Archive for category Dealing
Lordy, it’s been a hot minute! I can’t believe how much time has passed since my last post, which I can only attribute to my switch from Enbrel to Cimzia, which has me feeling perfectly healthy. And, feeling healthy means writing an RA blog is not top of mind.
This summer I found myself traveling quite a lot. As my readers will know, I’ve done a lot of traveling with Enbrel, which has been approved to safely remain out of the fridge for two weeks (a traveler’s dream!).
Cimzia is another story……
Part I – A Trail of Water
So, I packed up my three month’s worth of drugs with ice packs and spare Ziplocs for the ice I knew I’d need on my journey to Berlin – a domestic flight, a three-hour layover, an international flight, a twelve-hour layover, a taxi ride —> finally, fridge in Berlin, Germany.
Most airlines will not help you out by putting freezer packs in a freezer or drugs in a refrigerator during your flight. American Airlines was no different, but they did give me ice in a bucket, which helped a bit. But byy the time I got to Zurich, just halfway through my journey, my ice packs were dripping and I was worried about my drugs warming up.
I got off the plane in Zurich and immediately went on a mission for a waterproof cooler and ice. Apparently these things are hard to find…. I ultimately found ice at a restaurant, but not a cooler – even after being in grocery stores and pharmacies.
So me and my cloth cooler and dripping bags of ice went on a tour around the city, leaking water every step we took. I stopped at many cafes, got dirty looks from many waitresses as I asked for ice, and alternated between cursing my drugs and being grateful that I had them so I could travel at all.
I felt a huge relief getting them in the refrigerator in Berlin – their home for a month and a half.
Part II – This Bar Has Ice…. and Alcohol
I met my parents in the Netherlands and the hotel they booked didn’t have a refrigerator. For a ormal traveler, this wouldn’t matter in the least. For someone traveling with drugs that have to be refrigerated, it’s a total pain.
We got in late so the lobby was closed. I talked my mom into walking to a bar to try to convince the bartender to give me a few bags of ice (and, you know, maybe grab a drink or two).
We lucked out and got a late night glass of wine and enough ice to sustain me until the lobby and kitchen opened up and I could stash my RA drugs in the kitchen fridge.
Part III – So Much For the Good Seats
I flew from Germany to France to meet my friend in Bordeaux. The journey included a flight and long train ride, but at this point I’d gotten used to it and had plenty of ice packs to get me through the journey. At the hotel, I realized we didn’t have a refrigerator in our room (again!), so I asked the hotel to store my drugs, which they graciously did.
When it was time to depart to the coastal town of Biarritz, we were running late. We checked out in a rush, Ubered to the train station and sat down with relief that we made it. It was about the time that we were celebrating the proximity of our seats to the bar car that I realized I’d left my Cimzia in the hotel fridge.
“I left my drugs, I’ll meet you in Biarritz!” is all I had time to say as I grabbed my backpack and bolted off the train just in time to see it leave.
I took a cab back to the hotel, grabbed my drugs, cabbed back to the train station, realized my tickets were non-refundable and the next train wasn’t for awhile, booked a bus ticket, waited for a bus that was two hours late, and finally made it…..
Part IV – No Pain, No Gain
Yes, traveling with RA drugs is a pain. I wish I didn’t have to do it. But I am so grateful I get to travel. I am so grateful my joints are strong enough to grab a bag and run off a train. I am so grateful I am health enough to wander around Zurich for twelve hours. Drippy ice packs or not, I can only channel gratitude. I hope that RA drugs don’t stop you from going to the places you want to go!
If you live with a chronic disease, you’ve been told some variation of “you can cure your disease if you eat this or don’t eat this”. I’ve been told to eat ginger, turmeric, be vegan, go paleo, cut dairy, cut nightshades.
The list goes on, and I’m generally skeptical of these suggestions. But there’s nothing like mounting symptoms to get you to try anything.
So last fall, I decided to embrace the Autoimmune Protocol completely for 30 days and slowly add in foods. To help, I bought
- The Autoimmune Wellness Handbook: A DIY Guide to Living Well with Chronic Illness
- The Autoimmune Paleo Cookbook: An Allergen-Free Approach to Managing Chronic Illness
The diet is strict – essentially having you cut anything that could trigger a reaction, reset your gut, and add foods back one by one.
Here’s the guide I followed, created by Mickey Trescott:
After a month of following the diet, and a few months adding foods back in, here’s what I learned:
- Life is just not the same without coffee and wine. 😉 Seriously, I don’t care if my symptoms flare a bit, these “food groups” have been added back and are staying.
- The diet makes eating out nearly impossible. For me, this was difficult as I eat out a lot. Being forced to cook so much was a learning curve, but I’m now a much better cook!
- I now know how to cook all sorts of meats. Before this diet, my kitchen was essentially vegetarian because I didn’t like cooking meat. Now I cook it weekly.
- Nightshade vegetables DO cause achy joints for me the next day, particularly tomatoes and peppers.
- My gut feels better with WAY fewer grains in my diet. Though I’m currently not gluten free, I generally now stick to rice and corn if I’m eating grains.
- I have continued to eat more vegetables, meat, fermented foods and kombucha and feeling better for it. Most mornings, I still make myself a green smoothie to start the day.
I’m not about to tell you this diet will cure you. I’m feeling better, but I think that’s largely due to a change in medication (switching from Enbrel to Cimzia). Adding the “light” version of this diet I’ve landed on to my lifestyle keeps me healthy and makes me feel good. I recommend testing it for yourself and would love to hear if you have experience with this diet in the comments!
“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!
Here’s a challenge: love your body.
I mean it. Dance in front of a mirror and tell yourself your beautiful.
Love your tall, your short, your skinny, your fat. Love your freckles, your dimples, your birth marks. Love your hips, your boobs, your butt.
Love your joints that don’t quite straighten. Love your rheumatoid nodules. Love your body’s quirks and imperfections.
I mean, why not?
Next time you catch yourself “if only-ing” about your body…. If only my eyes were blue. If only I lost 10 pounds. If only my face was perfectly symmetrical. And I was taller, thinner. And I could run without sweating. And eat without gaining weight. And stand on the beach as though salt water were a hair product.
Breathe. Love. Embrace.
So, this is how it was supposed to go! Two painless weeks of hormones and 9 mature eggs now in the freezer.
After my canceled round a couple of months ago, I was feeling pretty discouraged. I took a month “off” to prep my body for a second round.
Of course, “off” in the world of fertility meant a month of testosterone gel, progesterone, estrogen, and blood thinners. So, the month off was taxing, but it let my brain take a break and forget about eggs.
Then, day one of my cycle came. The ultrasound brought news of another cyst. Last round, the cyst had been a showstopper and I chose to spend money to have it drained so I could continue with the hormones.
This time, the cyst was small enough that they gave me a choice: wait another month for it to go away, have it drained (for yet another $600), or continue with the hormones and risk the cyst growing as well.
My nurse told me to listen to my gut, and my gut was telling me that it had been a waste of money draining it last time and obviously my body is prone to cysts, so waiting it out didn’t seem rational. I opted to begin the hormones: Menopur, Omnitrope, Gonal-F and Clomid, this time at higher doses than the last round.
And this time around, in spite of the extra shots each day, I found it relatively easy. Giving myself shots wasn’t as emotionally taxing as last round and my body wasn’t bruising anymore (in spite of still being on blood thinners).
I eagerly awaited for day 6 when I could find out how my eggs were growing and whether the cyst was messing everything up. Last time the news on day 6 was that I only had four eggs growing, but two were so far behind, only two would be mature by my retrieval date. This time, I had 11 good-looking possibilities and my cyst was growing slowly enough not to be a concern.
After that, it was continued hormones, daily morning ultrasounds and bloodwork, and daily afternoon calls from the nurse. To my surprise, everything was growing right on schedule. My body was responding well and things were looking good.
Finally, I got the news that it was time to take my trigger shot. The shot had to be taken at exactly 8:30pm so that surgery could take place exactly 36 hours later. It was my fist time giving myself an intramuscular shot (versus subcutaneous) and I was super nervous. To my surprise, it was relatively painless (though I was pretty sore afterward).
My partner drove me to surgery 36 hours later and that went smoothly. No pain during or after and I didn’t even get sick from the anesthesia! I am very happy that we got 9 mature eggs (so much better than the 2 from last round!).
Seriously, after all the complications my body has thrown me, I was shocked that things just went well.
One major bonus of this whole process: I’m still off of methotrexate and my RA symptoms are under control. I still take Enbrel (and I will never complain about one shot per week again!), but my rheumatologist and I are going to try to keep me off methotrexate. I’m so excited to be down to one RA drug!!
Does rheumatoid arthritis effect fertility?
My fertility doctor thinks so, citing this study, but my rheumatologist disagrees. This lack on consensus means women aren’t counseled on this possibility by their rheumatologists and there is a general lack of information out there on the subject. But where does this uncertainty leave women like me, who are diagnosed with RA in the prime of our reproductive years.
In fact, women like me, who are diagnosed with RA before giving birth to their first child, have fewer children, possibly due to being on medications like methotrexate, which is linked to birth defects and therefore can’t be taken while trying to get/being pregnant or breastfeeding. It could also be because we’re choosing not to reproduce, fearing the burden of childbirth or raising a child with RA or passing our genes to our children.
It wasn’t until I was prompted by a gynecologist to test my ovarian reserve levels that I even gave this matter any thought. But now after being told my ovarian reserve is low, potentially due to RA, I do wish my rheumatologist would have told me to consider the possibility that my fertility might be effected by my RA earlier.
Had I considered this, I may have aligned my path to coincide with getting pregnant earlier or perhaps chosen to freeze my eggs earlier, a journey I’ve just set out on at age 33.
There are very few studies on the topic. This one, focusing on Systemic Lupus Erythematosus (SLE), found a higher correlation of SLE in infertile women than the general population, but the small sample size rendered the study inconclusive and its unknown if it would translate to women with other autoimmune diseases.
Others suggest that the higher incidence of inflammation which comes hand-in-hand with many autoimmune diseases could make it more difficult to carry a pregnancy to term. Autoimmune ID, a condition where your body’s immune system might attack an implanted embryo, resulting in a miscarriage, is more common in women with rheumatoid arthritis and other autoimmune disorders.
What’s more, it may take women with RA longer to get pregnant, perhaps due to trying to coordinate disease flares with needing to get off medications that would be harmful to the fetus.
Another thing to consider: autoimmune diseases may cause irregular ovulation, which can lead to more difficulty getting pregnant.
I don’t want to be too negative though, because many women with RA do successfully get pregnant and give birth, both naturally and through IVF. And one thing my rheumatologist and fertility doctor agree on is that, if anything, RA symptoms should lessen during IVF treatment as they do in pregnancy.
So what does this all mean? Does rheumatoid arthritis effect fertility? And what can we do about it?
Unfortunately, the answer is as unclear for me as when I started my research. I’ve taken all this inconclusive science, along with my own bloodwork showing low ovarian reserve, and my age (33), and have chosen to freeze my eggs with my partner’s support.
You’d think someone with RA would be used to their apartment being overrun by medications, but IVF takes it to a whole new level.
Here’s what my linen closet now looks like:
And here’s my fridge (my Enbrel now has company!):
And my kitchen counter:
I’m nervous about taking all the medications and what they might do to my RA symptoms, but I’m also feeling empowered about living in a time when I have the opportunity to freeze my eggs and get a bit of a fertility boost from science.