Monday, March 31, 2008

doctor writer

From: anonymous

Hello Nicola. I wanted to ask you for some advice. I'm a 36 y/o doctor who is about midway thru writing my first, and hopefully not last, book. I recently developed rheumatoid arthritis and want to write a book about it for people (and their families) who have the disease written from the perspective of someone who is both a doctor and has the disease. Do you have any advice about how to market the book? Should I get an agent or just send copies of the finished product to various publishing companies? Should I copyright it first before doing any of the above? Thanks.
P.S. I hope your MS is doing ok. I can sympathize with your plot: MS and RA both can be quite disabling to one's body. When I first got diagnosed, I went from lifting weights and playing sports one month to having a lot of difficulties with even simple tasks, such as retrieving my keys out of my jeans and opening bottles the next. Anyway, I am doing so well now on meds that I feel almost normal. I hope that you are doing as well as I.
I read Slow River years ago and really liked it. I am a big sci-fi fan and ran across your web site while looking to see if you had any new fiction out. I'm buying The Blue Place today. Perhaps if my writing career takes off, I can write sci-fi one of these days. I think that would be a huge challenge, however, especially for a guy who always fared better in the math and sciences than in the literary fields. Good luck and keep up the writing.

The time to think about selling a book is after you've finished it. I'm sorry to say that unless you're incredibly famous, or the eyewitness to a newsworthy event (the invention of fire; the assassination of Archduke Ferdinand), or you already have a writing track record, publishers and agents won't be the least bit interested in your book. Lots of people have nifty ideas, lots of people start books. Very few finish them, or, having do so, find that what they've written is publishable.

Essentially here's how to do it: finish the book, find a book like yours, find out which agent represented the author of that book, then write a query letter to that agent. It's a tedious, multi-step process; there are no shortcuts. My parter, Kelley Eskridge, has written a very helpful article, "From the Beginning: Advice for Aspiring Pro Writers" that will take you through the process in more detail. When the time comes to write a query letter, you might find Nathan Bransford's blog very useful. He's an agent with Curtis Brown and is endlessly patient. Fossick about in his posts for a day or two. You'll learn a lot.

I sympathise with your RA. What drugs are you taking? Some kind of Cox 2 inhibitor? I've taken just about all the MS drugs out there; they're all expensive, painful and, for me at least, useless. They all operate roughly the same way: down-regulating the immune response. The theory behind this kind of treatment is that MS is a demyelinating disease caused by an overactive immune system: the body attacks its own myelin sheath and eventually the axons beneath that myelin start to die. But this theory has never quite convinced me.

A few months ago I started thinking about it another way: what if it wasn't an overly aggressive immune response, but a confused one? Also, what if something was attacking the axons and then the myelin died? What if the best way to deal with this immune muddle was to regulate the whole system, yes, but to slightly up-regulate it, not down-regulate. So I dug into research on a drug called low-dose naltrexone (LDN), an opiate antagonist. It's an old drug, repurposed.

Back in the 1980s, naltrexone/Naloxone was used in high doses to treat people with alcohol and opiate dependencies. But at a very low dose, i.e. a tenth of the usual amount, it has a different effect. It blocks endorphins briefly, which then means that the body produces more endorphins to compensate. The endorphins then do a better job of orchestrating the entire immune response. (For a good layperson's explanation of some of this, visit the LDN homepage.)

When I first heard about LDN I scoffed. Some of the claims made it seem like a miracle drug and therefore definitely suspicious. But it's cheap (about $40 a month), it doesn't hurt (oral, no injections) and the only side effect is slight weight loss :) So, hey, what did I have to lose?

So I started using it and, well, it's a fucking miracle drug. I've had more energy, have recovered some function and strength, and I feel much, much less tired. (Haven't lost weight though. And there is one weird side effect: I don't want to drink as much.) So I encourage anyone with autoimmune disease--RA, lupus, MS, Crohn's, Parkinson's, IBS--to at least check out the information. It might not be for you, but it's unlikely to do you any damage if you try it...

...which is way, way more than can be said for most of the immunomodulatory/suppressive drugs out there. Those drugs literally kill people. They've certainly damaged me. Most of the side effects--blood count crash, for which I needed rescue shots (and until your bone marrow has been artificially expanded overnight you don't know pain); destruction of taste buds (I couldn't eat eggs for a year, didn't enjoy wine, even chocolate tasted weird); terrible weight loss; and more--have passed now that I've come off that crap, but I still wonder if I'll wake up with leukemia one day (a known side-effect of one of the nastier immunsuppressants I was on for a while, along with--woo hoo--heart damage).

So if/when your Cox 2 inhibitor stops working, or the side effects get to be too much, read up on LDN. Start with the website but then check out all the stuff that isn't available publicly on the web, e.g. 'Low dose naltrexone therapy in multiple sclerosis', Y.P. Agrawal, Medical Hypotheses (2005) 64, 721-724, and 'Low-Dose Naltrexone for Treatment of Multiple Sclerosis: Clinical Trials are Needed', Priti N Patel, The Annals of Pharmacotherapy, 2007 September, Volueme 41 p.1549.

And good luck.

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