Flourishing in the face of autoimmunity

Autoimmune diseases can leave sufferers feeling alone and vulnerable. To our friends, we sound like strangers spitting out words they have never heard. We try to get someone, anyone, to understand that every day, we walk a tightrope made taut by modern medicine over a 10,000-foot drop to oblivion. If and when we fall, doctors cast us lifelines. Sometimes, we lose our grip. Sometimes, the lines break.

The rarer the condition, the more anxious and more depressed its leaves the afflicted. We visit doctor after doctor and wander the world in search of charlatans who have answers to the darkest of questions: Why me? What caused this? Did I do this to myself?

Seeing talented sports stars, actors, singers, and musicians flourish despite their conditions inspires those of us battling autoimmunity.

We have to remind ourselves daily that diagnosis is not the end. Most autoimmune diseases have been thoroughly studied. Though few, if any have cures, many have multiple treatment options. Most treatments are safer and more effective than they have ever been. And in the twenty-first century, many autoimmune patients live long, productive, even happy lives.

Staying on top of their game: sports stars with autoimmune diseases

Pro golfer Kristy McPherson was told by many doctors she would have to give up sports after being diagnosed with juvenile idiopathic arthritis at age 11. A rheumatologist at the Medical University of South Carolina told her that even with the disease, she could still do whatever she wanted.

Pro golfer Kristy McPherson refused to give up sports after her doctors diagnosed her with juvenile rheumatoid arthritis and told her she would never be able to run or jump competitively again. [Chris McGrath | Getty Images]

“All I needed was that one doctor to tell me that,” McPherson said. “That’s when I went back to playing sports.”

Months after becoming the world’s top tennis player, Caroline Wozniacki was diagnosed with rheumatoid arthritis.

She explained: “You start asking yourself questions: What does this mean? Does it mean I can’t get in as great of shape as I was before?”

Though she initially struggled, she bounced back to win the 2018 China Open.

“[Wining in Being] meant so much to me,” Wozniacki added. “It also gave me the belief that nothing is going to set me back. I’m going to work with this and this is how it is, and I can do anything.”

Both McPherson and Wozniacki now speak with young people about living with the rheumatoid arthritis.

Having an autoimmune disease doesn’t mean you can’t be beautiful

Kim Kardashian’s makeup-free selfies have encouraged many others to acknowledge their psoriasis and helped me feel better about flare-ups on my face.

“The disease can cross all socioeconomic lines,” Randy Beranek, CEO of the National Psoriasis Foundation, told The Atlantic. “If someone as famous and visible as Kim Kardashian can have it, it doesn’t make your disease feel so isolating.”

Last December, Kardashian even polled her fans on Twitter about effective medications.

Celebrated singers and musicians have autoimmune diseases

Actress and pop singer Selena Gomez a few years ago revealed she has lupus and in 2017 informed her fans on Instagram about her life-saving kidney transplant.

Few 24-year-olds probably understand what it’s like to have their bodies threaten their lives. To deal with the psychological pain, Gomez checked into Arizona’s Meadows rehab facility. She then faced backlash from fans and from media, who thought she was being treated for drugs or alcohol addiction.

Like Kardashian, revealing her condition to the world opened up mainstream and social media discussions about lupus: What is it? What does it mean for Gomez’s career and for others living with the disease?

Singer Toni Braxton also has refused to let lupus derail her career or her commitment to her family. One of the most decorated pop singers in American history, she has won seven Grammy Awards, nine Billboard Music Awards, seven American Music Awards, among numerous other accolades.

As a guitarist, I find Shawn Lane’s story most inspiring. Widely regarded as one of the greatest guitar players ever, Lane struggled since he was twelve with psoriatic arthritis. His condition not only caused itchy, painful rashes on his skin, but also stiffness in his joints, making it increasingly difficult to play his instruments.

Shawn Lane psoriatic arthritis guitar player
Guitar player Shawn Lane played his entire career in spite of stiffening joints and skin rashes from psoriatic arthritis. His playing and compositions continue to inspire guitarists even after his untimely death in 2003.

Worse, Lane developed Cushing’s syndrome from his long-term use of cortisone to treat his skin and joints. He had to stop playing guitar and died a few years later after developing breathing problems.

Nonetheless, as readers can find more about here, Shawn Lane lived as full of a life as possible, playing in spite of the pain, and producing some of the most beautiful instrumental music of the last thirty years.

Laurence Olivier and Maria Callas: living with and dying from dermatomyositis

As I mentioned here, heralded actor Laurence Olivier and legendary soprano Maria Callas both battled and eventually died from dermatomyositis. That never stopped either of them from prolific careers.

Olivier has been called the most definitive actor of the twentieth century. He lived to be 82, dominating the British stage and starring in more than fifty films.

Callas had a vocal range just below three octaves and is still one of the best known and influential opera singers of the twentieth century. Despite her disease affecting her voice in her later years, she still performed. Forty-plus years after her death, Callas’s name still sells albums.

Modifying guitar effects to keep me grounded

Modifying guitar effects pedals with circuit designs that predate most Millennials has become another tangent of my guitar obsession and a welcome opportunity to create with my hands.

I rebuilt each of these classic Boss guitar effects: DS-1 Distortion, BD-2 Blues Driver, SD-1 Super Overdrive.
I rebuilt each of these classic Boss guitar effects: DS-1 Distortion, BD-2 Blues Driver, SD-1 Super Overdrive. Replacing cheap components and adjusting the circuit has made them sound richer and fuller.

In fall 2017, around the same time I first developed rashes on my elbows, I began tinkering with an old distortion pedal I had barely used in years.

Made to turn my electric guitar and amplifier into a heavy metal machine, the infamous Boss MT-2 Metal Zone needed an upgrade. It has been understandably lampooned all over YouTube for its fizzy, ultra-compressed, mid-scooped, nasally tone that teenagers flock to as though each pedal was boxed with cocaine and a porn mag.

Remarkably, with a soldering iron and some patience, by replacing and removing a few capacitors and resistors, it can be made decent. By overhauling every single cheap Taiwanese component with much higher-quality Japanese ones, the Metal Zone moves from a neglected embarrassment (paradoxically, it’s found in almost every guitarist’s closet; Boss has sold millions) to a marvel of modified Japanese engineering that performs as well as boutique distortions twice its price.

For an angry thirty-four-year-old anarchist who grew up on Metallica, Iron Maiden, and nu-metal, plugging a guitar into a modded Metal Zone is enough to get you through the days you want to tell your employer to take this job and shove it.

For me, overhauling a pedal I obtained from a friend as a teen was a wonderful exercise in taking my mind off the things I cannot control and rejuvenating the things I can, no matter my constraints.

These guitar projects have become a welcome relief from my usual, more cerebral pursuits that leave my head lost in the clouds.

Since finishing the project, modifying and improving these relatively simple circuits has become a part of my quest for my perfect guitar tone. I’ve rebuilt seven Boss classics in 8 months: two BD-2 Blues Drivers, one DS-1 Distortion (the same effect used by Prince, Kurt Cobain, Joe Satriani, Steve Vai, and others), an SD-1 Super Overdrive, a PH-2 Super Phaser, a CH-1 Super Chorus, and most recently, an HM-3 Hyper Metal.

These projects have become a welcome relief from my usual, more cerebral pursuits that leave my head so lost in the clouds that Aristophanes himself could come back from the dead to stage a sequel to his parody of Socrates. By day, I work at a university, trying to keep up with astrophysicists and bioengineers. By night, I write novels and blog posts that require equal research efforts. To some extent, hand-built guitar effects and the gym are all I have to remind me I live on Earth, that reality is ultimately material.

Dermatomyositis and dentistry

I hate the dentist. The mere thought of the pick scraping my teeth and gums drives me wild like a dog forced to endure a high-pitched whistle. The memories of the drill hitting a nerve the dentist thought she numbed causes me to cringe like a child being force-fed once-boiled, week-old brussel sprouts. If ever you put a committee into a room and asked them to think of ways to torture human beings, most would suggest the dentist’s chair–picks, drills, giant needles into the cheek and all.

Taking medications to keep my immune system in check has forced me to return to the dentist at least twice in the next month.

Because of this, I have spent much of my adult life taking care of my teeth, brushing daily, twice yearly cleanings. The best I could ask of myself is to floss more frequently. Between my hygiene and being subjected to numerous municipal fluoride experiments, my teeth have been largely impervious. I’ve had maybe six cavities my entire life–most of which were during my teen years, when my parents paid the dental bills and a toothbrush was as foreign to me as bathroom cleaner.

I returned to the dentist Thursday only to find out I have five cavities, including a nasty deep one that will require removing the tooth’s root. My dentist was so surprised by the decay he asked me: Had I changed my diet? Was I taking some crazy medication? Had I stopped brushing in protest of the Trump administration?

Immunosuppressants and oral health

Six months of immunosuppressants have desiccated my mouth like border patrol to the Arizona deserts and leaving my teeth to the mercy of the bacterial cartels.

Dental plaque (a bacterial mass) loves to hide in the canyons, ridges, and crevasses in between my teeth. A healthy mouth can better fight them. The immunocompromised, which now includes me, have to stay vigilant.

I’m now paying the price for those times I was too tired or too lazy or too busy to floss. The cost: a root canal, a crown, and five fillings. This amounts to over $2,000 in dental work and four hours in the dental torture chamber.

Autoimmune diseases and oral health

Interestingly, this may not be my fault alone. According to Colgate, dermatomyositis itself could be the cause. Their one-pager on autoimmune diseases and oral health points out how these diseases can cause trouble with eating, swallowing, and dry out the mouth and lead to more cavities.

Dermatomyositis dries out the mouth and causes trouble swallowing, leading to more cavities.

That said, as my dentist and hygienist explained, the solution is better oral hygiene. Three or four cleanings per year could also help. That and spending the ides of March in the dentist’s office having my teeth repaired.

Switching to azathioprine

Over three weeks ago, after having issues with my methotrexate, my rheumatologist switched me to another immunosuppressant, azathioprine.

Azathioprine is the Mayo Clinic dermatomyositis expert's drug of choice for treating dermatomyositis and polymyositis.
Azathioprine is the Mayo Clinic dermatomyositis expert’s drug of choice for treating dermatomyositis and polymyositis.

This drug best work without major side effects. That it starts with the letters A and Z is fitting because after azathioprine, for a largely amyopathic form of dermatomyositis, like mine, my doctors and I are out of realistic options.

Like methotrexate, scientists first developed and used azathioprine for chemotherapy. Scientists later discovered its use in suppressing the body’s formation of antibodies—proteins used by the immune system to neutralize anything that can produce disease. During the 1960s and 1970s, it became widely used for kidney and heart transplants, then later for rheumatoid arthritis.

Azathioprine works by inhibiting purine synthesis, a process in which the body produces organic compounds essential to synthesizing white blood cells. Since some of my white blood cells are attacking my skin (and to a lesser extent, my muscles), inhibiting their proliferation keeps a malfunctioning, overactive immune system like mine in check.

Interestingly, caffeine and theobromine (found in chocolate) are purines. The body specifically relies on purine synthesis to process both. That may explain my heart palpitations after one-too-many cups of coffee.

Azathioprine is finally healing my rashes

After only three weeks, my skin looks better than it has in a months, possibly since last June. The rashes have reduced and stopped itching altogether.

My scalp still itches and flakes in a manner that at times, is almost painful. My hair is also still slowly falling out. To date, the only drug to control these symptoms is prednisone in moderate doses.

I even feel stronger than I did on methotrexate and seem to build muscle more quickly.

As I wrote last week, I now need to control the chest tightness and shortness of breath. As I work up to the full dose, I think these symptoms will also go away.