All posts by Roy Wallace

ALS Society Support Groups

ALS Society Support Groups for PMA

ALS Society Support Groups & PMA

In most jurisdictions, ALS Society Support Groups include and welcome PMA sufferers. That is certainly the case here in Ottawa where I have just attended the May 2019 meeting, which is probably about the 12th that I have attended since my diagnosis in October 2017. I would strongly encourage all who are able to attend these meetings. Not only does it help you get a different perspective and helps you to realise that you are truly not alone but it also helps others gain from your own experience and knowledge of the disease.

Since even grouping the different varieties of ALS/MND together, we still do not make a huge grouping, it is all the more important that we stick together to make our voices heard. Although the meetings are moderated by the local ALS Society Regional Manager(s), it is usually very informal. Even when there are specific topics and guest speakers, there is always time to get to know each other and swap hints and tips for dealing with this disease.

There are ALS Society Support Groups in many areas and if you check with your local society, you will likely find one near to you. If not, there are also online support groups, some of which have regular online meetings for those unable to physically attend a regular one. One such group has been set up on Facebook specifically for PMA sufferers and their carers.

At our own local meeting here in Ottawa, I have met many different pALS and cALS and always come away with some new insight(s) and information. It is especially helpful to be able to discuss topics with fellow sufferers who often have more experience and knowledge of the disease than the medical professionals who treat us. This month, I finally managed to meet one of the other two PMA patients in my area.

If there is any way that you can get to one of these meetings, I would highly recommend it. If you would consider supporting these valuable and worthwhile meetings, the 2019 Walk to End ALS is a great way to do so.

The Full Cost of PMA

For some time now, I have been thinking of adding up the full cost of PMA since my diagnosis in 2017. It is a scary exercise but one which may help others to understand the monetary, physiological and psychological impact of the disease not only on the patient but also on friends and family. Although Motor Neuron Diseases are relatively rare, their costs are astronomical both to the individual sufferers and their families and to society at large.

Let me start out by saying that I am retired and still 100% independent so I have not suffered any loss of income and my wife is not required to stay home and care for me. In addition, I am fortunate(?) to have a slightly less virulent form of Motor Neuron Disease ie. Progressive Muscular Atrophy, currently affecting mostly my lower limbs. This is not the case for many ALS/MND/PMA sufferers. In many cases, both incomes are impacted and physical limitations are much greater, dealing a severe financial blow. What follows below is very much a PERSONAL accounting and there will be many with considerably higher costs and a few with lower ones. For the sake of simplicity, all amounts quoted here are in Canadian dollars.

Monetary

Since some costs are one time and others are ongoing, I will specify only the costs incurred since my diagnosis in October of 2017.

ITEM

REASON COST
Personal Outlay    
Accessible Vehicle Easier Access, Carry PWC/Scooter, No clutch $12,000
Acorn Stairlift (x2) 2 storeys (secondhand) $8,000
eBike Could no longer ride a normal bike $2,000
Non-prescription supplements, Cannabis, etc. ($300 monthly) $5,700
Mobility Scooter (x2) mobility $4,000
Various Mobility Aids walkers, canes, grab bars, stools, etc. $500
Clothing & Footwear heated socks, AFOs, footwear, compression socks, etc. $1,000
Sub Total From personal funds $33,200
From ALS Loan Cupboard    
Lift Chair   $1,000
Hospital Bed   $800
Airflow Mattress   $400
10′ Access Ramp   $600
Sub Total   $2,800
OHIP & Insurance    
Prescription Drugs Riluzole & Rabeprazole $22,800
AFOs Assist with walking $1,600
Massage Therapy & Acupuncture Reduce pain & stiffness $1,500
GP Visits 10 visits approx. $540
Blood tests, MRIx3, Misc. hospital tests Quarterly – Estimate only $10,000
ALS Clinic (OT, Physiatrist, PT, Pulmonologist, etc.) 6 months visits $4,000
Sub Total   $40,440
Grand Total   $76,440

Of course, some of the figures above are only estimates because costs for hospital visits and procedures here in Canada are not widely made public. The numbers here are simply to give an idea of the immense cost of this disease

PHYSICAL

As crippling as the financial cost may be, it is eclipsed by the physical cost. Almost all Motor Neuron Diseases are considered terminal. For the ‘average’ ALS patient, the usual prognosis is 2 – 5 years. In the case of PMA, those averages tend to be a little longer, perhaps 5 – 10 years. The more important factor is what those years look like. Motor neurons control the functioning of ALL muscles in the body. In the case of PMA which affects only the lower motor neurons, this means that limbs are usually the first to go. When the muscles can no longer be activated by the brain because the impulse from the brain can no longer reach the muscle, that muscle eventually withers and wastes away (atrophy). This leads to an incapacity to carry out even the most fundamental of activities: walking,  feeding oneself, bathing, moving in bed, etc. Even scratching an itch can be impossible for someone with advanced PMA/ALS. Eventually, the disease will likely spread to the lungs and affect the basic ability to breathe. The majority of MND patients eventually die from lack of oxygen!

PSYCHOLOGICAL

The psychological impact of PMA, although hard to measure, is also integral to the full cost of PMA. It affects much more than just the patient but also extends in particular to those required to care for them and generally to friends, family and co-workers as well as to the medical professionals involved. In broad terms, the devastating diagnosis of PMA or any motor neuron disease changes the lives of all involved. Only those who have experienced it can fully comprehend the magnitude of the changes that motor neuron diseases bring. As with all things, some handle it better than others.

Given these tremendous costs, please consider helping both the local and national ALS efforts by supporting our Walk to End ALS

Walk to end als – Ottawa

We NEED your help: Join the Fight to end ALS

The Ottawa Walk to End ALS for 2019 will take place on Saturday, June 8th at 11 AM (registration starts at 10 AM) at the War Museum in Ottawa. This is the central fundraising event for the ALS Society of Canada in Ottawa for this year.

My Personal ALS Story

You can read all about my personal journey with PMA/MND/ALS elsewhere on this site. I will just say here that I would be a lot worse off without the ALS Clinic and the services provided by the ALS Society. For me alone, in the last year, they have provided $3,000+ of equipment that was not funded elsewhere, helping to relieve some of the financial burdens of this crippling disease. Although I have been diagnosed with PMA, which in many jurisdictions is NOT considered to be ALS, we are fortunate that here in Canada, the ALS Society covers ALL patients with ALL varieties of Motor Neuron Disease.

Why MUST you help?

Unlike many mainstream diseases like Cancer, AIDS, Alzheimer’s, etc., ALS receives little to no public funding. According to the ALS Canada Website, “There are no significant sources of Canadian ALS research funding other than ALS Canada!” Since 2014, starting with the Ice Bucket Challenge, the Society has invested more than $20 million to fund research in addition to all equipment provided free of charge to ALS patients locally through the ALS Loan Cupboards. Without your support, this critical source of funding will dry up.

How Can You Help?

walk to end als
Join our Team!
  1. Join our team, come out and walk with us and raise some funds. Last year was my first Walk to End ALS. On my own, I managed to raise almost $2,500 for the cause. Imagine how much more we could do together. I have set our team goal at $3,000 but with YOUR participation, we could do even more! You can join the team PMA RoyALS here. Both Dorothy and I would love to have you join us!
  2. Make a Personal Donation. walk to end alsLast year, the average donation was around $35. Even if you can only afford $20, every little helps and you will be supporting the local ALS Community. ALS and other Motor Neuron Diseases are EXTREMELY costly. Aside from medical expenses that are covered by OHIP and equipment supplied by the ALS Society, I have calculated that we personally have spent in excess of $25,000  in the last year alone. As the disease progresses, the expenses will become even more onerous. You can make a contribution by clicking above or using the following link
  3. Help Spread the Word Even if you cannot join us personally, you can help spread the word by sharing this post or by simply telling your friends and co-workers and getting others involved. Many of the ALS patients both locally and nationwide NEED your help because they are physically unable to help themselves.

PMA Diagnosis – FACT or Fiction?

PMA DIAGNOSIS

 

PMA DIAGNOSIS – Fact or Fiction?

So, you have received a PMA Diagnosis? How can you be sure that this diagnosis is correct or at least the most likely candidate among a sea of unpleasant alternatives?

This conundrum is at the heart of my own situation. I have spent the better part of 2 years trying to either confirm or disprove my own diagnosis of Progressive Muscular Atrophy. During this time since PMA diagnosis, I have tried to keep an open mind while researching an area that is fraught with partial or misinformation.

What are the Chances?

One of the best articles that I have read on the variants that can mimic ALS can be found at: “Mimics and Chameleons in Motor Neurone Disease“. The graphic above that shows the typical process that leads to a definitive PMA diagnosis, mimics my own journey almost exactly. According to this article, variants with pure LMN (lower motor neuron) symptoms are the hardest to pin down and the most likely to be misdiagnosed.

This article offers some interesting statistics about MND and the diagnostic process. Apparently, 85% of suspected ALS patients present with clear upper AND lower motor neuron symptoms. In addition, studies have shown that approximately 1 in 10 pALS are incorrectly diagnosed, (I am using the terms ALS and MND interchangeably here). Those with lower motor neuron symptoms only represent about 10% of all cases. A final PMA Diagnosis occurs in only about 1  in 20 or 5% of pALS.

One of the most interesting insights that I discovered here is that there is a correlation between the period between the original onset of symptoms and final diagnosis and the eventual prognosis. The longer the symptoms were present, the longer the patient can be expected to survive. I suppose that this makes intuitive sense but be aware that this is not necessarily a hard and fast rule. However, just yesterday, as I was being assessed by my physiotherapist and OT for a power wheelchair, she opined that presentation history is the best predictor of future progression.

Why is the correct diagnosis critical?

Most of us are aware that there is currently no cure for ANY variant of Motor Neuron Disease and there are only a couple of approved and accepted prescription drugs available: Rilutek/Riluzole and Edaravone. Both of these drugs are controversial, expensive and come with some gnarly side-effects. What is more, the proof of effectiveness is tenuous at best. That being the case, one ought to be as confident as possible of the final diagnosis before embarking upon such a course of treatment.

If you are personally unconvinced with your own current diagnosis, you owe it to yourself to demand a second (or as in my case a third) neurological consult.

FRS – Functional Rating Scale

frs - functional rating scale

FRS – Functional Rating Scale or Faulty Reality Scheme

Another month has gone by and my FRS – Functional Rating Scale score comes in at 41 again. This should indicate that there has been little to no progression in my condition for the last 14 months. If only that were true!

Two years ago, my rating on the scale was 48 or fully able-bodied. I had some significant symptoms already though.  One year ago, while my score was still showing at 41, I could still walk a mile or so with a cane and could climb stairs with relative ease albeit with some assistance from my arms.

Today, although I still have the same score, I wear compression socks 100% of the time and I wear Ankle Foot Orthotics (AFOs) most of the time. I can no longer climb stairs and cannot walk with a cane more than a few steps.

If this disease stays confined to my lower limbs only, I will likely only lose a couple more points over the next couple of years but will almost certainly be in a wheelchair full-time. Many other pALS with scores much lower than 40 are still fully functional. The reason that the FRS – Functional Rating Scale fails is that it is trying to impose a simple measurement to a complex and varied disease.

 In my case, having been diagnosed with the PMA variant of ALS/MND, almost 2 years after diagnosis, I still have only Lower Motor Neuron symptoms. Many of the areas covered by the FRS Scale relate to Upper Motor Neurons and therefore will (hopefully) not decline. Although I will continue to update my FRS score, I have come to realise that it is NOT an effective measure of the degree of impairment or disease progression for many MND or ALS sufferers in general and for PMA patients in particular.

You can find further information about the FRS – Functional Rating Scale here

An ODE to PLM

An Ode to PLM

I have been a member on PLM (PatientsLikeMe) now for over 15 months and it has been a great help in getting me out of the doldrums whenever I feel myself start to sink into negative thoughts. I have made friends and gained a lot of helpful information as well as a new perspective Hence this Ode to PLM.
I thought that the following might help others find some solace when things get bad:

So you’ve been diagnosed and just joined our group,
MND, ALS, PLS, PMA it’s all just a bunch of alphabet soup

PLM is the place where you’ll find lots of friends
All in the same boat, all with the same ends

It’s not a death sentence as much as they say,
Your attitude can lessen the price that you pay!

Can’t promise you’ll get better but you won’t be alone
Now you’ve found your way here, you’ve a home of your own!

So make it your decision: be up and not down
For in spite of this sickness, beauty abounds! 🖖

You can join us on PLM Here

SAME S&$T, DIFFERENT DAY!

 
Same Shit, Different Day
 

The image above describes my feeling often as I contemplate getting out of bed in the mornings.
Last few days have been a whirlwind! I attempted to instal a new wifi thermostat and encountered significant problems. It turned out that it had shipped with incorrect default settings. I will have to wait till spring to determine whether it damaged my A/C compressor which ran for a couple of hours at the same time that the furnace was running! Next, my medical marijuana prescription expired and getting it renewed was horrendous (took 10 days). I also had a fitting for custom compression socks and came away with a single pair to trial. Cost: $175!!! Next, the technician who came to fix my airline-damaged scooter took 2 hours to fix a broken switch and probably did more damage than good.
Even though I have come off the dexamethasone, my leg strength has not returned. On a positive note, my weight is slowly returning to normal and although still slightly swollen, much to my wife’s relief, I can now wear my wedding band!
You might think that immobile as I am, that I represent no threat where the opposite sex is concerned. However, I find my new scooter attracts attention like a Ferrari and I can chase after them at 12mph! 😉

 
Applause
Support
Helpful

Dental Amalgam removal

 

I just joined PLM

Today, I joined Patients Like Me

I do not remember whether I just came across the site by accident or someone recommended it to me. Whatever the case, this site offers more information and support than any other source. Below is the message that I left for fellow members:

Interests: Advocacy and Working with my Condition

I have spent the last year trying to get a definitive diagnosis for my progressive muscle weakness and finally have an answer that makes sense (even though it sucks!).

From here on in, my only goal is to do everything that I can to maintain a reasonable quality of life and to extend it as much as I can. In so doing, perhaps I can benefit others as we make this journey together.

Patients Like Me is a large and active community of Patients and their caregivers where they can exchange information and give mutual support. The ALS/MND section has thousands of members although there are relatively few with PMA (Progressive Muscular Atrophy). In any event, much of the information on any variant of Motor Neuron Disease will likely apply to PMA.

D-Day A Diagnosis of PMA

Diagnosis of PMA

This was the day that my journey with PMA – Progressive Muscular Atrophy really began. Although I had been diagnosed with an unspecified variant of Motor Neuron Disease (MND) back in October of 2017, nobody, including myself, seemed to have a great deal of confidence in that diagnosis.

In spite of the fact that the previous neurologist had scheduled no follow-up and I had referrals from 2 different physicians, the hospital seemed reluctant to give me a second appointment. In fact, even after a consultation was set up, the neurologist’s assistant called me to try to convince me to forgo the appointment because, in her view, I didn’t really need it.

Nevertheless, I persisted and after a virtual repeat of the visit to the previous neurologist, I was told that I had PMA.  Two big takeaways from that discussion were that I would almost certainly end up in a wheelchair and that my life expectancy was anywhere from 2 -5 years. The first part will almost certainly become true since, 18 months later, I can barely walk with a cane or walker. The second part though is less certain. Because PMA is so rare and, in the early stages, is often misdiagnosed, it is hard to get valid data on progression and outcomes. Nevertheless, after reading most of the literature available on PMA and based on my current progression since symptom onset, I would appear to be in the ‘slow progression’ category.

In the posts that follow, I describe my personal journey with Progressive Muscular Atrophy.