Brendan, Joanna, and immunologist Dr. Paul Ibbett continue their deep dive into biologics, the immune system, and Brendan's treatment journey.

What's covered

• Demyelination explained — and why Brendan's optic-nerve-only damage points away from MS
• How the brain and immune system talk to each other (featuring a spawning salmon and a very over-enthusiastic ram)
• A new vagus-nerve implant that acts like a "snooze button" on TNF-alpha
• Why biologics cost so much — manufacturing in giant bioreactors, ~$1bn per approved drug, and the NHS vs. private cost question (Brendan paid £3,000 per Rituximab infusion privately)
• Bispecific antibodies — the next frontier, especially in cancer
• The future: sequencing patient immune systems and using AI/ML to pick the right drug
• Could biologics ever be injected directly into the CSF? Possibly, but not without certainty about the target

Last week we covered a lot of exotic tests and the exotic tests list continue. But there was also a time when I just flat out said no to a test because I thought it was silly. And the logic behind it was silly too.

As my diagnosis became harder and harder to figure out, they just ended up being more and more tests that had to be done people have been asking so here we are this week. We're gonna review some of these tests. Give you an idea about what the experience is like so that you can go into it with more knowledge less fear and a bit more control over the situation. And I really hope you don't have to have a lumber puncture.

Every time you go to see your specialist, they're going to ask you how your vision is. It helps them a lot if you can say something more insightful, and more descriptive than "it's a little better", so today we're going to discuss how to describe the different elements and aspects of your sight in a more objective way so that you can give your doc some more interesting data that might help them diagnose you sooner and help you understand where you are in the course of your overall journey.

Today's episode is split into two parts. The first is a discussion about some of the long-term impacts of steroids that I've had - the kinds of things that accumulate in your body after you've been using them for many months. And the second part of the episode is a discussion with my beautiful friend Lucy, who will talk about her experience using steroids as part of a fertilization enhancement therapy so that she could become pregnant and have the beautiful baby she now has. She offers a perspective on the steroid journey that I just can't have. I hope this adds a useful perspective for everybody.

With optic neuritis or most other inflammatory diseases in your body, doctors will often prescribe some kind of steroids to get the inflammation to go down quickly and to start managing the condition. But steroids do not come without caveats. And most doctors probably think you will be off the steroids before any of these things start to manifest themselves. But they're probably wrong and so there's some stuff in this episode you need to know.

The first medical team were circling the drain around a diagnosis that didn't fit the evidence. On top of that the diagnosis they were pursuing was cancer. These two factors made me lunge for a second opinion.

This is the episode where we talk about the heroic folks in my new team who got to work fixing my vision - one symptom at a time.