Slow burn - MS and addiction.

Slow Burn: One Smoker’s Battle with MS and Addiction

I have MS and I am a smoker. There, I said it.

But this simple admission does not absolve me. For my doctors, militant non-smokers, sin tax perps, and clinical researchers who insist that smoking is a factor in developing MS and in hastening its progression, fessing up is just not enough. I must quit the devil leaf or else face a hellish demise.

Last week, my seventh attempt to quit smoking since 2010 resulted thusly: It failed. Thanks for playing, we’re sending you home with a nice parting gift--your sanity.

Now, I'm stronger than this. I am! But it is beastly hard to quit and then to stay quit, even though I know that I risk COPD, lung cancer, esophageal and mouth cancers, stroke and heart disease. What’s more, my cholesterol is dramatically affected by smoking. After an eight-month interval of quitting smoking in 2011, my LDL plunged from 130 to 99 and my HDL rose by an impressive 19 points from 40 to 59. After I resumed smoking, those numbers quickly changed back again. And to make matters worse, I have a history of developing oral leukoplakia (white mouth lesions), none of which have been cancerous or pre-cancerous, thank goodness, and which decrease whenever I have quit smoking, then increase after I start up again.

I deeply wish I were the kind of timid soul that could easily feel terrorized by these facts and quit cold turkey, but I’m not. I’m fearless, and though this is a sterling quality when it comes to coping with a chronic disease such as Multiple Sclerosis, it also fuels denial and feeds my compulsion to chain smoke.

Across and within various studies conducted by questionnaire all the way back to the 1980s, researchers have documented an unmistakable--albeit tenuous--connection between having a history of smoking and the likelihood of developing active MS. Back in 2010, when I’d first caught wind of such a study, I dismissed it as poppycock and didn’t even bother to read it. After all, I thought, there are 47 million smokers in this country and only 400,000 MSers, a significant number of whom have never let a cigarette touch their lips. Here we go again, I grumbled, lighting up my fourteenth cigarette of the day, let’s blame smoking for every twinge, every ethnic cleansing, every death that isn’t from natural causes, inflation, unemployment, heck, let’s blame smoking for two world wars and the latest Wall Street abuses while we’re at it. Smokers are the catch-all scapegoats for everything that is wrong with the world. Why, I’ve gone so far as to feel solely accountable for the spiritual starvation of my neighbors when I realized that sightings of the images of Jesus and Mary burned onto a grill cheese sandwich or silhouetted on the side of a water tower have only occurred out west. I have read of no such sightings here in Tecumseh, Michigan, and I’m beginning to feel personally responsible for this embarrassing absence. Oh, it’s a heavy load I carry.

Clearly I cannot be objective. I’m a two-pack-a-day smoker and I love it, it’s my major coping tool. It’s the one thing I can do when I’m too weak to walk around, do the dishes, exercise, water the plants, or when my fingers are too numb and weak to do much typing. Smoking is easy, I don’t need fine motor skills to do it. It allays boredom and helps me to concentrate. It is a tactile, oral, chemical-laden orgy that is so richly satisfying on so many levels—and, you don’t need a buddy to do it. It’s my hobby, my lover, my most intimate friend.

It is also a toxic and life-threatening relationship.  I should pack my bags and leave forthwith. I’ve tried it so many times and then gone crawling back. If you were living with a loved one for decades, someone you loved more than your own life, and you were told that if you don’t end it, you’ll die—could you walk away? Stay away? I know, it sounds pretty twisted. It’s way up there on the list of dysfunctional, lethal relationships, coming in a close second to Hitler and Eva Braun. Or Bonnie and Clyde. Or, Cheech and Chong, they’ve been on-again-off-again for years now, we’ll have to see.

Believe it or not, though, I did holster my guns long enough to take a look at the data with a more objective eye.
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In a 2010 study that explored smoking as a risk factor in developing MS, it was discovered that those patients who ever smoked and also had antibodies for the Epstein-Barr virus were significantly more at risk for developing MS. Actually, it is a little more specific than that: Only the presence of a high viral load of EB made those smoking histories a relevant risk factor.1

I can see why a researcher might regard this mysterious connection between EBV and smoking as a carrot worth chasing down the clinical study rabbit hole. I can even imagine how this pursuit might help identify the perfect storm necessary to trigger that first myelin-killing spree committed by our newly psychotic T-cells. But as a smoker already diagnosed with MS, I hardly found this to be personally useful. I wanted to see a study that offered some kind of hope for a smoker with MS who quits long after her diagnosis. And then I read this:

A study published in the July 11, 2013 issue of “Brain” concluded that smokers with MS had a significantly higher risk of reaching the Expanded Disability Status Scale Scores (EDSS) of 4 and 6 than did non-smokers. Note the distinction here: Non-smokers rather than never smokers. In this case, non-smokers included former smokers. It's that one item in the study that jumped out at me, that there was no statistical difference in the risk of reaching those EDSS milestones between never smokers and smokers who quit either before or after the onset of their MS.2

I've chosen to interpret that last line thusly: Quitting smoking could slow the rate of disability progression no matter when a smoker quits.

So this sinner now harbors new hope for redemption. It won’t make quitting smoking any easier, but it does give a boost to my nicotine-addled spirit. I’ll never give up trying to quit. Even if it takes twenty more tries and a straitjacket in a padded cell, I’m going to leave that abusive lover behind once and for all, some day, somehow. Wish me luck. I’ll need it.

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