Neurology Now:
Feature: Managing Ms

Beating the Odds

MATTHEWS, WALLACE

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Wallace Matthews is a Newsday sports columnist whose favorite annual event to cover is the Kentucky Derby.

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Abstract

Whether training horses or treating his MS, Kiaran McLaughlin lives in the winner's circle

The medication that makes Kiaran McLaughlin feel his best these days doesn't come out of a bottle, nor is it dispensed from a syringe. No doctor can prescribe it, and the best place–in fact, the only place–to find it is at a racetrack.

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Figure. FAST FRIENDS...
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McLaughlin trains thoroughbred racehorses. In June, his 3-year-old colt Jazil won the Belmont Stakes and, for 2½ magical minutes, McLaughlin didn't feel like a 45-year-old guy with multiple sclerosis–he felt like a young, healthy kid achieving a lifelong dream.

“The Belmont Stakes was great medication,” he laughs. “Too bad they can't write a prescription for it.”

While the rush from winning lucrative stakes races can temporarily mask the pain and difficulty of living with multiple sclerosis (MS), McLaughlin is aware that nothing can make it disappear. “It's a real bitch,” he says. “It's a bad hand to be dealt, but we have to play it.”

He's been playing it since 1998, when MS announced itself as a sharp pain in his shoulder that came in the middle of the night. Today the disease lives in the form of persistent overall fatigue, sporadic numbness in his right arm, bladder problems and occasional visual disturbances.

Still, he arrives at Barn 11 on the Belmont Park backstretch every morning before the sun rises, having already completed his daily two-mile walk, and sets down to the task of keeping a 90-horse stable fit and ready to run.

At the same time, he tries to do likewise for himself. “MS is something that doesn't go away, I understand that,” he says. “So my condition will probably deteriorate over the years. But hopefully I can maintain the quality of life I have now. It might slow me down, but I could walk outside today and get run over by a bus too. So I don't live in fear of what's going to happen in the future. I figure I'm going to enjoy life and what I'm doing.”

So every night, he takes his prescribed medication: a glatiramer acetate (Copaxone) injection. And every morning, he gets a shot of his preferred medication: horse racing.

Growing up in Lexington, Ky., the heart of the thoroughbred breeding world, 12-year-old Kiaran McLaughlin wrote a school essay revealing his intention to train racehorses. He would serve a lengthy apprenticeship under D. Wayne Lukas, the sport's leading trainer, before starting his own stable in 1993. His career was proceeding smoothly until October of '98, when he was jolted out of a sound sleep by a pain so severe he thought he must have been having a heart attack. He was only 38, seemingly healthy, and scared.

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Figure. PALLING AROU...
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Not wanting to awaken his wife and two young children, he drove himself from his Garden City, N.Y., home to a nearby hospital. After doctors pronounced his heart fine, he was sent home with the recommendation to see his personal physician the next day. His doctor suspected a pinched nerve stemming from his active lifestyle, and prescribed a precautionary MRI.

“That's where it all started,” McLaughlin says. “Three days later, the doctor called and asked me, ‘Are you sitting down?’”

Upon hearing the diagnosis of MS, McLaughlin's reaction was, “What the hell is that?” Even after getting a second opinion from a neurologist, he found it hard to believe he had a chronic disease. “I didn't have any real symptoms,” he says. “No vision problems. No pain. No indication whatsoever.”

But when a neurologist asked him to drop his chin to his chest, McLaughlin screamed out in pain. “I got a sharp, shooting pain down my back,” he recalls. That sensation, known as L'hermitte's sign, is a telltale indication of MS. He was hospitalized for four days of IV steroid therapy and sent home. “They told me I might not have another attack for years,” he says, “and I shouldn't worry about it.”

Five months later, he suffered another attack. His vision was blurred, he required a cane to walk, the numbness crept down his arm. Accustomed to getting up early every morning and heading for the barn, he found himself unable to rise from his bed. It was not the disease keeping him down, but the depression brought on by the realization that he now had an insidious invader eating away at his central nervous system for the rest of his life. “I was definitely scared and in a deep state of depression,” he says. “I did not get off the couch for months.”

After overcoming his depression, he began learning to cope with the physical symptoms of MS. There was some numbness in his arm. And there was a slight but definite deterioration in the way he walked.

“It's hard to notice, but it's there,” he says. “The best way to explain it is: off my walk, you wouldn't buy me as a yearling.”

His neurologist monitors McLaughlin in much the way McLaughlin monitors his horses: by timing him with a stopwatch as he covers a distance of ground. But rather than galloping at top speed over six furlongs, McLaughlin's progress is measured in walks of about 30 feet. “I ask him, ‘Have I slowed down over eight years?’” McLaughlin says. “And he tells me, ‘No, exactly the same.’”

McLaughlin may have kept pace on the stopwatch, but he finds it increasingly difficult to put in the 12-hour to 14-hour days routinely required of a trainer. And the debilitating effect that hot weather has on MS forced him to give up a training job that required he live six months a year in Dubai.

He was also forced to make another significant concession to the disease: Unlike most trainers, he can no longer saddle many of his own horses before a race, since his difficulty with movement could place him in danger should a tightly wound thoroughbred begin acting up in the paddock. “I can saddle most horses, but if I know a horse is tough to manage, I'll have one of my assistants do it,” he says. “I just can't get out of the way as quickly as I used to.”

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Not even MS could keep McLaughlin from saddling Jazil for his victory in the Belmont Stakes as well as his fourth-place finish in the Kentucky Derby five week earlier. The Belmont gave McLaughlin his first career victory in a Triple Crown race, one year after coming within half a length of stealing the Derby with 72-to-1 longshot Closing Argument. After Closing Argument was run down in the stretch by Giacomo, however, McLaughlin could take the disappointment in stride.

“I have to say the disease has changed the way I look at things like that,” he says. “It showed me we have to enjoy every day while we can.”

And that made Belmont Stakes Day all the more enjoyable.

With only one career win, Jazil was facing the sternest test of the grueling Triple Crown series–a mile-and-a-half before 68,168 roaring fans at the country's biggest racetrack. As if that wasn't dramatic enough, Jazil broke last out of the gate and trailed by 11 lengths on the backstretch. But with McLaughlin jumping and dancing in the stands, Jazil made his customary late run, thundering past six horses over the final half-mile to finish 1¼ lengths ahead of the favorite.

The Belmont Stakes triumph instantly put McLaughlin and his challenges with MS in the spotlight. Six days later, he served as the guest handicapper for the Race Against MS, a charity event at Belmont that raised thousands of dollars.

“I don't mind being identified as the trainer with MS,” he says. “When an exercise rider was diagnosed with MS a few years ago, she came to me crying, ‘What am I gonna do?’ And I told her, ‘Look, it's not a death sentence.’ When you're first diagnosed, you don't know what you're going to be able to do, you don't know if you'll be able to keep working and live a normal life. Well, for eight years now, I've lived it and I can handle it. I have a positive outlook about whatever the future may bring.”

©2006 American Academy of Neurology

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