“Killer T cells” – a new way to fight Multiple Sclerosis. Read our interview with Gary Allen one of the test subjects for Prof Michael Pender MS research!


Gary Allen Multiple Sclerosis

Gary Allen Multiple Sclerosis

PatientTalk.Org have just completed perhaps the most important interview in the blog’s history.  Today we interview Mr Gary Allen.  Gary has been a participant in some of the most encouraging research into multiple sclerosis for some years.

In the interview below Gary tells us about his multiple sclerosis and his role as a “guinea pig” in the research of Prof Michael Pender of the  QIMR Berghofer Medical Research Institute.  He tells how being part of the research has been significant improvements on his pain levels, feelings of fatigue and general cognition.

You can check out more about the research at http://msqld.org.au/homepage/latest-news/808-prof-pender-research-update

 

a)      Please describe the story of your initial diagnosis and symptoms of MS?

I had what we now know was my first MS episode in 1994.  I had terrible motion sickness and nausea, lost control of some of my facial muscles and had some reduced power in my legs.  At the time there were a number of possible diagnoses, so when I recovered I got on with my life.  It wasn’t until 2000 when I had another major episode that I was clinically diagnosed with relapsing remitting ms.  In 2004 my MS went progressive.

b)      How did the MS progress?

During the last 10 years my symptoms have… well, progressed.  I slowly went from walking with a stick, to a crutch, to furniture walking and using a wheelchair for longer distances, to pretty much being in a wheelchair all the time, and then needing a hoist for transfers.  I have no real touch or temperature sensation in my legs or arms.  I also have intention tremors and lack of dexterity in my hands.  My legs reached a point where they have very little voluntary movement but my involuntary reflex / spasms were ‘brisk’ (a term that doesn’t do it justice).  The spasms can be painful and I had just started to experience the ‘lightning strike’ pain around my head before the treatment started.  I also would get long periods of painful pins and needles in my hands and face.  Looking back, I was really struggling with fatigue, concentration and cognition issues, which I didn’t notice because it crept up on me.  All of which was impacting on my working life (I have continued to be very busy with two plus jobs… yes I am a self-confessed workaholic), time with my family and my social life.

c)       Does the Queensland climate affect your MS?

Like many people living with MS, I have a certain degree of heat intolerance – so my symptoms become more pronounced as it gets hotter.  Consequently Brisbane’s 68-82 degree F average in Summer and subtropical humidity can be a real challenge.  At the age of 18 I moved from the grey and wet joys of England to Queensland, so you can imagine what a effortless transition in climate it was for me.  <chuckle>  Fortunately we have air conditioning at home so we can keep me reasonably cool.

d)      Please can you introduce our readers to Prof Michael Pender’s treatment and research?

Back in 2004 (or thereabouts) Prof Pender theorised that the Epstein Barr virus (a common cause of glandular fever) was mutating the B cells of people with MS.  As a consequence the virus was remaining in their systems – building up in the brain and spine.  This was also responsible for the body attacking the brain and spine column causing the implication and damage associated with the progression of MS.  More recently he’s been working with an oncology researcher at QIMR Berghofer Medical Research Institute. In 2013 Michael took 400ml of my blood, prompted it to develop ‘killer T Cells’ that eradicated EBV from my B cells.  Because I was the ‘first human guinea pig’, they reinfused my cells over 4 visits in a 6 week period.  Because I was first, we really had no idea of what to expect, but inside the first 2 weeks the results were astonishing.

e)      How did you hear about it?

I donated some blood to Prof Pender’s research back in 2000.  It turns out that I was an excellent candidate for the treatment (having lots of EBV infected cells and almost no EB antibodies).  So in 2012 Michael visited me a couple of times to meet with me and my wife to discuss the treatment.  It was something of a jump in the dark, with there not being any previous patients with MS receiving the treatment.  The science looked excellent (I read research proposals for a living) but essentially it boiled down to: we think it will put a handbrake on the progression, but it might cause you to have a massive attack.  Frankly 10 years into progression and no real treatment available, I had the attitude that it was well worth a punt.  Looking back I am just so grateful for having had the opportunity, delighted we made the right decision, and very conscious of my responsibility to get the message out there that there is a light at the end of the tunnel for families struggling with progressive MS.  I want to do what I can to help make a clinical trial a reality.  The extra lumbar punctures and MRIs I’ve had to help collect data to make the case for a trial is the smallest of  asks.

f)       Can you describe the procedure to us?

It took around 4 weeks to ‘grow’ the killer T cells and do the lab testing.  The cells were returned into my system via four infusions over a 6 week period.  It was done this way so I could be closely monitored for adverse reactions / side effects.  Following the treatment I returned to the ward several times for tests and neurological assessments. Next month I am due to have my (12 months on) lumbar puncture and MRI.

g)      What were the outcomes negative and positive?

In less than 2 weeks we started seeing very positive outcomes.  At first I was very conscious of the potential for the placebo effect, but the positives kept building, and have been sustained for a year.  I have a remarkable change to my fatigue, cognition and memory.  I have a significant improvement in pain levels (which is pretty much gone) and marked improvement in the size and duration of pins-and-needle discomfort.  I saw a reduction in painful legs spasms and my intention tremor has in my left hand has reduced.  I work as a policy officer at Griffith University and went from struggling through the delivery of three workshops a year to delivering one or two per week.   I have a very nerdy indicator of the improvements: Prior to 2007 I could score up to 97 planes landed in the iPad game Flight Control.  After 2007 I gave up playing because I couldn’t land more than 14.  Two weeks after starting the treatment I got 117.  In May last year I landed 561!  At which point my wife gently observed that it might be time for a different challenge.  🙂  Last month my wife, son and I went on our first long holiday together in more than 10 years.  I have the energy and enthusiasm to play with my boy.  We’ve noticed some increase in voluntary movement in my legs – not much and we’re trying to work out now how much of that is because muscle shortening and atrophy.  It was exciting when the scans and tests started to echo my lived experience.  My MRI, (pre, during and post) went from showing four areas of my brain under attack to 2 and those 2 areas were 40% the size of what they were.  The next scan results are going to be very interesting.  I am yet to experience any side effect or negative outcome.

h)      What do you think the future for the technique is?

MS Queensland is trying to raise AU$400,000 to conduct a clinical trial.  That will provide more data about the effectiveness and safety of the treatment and is the first step in registering the testament with the Australian TGA.  Ironically one of the of the things that attracted me to the treatment – the fact it involves no drug, no stem cells, just my own cells returned to me – also now is the funding challenge, there’s no drug for a pharmaceutical company to commercialise.

i)        What is the prognosis of your multiple sclerosis?

Because I am the first guinea pig we  have no idea how long this will last, whether it will need to be ‘topped up’ or what it means for my long-term prognosis.  What I can say is that I have been blessed with an amazing year with no progression, some tangible improvements and perhaps the greatest gift of all: Hope.

 

j)        Have you any advice for somebody just diagnosed with multiple sclerosis?

Oooo how much space do I have?  <chuckle>.  Perhaps 3 things:

  1. There really is reason to hope.  An effective treatment is within reach.
  2. Keep up with your physio, stretches and working those muscles because you don’t want to be like me now wondering whether, if I’d practised what I’m preaching now, my legs maybe could be doing more.
  3. Always remember that accepting help, whether it’s in the form of pain management or other medication, counselling, a wheelchair or whatever isn’t giving up or admitting how bad things might go for you… it’s just help, and if it means you can cope better or can go out and about, it’s worth it!

k)      What is, in  your view, the future of Prof Pender’s research?

Michael believes that the theory and treatment works for early diagnosis relapsing remitting patients – i.e. at some point soon it will stop the damage before it happens.  Now if that doesn’t take your breath away I don’t know what will.

To help raise money for a clinical trial my wonderful wife Renay is conducting a short story competition where the entry fee is donated to the Society.  Go to http://www.renayallen.com/community-2/ to find out more and to enter the competition.

Trigeminal neuralgia. Can you help an old friend with advice on dealing with Trigeminal neuralgia, please?

Trigeminal neuralgia

Trigeminal neuralgia

A bit of an odd title for a blog I know, but sort of does what it says on the tin.  On Friday afternoon I got an email from an old friend who had just been diagnosed with Trigeminal neuralgia.

I’ll be honest it was not something I knew much about apart from it being a symptom of multiple sclerosis in around 3% of cases and, of course, is one of the most painful conditions there around.

As I could not answer Jayne’s questions I thought it would be a good idea to ask our readers who have Trigeminal neuralgia a bit more about their experiences and how they manage the pain.

As background, Trigeminal neuralgia is a stabbing nerve or neuropathic pain (https://patienttalk.org/what-is-neuropathic-pain-do-you-suffer-from-nerve-pain/) which affects the face.  The pain has been described as like being stabbed or an electric shock.

As well as the pain (which can last between a few seconds and a couple of minutes) people with Trigeminal neuralgia may also experience numbness prior to the pain and a dull ache during an attack.  It should be noted that attacks of Trigeminal neuralgia come and go over time.  Attacks may take place over a few hours but can go on for months.

The triggers really vary from cold breezes to facial movements such as chewing or even turning the head.

It is worth bearing in mind that for many people living with Trigeminal neuralgia can be very tough and in some cases can lead to depression.

Often doctors are uncertain as to what may cause Trigeminal neuralgia but in many cases it is a symptom of multiple sclerosis or a by-product of a tumour.

Current research suggests that surgery is the most effective treatment (successful in around 70% of cases) if use of painkillers has not worked as a first line treatment.

Going back to Jayne’s questions, she is interested in finding out the answers to the following questions:-

1)Please can you describe a typical Trigeminal neuralgia attack both in the short and long term?

2)How frequent are your attacks and how long do they typically last?

3)How firm was the diagnosis and who made the diagnosis of Trigeminal neuralgia?

4)Which type of Trigeminal neuralgia do you have?  What was the cause of your Trigeminal neuralgia?

5)How do you treat your Trigeminal neuralgia and how successful have the treatments been?

Obviously any part of your Trigeminal neuralgia journey will be really useful for Jayne so it would be great if you could share your experience using the comments box below.

Many thanks from Jayne and me.

Breakthrough Pain – Do you get pain spikes or flares? Join us at this blog post to share your experience.

Breakthrough Pain

Breakthrough Pain

A few weeks ago we ran a short poll to find out more about the types of pain suffered by our readers.  You can check out the poll and its results here https://patienttalk.org/?p=2506.

I have to say the results were a great surprise.  It turned out that over 12% of our readers suffer from breakthrough pain.  Now this was interesting because my preliminary research suggested that breakthrough pain is associated with conditions like cancer.  But these results suggest that it is far more widespread.

So what actually is breakthrough pain or, as it is sometimes called, a pain flare?

It has been best described as spikes of pain which cannot be controlled by normal pain management techniques.  In fact these can happen a number of times each day or on a less frequent basis.

Current thinking as to why breakthrough pain occurs is interesting.  One explanation looks at a concept of conditioned pain response.  There is an excellent article by Christina Lasich on the subject here http://www.healthcentral.com/chronic-pain/c/23153/117921/salivating. The way I see it Dr Lasich takes the view that in some cases breakthrough pain is a condition response to the use of medication.  By that she means that people who take regular pain medication (say four times a day) will, slightly prior, to the appointed time for the medicine, start feeling heightened levels of pain.  She compared this to Pavlov’s dogs experiment – of which more here http://www.simplypsychology.org/pavlov.html.  The article is by McLeod, S. A. (2007) and called Pavlov’s Dog.

Dr Lasich also points to opioid-induced hyperalgesia as another potential cause.  This is a scenario where people who use many medications become over-sensitive to things which would not have caused pain in the past.  While affecting people who take these products it should not be confused with the increased tolerance that such medications may cause.  To find out more please have a look at this page http://en.wikipedia.org/wiki/Opioid-induced_hyperalgesia.

Obviously we must also bear in mind that these pain spikes are part and parcel of various medical conditions such as cancer and fibromyalgia.

Going back to the figure of 12% of people with pain who suffer from pain flares, I spoke about this yesterday to a physician.  She was firmly of the view that this is, in fact, a very realistic figure.  So I thought it would be of value and interest to get the views and experiences of our readers as regards to breakthrough pain.  It would be great if you could share your experiences using the comment boxes below.

You may wish to consider some of the following questions:-

1)   What is the background condition that causes your pain?

2)   What treatments for that pain do you use?

3)   Can you describe a typical pain flare for our readers?

4)   What triggers these pain spikes?

5)   How do you deal with/ treat breakthrough pain?

Please consider these questions just as a guide.  Anything you might like to share will be of great interest to our readers.

 

Many thanks in advance.

Pain Management – what sort of pain do you suffer from? Take our poll


Pain

Pain

Over the course of the last few years we have run regular blog posts on the issues surrounding pain management.  You can check them out here https://patienttalk.org/?tag=pain-management.

One area we have not explored is the kinds of pain our readers suffer from.  As you know there are many different kinds such as neuropathic or nerve pain which we blogged about here  https://patienttalk.org/?p=281.

We would love it if you could use this blog post to take part in our poll and types of pain.  Please note that we can have multiple answers.

If you think that there is an area of pain we have missed please use the comments box to mention them so we can produce an updated survey.

Many thanks in advance



What is your worst symptom of Fibromyalgia? Please take our poll!

While pain seems to be the most common symptom of fibromyalgia is is certainly not the only one.

Fibromyalgia

Fibromyalgia

You may find a previous blog which explores some of these issues with fibromyalgia of interest https://patienttalk.org/?p=451

So we thought it would be useful to run a poll among our readers to find out which aspect of fibro is the most debilitating.

It would be great if you could take part in the poll and use the comments box below to share your views and experiences.

Thanks very much in advance