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Back Here Again

“I just don’t know how much pain I’m expected to endure,” I confided to my friend.

And so, I had to admit to myself that I’ve been living with more pain, more morning stiffness, more burning sensations in my joints waking me up at night than I was willing to tolerate.

Because the pain is scary. It makes me think of my X-rays when I first got diagnosed, showing the pain that I had ignored had turned into bone erosions – permanent damage.

And because the pain is exhausting. Emotionally and physically exhausting. Invading my thoughts throughout the day. Throbbing right wrist, stiff left pinky, swollen left ankle, burning right elbow — Oh, was I supposed to be paying attention in this meeting? Invading my sleep at night. Invading my optimism that I had this disease under control.

And then I had to admit it to my rheumatologist. And then I heard him asking if I wanted to get on Prednisone. No. Methotrexate? I’d rather not….. I like a drink. I like to know if I get pregnant I won’t have to abort the child. I like not feeling nauseous one day a week and shedding copious amounts of hair. What else is there?

So now, Plaquenil. A malaria medication, which is a DMARD used to treat lupus and rheumatoid disease (though the printed information the pharmacist gave me states “they don’t know why it works to treat these diseases” — encouraging, right?).

Following the appointment came a struggle. Reading the side effects, wondering if more drugs were the right course, determining to also try lifestyle and diet changes.

Wondering if this was somehow because of something I could have prevented. Something I did. Eating the wrong thing? Stressing about my breakup and work too much? What if I could meditate and eat more kale? And cut out nightshade vegetables and gluten and dairy and sugar and caffeine and never drink again and basically become a monk? Would this disease leave me alone then?

And then depression. And acceptance. And sadness.

Because I’m back here again. Wondering if this treatment will work. Remembering that this disease is labeled chronic and I’m probably stuck with it for the rest of my life. Trying to remember how to feel optimistic and hopeful.

And two pills a day. And one shot a week. And less gluten, dairy, sugar, nightshade veggies, caffeine and alcohol. And more acupuncture.

And maybe starting to feel better. Maybe remembering how to have hope.

Love to all of you dealing with the taxing ups and downs of autoimmune diseases. I would not wish this on anyone, but it does force you to slow down, to be aware of your body, to appreciate the moments that are pain free and the moments where you surprise yourself with what you can do and what you can bear.

If anyone has experience with Plaquenil – good or bad, I’d love to hear it!

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‘Tis the Season to be Screwed by Insurance

Ah, late December. A time of beautiful lights, giving, and the great health insurance scramble.

As co-founder of my company, I’m lucky enough to have a huge impact on choosing the health insurance we provide. One of the deciding factors for me is being able to get my Rheumatoid Arthritis drugs at a low co-pay. Through United Healthcare, it’s been $10 per month for methotrexate, $10 per month for folic acid, and $30 per month for Enbrel.

In other words, $50 a month for drugs. A reasonable-enough price to pay for my health. It is the number one reason we decided to keep our UHC plan for 2015.

So shock me, shock me, shock me (Any Empire Records fans? Read on, there’s a gif for you below.) when I get a letter saying that beginning January 1, 2015, Enbrel will be considered a “Tier 4” drug and will not be eligible for the Enbrel Assistance program. After some digging, I found out that this means it’s going up to $250 per month with no opportunity to enroll in any payment assistance programs Enbrel provides.

What? Merry Christmas to you too, United Healthcare.

Their advice? Try another drug.

That’s all good and fine. They’re willing to cover Humira or Cimzia, but I’m feeling pretty violated. I know violated may seem like a strong word for this situation, but that’s how it’s feeling. I’m being forced to put an unknown drug into my body because my healthcare has made an arbitrary change to their coverage. Enbrel is a known quantity for me. It’s effective in treating my RA, side effects are pretty minimal for me, and my body is used to it. Humira and Cimzia are not.

Not to mention, my rheumatologist claims that though the risk of switching is “probably pretty minimal”, there is a risk that I could lose the efficacy of Enbrel if I ever need it again. Joy!

So, have any of you RA folks made the change from Enbrel to Humira or Cimzia? How did it go? Are any of you on Humira or Cimzia? How did you like it?

Thanks for all your input and Happy Holidays to you all (in the non-grinchy, healthcare-trying-to-screw-you way, of course!)

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Invisible Illness Week: 30 Things You May Not Know…

Rude Awakening posted some great answers to the “30 Things You May Not Know About My Invisible Illness” questionaire in honor of Invisible Illness week: Invisible Illness Week: 30 Things You May Not Know….

She also reminded me, it’s that time of the year again! My answers are below.

30 Things You May Not Know About My Invisible Illness

1. The illness I live with is: Rheumatoid Arthritis (plus Raynaud’s Phenomenon and Chilblains)
2. I was diagnosed with it in the year: 2012
3. But I had symptoms since: I noticed what I now believe were RA symptoms as far back as 2009. I’ve had Raynaud’s since at least age 14, though possibly much longer. Chilblains began in 2012.
4. The biggest adjustment I’ve had to make is: Slowing down more often to give my body a break.
5. Most people assume: I’m fine now that I’ve been to the doctor, because I’ve gained weight back and look healthy. They don’t realize that I’m treating symptoms that are chronic and occasionally flare even with treatment – I haven’t “cured” my disease.
6. The hardest part about mornings is: This absolutely depends on the day! Some days mornings are the best, some I have so much fatigue and stiffness I don’t want to move.
7. My favorite medical TV show is: Scrubs!
8. A gadget I couldn’t live without is: Comfy flats and boots, a jar opener, and warm socks and gloves!
9. The hardest part about nights is: Some days it’s fatigue, some it’s pain, some it’s just knowing I have to get up the next morning, some are totally fine.
10. Each day I take 4-15 pills & vitamins.
11. Regarding alternative treatments I: I love acupuncture and find it helpful and relaxing. Would if I could get more massages! I watch my diet and have cut down on many inflammatory foods, including dairy and gluten. I incorporate anti-inflammatory food/supplements into my diet as much as possible: ginger, turmeric, cinnamon, omega 3s. Perhaps most importantly, I try to do something active most days. On rough days, it may just be a very short walk, on good days, it’s runs, swims, boot camps, dance or yoga.
12. If I had to choose between an invisible illness or visible I would choose: Invisible, even though it can be frustrating. Some days I look and feel normal and am able to forget about RA. Those are the best. Plus, being a private person, I prefer being able to choose whether or not I want to share my illness with others. Its invisibility affords me that choice.
13. Regarding working and career: I’m an entrepreneur working on a tech start-up that I co-founded. This means I  likely work harder under more stressful conditions than my health and doctor would like. It also means I’m able to work flexible hours that allow me to make my doctor’s appointments and work from home on bad days (even from bed sometimes!). I try to remember to take time to myself to rest and replenish and focus on being healthy.
14. People would be surprised to know: I agree with Rude Awakenings: “Fatigue is as debilitating as pain – some days more so. And I feel like a definition is needed here.  Fatigue = flu-like symptoms, not simply being sleepy.” On days with bad fatigue I struggle to do anything, including just talking to the people I love.
15. The hardest thing to accept about my new reality has been: Relying on drugs to feel well and accepting my body’s limitations on rough days.
16. Something I never thought I could do with my illness that I did was: I agree with Rude Awakenings here too: “Talk about it so openly.”  When I was first diagnosed, I didn’t think I’d be educating people on my illness or reaching out to strangers!
17. The commercials about my illness: All feature older adults, seemingly in their 60s. They perpetuate the myth that Rheumatoid Arthritis is the same as Osteoarthristis and mainly effects older populations.
18. Something I really miss doing since I was diagnosed is: Not having to wonder how an activity, meal, or drink will effect my RA or interact with my meds. Not having to plan my life and trips around bi-weekly medication, bi-monthly blood tests, and tri-monthly doctor appointments.
19. It was really hard to have to give up: Control over my body. Oh, and dairy, gluten, alcohol and heels (I still enjoy all four in moderation).
20. A new hobby I have taken up since my diagnosis is: Blogging!
21. If I could have one day of feeling normal again I would: Similar to last year – I would just go, go, go all day and night, not worrying about lack of sleep, stress on my body, any of that.
22. My illness has taught me: Celebrate the good days and all that my body does for me. Always be patient and kind to others – invisible illnesses are a good reminder that you really don’t know what others are struggling with!
23. Want to know a secret? One thing people say that gets under my skin is: Agree with Rude Awakening again, absolutely this: “When people equate their grandmother’s osteoarthritis (or their own!) in her wrist to my autoimmune disease.”
24. But I love it when people: Ask me how I’m doing even if I look fine and want to learn more. I also love when people share their own experiences with autoimmune diseases or offer to put me in touch with friends who also have RA.
25. My favorite motto, scripture, quote that gets me through tough times is:  I have many. Here’s a kinda nerdy one: “We take what we can get, Champ, and we do our best with it.” – Cordelia Chase. Another one along the same vein: “Do what you can, where you are, with what you have.”  – Teddy Roosevelt
26. When someone is diagnosed I’d like to tell them: It gets better. The pain will decrease when you find the right meds. The loneliness will start to dissipate when others with RA come out of the woodwork and you find online communities to connect with.
27. Something that has surprised me about living with an illness is: Most people, even those close to you, do not want to think or hear about your illness. Everyone prefers to think that all’s well.
28. The nicest thing someone did for me when I wasn’t feeling well was: My boyfriend does this well: we’ll order in and watch a movie, and he won’t let me entertain thoughts of guilt over all that I didn’t accomplish that day.
29. I’m involved with Invisible Illness Week because:  I want to create more awareness and understanding of autoimmune diseases. There’s so much that is unknown, underfunded and misunderstood.
30. The fact that you read this list makes me feel: Grateful. Thank you for taking the time, and for your support of Invisible Illness Week!

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Rheumatoid Arthritis and All the RAD Diseases Correlated With It

I was recently diagnosed with the beginning stages of gum disease. At 30.

Though totally treatable, it means going to the dentist WAY more often than I’d like (every 3-4 months), more expenses, and another item to add to the list of things I need to spend extra time caring for.

Maybe it’s because of my wisdom teeth removal complications, which led to a few months of less-than-stellar teeth care. Or maybe it’s because I have RA and my body is prone to inflammation.

Gum (periodontal) disease, as it turns out, is one of the many things more common in people with RA. Others include fun stuff like heart disease, depression and poor concentration (which I have definitely been noticing recently, but hadn’t bothered blaming on my RA).

One study found those with RA are more than twice as likely to have gum disease (65% or the studies 91 participants who had RA also had gum disease versus 28% of those RA-free). And, of those who had it, it tended to be more severe.

There’s also some that believe gum disease is not only correlated with RA, but can LEAD to it.

So what, aside from a propensity for inflammation, is causing this link? Well, some scientists have found that porphyromonas gingivalis (PG), the bacteria involved in gum disease, also produces a specific type of enzyme and it’s this enzyme that promotes the progression of collagen-induced arthritis. The enzyme triggers changes in the body’s proteins, which then causes the body to mistakenly attack those proteins. The result is chronic inflammation.

PG works in much the same way as the anti-citrullinated protein antibodies (ACPA) found in some patients with RA. In fact, those with RA who have ACPAs have higher rates of gum disease. It all gets pretty complex, and the studies are relatively new, but you can read more here.

Apparently relating the teeth and gums to other ailments is by no means a new thought. Hippocrates was known to suggest pulling teeth as a cure for arthritis.

The moral of the story is two things we already knew:

  1. brush your teeth and floss religiously, and
  2. having RA and all that goes with it is no fun.

Oh, and don’t smoke. That apparently raises your chances of both RA and periodontal disease. But I’m tired of reading that, as I’ve never been a smoker.

Anyone else have RA and gum disease? I’d love to hear about your experience!

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Optogenetics Makes Mice Resistant to Pain | MIT Technology Review

http://www.technologyreview.com/news/524771/for-mice-and-maybe-men-pain-is-gone-in-a-flash/?utm_campaign=newsletters&utm_source=newsletter-daily-all&utm_medium=email&utm_content=20140217

It’s not a cure, but a better way to manage pain could certainly change the lives of millions of people.

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What’s Faith Got To Do With It?

Putting your life in someone else’s hands is one of the hardest things patients are asked to do. We have no choice but to place our faith in the abilities and opinions of other people.

Sure, we can mitigate risk and make ourselves feel better by doing loads of fear-inducing Google research or seeking a second opinion. But, in the end, you choose your doctor and you move forward.

I recently read an op-ed in the NY Times about the way we make decisions in the medical sphere. It brought up some interesting points. First, we tend to trust authority figures, including doctors, without question. This is especially true when we’re frightened and vulnerable. And who isn’t when dealing with a scary, life-altering diagnosis? This can be dangerous since as many as one in five diagnoses are wrong (according to the article, which didn’t quote the source).

What’s more, we tend toward optimism, filtering in only the information we want to hear. I believe this can be a highly beneficial strategy of coping. After all, optimism, even in the face of a dismal diagnosis, can keep you feeling strong and keep the depression that effects up to one-third of patients with chronic disease at bay. But there’s a risk to the optimism bias, which is that you may be ignoring potential lifestyle risks or bad news, leading to decisions that may hurt you in the long run.

So how do you keep a clear head and move forward confident in the abilities of your chosen doctor? Well, for one, you don’t put your blinders on simply because you made a choice. The treatment you’re on now may not be the one that will be best for you a year from now. New treatments come out and sometimes our bodies begin to reject past treatments. Only you, not your doctor, can be responsible for noticing the changes in your symptoms. You can listen to your gut about what’s working and you can follow research and bring new treatment ideas to the table.

There’s more you can do to remain confident in your treatment. You can always seek second opinions for big treatment changes. You can bring in another set of ears to appointments so that when your emotions are running high and you’re hearing not-so-great news, you have another person to interpret what the doctor said later.

When you’re doing all that, you have nothing left but your best option, your best guess, and faith in your doctor’s treatment. And a healthy dose of optimism, of course.

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This is Just Ridiculous

Well, my running and office life have once again been sidelined by my health. For the fourth time since getting my wisdom teeth out in June, I’m sitting at home, swollen, bored, exhausted, and on antibiotics and pain meds (oh, and off my RA drugs to let the antibiotics do their job).

The first time was being swollen for about a month after getting the teeth removed. The second two times were when blood started collecting in my right jaw – a hematoma or blood tumor. That happened twice, people! Each time involved making an incision in my gumline/inner cheek under local anesthesia, draining the blood, undergoing antibiotics, and giving it time and rest to make sure it healed.

I’ve been totally fine and hematoma/jaw swelling free for five blissful weeks.

Then, this last weekend I had subtle, sporadic pain in my left ear. I was busy having a blast at a wedding, so I ignored it. Sunday night, I had some pain in my lower left jaw. I noted it, but went to bed.

Then, Monday morning I woke up to one half chipmunk cheek. Whhhhhhyyyyyyy?????

If only I were this cute.

Of course, the oral surgeon who I had been doing follow up care with was out of the office Monday, so I went to a new dentist who ruled out a tooth infection and put me on antibiotics.

I spoke to my marvelous rheumatology nurse at least four times, trying to determine if it could be related to Rheumatoid Arthritis. The short answer is, yes, it could, but it probably isn’t.

So Tuesday I went back to my oral surgeon. He ruled out a hematoma or an infection, but numbed me up, sliced in, drained the area, “smoothed” the bone, and added a “drain” in my gumline to prevent fluid from building in my jaw again. Fun stuff, let me tell you. Apparently, he believes my body was reacting to a stray bone fragment left over from getting my wisdom teeth removed. Great, so could this happen spontaneously for years??

Since Tuesday, I’ve been taking my antibiotics, managing the pain with Percocet and IBProfen, and WAITING for the swelling to go down so I can look and feel like myself again. I’m still waiting.

I’m going in to see my oral surgeon tomorrow to hopefully get the drain out and get more answers. In the meantime, cabin fever is setting in because I’m supposed to be relaxing. Though good for blog posts (as in, I actually find myself writing them), this is pretty bad for sanity. :/

I’d like to ask you RAers if anyone has experienced lower jaw swelling related to their RA? What was it like and how was it treated? 

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