A Double Dose of Autoimmune Disorders

I have Diabetes Mellitus, a disease that affects almost every facet of my life, and it is something I think about and plan for throughout every day.  Never would I have thought, but I am thankful for how Diabetes has impacted me.  Diabetes has taught me to treat myself and body well, all in an effort to manage my chronic disease to an optimal level.

While managing well, sometimes curve balls are thrown at you.  In May 2015 as I was walking down my street in New York City, all the objects to the left side of my body appeared to split into two images.  I had just completed a gauntlet of exams and final projects for school, which included many long hours staring at computer screens, so I deduced my eyes were just tired and that I should get more sleep.  In a few short weeks, almost every image in my line of sight is doubled and stacked on top of one another, all while I’ve lost the ability to hold my right eyelid open. Fast forward a couple months and a few ophthalmologist and neurologist appointments later, and I’m being told about two words I had never previously heard before:

Myasthenia Gravis

Myasthenia is a neuromuscular disease that is often characterized by fluctuating muscle weakness and disease. The disease is classified under autoimmune disorders because it is caused by antibodies that block acetylcholine receptors in the postsynaptic neuromuscular junction.  For a sports analogy, my overactive immune system is acting as a set of determined goalkeepers, defending a necessary chemical from reaching their appropriate receptacles to keep my eyelids open and my pupils focused in the same direction.

My version of the disease so far has been ocular, or only detectable in the muscles in and around my eye. I’m very fortunate to not have to deal with overall muscle weakness and fatigue.  As disruptive as my double vision has been, at least my active lifestyle has not been altered at a significant level.

As far as therapies being discussed, there are several new medications and measures I have had to endure. Blocking the inhibitors that intercept acetylcholine was the first medicine prescribed to me.  I’ve also been donning a nice pair of prisms that work to correct my double vision that resemble reading glasses.  For 24 and half years, I was able to boast in front of anyone who will listen that I was the only member of my family with vision well enough to not require glasses (20/15 vision, no big deal).  But alas, my reign has ended as I join the other bespectacled members of the Collins Family.

The symptoms of double vision and ptosis (eyelid drooping) are reaching a level of severity that higher measures of treatment are becoming necessary.  The next steps of medication involve lose-dose steroids or immune suppressant drugs.  Some patients even find relief after removing their thymus glands in a procedure called a thymectomy.

What makes this diagnosis especially problematic is the fact that I already am a diabetic, which essentially creates a strong set of risks for each method of stronger treatments.  One always should avoid anesthetic surgical procedures if possible, immune suppressant drugs as they increase your rate of certain infections and sometimes cancers, and steroids which make managing blood glucoses difficult due to rampant highs from insulin resistance.

The risk of developing another autoimmune disorder is 4-6 times higher for individuals already suffering from one autoimmune disorder (Somers, 2009). So as patients living with chronic diseases, we have to be especially careful and mindful of our symptoms.  As is with my condition and my treatment options, some of the potential therapies will require even more careful planning and execution in order to avoid making matters worse. I would of course like to see better, but I also should not have to send my blood sugars out of control in the process. To mediate this problem, I’ve been in close contact with my neuromuscular specialists as well as my endocrinologists to have a cohesive game plan to tackle these two conditions.

With careful planning, execution, and problem solving, compounding problems such as two autoimmune disorders can be beat or in the worse case, controlled.  While it is time consuming and taxing, in the end, only I can control my health in the best way possible to ensure a long, healthy, happy life.  I do not plan on letting these “speed bumps” slow down my life too drastically.

Somers EC, Thomas SL, Smeeth L, Hall AJ. Are individuals with an autoimmune disease at higher risk of a second autoimmune disorder? Am J Epidemiol. 2009 Mar  15;169(6):749-55. doi: 10.1093/aje/kwn408.