain: imagine you're sitting at your TV, PS3 or your computer and there is a power cut. The room goes dark and all our electronic devices die on us and worst of all, there is no Internet - the router is down - our twenty-first century life blood has stopped flowing. Suddenly, nothing. That is the closest I can get to describe the fatigue that comes with MS. It might be a just a few hours after waking in the morning - but, it's as if someone just switched off the power and it's game over - at least for a few hours. It can be as quick as that. There's no 'beginning to feel tired', just a sudden absence of energy and with that goes the ability to concentrate and process thoughts - at least to some extent. This explains why I don't drive in the afternoons if I can possibly avoid it and why I prefer to do everything in the morning - there's no guarantee of anything after early afternoon. So, fatigue is my number one enemy! It wins every time and there's nothing I can do about it other than arrange my life around it. Once I came to realise that life went on at what I term the 'new' normal.

It wasn't so bad in the early days of MS, but, it got worse. I phoned a friend's sister in Switzerland who has had MS for many years and she gave me the best advice that I alluded to above. She told me the days of seeing how much you could achieve each day were over: plan your rest times first and prioritise those things which must have your energy over others - be ruthless and learn to say 'no'! It meant a reappraisal of life in general and many things more specific, but, it's a way to survive. I am surprised sometimes by how much I manage to achieve, but, life had to become workable. The clutter that had surrounded me for years had to go. I had to keep up with the admin - you know, paperwork and such like, because, if there was anything gnawing at me for attention my energies were divided and I achieved little. I like to write and arrange music in a small way, but, if my desk was a mess or there was paperwork lying there that should have been attended to last week, or maybe the week before, then I couldn't just sit down and do an hour's music, I would have to clear my desk first in order to be able to work. So, keeping organised became a key part of managing fatigue, that means, when I feel creative I can sit right down and start working. Keeping my feet clear of distractions has become quite a discipline.

I suppose it's not surprising that fatigue is such a common symptom of MS. If something is going on in your brain that isn't supposed to then it makes sense that some of the collateral damage would manifest itself as fatigue and lack of energy. It makes sense, but it doesn't necessarily make it any easier to live with.

I'm being hospitable!

Sometimes you have a choice who to let into your house - and sometimes you don't (like the deranged psycho, covered in blood with torn clothing who forced his way into our house in early July! But, that's for another day..). Again, on this particular occasion I didn't have a choice, but it's not my house, it's my throat.
Yes, one of natures little (very little) viruses has popped in for a visit. The trouble is that it has caused quite a disturbance during its stay. The first sign of its arrival was a bit of a sore throat and a headache on Saturday evening, getting worse through Sunday, until today I am a coughing sneezing wreck! Poor Susie has got to listen to me doing impressions of her car refusing to start. In fact, I think I sound worse than her car. The trouble was that my car was booked into the garage this morning and I didn't want to cancel it and I've got to go back to pick it up tomorrow! That will be an effort and a half. So, ordinary life is cancelled. And, so it shall remain for a few days. I'll update you when health and time permit!

MS and the last six months..

I retired at the end of January this year (2011). A few years back I would have been shocked at the prospect of having to give up work so early. But, none of us knows what is round the corner and having become ill in 2007, diagnosed in 2008, giving up the dental practice side of my career in 2009, numbness and stiffness in my right hand in 2010 leading to difficulty in teaching the dental students hands-on practical skills and the safety concerns of using a dental handpiece (drill) on a patient thereafter. So, when it came to being retired earlier this year, I must confess that it actually came as a relief!

MS can affect any part of your body. It's a neurological illness - in other words, it primarily affects your brain and your spinal cord, so if it damages nerves then wherever those nerves travel to will be affected.

The myelin sheath (think of the plastic covering on a speaker cable) is damaged in MS leading to poor transmission of electrical signals, or possibly no signals getting through at all. On an MRI scan these damaged areas appear as white areas damaged by the illness.

For me, there have been a variety of symptoms. After an episode six or seven years ago now (which I now recognise as MS, but didn't at the time), my vision became temporarily blurred, my balance was affected then for about two weeks and the only lasting effect was that my ability to remember how to spell certain words has never come back! My wife and colleagues at work got used to me asking them how to spell the simplest of words. I just have a blank sometimes and literally can't remember words which are very familiar to me. The same goes for peoples names too! So, if I can't remember your name when I meet you - please don't be offended!

So, spelling hasn't been so good.

Then my walking and balance and then my right hand were affected. But, I find the most frustrating symptom is fatigue and exhaustion. It makes sense, when you think about it - MS is a disease of the brain and spinal cord - so, things like cognitive function and fatigue make a lot of sense.  I find that I am reasonably able in the morning to do a little mental work - all the usual stuff, like sorting out paperwork or something on the computer. Once I get to about 2pm the energy has gone and I feel totally drained. Thinking becomes hard and cognitive ability definitely slows down.

On top of that I've spent quite a lot of time in the urology department of one of the local hospitals: several outpatient appointments and one day visit for a general anaesthetic. On a lighter note, it turned out that I used to work with the anaesthetist years ago. We caught up for a few minutes before he put me off to sleep! So that's the state of things just now. I'm on various pain killers which work pretty well and I'm on a daily injection of Copaxone, which is no bother at all. Susie gives it to me once in a while. It's a wife's dream, isn't it? - sticking needles in her husband!

(Images borrowed from the WWW - hope the WWW doesn't mind!)

 

A huge apology!

 
What can I say? It's been at least six months since I updated this blog. I offer huge apologies to you if you've been popping back now and again to look for any updates. Well, I'm starting again now and planning on updating at least once a week. Here goes....

Susie turns 50!

Another celebration at Anne's house.
Cupcakes are the order of the day!

Well, the calendar says 2011, so, if you subtract the year Susie was born - 1961, then I'm sorry to have to confirm that the result is 50! Yes Susie, you've just reached your half-century!

Susie was determined to keep her 50th birthday low-key. But, friends and colleagues had a different understanding of what low-key actually meant!

The first celebration took place in Elgin at Susie's sister Linda's house in early January. Since Susie's twin, Pauline, was going to be in India for their actual birthday it was decided to hold a celebration a few weeks early. After a lovely meal with what members of the family could be there, Linda presented the twins with a copy each of a family album Linda had researched. Her research went back generations into the mid-19th century and the photographs she found to about 1895. What a treasure! Linda had been working on this research for 18 months - and what a result! Thanks, Linda, from all of us.

Birthday meal at Crieff Hydro.

When Susie's actual birthday came along later in January, we took a couple of day's holiday in Crieff Hydro in Perthshire, Scotland to mark the event. Susie, being Susie, wanted to resist the acknowledging of the ageing process and went quad-biking on the morning of her 50th! It was a great couple of days. Crieff Hydro is a great place to chill, or to be active, just as you please. The hotel is in a vast area of land and apart from indoor swimming pools, gym, sauna, cinema and a beautiful Edwardian Garden Cafe (where you can sit all day reading and drinking coffee if you wish), there is golf, horse riding, off-roading, the aforementioned quad-biking, walks, etc. outside for those who wish to partake in these activities. We've been there several times over twenty years, and guess what? We've booked to go again in March, since we liked it so much!

Coming back home, our friend Anne had asked a few friends round for a Sunday lunch. After the meal, a plate of cupcakes with birthday candles came out and we all sand 'happy birthday' all over again! 

Susie and 'the ladies' from Cumbernauld.

Friends from Cumbernauld took Susie out for yet another celebratory meal. They went to The Grill on the Corner in Glasgow, where the food, I'm told, was superb and a very happy evening was had by all. Thank you ladies for your kindness.

Susie's final birthday celebration was provided by her work colleagues who took her for a meal to celebrate and presented her with a birthday cake adorned with photos from her growing up years (I was partially to blame for that). They also gave us vouchers for a night in the luxurious Cameron House Hotel on Loch Lomond. Thank you so much for that. So, a new decade begins! Let's look ahead to see where our good God will lead you in these coming days and years! Happy birthday, Susie!

Retired

Well, it's finally happened: I'm retired.
The management of the University quite rightly started the ball rolling in August or September 2009 in the procedure of retiral through ill-health. Part of the reason I've not been updating the blog is that I didn't want to comment on the process when it was part way through, so I've intentionally waited until it had run its course to completion. So, here I am, retired at 50. As I mentioned in a previous post, I developed tingling and numbness in my right hand and could no longer safely hold dental instruments. Therefore, I could no longer do my job: dentistry or teaching (much of my teaching was 'hands-on'). I will miss dentistry, the patients and possibly most of all, the students. They are so kind to me - whether looking out for me in corridors and at doors, or making sure I have everything I needed in the canteen - carrying trays, coffee and the like.
I feel I've been tremendously privileged to have had the trust of my patients to provide dental care and privileged to have assisted young professionals acquire the dexterous hands-on skills they need to be day-to-day dentists.
So, what next? I don't know is the answer to that. I've got a backlog of recording for the Church to get on with and after that I'll see what opens up. But for now, I'm actually quite happy it's worked out this way. Watch this space for the next instalment! 

Susie's 50th birthday is approaching!

Susie, my wife, has always wanted a personalised registration number, what the Americans call a licence plate. I've given in! We bought it now even although her birthday isn't for another four months. She's delighted with it and will transfer the number onto her car sometime soon. Here it is:

Injections - arrgghh!

The Rebismart Device

I saw the MS consultant in March for my annual review. That appointment coincided with the numbness that had developed in my legs. The consultant ordered an MRI scan (see a previous post for the images) and a review appointment in June this year. By the time I saw the consultant in June, I had also developed numbness in my right hand. The consultant said that he would have to reconsider the diagnosis of PPMS (primary progressive multiple sclerosis) as I was obviously experiencing some classic 'relapses' - more like RRMS (relapsing remitting multiple sclerosis). As I had had two relapses in quite a short time, he recommended that I begin self-injecting with Rebif - one of the interferon - beta drugs, which acts by reducing the immune response and cuts down the progression of MS by about 20%. The injection is three times weekly and administered with a trendy little gadget called the Rebismart. It's very easy to use and obviously has a little on-board computer which guides me through the whole procedure. Yes, there's a short needle involved, but, it's never seen and hardly hurts at all. Having given thousands of injections over many years to dental patients I consider this my just desserts. Payback time!
 It does have some side effects - I can feel pretty ill and washed out for a day or two after injecting, I've had itchiness of my hands, pain in my feet and there's a risk of serious liver damage! Therefore, regular blood tests are necessary. I've just reached the highest maintenance dose and I'll report back soon as to how I'm getting on.

Apologies for the late MS update.

I really need to apologise. It's been too long since I last posted anything, and truth be told, there has been too much going on and I wasn't quite sure how much to commit to the very public internet!

I posted quite a lot about the problem I had with my legs and the lower half of my body in general. That is a lot better, but some of the numbness and other physical effects remain. Just when I was getting back to work in May I developed tingling in my right hand. This got worse until I had a partial numbness and stiffness which has been with me now for about four months. This has stopped me working in dental clinics and teaching the students at Glasgow Dental School as I can't hold the dental handpiece (drill) safely as I might drop it. I have been attending work and doing a desk job for the last few months. My employers are very aware of the situation and I know that unless there is dramatic improvement soon then my future in dentistry is in serious doubt. This is very sad for me, as I've always loved my job and considered it a privilege to work with patients and then latterly young people entering the profession currently in their undergraduate years. I've been somewhat reticent about posting information about my hand problems as I'm aware of the serious implications for me if this continues. I'll post quite soon with an update on this.

MS update June 2010

Update:

Well, it's been an interesting month and I'm not talking about the world cup! I posted before that I had developed numbness from the waist down; well, that's resolved to a great extent, or to an extent that I don't notice it too much. If I touch my legs and feet there is still 'altered sensation' but, I think my brain has just got used to it and I can drive and have been back at work. When I had just developed the aforementioned numbness I happened to have my annual review with the specialist MS consultant, which was good. I explained the situation to him and he didn't say that he would have to review the diagnosis of primary progressive MS (PPMS), but explained that, these diseases don't necessarily fit into the man-made categories that academics like! So, he ordered an MRI scan to see if there had been any significant change in the brain scan. I'll have to read up on this as I imagined that more would be seen on a scan of the spinal cord, but, the outcome is the same in any case.

So, I went for the MRI scan and it really is no bother at all. You just lie very still in this long metal tube that buzzes and makes clicking noises. This time a contrast medium was used to highlight different parts of the brain. When I went for the review appointment just a week or so ago, I asked the consultant if I could have a few of the images for my own photo album - so here they are! (remember to click for the full-size image)

The front of my head is to the top of the picture.

This is the same view of my head but with a contrast medium injected just before the scan was taken. All the blood vessels and 'sinuses' are highlighted.

This is a view from the side of my head a 'sagittal' view. If you look to the front of my head (that's on the left of the picture) you'll notice that my nose is missing. It's OK, though, they added it in at the back (look where the red arrow is pointing!), at least they got it in!

More complications!

So, where was I? Oh, yes. The numbness in my lower half began to recede. It's not away, but, I can live with it. I wanted to get back to work (this would be at the beginning of May), so, I saw my GP and arranged that. The day after I saw my doctor, I began to get tingling in my right hand! Oh no! It has got steadily worse until all the fingers are affected to some degree and the palm of my hand too. More worrying for me is the fact that the 'motor function' (that is the strength and dexterity of control) seems to be affected too. So, writing is difficult. I can do it, but, slowly and only for about half a page. From a dental point of view, I can't teach or treat patients as I can't take the risk, so, I spoke to our Head of School and told him what was going on. The dental school has been really great to me throughout all of this and allowed me to pursue a desk job, really, for the last two months and will review matters at the end of July.

Up to date:

Well, things are much the same. I can drive and hold a cup, but trying to do anything more delicate than that is difficult. Interestingly, the consultant said that since I have had two 'relapses' in quite a short time that he is keen that I try some of the 'disease modifying' drugs which are available. Great, that just means popping more pills? Actually, no. I've got to inject myself approximately every two days! I get my own syringes and needles, etc., and after I've been trained to do it (a dentist!!), I've got to make this a disciplined and regular part of my life. The MS nurse sent me a link to a website with several demonstrations of patients doing there own injections...Mmm. I know, I know..I'm a dentist and have been injecting patients for years and years and now, well, I'm not too keen at having to inject myself! Do you have sympathy for me? No, I didn't think so!

A New MS Friend:

I was at a dental study day recently, when I got chatting to a very nice lady whom I've spoken to before, but not for some time. She had obviously discovered that I've got MS and revealed to me that her daughter who is in her early 20s has MS too. She mentioned a few things relating to her daughter, and it came into my mind that I'd like to be in contact with this young lady and quiz her on her own experience. So, we've exchanged quite a few emails in just a few days. To say she's been helpful and informative is an understatement! I don't think I've 'met' anyone so knowledgeable on MS ever. Jenna, thanks! You've been a great help!

Armed Forces Day, 2010

I like to finish with a photo. We went to the Glasgow Armed Forces Day to show support for our serving, injured and veteran soldiers; and, especially to pause and remember those who have given their lives in the many past and present conflicts. It was good to see all those who turned out for the events in George Square. After the speeches, marching, an amazing flypast of a Dakota (four times!), there was music and a dance group called the Kennedy Cupcakes doing some 1940s routines.

Loch Tay Crannog Centre

I've been interested in crannogs for years. I read about what Stephen Lawhead imagined life would be like in a crannog in his fictional Celtic trilogy. Since then I've discovered that scores of crannogs remains have been discovered in Scottish lochs. A crannog is a dwelling place built on stakes or perhaps an artificial island on water. The remains are plentiful. Even as locally as Loch Lomond, it had been known for a long time that some of the islands appeared to be man-made. A couple of the conglomerations of stones are easily visible at the east end of Loch Tay. These are bronze age dwellings. On Loch Tay, a crannog has been reconstructed as a tourist attraction and also as a means of raising money for the continued underwater excavations which are revealing a wealth of artifacts.

This photo is from the Royal Signals Association website and it's a lot better than the pictures I took!

There is a small museum at the centre with some of the artifacts that have been recovered from the loch. The difference between land archeology and underwater archeology is that under water much of the organic material is preserved, such as wooden objects or a bracken floor that collapsed into the water. They're recovered everyday wooden utensils and some of the large timbers that would once have supported the crannog. Because of the cold they give you a blanket cape to wear and give you the guided tour of the place. I loved it.

After seeing the reconstructed crannog, the guide (a girl called Marion) demonstrated several ways that bronze age people would have cut wood, ground corn or made fire! That was amazing. She spun two bits of wood together until there was literally a tiny mound of smoldering sawdust. This was then put in a 'fire bowl' of fine wood shavings, and straw, etc. She then began to gently blow and blow and blow. I thought she was going to be smoked into failure, but, she persisted until the flames burst into life - and we were all really impressed! For anyone interested in Scottish history and archeology it's a great day out. The historians and archaeologists can only speculate why crannogs would be built in the first place. Could it have been for security? Well, possibly, but there weren't all that many people around in those days to be a threat. Could crannogs have been built to protect their farm animals and the people themselves from wild animals - wolves and bears? Possibly. But then, I discovered the real reason! Twenty-feet out into the water...there are no midges! These bronze-age folks weren't daft!

Summer's here!

Let's forget about the winter now that summer's here! It's a glorious day today with that lovely warmth in the air that makes it feel so summery (if that's a word). I sat outside this morning with a book and a cup of tea. Who could ask for more?

Health update I had another MRI scan a few days ago which followed on from my episode of numbness from the waist down. It's a strange experience. They make you get changed into 'scrubs' - the sort of pyjama clothing that hospital staff work in these days. They also make sure there is nothing metallic on you or in you (like a stainless steel repair to your bones or clamps to blood vessels) that would heat up during the scan. Ear plugs duly placed and then your head is well and truly clamped back and sides with a weird basket-like contraption over your face that looks like a Norman knight's helmet. Thereafter, you are slid into the large tube head first and told to lie as still as you can. A squeezy rubber bulb is given to you in case you feel you urgently have to get out of the MRI scanner. Actually, it sounds worse than it is. Some patients understandably find it a bit claustrophobic as it's like lying in the locker above your seats on an aeroplane, but, I could fall asleep quite easily if it wasn't for the noise. Once they start the scan, it buzzes every few seconds: a grating metallic noise that I think would be intolerable without the earplugs. The whole process lasts about 30 - 40 minutes. This time I was taken out midway through to give me an intravenous injection of a contrast medium which will no doubt show the MRI in glorious technicolor! So, that was that. I go back in a fortnight to hear what the consultant's got to say about it all. I'm going to ask him if there's any way I can get some of the images to post here! I've seen them before. The MRI takes 'cuts' or 'tomographs' every few millimetres through your head. The one I really don't like is the section through brain and eyeballs. It looks disgusting!

I did manage to get back to work a few weeks ago and our management have been very accommodating in allowing me more suitable work while I'm still coping with some numbness. Bless them all! And I mean that.

Annual MS review

I went to our local neurological specialist centre today for my annual review. It's timely as I've had a marked deterioration over the last few weeks and been unable to drive and walking as well as balance is affected. Thankfully, there has been a slight improvement over the last few days so I'm hoping that I'll fully recover soon. My first question was about the diagnosis - whether he still thought it was primary progressive MS since the recent episode has been a sort of 'relapse', which I didn't think happened in PPMS. He gave the same answer to me as I've given to others, namely, that disease categories are man made for convenience and the diseases themselves don't always oblige by falling tidily into a nice academic category. Secondly, he said that relapses or similar did happen in PPMS. He wants me to have another MRI scan in about ten weeks time. I can't have it sooner as I've been on steroids which can affect the results of the scan. I've to see him again after that. I found the last MRI scan OK. I was warned about the claustrophobia risks, etc as you're inside a compact vibrating tube, but, I could have fallen asleep if it hadn't been for the noisy vibrations.     He told me that symptoms could take 8 - 12 weeks to resolve, but, it was a good sign that some of the feeling was returning already. My son, being home just now, took me in and actually came into the consultation with me. After that? What do you think?! We went to the West End of Glasgow and had lunch. Male rule no. 1: every event should be marked by eating! (girls send greeting cards - boys eat!).

MS update March 2010

Not been so great recently. I've developed a parasthaesia (partial numbness) in lower limbs, really the lower half of my body. It's one of those annoying things as I can't feel my feet properly, therefore it would be unwise to drive. I contacted the hospital and after they weighed up one or two of the other effects this is causing they decided I should be on some high dosage steroids for five days to try to defuse this and get it back to something like normal. So, steroids. They are used as anti-inflammatory drugs and reduce inflammation in some known ways and other ways that are not fully understood. The side effects are a general feeling of being unwell, a very red face, heart racing and difficulty sleeping and most annoying of all I get hiccoughs (hiccups for those not UK spellers!) which can last for hours and hours and stop me sleeping. I left Susie alone in the bedroom as it must have been driving her totally crazy! So, tonight is the fifth and final dose and I'll be glad to see the back of these tablets. One more day of persistent hiccoughs and then hopefully, normality.

On a positive front, I saw a pain specialist a month ago who adjusted my pain medication and I must report with some measure of delight that my pain control is better than it has been in two years. This has a knock-on effect that I have more energy in the evenings and can get more done. I'm so grateful to the staff at the Beatson in Glasgow who deal with cancer patients, but, also chronic pain patients. It has been a delightful experience. Thank you!